Impact of Cognitive Training on Balance and Gait in Older Adults.

OBJECTIVES Cognitive processing plays an important role in balance and gait and is a contributing factor to falls in older adults. This relationship may be explained by the fact that higher order cognitive functions such as executive functions are called upon while walking. The purpose of this study was to examine whether a cognitive training intervention leads to significant improvements on measures of balance and gait. METHOD This randomized trial tested whether cognitive training over 10 weeks improves balance and gait in older adults. Participants were randomly assigned to a computer-based cognitive training intervention or measurement-only control. Outcomes included Timed Up and Go (TUG), gait speed, and gait speed with a cognitive distraction. Data were analyzed using analysis of covariance models with change scores. RESULTS Participants' (N = 51) average age was 82.7 for those randomized to intervention and 81.1 for those randomized to control. After 10 weeks, intervention group participants performed significantly better than controls on the TUG. When the cohort was limited to those categorized as slow walkers (baseline 10-m walk ≥ 9 s), intervention participants performed significantly better than controls on TUG and distracted walking. DISCUSSION Cognitive training slows degradation of balance and improves gait while distracted, rendering it a promising approach to falls prevention.

[1]  Leigh Blizzard,et al.  Cognitive function, gait, and gait variability in older people: a population-based study. , 2013, The journals of gerontology. Series A, Biological sciences and medical sciences.

[2]  Jerri D Edwards,et al.  Cognitive function as a prospective predictor of falls. , 2012, The journals of gerontology. Series B, Psychological sciences and social sciences.

[3]  Daniel A. Braun,et al.  A sensorimotor paradigm for Bayesian model selection , 2012, Front. Hum. Neurosci..

[4]  O. Bock,et al.  Age-Related Deficits of Dual-Task Walking: A Review , 2012, Neural plasticity.

[5]  Jeffrey M. Hausdorff,et al.  Executive Function and Falls in Older Adults: New Findings from a Five-Year Prospective Study Link Fall Risk to Cognition , 2012, PloS one.

[6]  K. R. Ridderinkhof,et al.  Brain training in progress: a review of trainability in healthy seniors , 2012, Front. Hum. Neurosci..

[7]  A. Berardelli,et al.  The neurobiology of falls , 2012, Neurological Sciences.

[8]  T. Liu-Ambrose,et al.  Examining the relationship between specific cognitive processes and falls risk in older adults: a systematic review , 2012, Osteoporosis International.

[9]  L. Lipsitz,et al.  The Nonlinear Relationship Between Gait Speed and Falls: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study , 2011, Journal of the American Geriatrics Society.

[10]  H. Dawes,et al.  Cognitive motor interference while walking: A systematic review and meta-analysis , 2011, Neuroscience & Biobehavioral Reviews.

[11]  S. Studenski,et al.  Gait speed and survival in older adults. , 2011, JAMA.

[12]  P. Mckinley,et al.  Benefits of cognitive dual-task training on balance performance in healthy older adults. , 2010, The journals of gerontology. Series A, Biological sciences and medical sciences.

[13]  Roee Holtzer,et al.  Effect of cognitive remediation on gait in sedentary seniors. , 2010, The journals of gerontology. Series A, Biological sciences and medical sciences.

[14]  Sabine Schaefer,et al.  The Interplay between Cognitive and Motor Functioning in Healthy Older Adults: Findings from Dual-Task Studies and Suggestions for Intervention , 2010, Gerontology.

[15]  Jeffrey M. Hausdorff,et al.  Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. , 2010, The journals of gerontology. Series A, Biological sciences and medical sciences.

[16]  Kristine Yaffe,et al.  A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity‐based Adaptive Cognitive Training (IMPACT) Study , 2009, Journal of the American Geriatrics Society.

[17]  R. Krampe,et al.  Working memory and postural control: adult age differences in potential for improvement, task priority, and dual tasking. , 2009, The journals of gerontology. Series B, Psychological sciences and social sciences.

[18]  Jeffrey M. Hausdorff,et al.  Guest editorial: linking thinking, walking, and falling. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  Jeffrey M. Hausdorff,et al.  Dual-task decrements in gait: contributing factors among healthy older adults. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[20]  Michael Voigt,et al.  Residual attentional capacity amongst young and elderly during dual and triple task walking. , 2008, Human movement science.

[21]  P. Reuter-Lorenz,et al.  Neurocognitive Aging and the Compensation Hypothesis , 2008 .

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

[23]  Xiaonan Xue,et al.  The relationship between specific cognitive functions and falls in aging. , 2007, Neuropsychology.

[24]  S. Rubin,et al.  Cognitive function, gait speed decline, and comorbidities: the health, aging and body composition study. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[25]  K. Ball,et al.  Long-term effects of cognitive training on everyday functional outcomes in older adults. , 2006, JAMA.

[26]  Jeffrey M. Hausdorff,et al.  Dual‐tasking effects on gait variability: The role of aging, falls, and executive function , 2006, Movement disorders : official journal of the Movement Disorder Society.

[27]  Shu-Chen Li,et al.  Dual-tasking postural control: Aging and the effects of cognitive demand in conjunction with focus of attention , 2006, Brain Research Bulletin.

[28]  Xiaonan Xue,et al.  Cognitive processes related to gait velocity: results from the Einstein Aging Study. , 2006, Neuropsychology.

[29]  Volker Dietz,et al.  Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. , 2005, Archives of physical medicine and rehabilitation.

[30]  W. Leslie,et al.  Preventing falls in elderly persons. , 2003, The New England journal of medicine.

[31]  M. Tinetti Clinical practice. Preventing falls in elderly persons. , 2003, The New England journal of medicine.

[32]  M. Woollacott,et al.  Attention and the control of posture and gait: a review of an emerging area of research. , 2002, Gait & posture.

[33]  L. Mollinger,et al.  Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. , 2002, Physical therapy.

[34]  E. McAuley,et al.  Predictors of adherence to behavior change interventions in the elderly. , 2000, Controlled clinical trials.

[35]  C. Foy,et al.  Exercise adherence among older adults: challenges and strategies. , 2000, Controlled clinical trials.

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

[37]  R. Cameron,et al.  Promoting adherence to health behavior change interventions: Recent findings from behavioral research , 1987 .

[38]  J. Yesavage,et al.  Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. , 1986 .

[39]  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.

[40]  L. Brooks The Suppression of Visualization by Reading , 1967, The Quarterly journal of experimental psychology.

[41]  Caterina Rosano,et al.  Slower gait, slower information processing and smaller prefrontal area in older adults. , 2012, Age and ageing.