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: 5.42). 01/2009; 63(12):1344-9. DOI: 10.1016/S1353-8020(08)70217-7
Source: PubMed


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.

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    • "Minimum, mean, and median CoF velocity all decreased for DT walking. Since mean and median CoF velocity should relate to walking speed, these decreases were consistent with literature where walking velocity decreased under DT conditions [1] [7] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19]. CoF velocity could be considered as a surrogate for walking speed in gait analysis by wearable-sensors, since the measurement of stride length would not be required to calculate the outcome measure. "
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    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
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    • "Executive functions are important both in gait control and the regulation of gait speed and variability (Amboni et al., 2013); this is because they moderate the influence of motor and sensory deficits on fall incidence prospectively (Rapport et al., 1998). They are also instrumental in coordinating multi-tasking that when confronted by dual tasks, executive functions are associated with gait and balance impairments (reduced gait speed and length and increased gait variability and body sway) (van Iersel et al., 2008; Martin et al., 2013b). "
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    ABSTRACT: Falls, a common cause of injury among older adults, have become increasingly prevalent. As the world's population ages, the increase in-and the prevalence of-falls among older people makes this a serious and compelling societal and healthcare issue. Physical weakness is a critical predictor in falling. While considerable research has examined this relationship, comprehensive reviews of neuropsychological predictors of falls have been lacking. In this paper, we examine and discuss current studies of the neuropsychological predictors of falls in older adults, as related to sporting and non-sporting contexts. By integrating the existing evidence, we propose that brain aging is an important precursor of the increased risk of falls in older adults. Brain aging disrupts the neural integrity of motor outputs and reduces neuropsychological abilities. Older adults may shift from unconscious movement control to more conscious or attentive motor control. Increased understanding of the causes of falls will afford opportunities to reduce their incidence, reduce consequent injuries, improve overall well-being and quality of life, and possibly to prolong life.
    Frontiers in Aging Neuroscience 04/2014; 6:64. DOI:10.3389/fnagi.2014.00064 · 4.00 Impact Factor
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    • "Here, we show that in addition to processing speed and executive function, gait speed during DTW is also associated with working memory in MCI participants, even after adjusting for normal gait speed. The effect of DTW on gait variables [24,25] and the requirement for executive function in older adults have been reported [21,22], and cognitive impairment (e.g., MCI) has been shown to have an impact on DTW performance. Montero-Odasso et al. [26] suggested that gait speed in MCI participants is related to working memory ability, and that the relationship is exaggerated during DTW. "
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    ABSTRACT: Gait ability and cognitive function are interrelated during both normal walking (NW) and dual-task walking (DTW), and gait ability is thus adversely affected by cognitive impairment in both situations. However, this association is insufficiently understood in people with mild cognitive impairment (MCI). Here, we conducted a study with MCI participants, to examine whether the association depends on walking conditions and MCI subtypes. We classified 389 elderly adults into amnestic MCI (n = 191) and non-amnestic MCI (n = 198), assessed their cognitive functions, and administered gait experiments under NW and DTW conditions. Gait ability was defined as gait speed. Five aspects of cognitive function were assessed: processing speed, executive function, working memory, verbal memory, and visual memory. Regression analysis adjusted for covariates showed a significant association between cognitive functions and gait speed. Processing speed and executive function correlated with gait speed during both NW and DTW (p < .05). Gait speed during DTW was also significantly associated with working memory (p < .001). Visual memory was associated during NW and DTW, particularly for amnestic MCI participants (p < .05). Our findings support the idea that the association between gait speed and cognitive function depends on walking condition and MCI subtypes. Additional studies are necessary to determine the neural basis for the disruption in gait control in older adults with MCI.
    BMC Neurology 04/2014; 14(1):67. DOI:10.1186/1471-2377-14-67 · 2.04 Impact Factor
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