44 * COGNITIVELY ENHANCING MEDICATIONS FOR TREATMENT OF GAIT AND BALANCE IMPAIRMENTS IN OLDER ADULTS THROUGH MODULATION OF COGNITION, ATTENTION OR EXECUTIVE FUNCTION: A SYSTEMATIC REVIEW

Abstract

Scope: Older adults with dementia have a two-fold increased risk of falls. Poor executive function and attention are associated with an increased risk of falls in this group. A better understanding of the potential role for cognitively enhancing medications, targeting attention and executive function, to modify gait and balance parameters, and thus reduce falls risk is required.Search methods: Systematic searches of MEDLINE, EMBASE, PsycInfo, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to October 2011 were conducted and reference lists of retrieved articles examined to identify prospective studies in adults over 65 years examining the effect of cognitively enhancing medications on gait and balance parameters. Two independent reviewers extracted data on study populations, medications used, outcome measures, and study findings.Results: Of 4992 abstracts identified, 10 studies met inclusion criteria. Two studies evaluated cholinesterase inhibitors, six studies evaluated methylphenidate, and a single study each evaluated amantadine and caffeine and their effects on gait or balance parameters. Cholinesterase inhibitors demonstrated favourable effects on gait speed and stability in older adults with Alzheimer's disease. The methylphenidate studies yielded conflicting results. Amantadine demonstrated a trend towards improved gait parameters with treatment but effects were not statistically different to placebo. Caffeine failed to mediate any improvements in gait speed and led to more postural instability.Conclusions: The findings represent early experimental work in this area and require further evaluation in randomised controlled trials. However, there is adequate evidence to support trialling pharmacological interventions, targeting executive function and attention, to reduce falls risk in older adults.