Executive functions are associated with gait and balance in community-living elderly people.
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.
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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
Virtual Reality for Physical and Motor Rehabilitation, Edited by Patrice L (Tamar) Weiss, Emily A Keshner, Mindy F Levin, 01/2014: chapter Sensorimotor Recalibration in Virtual Environments: pages 71-94; Springer., ISBN: 978-1-4939-0967-4
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ABSTRACT: Introduction. Fall prevention is important for maintaining mobility and independence into old age. Approaches for reducing falls include exercise, tai chi, and home modifications; however, causes of falling are multifactorial and include not just physical but cognitive factors. Cognitive decline occurs with age, but older adults with the greatest declines in executive function experience more falls. The purpose of this study was twofold: to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population. Method. This pilot study used a pretest/posttest randomized trial design with assignment to an intervention or control group. Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks. Classes were held at senior/community centers. Primary outcomes included balance as measured by the Berg Balance Scale (BBS), 10-meter gait speed, and 10-meter gait speed under visuospatial dual-task condition. All measures were assessed at baseline and immediately post-intervention. Results. Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls (N = 45). Compared to controls, intervention participants experienced statistically significant improvements in BBS and gait speed. Mean performance on distracted gait speed also improved more for intervention participants compared to controls. Conclusion. Findings from this pilot randomized trial demonstrate the feasibility of a community-based cognitive training intervention. They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls.Health Education & Behavior 10/2014; 41(1 Suppl):62S-9S. DOI:10.1177/1090198114537068 · 1.54 Impact Factor