Article

Executive Functions Are Associated With Gait and Balance in Community-Living Elderly People

Radboud University Nijmegen Medical Centre, Department of Geriatrics, 6500 HB Nijmegen, the Netherlands.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences (Impact Factor: 4.98). 01/2009; 63(12):1344-9. DOI: 10.1016/S1353-8020(08)70217-7
Source: PubMed

ABSTRACT Cognition influences gait and balance in elderly people. Executive functions seem to play a key role in this mechanism. Previous studies used only a single test to probe executive functions, and outcome measures were restricted to gait variables. We extend this prior work by examining the association between two different executive functions and measures of both gait and balance, with and without two different cognitive dual tasks.
This is a cross-sectional study with randomly selected community-living elderly people. Executive functions were tested with the Trail Making Test Parts A and B and the Stroop Color Word Test; memory with Cambridge Neuropsychological Test Automated Battery (CANTAB) subtests. Patients walked without and with two dual tasks (subtracting serial sevens and animal naming). Main outcomes focused on gait (velocity, stride length, and stride time variability), measured on an electronic walkway, and balance, measured as trunk movements during walking. Associations were assessed with multiple regression models.
One hundred elderly people, with a mean age 80.6 years (range 75-93 years) participated. Both dual tasks decreased gait velocity and increased variability and trunk sway. Executive functions were associated with only stride length variability and mediolateral trunk sway during performance of animal naming as the dual task. Memory was not associated with the gait and balance variables.
In community-living elderly people, executive functions are associated with gait and balance impairment during a challenging dual-task condition that also depends on executive integrity. Next steps will be to explore the value of executive functions in defining fall-risk profiles and in fall-prevention interventions for frail patients.

0 Followers
 · 
135 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dual-task gait allows assessment of impaired executive function and mobility control in older individuals, which are risk factors of falls. This study investigated gait changes in older individuals due to the addition of a cognitive load, using wearable pressure-sensing insole and tri-axial accelerometer measures. These wearable sensors can be applied at the point-of-care. Eleven elderly (65 years or older) individuals walked 7.62 m with and without a verbal fluency cognitive load task while wearing FScan 3000E pressure-sensing insoles in both shoes and a Gulf Coast X16-1C tri-axial accelerometer at the pelvis. Plantar-pressure derived parameters included center of force (CoF) path and temporal measures. Acceleration derived measures were descriptive statistics, Fast Fourier Transform quartile, ratio of even-to-odd harmonics, and maximum Lyapunov exponent. Stride time, stance time, and swing time all significantly increased during dual-task compared to single-task walking. Minimum, mean, and median CoF stance velocity; cadence; and vertical, anterior-posterior, and medial-lateral harmonic ratio all significantly decreased during dual-task walking. Wearable plantar pressure-sensing insole and lower back accelerometer derived-measures can identify gait differences between single-task and dual-task walking in older individuals and could be used in point-of-care environments to assess for deficits in executive function and mobility impairments.
    IEEE Engineering in Medicine and Biology Society (EMBC'14), Chicago, IL; 10/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Reduced executive function and physical performance are common age-related conditions. This study evaluated the associations between executive function and physical performance in a representative sample of older adults. Cross-sectional data were analyzed from a population-based sample of 629 men and women aged 65 or older and living in one typical city in Korea. Specific aspects of executive function were assessed using the trail making test, digit span test, and lexical fluency test to measure set shifting, working memory and cognitive flexibility functions. Physical performance was measured using performance-oriented mobility assessment (POMA) scores and isokinetic muscle strength. Subjects' self-efficacy was also assessed using the activities-specific balance confidence (ABC) scale. Results of the lexical fluency test were associated with POMA scores and muscle strength, independent of age, gender, education, comorbidity, physical activity status, depression, and global cognition, suggesting that reduced cognitive flexibility is associated with reduced physical performance and muscle strength. Self-efficacy was also independently associated with physical performance and muscle strength. Clinicians need to consider the association between executive function and physical performance when working to improve physical functioning in an aged population.
    Archives of gerontology and geriatrics 11/2010; 52(3):e156-61. DOI:10.1016/j.archger.2010.10.018 · 1.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Gangstörungen treten bei Demenz häufiger auf als im Rahmen des physiologischen Alterungsprozesses. Die Prävalenz dieser demenzassoziierten Gangstörungen hängt dabei vom Demenztyp und vom Schweregrad der kognitiven Beeinträchtigung ab. Während bei der vaskulären Demenz schon im Frühstadium klinisch manifeste Gangstörungen zu beobachten sind, zeigen sich diese bei der Alzheimer-Demenz meist erst im späteren Krankheitsverlauf. Mit modernen Methoden des „brain imaging“ wurde gezeigt, dass an Demenz erkrankte Personen vermehrt auf kortikale Aktivität angewiesen sind, um die Gangstabilität in komplexen Situationen aufrechtzuerhalten. Bei Dysfunktionen des Frontal- oder Temporallappens kann die Allokation dieser Ressourcen nicht mehr ausreichend sein. Klinisch lässt sich dies mithilfe von Dual-Task-Paradigmen überprüfen. Übersteigt die Aufmerksamkeitsanforderung die verfügbare Aufmerksamkeitskapazität, kommt es bei Alzheimer-Patienten auch schon im Frühstadium zu quantitativen Gangveränderungen, wie z. B. einer signifikanten Reduktion der Gehgeschwindigkeit und einer Zunahme der Schrittzeitvariabilität. Dies könnte die frühe Diagnose einer Alzheimer-Erkrankung erleichtern.
    Zeitschrift für Gerontologie + Geriatrie 01/2012; 45(1). DOI:10.1007/s00391-011-0260-8 · 1.02 Impact Factor