Balance confidence and falls in nondemented essential tremor patients: The role of cognition

Ashwini K. Rao, Arthur Gilman, Elan D. Louis

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objectives To examine (1) the effect of cognitive ability on balance confidence and falls, (2) the relationship of balance confidence and falls with quantitative measures of gait, and (3) measures that predict falls, in people with essential tremor (ET).

Design Cross-sectional study.

Setting General community.

Participants People with ET (n=132) and control subjects (n=48). People with ET were divided into 2 groups based on the median score on the Modified Mini-Mental State Examination: those with lower cognitive test scores (ET-LCS) and those with higher cognitive test scores (ET-HCS).

Interventions Not applicable.

Main Outcome Measures Six-item Activities of Balance Confidence (ABC-6) Scale and falls in the previous year.

Conclusions People with ET-LCS have impaired gait and report lower balance confidence and a higher number of falls than their counterparts (ET-HCS) and than control subjects. We have identified assessments that are easily administered (gait speed, ABC-6 Scale) and are associated with falls in ET.

Results Participants with ET-LCS had lower ABC-6 scores and a greater number of falls than those with ET-HCS (P<.05 for all measures) or control subjects (P<.01 for all measures). Quantitative gait measures were significantly correlated with ABC-6 score and falls. Gait speed (P<.007) and ABC-6 score (P<.02) were significant predictors of falls. Receiver operating characteristic curve analysis revealed that gait speed <0.9m/s and ABC-6 score <51% were associated with moderate sensitivity and specificity in identifying fallers.

Original languageEnglish (US)
Pages (from-to)1832-1837
Number of pages6
JournalArchives of physical medicine and rehabilitation
Issue number10
StatePublished - Oct 1 2014
Externally publishedYes


  • Accidental falls
  • Balance confidence
  • Cognition
  • Essential tremor
  • Gait
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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