By Dave DeFusco
Falls are among the most significant health concerns for people with Multiple Sclerosis, a chronic neurodegenerative disease that affects the central nervous system. With over 50% of individuals with MS experiencing at least one fall within a six-month period, the risk of injury, reduced mobility and loss of independence looms large; however, a crucial question remains: do individuals with MS have an accurate perception of their own risk of falling, and does cognitive function play a role in this perception?
A recent Multiple Sclerosis and Related Disorders study co-authored by Dr. Marissa Barrera, director of the M.S. in Speech-Language Pathology and assistant dean of health sciences at the Katz School of Science and Health, explores the relationship between cognitive performance and the mismatch between physiological and perceived fall-risk in people with MS.
The risk of falling is typically evaluated through two distinct lenses: physiological and perceived risk. Physiological fall-risk refers to an individual鈥檚 actual physical susceptibility to falls, often measured through objective assessments like gait speed. Perceived fall-risk, on the other hand, is a subjective evaluation of one鈥檚 own risk of falling, commonly assessed using self-reported measures like the Modified Falls Efficacy Scale.
鈥淲hile many people with MS exhibit alignment between these two measures, a significant subset of individuals either overestimate or underestimate their fall-risk, creating a discordance that could lead to either unnecessary restrictions in daily activities or dangerous overconfidence in mobility,鈥 said Dr. Tobia Zanotto, a lead author of the paper and an assistant professor in the Department of Occupational Therapy Education in the University of Kansas Medical Center.
The study, 鈥,鈥 analyzed data from 201 people with MS, categorizing them into four groups based on their physiological and perceived fall-risk: High physiological鈥攈igh perceived (Hphy-Hper); high physiological鈥攍ow perceived (Hphy-Lper); low physiological鈥攍ow perceived (Lphy-Lper); and low physiological鈥攈igh perceived (Lphy-Hper).
To evaluate cognitive function, the researchers used the NeuroTrax computerized cognitive battery, which measures global cognitive performance and specific domains, such as information processing, attention, motor skills, executive function and visual-spatial ability.
The results revealed that 27.4% of participants exhibited a discordance between their physiological and perceived fall-risk; however, contrary to the researchers鈥 hypothesis, individuals with discordant fall-risk did not exhibit significantly different cognitive scores compared to those with concordant fall-risk. This suggests that cognitive impairment does not necessarily explain why some individuals misjudge their fall-risk.
Within the concordant groups, however, cognitive performance was notably lower among individuals in the Hphy-Hper category compared to those in the Lphy-Lper group. These individuals showed significant deficits in global cognition, information processing, attention, motor skills, executive function and visual-spatial abilities, reinforcing the well-documented link between cognitive decline and increased fall-risk in MS.
鈥淲hile cognitive impairment did not account for the mismatch in physiological and perceived fall-risk, our study highlights the broader impact of cognitive deficits on fall susceptibility,鈥 said Dr. Danya Pradeep Kumar, the other lead author of the paper and a postdoctoral research associate in the School of Health Professions at the University of Kansas Medical Center. 鈥淭he findings suggest that individuals with MS who demonstrate both high physiological and perceived fall-risk may benefit from targeted interventions to improve cognitive and motor functions.鈥
Moreover, the study raises important clinical considerations for identifying individuals who either underestimate or overestimate their fall-risk. Those who underestimate their risk (Hphy-Lper) may require greater fall-prevention education, while those who overestimate their risk (Lphy-Hper) may benefit from interventions aimed at improving balance confidence and mobility.
The study opens the door for further investigation into the factors that contribute to fall-risk perception in MS. Future research could explore whether psychological factors, such as anxiety or depression, play a role in fall-risk discordance. Additionally, longitudinal studies could examine how fall-risk perception changes over time and whether targeted cognitive or motor interventions can help bridge the gap between physiological and perceived fall-risk.
鈥淏y improving assessment methods and developing targeted interventions, clinicians and researchers can work toward reducing falls and enhancing the quality of life for people with MS,鈥 said Dr. Barrera, who is a Multiple Sclerosis certified specialist.
