Association between falls in Alzheimer disease and scores on the Balance Evaluation Systems Test (BESTest) and MiniBESTest.

Background and purpose: Alzheimer disease (AD) is the most common form of dementia and the sixth leading cause of death in the United States. Falls are associated with AD and can lead to injury. The Balance Evaluation Systems Test (BESTest) is a balance measure used in other neurological conditions to predict fall risk. The purpose of this study is to examine the relationship between MiniBestest, BESTest, and BESTest subsection scores and fall incidence among individuals with a diagnosis of mild AD.

Methods: The study was a single centre, prospective, observational cohort study. Participants completed baseline questionnaires including a demographic form, a fall history questionnaire and the Barthel Index of Activities of Daily Living (ADLs). Balance and gait were assessed using the MiniBESTest and BESTest. After completing baseline assessment, participants were given monthly fall calendars to track falls for the next 12 months.

Results: MiniBESTest total raw score for fallers was 13.4 out of 28 (SD = 3.6) and for non-fallers was 18.4 of out 28 (SD = 3.7). MiniBESTest total percentage score for fallers was 47.8% (SD = 12.8%) and for non-fallers was 65.5% (SD = 13.1%). BESTest total percentage scores for fallers was 58.2% (SD = 3.9%) and for non-fallers was 73.9% (SD = 7.9%). Subsections II-IV of the BESTest correlated with faller status.

Discussion and conclusions: Among individuals with mild AD, fall status was associated with certain balance deficits on the BESTest including moving body outside base of support (subsection II), changing centre of mass (subsection III), and reacting to external perturbations (subsection IV). Future studies could explore differences between AD and other neurological conditions and how physical therapy could improve these areas to reduce fall risk.