Relationship between balance and dual task walking in the very elderly

Dual task impact on functional mobility and interaction of functional level and balance in patients with Duchenne muscular dystrophy

BACKGROUND

Dystrophin, a protein crucial for various brain regions governing higher-order functions like learning and memory is notably absent in individuals with Duchenne muscular dystrophy (DMD). This absence of dystrophin in the brain is believed to underlie cognitive challenges in DMD. Cognitive and motor challenges observed in DMD could potentially hinder the execution of dual tasks.

RESEARCH QUESTION

Is there a significant correlation between dual-task performance, functional mobility, and balance in children with DMD?

METHOD

The study included 28 participants (14 DMD, 14 typical development). Timed Up and Go (TUG) test results were recorded for single and dual-task conditions (motor-motor, cognitive-motor). Functional level was assessed using Motor Function Measurement-32 (MFM-32), Brooke Upper Extremity Scale, and Vignos Scale. Balance was evaluated using Balance Master System and Pediatric Functional Reach Test (PFRT).

RESULTS

Significant differences in TUG test scores across conditions were observed in both DMD and typical development groups (p < 0.05). Children with DMD exhibited longer completion times compared to typical development children (p < 0.05). Among children with DMD, there was a significant correlation between TUG scores in different task conditions and balance assessment (p < 0.05, r = 0.571 to -0.819). Lower MFM-32 scores in DMD children were correlated with worse TUG performance across conditions (p < 0.05, r = 0.586 to -0.868).

SIGNIFIANCE

This study sheds light on the multifaceted nature of dual-tasking challenges in individuals with DMD, thereby contributing to a deeper understanding of the implications for rehabilitation strategies.

Do the dual-task "8-foot up and go" tests provide additional predictive value for early detection of cognitive decline in community-dwelling older women?

BACKGROUND

The 8-Foot Up and Go (8UG) test is a widely used mobility assessment. Some dual-task mobility assessments have been developed to help detect cognitive decline.

AIMS

This study developed a dual-task version of 8UG test to investigate the dual-task 8UG performance and to evaluate the ability of dual-task 8UG test in detecting cognitive decline.

METHODS

A total of 101 eligible community-dwelling women aged 60-74 years were grouped into the mild cognitive impairment group (MCI, n = 49) and the non-cognitive impairment group (NCI, n = 52). The 8UG tests under single-task (ST), manual dual-task (MT), and cognitive dual-task (CT) conditions were performed respectively. The dual-task cost (DTC) and the correct response rate (CRR) were calculated to quantify the dual-task interference.

RESULTS

Participants spent more time in performing the 8UG test under dual-task conditions. No differences were observed between NCI and MCI groups for 8UG parameters under ST and MT conditions (p > 0.05). When executing CT, significant differences were found in the number of correct answers and CRR (p < 0.05). CRR showed the strongest ability to predict MCI with a cut-off point of 0.50 (71.2% sensitivity and 61.2% specificity).

DISCUSSION

Both manual and cognitive dual-task were found to interfere with the 8UG performance. CRR with cutoff point of 0.50 could be a potential predictor of MCI in community-dwelling older women.

CONCLUSIONS

The CRR of the cognitive dual-task 8UG test could be recommended as a potential predictor for the early detection of MCI in community-dwelling older women.

A systematic review of one-legged balance performance and falls risk in community-dwelling adults

OBJECTIVE

The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls.

METHODS

Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults.

RESULTS

Of 4310 records screened, 55 papers were included (n = 36954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29 (95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19 (-0.28, -0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity.

CONCLUSIONS

This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.

Can dual-task paradigms predict Falls better than single task? - A systematic literature review

With about one third of adults aged 65 years and older being reported worldwide to fall each year, and an even higher prevalence with advancing age, aged-related falls and the associated disabilities and mortality are a major public health concern. In this context, identification of fall risk in healthy older adults is a key component of fall prevention. Since dual-task outcomes rely on the interaction between cognition and motor control, some studies have demonstrated the role of dual-task walking performance or costs in predicting future fallers. However, based on previous reviews on the topic, (1) discriminative and (2) predictive powers of dual tasks involving gait and a concurrent task are still a matter of debate, as is (3) their superiority over single tasks in terms of fall-risk prediction. Moreover, less attention has been paid to dual tasks involving postural control and transfers (such as gait initiation and turns) as motor tasks. In the present paper, we therefore systematically reviewed recent literature over the last 7 years in order to answer the three above mentioned questions regarding the future of lab-based dual tasks (involving posture, gait initiation, gait and turning) as easily applicable tests for identifying healthy older adult fallers. Despite great heterogeneity among included studies, we emphasized, among other things, the promising added value of dual tasks including turns and other transfers, such as in the Timed Up and Go test, for prediction of falls. Further investigation of these is thus warranted.

