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Senior’s ability to balance on one leg may detect brain health, stroke risk

One-leg standing test is easy way to determine early signs of being at risk for a stroke and cognitive impairment

By Tucker Sutherland, editor,

Man standing on one legDec. 19, 2014 – You know how they warn you on TV when they are about to show something gruesome. We need to use that same type of warning on this report. It is about a new study that finds senior citizens - average age of 67 - that have trouble balancing on one leg for at least 20 seconds may have increased risk of small blood vessel damage in the brain - stroke - and reduced cognitive function.

The research included healthy older people with no clinical symptoms, according to the report in the American Heart Association’s journal Stroke.

“Our study found that the ability to balance on one leg is an important test for brain health,” said Yasuharu Tabara, Ph.D., lead study author and associate professor at the Center for Genomic Medicine at Kyoto University Graduate School of Medicine in Kyoto, Japan.

“Individuals showing poor balance on one leg should receive increased attention, as this may indicate an increased risk for brain disease and cognitive decline.”

The study consisted of 841 women and 546 men, average age of 67. To measure one-leg standing time, participants stood with their eyes open and raised one leg. The maximum time for keeping the leg raised was 60 seconds.

Participants performed this examination twice and the better of the two times was used in the study analysis.  Cerebral small vessel disease was evaluated using brain magnetic resonance imaging.

Researchers found that the inability to balance on one leg for longer than 20 seconds was associated with cerebral small vessel disease, namely small infarctions without symptoms such as lacunar infarction (type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain's deep structures) and microbleeds.

Infarct is an area of necrosis (death of body tissue) in a tissue or organ resulting from obstruction of the local circulation by a thrombus (a clot of blood formed within a blood vessel and remaining attached to its place of origin ) or embolus (abnormal particle circulating in the blood vessel).

They noted that:

  ● 34.5 percent of those with more than two lacunar infarction events had trouble balancing.

  ● 16 percent of those with one lacunar infarction event had trouble balancing.

  ● 30 percent of those with more than two microbleed events had trouble balancing.

  ● 15.3 percent one microbleed events had trouble balancing.

Overall, those with cerebral diseases were older, had high blood pressure and had thicker carotid arteries than those who did not have cerebral small vessel disease.


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However, after adjustment for these variables, people with more microbleeds and lacunar infarctions in the brain had shorter one-legged standing times.

Short one-legged standing times were also independently linked with lower cognitive scores.

Although previous studies have examined the connection between gait and physical abilities and the risk of stroke, this is among the first study to closely examine how long a person can stand on one leg as an indication of their overall brain health.

“One-leg standing time is a simple measure of postural instability and might be a consequence of the presence of brain abnormalities,” said Tabara.

Small vessel disease occurs due to microangiopathy (disease of very fine blood vessels) in the brain, making these arteries less flexible, which can interfere with blood flow. Small vessel disease typically increases with age. Loss of motor coordination, including balance, as well as cognitive impairment has been suggested to represent subclinical brain damage.

Tabara and colleagues also found a strong link between struggling to stand on one leg and increased age, with marked shorter one-leg standing time in patients age 60 and over.

Although the study did not assess participants’ histories of falling or physical fitness issues, such as how fast they could walk or any gait abnormalities, Tabara said the one-leg standing test is an easy way to determine if there are early signs of being at risk for a stroke and cognitive impairment and whether these patients need additional evaluation.

Previous research has shown that patients with lacunar infarcts suffer from dementia 4-12 times more frequently than the normal population. Cerebral atrophy and recurrent stroke, as well as other as-yet unclarified factors, are involved in producing dementia.

Co-authors areYoko Okada, M.D., Ph.D.; Maya Ohara, M.D.; Eri Uetani, M.D., Ph.D.; Tomoko Kido, M.D., Ph.D.; Namiko Ochi, M.D., Ph.D.; Tokihisa Nagai, M.D., Ph.D.; Michiya Igase, M.D., Ph.D.; Tetsuro Miki, M.D., Ph.D.; Fumihiko Matsuda, Ph.D.; and  Katsuhiko Kohara, M.D., Ph.D. Author disclosures and funding are on the manuscript.

>> About balance exercise from American Heart Association.

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