Falls signal faster cognitive decline in older adults

Older adults who experienced at least one fall exhibited a faster decline in cognitive skills over the following decade than those who hadn’t fallen, according to a new study by researchers at Washington University School of Public Health in St. Louis. The study also revealed that falls are a risk factor for Alzheimer’s disease on par with Alzheimer’s brain proteins, the gold standard for gauging Alzheimer’s dementia risk. 

The findings suggest that falls could be an early warning sign of Alzheimer’s disease — one much less expensive and easier to measure than levels of brain proteins, and potentially just as informative.

“The fact that falls and biomarker status are equally risky for developing Alzheimer’s really caught my attention and made me think we need to explore this more,” said senior author Susan L. Stark, MS, PhD, a professor of public health. “We don’t have a good way of identifying people at risk of Alzheimer’s before they start showing cognitive symptoms, which is a missed opportunity because we have disease-modifying therapies now, and the sooner people get started on them, the better they work. Maybe falls should be part of the profile that we look at when we’re trying to identify who is at risk.”

Falls were already known to be associated with Alzheimer’s disease. But falls are also associated with normal aging, and disentangling the relationship between aging, falling and cognitive decline has proven challenging.  

To understand whether falls are associated with progression to dementia, Stark and then-graduate student Audrey Kelemen, PhD, the first author on the paper, studied 125 older adults who volunteer with WashU Medicine’s Charles F. and Joanne Knight Alzheimer Disease Research Center (ADRC). These volunteers are people — some with dementia in their families, some without — who participate in Alzheimer’s studies to help scientists better understand the disease.

Participants underwent a clinical and cognitive assessment at baseline followed by annual checkups — a standard routine for Knight ADRC volunteers. In addition, for the first 12 months, participants monitored themselves for falls and reported all events to the research team. The research team continued following the participants for an average of 10 years to track any changes to their cognitive health. 

At the start of the study, none of the volunteers had any cognitive problems, although some had elevated levels of the Alzheimer’s protein amyloid beta in their brains. For analysis, the participants were divided into four groups by amyloid level and history of falling. Those who had high amyloid and a history of falls declined fastest, while those that had neither declined most slowly. The other two groups exhibited an intermediate rate of cognitive decline — and, surprisingly, the rate was much the same between the two groups. People who fell in the first year but had normal amyloid levels were just as likely to develop the symptoms of Alzheimer’s dementia over the course of the 10-year follow-up as people who started the study with high levels of amyloid but did not fall.  

“What we can’t tell from this study is whether falls are a sign or a cause of Alzheimer’s disease,” Stark said. “There’s evidence that repeated concussions are a risk factor for Alzheimer’s. I wonder if people are falling and hitting their heads and that’s what is accounting for this increased risk. But it also may be something else. There are many sensorimotor changes that are associated with increased risk of Alzheimer’s disease — changes in vision, hearing, balance — and we don’t know if they’re causative or a predictor of things to come. It would be interesting to explore some mechanisms to see why falls are so tightly linked to Alzheimer’s disease.”

Whatever the relationship between falls and Alzheimer’s turns out to be, one thing is already clear, Stark said: Older people who fall should be screened for Alzheimer’s disease, and people with Alzheimer’s disease should be screened for fall risk.

“There are relatively simple, low-cost things that we can do that reduce the risk of falls significantly, such as installing grab bars in tubs and removing clutter from walkways,” Stark said. “These sorts of interventions are worthwhile in terms of preventing falls, which can be devastating on their own, but I also think it is worth exploring whether fall-prevention interventions can delay the onset of dementia in people at high risk for Alzheimer’s disease.”

Keleman AA, Li M, Wisch JK, Bollinger RM, Krauss MJ, Grant EA, Benzinger TLS, Ances BM, Morris JC, Stark SL. Falls predict faster progression to Alzheimer’s dementia. Alzheimer’s and Dementia. February 7, 2026. DOI: 10.1002/alz.71177

This work was supported by the National Institutes of Health (NIH), grant numbers R01AG057680, R25HD105583, P30AG066444, P01AG03991 and P01AG026276. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.