Dose-response effects of years of self-reported physical activity on old females' motor and cognitive function

BACKGROUND

There is a poor understanding of the dose-response relationship between years of physical activity and motor and cognitive function. We determined the dose-response effects of physical activity duration in years on motor and cognitive function and their relationship in healthy old females.

OBJECTIVES

To determine the dose-effects of physical activity duration in years on motor and cognitive function and their relationship in health aging adults.

METHODS

We conducted a retrospective observational study with 201 old (age 69 years; SD=5.9) and 12 young (mean age 21 years; SD=1.9) females, with sub-groups based on number of years of self-reported physical activity. Aerobic capacity, mobility, functional reach, standing balance, global cognition, episodic memory, executive function, and processing speed were assessed with performance-based tests. We analyzed sub-group differences quantitatively and qualitatively and performed regression and mediation analyses to determine predictors and mediators of physical activity effects.

RESULTS

Based on physical activity of minimal (0.3 y, n=29), short (2.4 y, n=77), moderate (6.2 y, n=36) and long (16.6 y, n=59) duration, physical activity for at least 2.4 years affords old adults benefits in body mass index with peak dose-effects present in aerobic capacity and mobility at 6.2 years without additional benefits after 16.6 years of physical activity. Physical activity for any duration had no effects on functional reach, balance, executive function, episodic memory, and processing speed. Although weakly mobility predicted global cognition and executive function.

CONCLUSION

Performing physical activity up to 6.2 years on average had favorable effects on body mass index, aerobic capacity and mobility. The data strengthen current recommendations for an active lifestyle in adulthood to prevent aging-related motor and cognitive decline.

Uso de test dual en ancianos institucionalizados con diferentes niveles de deterioro cognitivo. Estudio transversal

Introducción. El envejecimiento se ha relacionado con una mayor prevalencia de deterioro cognitivo. Las personas mayores con pérdida de funciones cognitivas presentan elevadas tasas de caídas. El desarrollo de las actividades de la vida diaria engloba dos o más tareas, siendo necesarios componentes cognitivos y motores.Objetivo. Analizar el rendimiento en pruebas sencillas y duales de sujetos en entorno residencial con diferentes grados de deterioro cognitivo.Materiales y métodos. Se realizó un estudio observacional de corte transversal en ancianos institucionalizados >65 años (n=80). Se evaluó el deterioro cognitivo con el Mini-Mental State Examination y se solicitó a los participantes realizar una tarea simple y dual en las pruebas Six-Minute Walk Test (6MWT) y Timed Up and Go (TUG).Resultados. Se distribuyeron los participantes en tres grupos. Se encontraron diferencias significativas entre los grupos con deterioro cognitivo y el grupo sin deterioro cognitivo para las pruebas 6MWT (p<0.05) y TUG (p<0.05), tanto en la tarea simple como en la tarea dual. Un peor rendimiento se asoció con una menor capacidad cognitiva.Conclusión. La severidad del deterioro cognitivo se encuentra relacionada con el desempeño en las tareas duales.

Age-related differences in dual task performance: A cross-sectional study on women

AIM

Simultaneous performances of motor and attention-demanding tasks are common in activities of everyday life. The present cross-sectional study examined the changes and age-related differences on mobility performance with an additional cognitive or motor task, and evaluated the relative dual-task cost (DTC) on the motor performance in young, middle-aged and older women.

METHODS

A total of 30 young (mean age 25.12 ± 3.00 years), 30 middle-aged (mean age 47.82 ± 5.06 years) and 30 older women (mean age 72.74 ± 5.95 years) were recruited. Participants carried out: (i) single task: Timed Up & Go Test; (ii) cognitive dual-task: Timed Up & Go Test while counting backwards by three; (iii) manual dual-task: Timed Up & Go Test while carrying a glass of water. A repeated measures anova with between-factor as age groups and within-factor as tasks was carried out to assess the effect of aging on the performance of mobility tasks. DTC was calculated as ([performance in single-task - performance in dual-task] / performance in single task) × 100%. One-way ancova were carried out to compare the DTC among the three age groups.

RESULTS

A significant interaction between age groups and task (F_4,172  = 6.716, P < 0.001, partial η²  = 0.135) was observed. Specifically, older women showed a worse mobility performance under dual-task condition compared with young and middle-aged groups. Furthermore, DTC differences in cognitive task were observed in older women compared with younger and middle-aged women (F_2,86  = 7.649, P < 0.001, partial η²  = 0.151), but not in manual task.

CONCLUSION

Dual-task conditions might affect mobility performance differently across the lifespan, and could be particularly challenging in older women. Geriatr Gerontol Int 2017; 17: 315-321.