Objective: To examine the range of neuropathology in people who die from a fall compared to those who die in alternate circumstances.

Background: The neural control of gait is complex and the aetiology of falls is often multifactorial. The neuropathological subtrates which contribute to falls are poorly described. Neuroimaging studies have suggested subclinical pathologies such as small vessel disease and cerebral amyloid may contribute to falls. Only two post-mortem series in fallers have been undertaken to date which revealed that fallers have an excess of microinfarcts¹ and increased incidence of progressive supranuclear palsy².

Method: Post-mortem reports from the authors’ institution were reviewed over a 10 year period from 2009-2018. Neuropathological examination was performed. These cases were dichotomized depending on the person dying in the setting of a fall (or reporting recurrent falls) or not. Data from the neuropathological exam were compared between groups,

Results: 744 neuropathological examinations were recorded (226 fallers, 486 non-fallers, 32 unclear). Aside from the acute injuries, there was an increased incidence of vascular pathology (in particular atherosclerosis) and cerebral amyloid in fallers. In addition there was a trend toward undiagnosed substantia nigra pathology in fallers.

Conclusion: These results confirm pathologically the association between atherosclerosis, cerebral amyloid and falls leading to death.

References: 1. Richardson K, Hunter S, Dening T, et al. Neuropathological correlates of falling in the CC75C population-based sample of the older old. Curr Alzheimer Res. 2012 Jul;9(6):697-708. 2. Yoshida K, Hata Y, Kinoshita K, et al. Incipient progressive supranuclear palsy is more common than expected and may comprise clinicopathological subtypes: a forensic autopsy series. Acta Neuropathol. 2017 May;133(5):809-823.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/undiagnosed-neuropathology-in-fallers-findings-from-a-10-year-autopsy-series/