A Case Stuy on Relationship Between Cognitive Impairment and Postural Stability in the Elderly

Abstract

Background: Postural instability and cognitive decline are associated geriatric disorders that lower quality of life and increase the risk of falls. This study examined the relationship between balance and cognitive impairment, determined which cognitive domain is most predictive of instability, and assessed whether an eight-week combined cognitive–balance training program is better for older adults with cognitive impairment than balance training alone.

Methods: The Montreal Cognitive Assessment (MoCA), Berg Balance Scale (BBS), and Timed Up and Go (TUG) were among the baseline tests that thirty community-dwelling people aged 55 to 75 years (15 cognitively impaired, 15 cognitively healthy) performed under single-task and dual-task (serial subtraction) settings. Over the course of eight weeks, falls were prospectively documented. After that, the cognitively challenged individuals were randomly assigned to either balance-only training (n = 7) or combined cognitive–balance training (n = 8) for eight weeks (3 sessions per week). Changes in BBS and dual-task TUG were the main results.

Results: Significantly inferior balance (BBS: 43.2±6.1 vs. 51.8±3.9, p<0.001, d=1.68), slower single-task TUG (14.1±2.7 vs. 9.4±1.6 sec, p<0.001), and higher dual-task cost (34.0% vs. 18.1%, p<0.001, d=1.87). The incidence of falls was 40.0% vs 13.3% (p=0.109). The sole independent cognitive predictor of BBS was executive function (β=0.51, p<0.001, model R²=0.61). Following the intervention, the combined training group demonstrated considerably higher gains on dual-task TUG (−5.2 vs. −1.5 sec, p<0.001, η²=0.55) and BBS (+6.5 vs. +2.7 points, p<0.001, η²=0.58), with a notable decrease in dual-task cost (35.2% to 21.4%) not seen in the balance-only group. The greatest beneficiaries were those with weaker baseline executive function. There were no significant adverse events and adherence was above 85%.

Conclusions: The most significant cognitive factor influencing postural instability in the elderly is executive impairment. When compared to traditional balance training alone, combined cognitive-balance training greatly enhances balance and dual-task performance, which supports its inclusion in fall prevention programs for older persons with cognitive decline.