Interaction of age, cognitive function, and gait performance in 50–80-year-olds

The variability of walking gait timing increases with age and is strongly related to fall risk. The purpose of the study was to examine the interaction of age, cognitive function, and gait performance during dual-task walking. Forty-two, healthy men and women, 50–80 years old, completed the Mini-Mental State Exam (MMSE) and Trail Making Test (TMT) to assess cognitive performance and were separated into groups by decade of life. They then performed dual-task walking, at a self-selected pace, on an instrumented treadmill during three cognitive loading conditions: (1) no cognitive load, (2) subtraction from 100 by 1s, and (3) subtraction from 100 by 3s. The treadmill recorded spatiotemporal gait parameters that were used to calculate the mean and coefficient of variation for each variable over ten strides. Time to complete the TMT was positively correlated with age, stride time, double-limb support time, and mediolateral instability and was inversely correlated with single-limb support time. Subjects in their 70s increased their stride time and double-limb support time during the most challenging dual-task condition (subtraction by 3s), whereas subjects in their 50s and 60s did not. Across conditions, the variability of stride length, stride time, and single-limb support time was greatest in the 70s. Mediolateral instability increased only for subjects in their 70s in the subtraction by 3s condition. Reduced cognitive function with age makes it difficult for older adults to maintain a normal, rhythmical gait pattern while performing a cognitive task, which may place them at greater risk for falling.

[1]  Krzysztof Mackala,et al.  Strength asymmetry increases gait asymmetry and variability in older women. , 2012, Medicine and science in sports and exercise.

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

[3]  John H Hollman,et al.  Age-related differences in dual task walking: a cross sectional study , 2008, Journal of NeuroEngineering and Rehabilitation.

[4]  Olivier Daniel,et al.  Human treadmill walking needs attention , 2006, Journal of NeuroEngineering and Rehabilitation.

[5]  Luigi Ferrucci,et al.  Association of executive function and performance of dual-task physical tests among older adults: analyses from the InChianti study. , 2006, Age and ageing.

[6]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  Matthew C Keller,et al.  Mental Exercising Through Simple Socializing: Social Interaction Promotes General Cognitive Functioning , 2008, Personality & social psychology bulletin.

[8]  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.

[9]  D. Winter,et al.  Biomechanical walking pattern changes in the fit and healthy elderly. , 1990, Physical therapy.

[10]  Jeffrey M. Hausdorff,et al.  Increased gait unsteadiness in community-dwelling elderly fallers. , 1997, Archives of physical medicine and rehabilitation.

[11]  Jeffrey M. Hausdorff,et al.  Age-associated differences in the gait pattern changes of older adults during fast-speed and fatigue conditions: results from the Baltimore longitudinal study of ageing. , 2010, Age and ageing.

[12]  Subashan Perera,et al.  The reliability and validity of measures of gait variability in community-dwelling older adults. , 2008, Archives of physical medicine and rehabilitation.

[13]  Pamela W. Duncan,et al.  Guideline for the Prevention of Falls in Older Persons , 2001 .

[14]  Howard Chertkow,et al.  Dual-tasking and gait in people with Mild Cognitive Impairment. The effect of working memory , 2009, BMC geriatrics.

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

[16]  Jeffrey M. Hausdorff,et al.  How Does Explicit Prioritization Alter Walking During Dual-Task Performance? Effects of Age and Sex on Gait Speed and Variability , 2010, Physical Therapy.

[17]  J. Hollman,et al.  Age-related differences in spatiotemporal markers of gait stability during dual task walking. , 2006, Gait & posture.

[18]  Jeffrey M. Hausdorff,et al.  When does walking alter thinking? Age and task associated findings , 2009, Brain Research.

[19]  Lynn Rochester,et al.  Is gait variability reliable in older adults and Parkinson's disease? Towards an optimal testing protocol. , 2013, Gait & posture.

[20]  Jeffrey M. Hausdorff,et al.  When human walking becomes random walking: fractal analysis and modeling of gait rhythm fluctuations. , 2001, Physica A.

