Falls are an important source of injury and disability in a patient with cognitive impairment or dementia. Identification of risk factors for falls by a patient permits planning an program to reduce their occurrence.


Risk factors for a fall in a patient with cognitive impairment or dementia:

(1) gait disorder (ataxia, etc)

(2) balance disorder

(3) poor vision

(4) disturbed sleep

(5) seizure disorder

(6) medications, including sedatives and neuroleptic drugs

(7) periventricular white matter lesions seen on CNS MRI studies

(8) peripheral neuropathy or sensory loss in the lower extremities

(9) lower extremity muscle weakness

(10) neurocardiovascular instability, autonomic dysfunction (orthostatic hypotension, carotid sinus hypersensitivity, vasovagal syncope, etc)

(11) malnutrition

(12) behavioral problems

(13) environmental hazards (that would predispose to tripping or slipping)

(14) history of falls, especially in the past year

(15) problems with feet or footwear


The type of dementia may influence the number of risk factors present.

(1) Progressive supranuclear palsy (PSP) is associated with falls soon after symptom onset.

(2) vascular dementia

(3) dementia with Lewy bodies


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