Balance, executive functions and falls in elderly with Alzheimer’s disease (AD): A longitudinal study Renata Valle Pedroso a, *, Fla ´ via Gomes de Melo Coelho a , Ruth Ferreira Santos-Galduro ´z a,b , Jose ´ Luiz Riani Costa a , Sebastia ˜o Gobbi a , Florindo Stella a,c a Institute of Biosciences, UNESP, Univ Estadual Paulista, Department of Physical Education, Physical Activity and Aging Lab (LAFE), Avenida 24 A, 1515, Bela Vista, Rio Claro/SP 13506-900, Brazil b Universidade Federal do ABC, Centro de Matema ´tica Computac ¸a ˜o e Cognic ¸a ˜o, Rua Santa Ade ´lia, 166, Bangu ´, Santo Andre ´/SP 09210-170, Brazil c Institute of Biosciences, UNESP, Univ Estadual Paulista, Department of Physical Education, Physical Activity and Aging Lab (LAFE), Clinic of Geriatric Psychiatry, UNICAMP, Univ. Estadual de Campinas, Distrito de Bara˜o Geraldo, Campinas/SP 13083-970, Brazil 1. Introduction AD is a progressive neurodegenerative process characterized by the decline of cognitive functions and functional activities, as well as behavioral alterations. Initially, the patient presents greater impairment of the recent memory and attention deficits (Stella, 2006; Yaari and Corey-Bloom, 2007). As the clinical condition evolves, we can observe the impairment of cognitive functions associated with the frontal lobe, mainly the executive functions, which regard the cognitive abilities involved in task planning, initiation, sequencing and organization, and also working memory and abstraction (Magila and Caramelli, 2000; Sjo ¨ beck et al., 2010). The decline of executive functions can make difficult simple tasks as those involved in personal hygiene, cooking, shopping, analyzing a situation, and even starting a certain action, directly affecting daily life activities (Sheridan and Hausdorff, 2007). It has also been widely reported in the literature that executive dysfunctions contribute to instability in gait and balance, and therefore to the increase in the number of falls in those patients (Sheridan and Hausdorff, 2007; Piermartiri et al., 2009). Up to the present moment, there has been no consensus on the incidence of falls in the elderly with AD. It may range from 60% to 80% (Carvalho and Coutinho, 2002), being considered twice as high as the rate in the general population, which is 30% (Tinetti et al., 1988; Perracini and Ramos, 2002). Moreover, according to Imamura et al. (2000), elderly with AD are three times more prone to falls when compared with elderly without dementia. Falls in the elderly population constitute one of the main clinical and public health issues due to the resulting general health complications; the increased risk of institutionalization, and the high care costs (Carvalho and Coutinho, 2002; Perracini and Ramos, 2002). Consequently, it is necessary that strategies be created which might reduce the deterioration of the executive functions and the components of functional capacity in the elderly with AD. Some researches showed that physical activity can indeed reduce the decline of executive functions and the loss of functional capacity components, such as balance, in elderly patients with AD, thus helping reduce the fall risk in those individuals (Sheridan and Hausdorff, 2007; Arcoverde et al., 2008). Archives of Gerontology and Geriatrics 54 (2012) 348–351 ARTICLE INFO Article history: Received 16 January 2011 Received in revised form 7 May 2011 Accepted 8 May 2011 Available online 20 July 2011 Keywords: Alzheimer’s disease Falls and cognitive performance Executive functions in elderly Balance in elderly Physical activity of elderly ABSTRACT Elderly individuals with AD are more susceptible to falls, which might be associated with decrements in their executive functions and balance, among other things. We aimed to analyze the effects of a program of dual task physical activity on falls, executive functions and balance of elderly individuals with AD. We studied 21 elderly with probable AD, allocated to two groups: the training group (TG), with 10 elderly who participated in a program of dual task physical activity; and the control group (CG), with 11 elderly who were not engaged in regular practice of physical activity. The Clock Drawing Test (CDT) and the Frontal Assessment Battery (FAB) were used in the assessment of the executive functions, while the Berg Balance Scale (BBS) and the Timed Up-and-Go (TUG)-test evaluated balance. The number of falls was obtained by means of a questionnaire. We observed a better performance of the TG as regards balance and executive functions. Moreover, the lower the number of steps in the TUG scale, the higher the scores in the CDT, and in the FAB. The practice of regular physical activity with dual task seems to have contributed to the maintenance and improvement of the motor and cognitive functions of the elderly with AD. ß 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +55 19 3526 4312; fax: +55 19 3526 4321. E-mail address: re.pedroso@hotmail.com (R.V. Pedroso). Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger 0167-4943/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.archger.2011.05.029