The Relationship of Cognitive Functions with Physical Fitness Parameters, Balance, and Fall Risk in Older Adults

Year 2025, Volume: 12 Issue: 2, 571 - 583, 31.08.2025

Süleyman Korkusuz , Büşra Seçkinoğulları Korkusuz , Öznur Yiğit

https://doi.org/10.21020/husbfd.1661580

Abstract

Objectives: This study examines the effects of cognitive parameters on physical fitness, balance, and fall risk.
Materials and Methods: The study included 79 older adults. Cognitive functions of older adults were assessed using the Montreal Cognitive Assessment Scale (MoCA) and Clock Drawing Test (CDT). The Berg Balance Scale (BBS) was used to assess balance and fall risk, and the Senior Fitness Test (SFT) was used to assess physical fitness parameters (PFP). According to MoCA, individuals were included in the Mild Cognitive Impairment (n=38) and Normal Cognitive Level (n=41) groups.
Results: The mean age of individuals in the Mild Cognitive Impairment group was 71.50 ± 4.41, while the mean age of individuals in the Normal Cognitive Level group was 70.48 ± 4.57. In our study, individuals with mild cognitive impairment were found to have worse balance scores and physical fitness parameter scores, except for lower and upper extremity flexibility and aerobic endurance. While a significant relationship was noted between MoCA and balance as well as fall risk, no relationship was found between CDT and the balance score. Furthermore, no association between the CDT and any physical fitness parameter was found, despite a good correlation between the MoCA and several physical fitness parameters.
Conclusion: In conclusion, it was shown that global cognition in geriatric individuals is related to balance and PFP, such as agility, upper and lower extremity strength.

