Effects of age, sex, frailty and falls on cognitive and motor performance during dual-task walking in older adults

Factors influencing gait performance in older adults in a dual-task paradigm

The aim of this study was to determine the effect of cognitive interference through a dual-task (DT) paradigm on gait parameters by sex or other predictive variables, such as physical fitness, health status, and cognition. A total of 125 older adults joined in this study (age, 72.42 ± 5.56 years old; 28 men and 97 women). The DT paradigm was evaluated through Comfortable Linear Gait (CLG) and Complex Gait Test (CGT). The gait parameters between single task (ST) vs. DT condition in men showed a significant reduction in speed (p < 0.001), cadence (p < 0.001), and step length (p = 0.049) and increased time to execute the CGT (p < 0.001), while women showed a decreased speed (p = 0.014), cadence (p < 0.001), and double support coefficient variation (CV) (p = 0.024) and increased single support time (p < 0.001) and CV step length (p < 0.05). In addition, women increased CGT time (p < 0.001). Furthermore, correlations between DT cost (DTC) cadence vs. Physical Activity for Elderly questionnaire (PASE) (r =  - 0.399; p = 0.008), DTC single support vs. 30 s Sit to Stand Test (r = - 0.356; 0.016), DTC single support vs. Rey Auditory Verbal Learning Test-Learning curve (r =  - 0.335; p = 0.023), DTC double support vs. 30 s Sit to Stand Test (r =  - 0.590; p < 0.001), DTC CV step length vs. 30 s Sit to Stand (r =  - 0.545; p = 0.003), and DTC CGT vs. 30 s Sit to Stand Test (r =  - 0.377; p = 0.048) were found. The results of our study indicate that the gait parameters within the DT condition decreased speed and cadence, while increasing CV step length and CGT time, causing slower gait with shortened steps in men and women.

Graceful gait: virtual ballet classes improve mobility and reduce falls more than wellness classes for older women

Introduction

Dance is an effective and motivating form of exercise for older women, but few studies have quantified the benefits of virtual dance classes nor, specifically, ballet. This study tested the effectiveness of virtual ballet compared to virtual wellness classes, with the goal of reaching underserved populations. It is among the first to explore the effects of virtual classical ballet on functional gait mobility, balance, and quality of life measures in older women.

Methods

Older women were recruited in two waves and randomized to two groups: a ballet class modified for older adults and a wellness-based control class. Both groups received 12 weeks of online classes, meeting twice per week for 45-min sessions. Classes were taught by a local company that offers community-based ballet classes. The same instructor led both the ballet and the wellness classes. Pre- and post-intervention assessments include gait and balance testing using wearable inertial sensors and self-report outcomes including quality of life and mood questionnaires.

Results

Forty-four older women completed the study: Ballet group (n = 21, 67.81 ± 7.3 years); Wellness group (n = 23, 69.96 ± 6.7 years). Pre- to post-intervention, both groups increased velocity on the two-minute walk test (F1,42 = 25.36, p < 0.001) and improved their time on the Timed Up and Go (F1,42 = 4.744, p = 0.035). Both groups improved balance on the Mini-BESTest (F1,42 = 38.154, p < 0.001), increased their scores on the Activities-Specific Balance Confidence Scale (F1,42 = 10.688, p < 0.001), and increased quality of life via the Short Form Health Survey (F1,42 = 7.663, p = 0.008). The ballet group improved gait variability in the backward direction (F1,42 = 14.577, p < 0.001) and reduced fall rates more than the wellness group [χ2(1) = 5.096, p = 0.024].

Discussion

Both virtual ballet and wellness classes improve select measures of gait, balance, and quality of life. The benefits seen in both groups highlight the importance of considering social interaction as a key component when developing future interventions to target mobility in older women.

Performance of the walking trail making test in older adults with white matter hyperintensities

BACKGROUND

Several studies have reported that the walking trail making test (WTMT) completion time is significantly higher in patients with developmental coordination disorders and mild cognitive impairments. We hypothesized that WTMT performance would be altered in older adults with white matter hyperintensities (WMH).

AIM

To explore the performance in the WTMT in older people with WMH.

METHODS

In this single-center, observational study, 25 elderly WMH patients admitted to our hospital from June 2019 to June 2020 served as the WMH group and 20 participants matched for age, gender, and educational level who were undergoing physical examination in our hospital during the same period served as the control group. The participants completed the WTMT-A and WTMT-B to obtain their gait parameters, including WTMT-A completion time, WTMT-B completion time, speed, step length, cadence, and stance phase percent. White matter lesions were scored according to the Fazekas scale. Multiple neuropsychological assessments were carried out to assess cognitive function. The relationships between WTMT performance and cognition and motion in elderly patients with WMH were analyzed by partial Pearson correlation analysis.

