Resumen de Relationship of neuropsychiatric symptoms with falls in Alzheimer's disease – does exercise modify the risk?

Hanna Maria Roitto, Hannu J. Kautiainen, Hannareeta Öhman, Niina Savikko, Timo E. Strandberg, Minna M. Raivio, Marja-Liisa Laakkonen, Kaisu H. Pitkälä

• OBJECTIVES To explore how neuropsychiatric symptoms (NPS) are associated with number of falls and how exercise modifies the risk of falling in community‐dwelling people with Alzheimer's disease (AD) and NPS.

  DESIGN Secondary analysis of a randomized controlled trial.

  SETTING Community.

  PARTICIPANTS Community‐dwelling individuals with AD (N=210) who completed the Neuropsychiatric Inventory (NPI) (N = 179).

  INTERVENTION Participants were randomized into 3 groups: group‐based exercise (4‐hour sessions with approximately 1 hour of training) and tailored home‐based exercise (1 hour of training) twice a week for 1 year and a control group receiving usual community care. In this secondary analysis, we merged the home‐based and group‐based exercise groups and compared this group with the control group.

  MEASUREMENTS NPS were measured using the NPI at baseline, and spousal caregivers recorded falls in daily fall diaries during 1 year of follow‐up.

  RESULTS The number of falls increased linearly with NPI score in the control group. Fall rates were 1.48 (95% confidence interval (CI)=1.26–1.73) per person‐year in the intervention group and 2.87 (95% CI=2.43–3.35) in the control group. Adjusted for age, sex, Mini‐Mental State Examination (MMSE) score, and Short Physical Performance Battery (SPPB) score, incidence rate ratio (IRR) was 0.48 (95% Cl=0.39–0.60, p < .001). Main effects for fall rate were significant for group (p < .001) and NPI total (p < .02); the interaction effect was also significant (p = .009) (adjusted for sex, age, MMSE score, SPPB score, and psychotropic medication use).

  CONCLUSION Exercise may decrease the risk of falling in community‐dwelling individuals with AD and NPS. Future exercise trials should confirm this finding in participants with significant NPS.

  TRIAL REGISTRATION ACTRN12608000037303. J Am Geriatr Soc 66:2377–2381, 2018.