Keywords

cognitive function , physical fitness , postural balance , falls , older adults

References

• Adamo, D. E., Anderson, T., Koochaki, M., & Fritz, N. E. (2020). Declines in grip strength may indicate early changes in cognition in healthy middle-aged adults. PLoS One, 15(4), e0232021. https://doi.org/10.1371/journal.pone.0232021
• Azhdar, M., Mirzakhani, N., Irani, A., Baghban, A., Daryabor, A., Sangi, S., & Jah, N. A. (2022). The Effect of Balance Training on Cognitive and Occupational Performance of the Elderly. Caspian Journal of Pediatrics, 24(1). https://doi.org/10.22088/jbums.24.1.41
• Berryman, N., Bherer, L., Nadeau, S., Lauzière, S., Lehr, L., Bobeuf, F., Kergoat, M. J., Vu, T. T. M., & Bosquet, L. (2013). Executive functions, physical fitness and mobility in well-functioning older adults. Experimental Gerontology, 48(12), 1402-1409. https://doi.org/https://doi.org/10.1016/j.exger.2013.08.017
• Blackwood, J., Shubert, T., Forgarty, K., & Chase, C. (2016). Relationships Between Performance on Assessments of Executive Function and Fall Risk Screening Measures in Community-Dwelling Older Adults. Journal of Geriatric Physical Therapy, 39(2). https://journals.lww.com/jgpt/fulltext/2016/04000/relationships_between_performance_on_assessments.8.aspx
• Bunce, D., Batterham, P. J., Mackinnon, A. J., & Christensen, H. (2012). Depression, anxiety and cognition in community-dwelling adults aged 70 years and over. J Psychiatr Res, 46(12), 1662-1666. https://doi.org/10.1016/j.jpsychires.2012.08.023
• Buracchio, T. J., Mattek, N. C., Dodge, H. H., Hayes, T. L., Pavel, M., Howieson, D. B., & Kaye, J. A. (2011). Executive function predicts risk of falls in older adults without balance impairment. BMC Geriatrics, 11(1), 74. https://doi.org/10.1186/1471-2318-11-74
• Can, S. S., Kizil, E. T. Ö., Varli, M., Turan, E., & Atli, T. (2010). Demans Hastalarinda Üç Farkli Saat Çizme Testinin Türkçe Uyarlamalarinin Psikometrik Özellikleri [Psychometric Properties of the Turkish Versions of Three Different Clock Drawing Tests in Patients with Dementia]. Noro-Psikyatri Arsivi, 47(2), 91. https://doi.org/10.4274/npa.5340
• Cui, Y., Liu, B., Zhou, J., Liu, Q., & Ye, H. (2023). Quantitative analysis of balance function characteristics in older patients with mild to moderate cognitive impairment. Experimental Gerontology, 182, 112302. https://doi.org/https://doi.org/10.1016/j.exger.2023.112302
• Divandari, N., Bird, M. L., Vakili, M., & Jaberzadeh, S. (2023). The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis. Curr Neurol Neurosci Rep, 23(11), 681-693. https://doi.org/10.1007/s11910-023-01305-y
• Gleason, C. E., Gangnon, R. E., Fischer, B. L., & Mahoney, J. E. (2009). Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial. Dementia and geriatric cognitive disorders, 27(6), 557-563. https://doi.org/10.1159/000228257
• Gray, M., Gills, J. L., Glenn, J. M., Vincenzo, J. L., Walter, C. S., Madero, E. N., Hall, A., Fuseya, N., & Bott, N. T. (2021). Cognitive decline negatively impacts physical function. Exp Gerontol, 143, 111164. https://doi.org/10.1016/j.exger.2020.111164
• Hauer, K., Pfisterer, M., Weber, C., Wezler, N., Kliegel, M., & Oster, P. (2003). Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls. J Am Geriatr Soc, 51(11), 1638-1644. https://doi.org/10.1046/j.1532-5415.2003.51517.x
• Herman, T., Mirelman, A., Giladi, N., Schweiger, A., & Hausdorff, J. M. (2010). Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 65(10), 1086-1092. https://doi.org/10.1093/gerona/glq077
• Holtzer, R., Friedman, R., Lipton, R. B., Katz, M., Xue, X., & Verghese, J. (2007). The relationship between specific cognitive functions and falls in aging. Neuropsychology, 21(5), 540. https://doi.org/10.1037/0894-4105.21.5.540
• Jia, X., Wang, Z., Huang, F., Su, C., Du, W., Jiang, H., Wang, H., Wang, J., Wang, F., Su, W., Xiao, H., Wang, Y., & Zhang, B. (2021). A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study. BMC Psychiatry, 21(1), 485. https://doi.org/10.1186/s12888-021-03495-6
• Jiménez-García, J. D., Ortega-Gómez, S., Martínez-Amat, A., & Álvarez-Salvago, F. (2024). Associations of Balance, Strength, and Gait Speed with Cognitive Function in Older Individuals over 60 Years: A Cross-Sectional Study. Applied Sciences, 14(4), 1500. https://www.mdpi.com/2076-3417/14/4/1500
• Kletzel, S. L., Hernandez, J. M., Miskiel, E. F., Mallinson, T., & Pape, T. L.-B. (2017). Evaluating the performance of the Montreal Cognitive Assessment in early stage Parkinson's disease. Parkinsonism & Related Disorders, 37, 58-64. https://doi.org/https://doi.org/10.1016/j.parkreldis.2017.01.012
• Kunutsor, S. K., Isiozor, N. M., Voutilainen, A., & Laukkanen, J. A. (2022). Handgrip strength and risk of cognitive outcomes: new prospective study and meta-analysis of 16 observational cohort studies. Geroscience, 44(4), 2007-2024. https://doi.org/10.1007/s11357-022-00514-6
• Liu-Ambrose, T. Y., Ashe, M. C., Graf, P., Beattie, B. L., & Khan, K. M. (2008). Increased risk of falling in older community-dwelling women with mild cognitive impairment. Physical therapy, 88(12), 1482-1491. https://doi.org/10.1007/s11357-022-00514-6
• Martin, K., Thomson, R., Blizzard, L., Wood, A., Garry, M., & Srikanth, V. (2009). Visuospatial ability and memory are associated with falls risk in older people: a population-based study. Dement Geriatr Cogn Disord, 27(5), 451-457. https://doi.org/10.1159/000216840
• Meunier, C. C., Smit, E., Fitzpatrick, A. L., & Odden, M. C. (2021). Balance and cognitive decline in older adults in the cardiovascular health study. Age Ageing, 50(4), 1342-1348. https://doi.org/10.1093/ageing/afab038
• Morrison, J. H., & Baxter, M. G. (2012). The ageing cortical synapse: hallmarks and implications for cognitive decline. Nature Reviews Neuroscience, 13(4), 240-250. https://doi.org/10.1038/nrn3200
• Nazrien, N. M. D., Novitri, Prabowo, T., & Arisanti, F. (2024). The Role of Cognition in Balance Control. OBM Neurobiology, 08(01), 211. https://doi.org/10.21926/obm.neurobiol.2401211
• Peng, Y., Wang, Y., Zhang, L., Zhang, Y., Sha, L., Dong, J., & He, Y. (2024). Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: A systematic review and meta-analysis. Geriatric Nursing, 57, 31-44. https://doi.org/https://doi.org/10.1016/j.gerinurse.2024.02.032
• Persad, C. C., Jones, J. L., Ashton-Miller, J. A., Alexander, N. B., & Giordani, B. (2008). Executive Function and Gait in Older Adults With Cognitive Impairment. The Journals of Gerontology: Series A, 63(12), 1350-1355. https://doi.org/10.1093/gerona/63.12.1350
• Peters, R. (2006). Ageing and the brain: This article is part of a series on ageing edited by Professor Chris Bulpitt. Postgraduate medical journal, 82(964), 84-88. https://doi.org/10.1136/pgmj.2005.036665
• Prokopidis, K., Giannos, P., Ispoglou, T., Kirk, B., Witard, O. C., Dionyssiotis, Y., Scott, D., Macpherson, H., Duque, G., & Isanejad, M. (2023). Handgrip strength is associated with learning and verbal fluency in older men without dementia: insights from the NHANES. Geroscience, 45(2), 1049-1058. https://doi.org/10.1007/s11357-022-00703-3
• Ramnath, U., Rauch, L., Lambert, E. V., & Kolbe-Alexander, T. L. (2018). The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study. PLoS One, 13(4), e0194918. https://doi.org/10.1371/journal.pone.0194918
• Sahin, F., Yilmaz, F., Ozmaden, A., Kotevolu, N., Sahin, T., & Kuran, B. (2008). Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther, 31(1), 32-37. https://doi.org/10.1519/00139143-200831010-00006
• Tabbarah, M., Crimmins, E. M., & Seeman, T. E. (2002). The Relationship Between Cognitive and Physical Performance: MacArthur Studies of Successful Aging. The Journals of Gerontology: Series A, 57(4), M228-M235. https://doi.org/10.1093/gerona/57.4.M228