RESULTS

Patients with WMH performed significantly worse on the choice reaction test (CRT) (0.51 ± 0.09 s vs 0.44 ± 0.06 s, P = 0.007), verbal fluency test (VFT, 14.2 ± 2.75 vs 16.65 ± 3.54, P = 0.012), and digit symbol substitution test (16.00 ± 2.75 vs 18.40 ± 3.27, P = 0.010) than participants in the control group. The WMH group also required significantly more time to complete the WTMT-A (93.00 ± 10.76 s vs 70.55 ± 11.28 s, P < 0.001) and WTMT-B (109.72 ± 12.26 s vs 82.85 ± 7.90 s, P < 0.001). WTMT-A completion time was positively correlated with CRT time (r = 0.460, P = 0.001), while WTMT-B completion time was negatively correlated with VFT (r = -0.391, P = 0.008). On the WTMT-A, only speed was found to statistically differ between the WMH and control groups (0.803 ± 0.096 vs 0.975 ± 0.050 m/s, P < 0.001), whereas on the WTMT-B, the WMH group exhibited a significantly lower speed (0.778 ± 0.111 vs 0.970 ± 0.053 m/s, P < 0.001) and cadence (82.600 ± 4.140 vs 85.500 ± 5.020 steps/m, P = 0.039), as well as a higher stance phase percentage (65.061 ± 1.813% vs 63.513 ± 2.465%, P = 0.019) relative to controls.

CONCLUSION

Older adults with WMH showed obviously poorer WTMT performance. WTMT could be a potential indicator for cognitive and motor deficits in patients with WMH.

Effects of muscular and mental fatigue on spatiotemporal gait parameters in dual task walking in young, non-frail and frail older adults

BACKGROUND

Dual-task (DT) walking is of great interest in clinical evaluation to evaluate frailty or cognitive declines in older adults. Frail older adults are known to adopt different walking strategy to overcome fatigue. However, no studies evaluated the effect of muscular or mental fatigue on dual-task walking strategy and the difference between frail and non-frail older adults.

AIMS

Evaluate the effect of mental and muscular fatigue on spatio-temporal parameters in dual-task walking in young, non-frail and frail older adults.

METHODS

59 participants divided into 20 young (Y) (24.9 ± 3 years old), 20 non-frail (NF) (75.8 ± 4.9 years old) and 19 frail older adults (F) (81 ± 4.7 years old) performed single-task (ST) walking, single-task cognitive (serial subtraction of 3), and dual-task (subtraction + walking) for 1 min at their fast pace. Gait speed, step length, step length variability, stance and swing phase time, single and double support time, cadence, gait speed variability were recorded in single- and dual-task walking. The dual-task effect (DTE) was calculated as ((DT - ST)/ST) × 100). Generalized linear mixed models (GLMM) were used to compare the effects of mental and muscular fatigue on gait and cognitive variables between the groups.

RESULTS

The DTE walking parameters were worse in F compared to NF or Y but no significant effect of fatigue were highlighted except for swing time and single support time DTEs.

CONCLUSIONS

The results were mitigated but a clear difference in dual-task spatio-temporal parameters was found between F and NF which brings hope into the capacity of DT to better reveal frailty.

Impact of Using Smartphone While Walking or Standing: A Study Focused on Age and Cognition

BACKGROUND

Using smartphones during a task that requires upright posture is suggested to be detrimental for the overall motor performance. The aim of this study was to determine the role of age and specific aspects of cognitive function on walking and standing tasks in the presence of smartphone use.

METHODS

51 older (36 women) and 50 young (35 women), mean age: 66.5 ± 6.3 and 22.3 ± 1.7 years, respectively, were enrolled in this study. The impact of using a smartphone was assessed during a dynamic (timed up and go, TUG) and a static balance test (performed on a force platform). Multivariate analyses of variance were applied to verify main effects of age, task, estimates of cognitive function and interactions.

RESULTS

Compared to young, older individuals exhibited a poorer performance on the dynamic and on the static test (age effect: p = 0.001 for both variables). Dual-tasking with a smartphone had a negative impact on both groups (task effect: p = 0.001 for both variables). The negative impact, however, was greater in the older group (age × task effect: p = 0.001 for both variables). Executive function and verbal fluency partially explained results of the dynamic and static tests, respectively.

CONCLUSIONS

The negative impact of using a smartphone while performing tasks similar to daily activities is higher in older compared to young people. Subclinical deficits in distinct aspects of cognitive function partially explain the decreased performance when dual-tasking.