Investigating the Interplay between Executive Function, Apolipoprotein E4, and Falls in Older Adults with Normal Cognition, Mild Cognitive Impairment, and Alzheimer's Dementia

Falls are a public health concern for older adults with or without cognitive impairment, including clinical Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD) dementia. Executive function (EF) is linked to falls and is notably impaired in individuals with MCI and AD dementia. However, it is unclear which EF assessments are associated with falls in older adults with intact cognition, MCI, and AD dementia. Apolipoprotein E4 (ApoE4) increases the risk of MCI and AD dementia, with limited information suggesting decreased EF and gait impairment in ApoE4 carriers. The purpose of this study was to 1) investigate the relationships between EF assessments and falls (fall history and future fall) by cognitive status (intact cognition, MCI, AD dementia) and 2) determine if ApoE4 moderates the relationship between EF and falls across cognitive status. EF assessments included Digit Span (DS), Trail Making Test (ΔTMT), Stroop Interference Test, Controlled Oral Word Association assessments of phonemic and semantic fluency (COWAC), and Clock Drawing Test. Binary logistic regression was used with secondary data to analyze the EF and falls relationship. Results showed a significant association of the ΔTMT with fall history but may not be appropriate for use with people with AD dementia due to a floor effect. Significant interaction effects were shown between AD dementia and DS, ΔTMT, and EF as a latent variable, where individuals with a fall history had better EF performance. The interaction effects are influenced by the lower percentage of reported falls in people with severe AD dementia. In the second aim, a confounding effect exposed a potential four-way interaction where higher EF in ApoE4 non-carriers with AD dementia experienced a future fall without a fall history. Overall, more research is needed to determine which EF assessments are best suited for fall risk assessment and whether ApoE4 plays a role in the relationship between EF and falls. Since the low percentage of reported falls in people with severe AD dementia exposed a differing trend between EF and falls, more research is needed to develop valid and reliable tools for collecting fall data in individuals with severe AD dementia.