Who Falls After Stroke? Evidence From a Prospective Stroke Cohort

Abstract Background Falls are a frequent and serious complication after stroke, affecting more than 30% of survivors within the first year. While age and comorbidities are established risk factors for falls, stroke-specific contributors—particularly lesion-related impairments in mobility and gait—are less well understood and may inform targeted secondary prevention. Methods We analyzed data from 94 patients with disabling subacute ischemic stroke enrolled in the prospective BAPTISe cohort, a predefined imaging and biomarker sub-cohort of the multicenter PHYS-STROKE trial. Detailed gait and mobility assessments were performed at baseline. Principal component (PC) analysis reduced seven mobility-related and four gait-related variables into two composite scores: PC1-Mobility and PC1-Gait, explaining 56% and 82% of variance, respectively. PC1-Mobility reflected global disability and functional mobility in daily life, whereas PC1-Gait captured spatiotemporal walking capacity and efficiency. Lesion network mapping (LNM) using a normative connectome identified functional networks associated with each domain. Patient-reported falls up to six months post-enrollment were the primary endpoint. Results LNM of PC1-Mobility revealed a predominantly cortical network involving pre- and postcentral gyri, superior and middle frontal gyri, and sensorimotor integration areas. In contrast, PC1-Gait was associated with subcortical and infratentorial connectivity, including bilateral thalamus, brainstem, and cerebellum. In multivariable regression, network similarity scores were not independently associated with falls; only older age was significant (adjusted OR1.08, 95%CI1.02–1.15,p=0.013). LNM of fall occurrence showed a cortical network with significant spatial overlap with the PC1-Mobility network(p