Association Between Fear of Falling and Visuospatial and Executive Functions in Older Adults With Subjective Cognitive Decline: A Cross-Sectional Study.

Abstract

Objectives: Fear of falling (FOF) is a common health concern among older adults. Although cognitive impairment (CI) is a risk factor for FOF, the specific cognitive domains associated with FOF remain unclear. This study examined the association between FOF and domain-specific cognitive functions in older adults. We also analyzed whether this association varied based on CI, recent fall experience, or engagement in physical activity.

Design: This was a cross-sectional study analyzing the relationship between FOF and cognitive performance across various domains, with stratifications by CI status, fall history, and physical activity levels.

Setting and participants: The study included 591 older adults with mild CI who visited the Veterans Health Service Medical Center in Korea.

Methods: Cognitive performance in attention, language, visuospatial, memory, and frontal or executive domains was assessed using the Seoul Neuropsychological Screening Battery-Core. FOF was measured using the Activities-specific Balance Confidence Scale. Covariates, including demographics, physical health, and activity levels, were adjusted in the analyses.

Results: Higher FOF was significantly associated with lower performance in the visuospatial domain [Rey Complex Figure Test (β = 0.04, P = .002)] and the frontal or executive domain [Digit Symbol Coding (β = 0.05, P < .001), Controlled Oral Word Association Test (β = 0.02, P = .041), Trail Making Test (β = 0.06, P < .001), and Color Word Stroop Test (β = 0.04, P < .001)] after adjusting for covariates. The observed association was particularly evident in older adults with CI or those not engaging in moderate physical activity. The association was consistent regardless of fall history in the past year.

Conclusions and implications: High FOF was associated with poor visuospatial and frontal or executive functions. These findings underscore the link between FOF and cognitive function, suggesting that specific cognition in visuospatial and frontal or executive domains may contribute to FOF development.