Admin supplement: Intervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer's Symptomatic Expression: The INCREASE Study

Polypharmacy and inappropriate medication use are major independent risk factors for falls in older adults. These effects are the result of negative influences on proprioception, cerebellar function, visual processing, vestibular responses, and cognition leading to major alterations on gait and balance. Falls, as a result of these influences, represent a highly prevalent and increasing problem in older adults, leading to an increase in health care costs due to disability, admission to long term care, or death. Quantitative measures of gait and balance, including plantar pressure and plantar pressure distribution, postural sway, performance on timed up & go tests, and limitations in range of movement have all been independently associated with the risk of falls. The technology to more accurately measure both gait and balance has increased dramatically in recent years, allowing more precise quantitation of these independent contributions to overall gait and balance, using both floor sensor and wearable accelerometer devices. The overarching hypothesis of this administrative supplement is that use of such technology to measure gait and balance subtleties in subjects with varying degrees and types of medication inappropriateness will allow targeted approaches to reduce fall risks in the elderly that may be at least partially caused by inappropriate medication use. This proposal stems directly from DSMB recommendations for the parent study (see attached minutes for INCREASE DSMB meeting #2). We will add gait and balance measures to the existing visits as described in the INCREASE protocol; specifically, at baseline (both challenged and non-challenged), 6 months, and EOS visits (both challenged and non-challenged). We are proposing to measure gait and balance using two systems that will provide complementary information that would provide a thorough assessment of fall risk in our participants.