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Association between Hypometabolism in the Supplementary Motor Area and Fear of Falling in Older Adults.

ABSTRACT: Background: A better understanding of the neural mechanisms that underlie the development of fear of falling (FoF) in seniors may help to detect potential treatable factors and reduce future falls. We therefore investigate the neural correlates of FoF in older adults using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). Methods: This cohort study included 117 community-dwelling older adults. At baseline, participants were assessed for FoF, psychiatric symptoms, walking speed, global cognition and cerebral glucose metabolism with FDG-PET. The incidence of FoF in the participants who did not report FoF (N-FoF) at baseline was again ascertained 2 years later. FDG uptake was compared between the FoF and non-FoF groups. Logistic regression analyses to examine the predictors of newly developed FoF (D-FoF) using normalized regional FDG uptake were then performed. Results: At baseline, 50.4% (n = 59) of participants had FoF. The FoF group had significantly decreased glucose metabolism in the left superior frontal gyrus (supplementary motor area, SMA; BA6) compared to the non-FoF group. After 2 years, 19 out of the 58 participants in the non-FoF group developed FoF. Logistic regression analysis revealed that decreased cerebral glucose metabolism in the left SMA at the baseline was a significant predictor of the future development of FoF, independently of psychiatric symptoms and walking speed. Conclusion: In healthy older adults, hypometabolism in the left SMA, which is involved in motor planning and motor coordination, contributes to the development of FoF. Our result might help elucidate underlying mechanism of the association between deficits in motor control and FoF.

SUBMITTER: Sakurai R

PROVIDER: S-EPMC5532384 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:BackgroundFear of falling is associated with numerous negative health outcomes in older adults and can limit the rehabilitation process. Hypnosis is now recognized as an effective treatment for a variety of conditions, especially anxiety and pain, which can be integrated safely with conventional medicine. The objective of this study was to assess the feasibility and acceptability of a hypnosis intervention in hospitalized older adults to reduce fear of falling.MethodsIn this feasibility randomized controlled trial, 32 older patients, hospitalized in geriatric rehabilitation wards, were randomly allocated (1:1 ratio) to either an intervention group (hypnosis, 2 sessions, one per week, plus usual rehabilitation program) or a control group (usual rehabilitation program only). Clinical assessors and statistician were blinded to group allocation. Primary outcomes were recruitment rate, retention rate, and adherence to the intervention. Exploratory outcomes, analyzed according to the intention-to-treat principle, included impact of hypnosis on fear of falling (assessed by a new scale perform-FES), functional status, in-hospital falls, and length of hospital stay.ResultsRecruitment rate was 1.3 patients per week. The recruitment of the population sample was achieved in 5.5 months. The retention rate did not differ significantly between groups and a good adherence to the hypnosis intervention was achieved (77% of patients received the full intervention). No adverse event related to the hypnosis intervention was observed. Regarding exploratory clinical outcomes, no differences were found between groups on any outcome.ConclusionHypnosis is feasible and well accepted in a geriatric hospitalized population undergoing rehabilitation. Further pilot work should be conducted, with an increased number of hypnosis sessions, before conducting a full-scale trial to conclude whether, or not, hypnosis is effective to reduce fear of falling.Trial registrationNCT04726774.

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Association between Hypometabolism in the Supplementary Motor Area and Fear of Falling in Older Adults.

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