[21]  J. Cummings,et al.  Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. , 2002, The Journal of neuropsychiatry and clinical neurosciences.

[22]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[23]  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.

[24]  G. Giakas,et al.  Time and frequency domain analysis of ground reaction forces during walking: an investigation of variability and symmetry , 1997 .

[25]  L. Poujol,et al.  Risk factors for falling in community-dwelling older adults: Which of them are associated with the recurrence of falls? , 2010, The journal of nutrition, health & aging.

[26]  J. Cerella,et al.  Aging, executive control, and attention: a review of meta-analyses , 2002, Neuroscience & Biobehavioral Reviews.

[27]  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.

[28]  J Hausdroff.  Gait variability : methods, modeling and meaning , 2005 .

[29]  Dain P LaRoche,et al.  Low strength is related to diminished ground reaction forces and walking performance in older women. , 2011, Gait & posture.

[30]  G. Borm,et al.  The effect of cognitive dual tasks on balance during walking in physically fit elderly people. , 2007, Archives of physical medicine and rehabilitation.

[31]  F. Wei,et al.  Falls in the community: state of the science , 2013, Clinical interventions in aging.

[32]  Age , 2000, BMJ : British Medical Journal.

[33]  Li-Shan Chou,et al.  Does inability to allocate attention contribute to balance constraints during gait in older adults? , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[34]  Lynn Rochester,et al.  Gait variability in older adults: a structured review of testing protocol and clinimetric properties. , 2011, Gait & posture.

[35]  T. Tombaugh.  Trail Making Test A and B: normative data stratified by age and education. , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[36]  L. Nyberg,et al.  “Stops walking when talking” as a predictor of falls in elderly people , 1997, The Lancet.

[37]  Orthopaedic Surgeons Panel On Falls Prevention.  Guideline for the Prevention of Falls in Older Persons , 2001 .

[38]  R. Craik,et al.  Gait Variability in Community‐Dwelling Older Adults , 2001, Journal of the American Geriatrics Society.

[39]  Brenda Brouwer,et al.  Kinematic, kinetic and metabolic parameters of treadmill versus overground walking in healthy older adults. , 2009, Clinical biomechanics.

[40]  John H Hollman,et al.  Number of strides required for reliable measurements of pace, rhythm and variability parameters of gait during normal and dual task walking in older individuals. , 2010, Gait & posture.

[41]  A. H. Lawton,et al.  GAIT AND STEPPING AS FACTORS IN THE FREQUENT FALLS OF ELDERLY WOMEN. , 1964, The Gerontologist.

[42]  U. Nayak,et al.  The effect of age on variability in gait. , 1984, Journal of gerontology.

[43]  F. Barceló,et al.  Construct validity of the Trail Making Test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities , 2009, Journal of the International Neuropsychological Society.

[44]  K. Aminian,et al.  Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults. , 2006, Human movement science.

[45]  J. Hollman,et al.  Age-related differences in spatiotemporal markers of gait stability during dual task walking. , 2006, Gait & posture.

[46]  Jeffrey M. Hausdorff,et al.  Gait variability and fall risk in community-living older adults: a 1-year prospective study. , 2001, Archives of physical medicine and rehabilitation.

[47]  Leonard L. LaPointe,et al.  Talking while walking: Cognitive loading and injurious falls in Parkinson's disease , 2010, International journal of speech-language pathology.

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

[49]  R. Guimarães,et al.  Characteristics of the gait in old people who fall. , 1980, International rehabilitation medicine.

[50]  S. Studenski,et al.  Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed , 2005, Journal of NeuroEngineering and Rehabilitation.

[51]  R. van Emmerik,et al.  Identification of axial rigidity during locomotion in Parkinson disease. , 1999, Archives of physical medicine and rehabilitation.

[52]  R. Buckner.  Memory and Executive Function in Aging and AD Multiple Factors that Cause Decline and Reserve Factors that Compensate , 2004, Neuron.