Prognosis of an abnormal one-leg balance in community-dwelling patients with Alzheimer's disease: a 2-year prospective study in 686 patients of the REAL.FR study

Abstract

Objectives: The aim of this study was to explore the predictive value of an abnormal one-leg balance (OLB) test for functional decline, nursing home admission, and mortality in community-dwelling patients affected with Alzheimer's disease (AD).

Design: A 2-year prospective, observational cohort study.

Setting: Nineteen memory centers across France.

Participants: A total of 686 community-dwelling patients with AD.

Measurements: Mini-mental state examination, Activity of Daily Living scale, and balance (ability to stand unassisted for 5 seconds on 1 leg) were reported every 6 months. Functional decline was defined as a loss of 0.5 or more points at a 5-point Activity of Daily Living score (bathing, dressing, toileting, continence, and feeding). Nursing home admission and mortality were recorded. Neuropsychiatric symptoms, medication, and caregiver's burden were assessed every 6 months. Time-to-event analyses were used.

Results: At baseline, 632 patients with AD had a balance measurement (mean age = 77.8 years, SD = 6.9; 72.2% were women) and 15.2% had an abnormal OLB test: these patients were older, had lower mini-mental state examination and Activity of Daily Living scores, and more neuropsychiatric symptoms, osteoarthritis, comorbidities and medications (all P < .05). After adjustment for age and sex, the risk of functional decline (hazard ratio [HR]: 1.69; 95% confidence interval [CI], 1.26-2.26), nursing home admission (HR: 2.51; 95% CI, 1.69-3.73), and death (HR: 2.42; 95% CI, 1.43-4.11) was higher in patients with an abnormal OLB. After adjustment for other potential confounders, the presence of an abnormal OLB was significantly associated only with nursing home admission (HR: 1.73, 95% CI, 1.09-2.75).

Conclusion: In the present study, an abnormal OLB predicts nursing home admission in patients with AD. Although statistically significant when solely adjusted for age and sex, an abnormal OLB test failed to predict functional decline and mortality when adjusted for multiple confounders.