Balance Confidence and Falls in Nondemented Essential Tremor Patients: The Role of Cognition

Objectives

To examine (1) the effect of cognitive ability on balance confidence and falls, (2) the relationship of balance confidence and falls with quantitative measures of gait, and (3) measures that predict falls, in people with essential tremor (ET).

Design

Cross-sectional study.

Setting

General community.

Participants

People with ET (n=132) and control subjects (n=48). People with ET were divided into 2 groups based on the median score on the Modified Mini-Mental State Examination: those with lower cognitive test scores (ET-LCS) and those with higher cognitive test scores (ET-HCS).

Interventions

Not applicable.

Main Outcome Measures

Six-item Activities of Balance Confidence (ABC-6) Scale and falls in the previous year.

Results

Participants with ET-LCS had lower ABC-6 scores and a greater number of falls than those with ET-HCS (P<.05 for all measures) or control subjects (P<.01 for all measures). Quantitative gait measures were significantly correlated with ABC-6 score and falls. Gait speed (P<.007) and ABC-6 score (P<.02) were significant predictors of falls. Receiver operating characteristic curve analysis revealed that gait speed <0.9m/s and ABC-6 score <51% were associated with moderate sensitivity and specificity in identifying fallers.

Conclusions

People with ET-LCS have impaired gait and report lower balance confidence and a higher number of falls than their counterparts (ET-HCS) and than control subjects. We have identified assessments that are easily administered (gait speed, ABC-6 Scale) and are associated with falls in ET.