Could the Ability to Balance on One Leg Identify Stroke Risk?

New research suggests that the ability to balance on one leg may tell us more about a person’s brain health and risk of stroke.

Struggling to stand on one leg for less than 20 seconds was associated with a higher risk of stroke, small blood vessel damage in the brain, and reduced cognitive function in otherwise healthy people, according to a new study in the journal Stroke.
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“Postural instability assessed by one-leg standing time was associated with early pathological changes in the brain, namely asymptomatic lacunar infarction and microbleeds, as well as cognitive functional decline, even in apparently healthy subjects,” says lead study author Yasuharu Tabara, PhD, associate professor at the Center for Genomic Medicine at Kyoto University Graduate School of Medicine in Kyoto, Japan.

Tabara and colleagues conducted a cross-sectional study, which included 841 women and 546 men, who were an average age of 67. They measured one-leg standing time by having subjects stand with their eyes open and one leg raised. They measured the time interval until the raised leg was put down, with a maximum of 60 seconds allowed.

The researchers found that:

• 34.5% of those with more than two lacunar infarctions had trouble balancing.

• 16% of those with one lacunar infarctions had trouble balancing.

• 30% of those with more than two microbleeds had trouble balancing.

• 15.3% of those with one microbleed had trouble balancing.

Compared to those without celebral small vessel disease, those with cerebral diseases were older, had higher blood pressure, and thicker carotid arteries. In addition, short one-legged standing times were also independently linked with lower cognitive scores as well as increased age, with patients over age 60 displaying markedly shorter times.

The researchers suggest this test could be a simple, useful way to determine if a patient has early signs of increased risk for stroke and cognitive impairment and whether the patient needs additional evaluation. It could also play an important role in more comprehensive testing.

“In older individuals, comprehensive geriatric assessment (CGA) of frailty has been reported useful in increasing hospitalized patients’ survival duration,” Tabara says. CGA is usually defined as a multidimensional diagnostic process focused on determining a frail older person’s medical, psychological, and functional capability.

“Our findings incorporate postural instability as an important measure of CGA, and individuals showing postural instability should subsequently receive increased attention, as this instability may signal potential brain abnormalities and cognitive decline,” Tabara adds.

She and her colleagues would like to further identify parameters that represent frailty of elderly persons and fully understand the link between those parameters and clinical abnormalities.

—Colleen Mullarkey

Reference

Tabara Y, Okada Y, Ohara M, Uetani E, Kido T, Ochi N, et al. Association of postural instability with asymptomatic cerebrovascular damage and cognitive decline: The Japan Shimanami Health Promoting Program Study. Stroke. 18 Dec 2014. [Epub ahead of print].