Does inability to allocate attention contribute to balance constraints during gait in older adults?

BACKGROUND Recent research has explored dual-task deficits during locomotion in older adults, yet the mechanisms underlying these deficits are poorly understood. In the current study, we examined one possible factor contributing to these deficits, the inability to flexibly allocate attention between two tasks. METHODS Twelve healthy young adults and 12 healthy elderly adults performed obstacle avoidance while walking and an auditory Stroop task either alone or simultaneously. RESULTS Using an attentional allocation index (AAI) to compare performance of healthy young and older adults and to measure the flexibility of allocation of attention, results showed a tendency in older adults toward a decreased ability to flexibly allocate their attention between the two tasks, with small AAI values. The decreased ability to allocate attention in older adults was found to be more prominent in the auditory Stroop task performance than in the obstacle avoidance task. CONCLUSION This study suggests that an important factor contributing to decreased dual-task performance in older adults when simultaneously performing a postural and secondary cognitive task is a reduced ability to flexibly allocate attention between the two tasks, with the general ability to switch attention flexibly being predictive of the ability to adhere to a prioritized focus.

[1]  B E Maki,et al.  Cognitive demands of executing postural reactions: does aging impede attention switching? , 2001, Neuroreport.

[2]  S. Cummings,et al.  Risk factors for injurious falls: a prospective study. , 1991, Journal of gerontology.

[3]  P. Baltes,et al.  Memorizing while walking: increase in dual-task costs from young adulthood to old age. , 2000, Psychology and aging.

[4]  M. Woollacott,et al.  Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. , 2000, Physical therapy.

[5]  David A. Winter,et al.  Biomechanics and Motor Control of Human Movement , 1990 .

[6]  M. Woollacott,et al.  Visual, vestibular and somatosensory contributions to balance control in the older adult. , 1989, Journal of gerontology.

[7]  D. Prudham,et al.  Factors associated with falls in the elderly: a community study. , 1981, Age and ageing.

[8]  U. Mayr,et al.  Is there an age deficit in the selection of mental sets? , 2001 .

[9]  M. Woollacott,et al.  Attentional demands and postural control: the effect of sensory context. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[10]  A B Schultz,et al.  Neuropsychological predictors of complex obstacle avoidance in healthy older adults. , 1995, The journals of gerontology. Series B, Psychological sciences and social sciences.

[11]  Bastiaan R. Bloem,et al.  The Multiple Tasks Test. Strategies in Parkinson's disease , 2001, Experimental Brain Research.

[12]  R. Tideiksaar Falling in Old Age: Prevention and Management , 1997 .

[13]  M. Woollacott,et al.  Attentional demands and postural recovery: the effects of aging. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[14]  Jeffrey M. Hausdorff,et al.  The role of executive function and attention in gait , 2008, Movement disorders : official journal of the Movement Disorder Society.

[15]  L. E. Powell,et al.  The Activities-specific Balance Confidence (ABC) Scale. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[16]  P B Baltes,et al.  [Allocation of cognitive resources during the simultaneous performance of cognitive and sensorimotor tasks]. , 2003, Der Nervenarzt.

[17]  Ka-Chun Siu,et al.  Attentional demands of postural control: the ability to selectively allocate information-processing resources. , 2007, Gait & posture.

[18]  A. Shumway-cook,et al.  Predicting the probability for falls in community-dwelling older adults. , 1997, Physical therapy.

[19]  Philip Bobko,et al.  Testing hypotheses about ordinal interactions: Simulations and further comments. , 1989 .

[20]  Lester M. Wolfson,et al.  The Relationship of Knee and Ankle Weakness to Falls in Nursing Home Residents: An Isokinetic Study , 1987, Journal of the American Geriatrics Society.

[21]  L. Lipsitz The Drop Attack , 1983, Journal of the American Geriatrics Society.

[22]  K. Lamb,et al.  Falls in the Elderly: Causes and Prevention , 1987, Orthopedic nursing.

[23]  H N Zelaznik,et al.  The influence of aging and attentional demands on recovery from postural instability , 1990, Aging.

[24]  U. Mayr Age differences in the selection of mental sets: the role of inhibition, stimulus ambiguity, and response-set overlap. , 2001, Psychology and aging.

[25]  O. Spreen,et al.  A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary , 1991 .

[26]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[27]  A M Wing,et al.  Age differences in postural stability are increased by additional cognitive demands. , 1996, The journals of gerontology. Series B, Psychological sciences and social sciences.

[28]  R. Sattin Falls among older persons: a public health perspective. , 1992, Annual review of public health.

[29]  S. Studenski,et al.  Postural Responses and Effector Factors in Persons with Unexplained Falls: Results and Methodologic Issues , 1991, Journal of the American Geriatrics Society.

[30]  M. Woollacott,et al.  The effects of two types of cognitive tasks on postural stability in older adults with and without a history of falls. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[31]  A B Schultz,et al.  Stepping over obstacles: dividing attention impairs performance of old more than young adults. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[32]  B. E. Maki,et al.  Postural control in the older adult. , 1996, Clinics in geriatric medicine.

[33]  A. Campbell,et al.  Risk factors for falls in a community-based prospective study of people 70 years and older. , 1989, Journal of gerontology.

[34]  Gillian Cohen,et al.  Hemisphere differences in an auditory Stroop test , 1975 .

[35]  C. Bard,et al.  Attentional demands for static and dynamic equilibrium , 2004, Experimental Brain Research.

[36]  B. Bloem,et al.  The Multiple Tasks Test: development and normal strategies. , 2001, Gait & posture.

[37]  J. Rose,et al.  Postural sway reduction in aging men and women: Relation to brain structure, cognitive status, and stabilizing factors , 2009, Neurobiology of Aging.

[38]  P. B. Baltes,et al.  Selektion, Optimierung und Kompensation in Doppelaufgaben , 2003, Der Nervenarzt.

[39]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[40]  M. Hahn,et al.  Age-related reduction in sagittal plane center of mass motion during obstacle crossing. , 2004, Journal of biomechanics.

[41]  H. Buschke,et al.  Walking while talking: effect of task prioritization in the elderly. , 2007, Archives of physical medicine and rehabilitation.