A new study finds a link between lower cognitive performance and higher fall-risk in people with multiple sclerosis. Researchers also found one in four had a discordance between their physiological and perceived fall-risk. This discordance, however, was not explained by cognitive performance.

According to Marissa Barrera, a MS Focus medical advisor who participated in the study, the findings are “important and impactful for individuals living with multiple sclerosis because it deepens our understanding of fall risk, a major safety and significant quality-of-life concern in this clinical population.”

Cognitive impairment is linked with increased risk of falls in people with MS, but it is not clear whether cognitive performance may help to account for the discordance between fall-risk due to actual physiological functioning and the individual's perception of their fall-risk. A team of researchers set out to examine the relationship between cognitive performance and the concordance/discordance of physiological and perceived fall-risk in people with MS.

In this single-center cross-sectional analysis of 201 people with MS, proxies for physiological (gait speed) and perceived (Modified Falls Efficacy Scale) fall-risk were collected. Participants were categorized into four groups using established cut-off values: high physiological – high perceived, high physiological – low perceived, low physiological – low perceived, and low physiological – high perceived fall-risk. Cognitive performance was evaluated using the NeuroTrax computerized cognitive battery, which generates a global cognitive score as well as scores for individual cognitive domains.

Overall, 27.4 percent of participants exhibited a discordance between physiological and perceived fall-risk. Individuals with discordant fall-risk did not have worse cognitive scores than individuals with concordant fall-risk, whether global cognitive score or individual cognitive domains. However, among the concordant groups, participants in the high physiological – high perceived group had worse cognitive scores, as well as information processing, attention, motor skills, executive function and visual spatial domain scores when compared to the participants in the low physiological – low perceived group.

In this study, one in four people with MS had a discordance between their physiological and perceived fall-risk. This discordance was not explained by cognitive performance.

Barrera said, “While cognitive impairments are commonly linked to increased fall risk, this study highlights a critical nuance: the mismatch – or discordance – between physiological measures of fall risk and an individual's perception of their fall risk is not necessarily explained by cognitive performance. Notably, approximately one in four people with MS in the study exhibited this discordance, meaning they may underestimate or overestimate their fall risk regardless of their actual physical condition. 

“This insight is essential because it suggests that interventions aimed solely at improving cognition may not fully address perceived fall risk. Instead, a more comprehensive, interdisciplinary approach – potentially integrating physical therapy, education, and psychological support – may be necessary to help people with MS accurately assess and manage their fall risk, thereby reducing fall-related injuries, enhancing daily confidence, and independence.”

The findings were published in the journal Multiple Sclerosis and Related Disorders.