Cognitive, physical, and dual-task performances distinguish fallers from non-fallers in postmenopausal women: determination of cutoff scores

OBJECTIVES: The aim of this study was to compare cognitive, physical, and dual-task performances in postmenopausal women with and without a history of falls, and to determine cutoff scores for dual-task tests. METHODS: This cross-sectional study included 100 postmenopausal women, classified as fallers (n=50) or non-fallers (n=50) based on falls in the previous year. Cognitive performance was assessed using the Montreal Cognitive Assessment. Physical performance was evaluated using the Four Square Step Test, One-Leg Stand Test, Timed Up and Go Test (TUG), 3-Metre Backward Walk Test (3MBWT), and 30-second Chair Stand Test (30s-CST). The TUG, 3MBWT, and 30s-CST were additionally performed under dual-task conditions, and dual-task cost (DTC) was calculated. Receiver operating characteristic curve analysis was used to assess discriminative ability, and multivariable logistic regression evaluated incremental predictive value beyond established risk factors. RESULTS: Postmenopausal women without a history of falls had better cognitive, physical, and dual-task performance (P<0.05). Fallers had greater dual-task cost values (P<0.05). The discriminative abilities of the 3MBWT (AUC=0.742, 95% CI: 0.644-0.840, cutoff= 6.96) and 30s-CST (AUC=0.715, 95% CI: 0.615-0.815, cutoff=8.5) under dual-task conditions and the DTC of 3MBWT (AUC=0.789, 95% CI: 0.701-0.877, cutoff=-52.43) were acceptable (P<0.001). After adjustment for age, body mass index, and chronic disease, dual-task 3MBWT and 30s-CST performance and DTC of 3MBWT were significantly associated with fall risk and provided meaningful incremental improvement in model discrimination (P<0.05). CONCLUSIONS: Postmenopausal women with a history of falls exhibited poorer cognitive, physical, and dual-task performance. Dual-task assessments, particularly the 3MBWT and 30s-CST, provide clinically relevant discrimination of fall risk beyond traditional factors.