Poor Trail Making Test Performance Is Directly Associated with Altered Dual Task Prioritization in the Elderly – Baseline Results from the TREND Study

Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.
PLoS ONE (Impact Factor: 3.23). 11/2011; 6(11):e27831. DOI: 10.1371/journal.pone.0027831
Source: PubMed


Deterioration of executive functions in the elderly has been associated with impairments in walking performance. This may be caused by limited cognitive flexibility and working memory, but could also be caused by altered prioritization of simultaneously performed tasks. To disentangle these options we investigated the associations between Trail Making Test performance--which specifically measures cognitive flexibility and working memory--and dual task costs, a measure of prioritization.
Out of the TREND study (Tuebinger evaluation of Risk factors for Early detection of Neurodegenerative Disorders), 686 neurodegeneratively healthy, non-demented elderly aged 50 to 80 years were classified according to their Trail Making Test performance (delta TMT; TMT-B minus TMT-A). The subjects performed 20 m walks with habitual and maximum speed. Dual tasking performance was tested with walking at maximum speed, in combination with checking boxes on a clipboard, and subtracting serial 7 s at maximum speeds. As expected, the poor TMT group performed worse when subtracting serial 7 s under single and dual task conditions, and they walked more slowly when simultaneously subtracting serial 7 s, compared to the good TMT performers. In the walking when subtracting serial 7 s condition but not in the other 3 conditions, dual task costs were higher in the poor TMT performers (median 20%; range -6 to 58%) compared to the good performers (17%; -16 to 43%; p<0.001). To the contrary, the proportion of the poor TMT performance group that made calculation errors under the dual tasking situation was lower than under the single task situation, but higher in the good TMT performance group (poor performers, -1.6%; good performers, +3%; p = 0.035).
Under most challenging conditions, the elderly with poor TMT performance prioritize the cognitive task at the expense of walking velocity. This indicates that poor cognitive flexibility and working memory are directly associated with altered prioritization.

Download full-text


Available from: Walter Maetzler,
  • Source
    • "Likewise, the gait parameters that were linked to prefrontal TOI response also differed depending on the task. This finding is not particularly surprising, because the gait modification that is adopted by an individual can be expected to depend on task objectives and also on what facet of performance is prioritized (Al-Yahya et al., 2009; Hobert et al., 2011; Oh-Park et al., 2013). For instance, if a person adopts a cautious gait pattern characterized by greater stance width, then it may be possible to preserve walking speed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Walking in the home and community often involves performance of complex walking tasks. Understanding the control of such tasks is crucial to preserving independence and quality of life in older adults. However, very little research has been conducted in this area. Here, we assess the extent to which two measures of central nervous system (CNS) activity are responsive to the challenges posed by preparation and performance of complex walking tasks. Prefrontal cortical activity was measured by functional near-infrared spectroscopy (fNIRS) and sympathetic nervous system arousal was measured by skin conductance level (SCL). Materials and methods: Sixteen older men and women (age: 77.2 ± 5.6 years) with mild mobility deficits participated in this study. Participants walked at their preferred speed without distractions along an unobstructed, well-lit course (control task) and also walked on the same course under five separate challenging conditions: performing a cognitive verbal fluency task (verbal task), dim lighting (dim task), carrying a tray (carry task), negotiating obstacles (obstacles task) and wearing a weighted vest (vest task). Mean prefrontal activation and SCL were calculated during the preparation and performance phases of each task. Gait spatiotemporal measurements were acquired by an instrumented gait mat. Results: Prefrontal cortical activity and SCL were elevated during the preparation phase of complex walking tasks relative to the control task. During the performance phase, prefrontal activity remained elevated to a similar level as during task preparation. In contrast, SCL continued to increase beyond the level observed during task preparation. A larger increase in prefrontal activity was found to be linked to preserved quality of gait during complex walking tasks. Discussion: These findings indicate that availability and utilization of CNS resources are important for optimizing performance of complex walking tasks in older adults.
    Frontiers in Aging Neuroscience 08/2014; 6:217. DOI:10.3389/fnagi.2014.00217 · 4.00 Impact Factor
  • Source
    • "One hundred and ninety-four healthy controls were recruited from the TREND study (www.trend-studie.de) [31], [32]. Any clinical sign for a neurodegenerative disorder in these individuals led to exclusion from the study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Naturally occurring autoantibodies (NAbs) against a number of potentially disease-associated cellular proteins, including Amyloid-beta1-42 (Abeta1-42), Alpha-synuclein (Asyn), myelin basic protein (MBP), myelin oligodendrocyte glycoprotein (MOG), and S100 calcium binding protein B (S100B) have been suggested to be associated with neurodegenerative disorders, in particular Alzheimer's (AD) and Parkinson's disease (PD). Whereas the (reduced) occurrence of specific NAbs in AD is widely accepted, previous literature examining the relation of these NAb titres between PD patients and controls, as well as comparing these levels with demographic and clinical parameters in PD patients have produced inconsistent findings. We therefore aimed, in a cross-sectional approach, to determine serum titres of the above NAbs in a cohort of 93 PD patients (31 of them demented) and 194 controls. Levels were correlated with demographic and clinical variables, cerebrospinal fluid Abeta1-42, total tau and phospho-tau levels, as well as with single nucleotide polymorphisms (SNPs) of genes which either have been reported to influence the immune system, the amyloid cascade or the occurrence of PD (ApoE, GSK3B, HLA-DRA, HSPA5, SNCA, and STK39). The investigated NAb titres were neither significantly associated with the occurrence of PD, nor with demographic and clinical parameters, neurodegenerative markers or genetic variables. These results argue against a major potential of blood-borne parameters of the adaptive immune system to serve as trait or state markers in PD.
    PLoS ONE 02/2014; 9(2):e88604. DOI:10.1371/journal.pone.0088604 · 3.23 Impact Factor
  • Source
    • "Each participant completed a questionnaire that included information on their demographic characteristics, instrumental daily living (IADL), whether or not they were consulting a doctor, medication, and their subjecttive well-being. The Trail Making Test (TMT) is a widely used test that evaluates the cognitive domains of executive function and it consists of two parts (TMT A and B) [20] [21]. The Japanese version has also been used for evaluating cognitive function [22] [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate the efficacy of specially designed zori, a Japanese-style sandal, for enhancing walking performance. A total of 89 women aged 59-75 were randomly assigned to either the intervention or control group. The intervention group wore the zori for 6 months while the control group did not. We conducted physical assessments, including The Good Walker’s Index, which consisted of a 10-m walking time measurement, maximal step length, the 40/20-cm step test and tandem gait, and measurement of the toe-gap force (TGF). Additionally, bare foot plantar pressure distribution was measured using a foot-mapping sensor, while gait characteristics were measured using three dimensional sensors. In the intervention group, means for TGF improved significantly between baseline and three months and between baseline and six months, but this improvement was not evident in the control group. In the intervention group, the means for pressure and surface areas of both left and right feet significantly decreased over time compared with the control group. Three-dimensional analysis found that left and right ankle height was enhanced in the intervention group, and their walking speed was improved by the extension of their stride length and an increase in the height of the tiptoe in one cycle. The findings in our study indicate that zori can be useful in improving lower leg function through TGF enhancement and adjustment of the pressure pattern.
    Health 12/2013; 5(12):1-7. DOI:10.4236/health.2013.512A001 · 0.51 Impact Factor
Show more