The relationship between dual-task and cognitive performance among elderly participants who exercise regularly

The impact of sociodemographic, psychological, and quality of life factors on dual-task performance in elderly individuals: a cross-sectional study in Iraq

OBJECTIVE

This study aims to explore how sociodemographic, psychological, and quality of life factors impact dual-task performance among elderly individuals in Iraq.

METHODS

This cross-sectional study included 384 healthy community-dwelling participants aged 60 years and over, recruited from Najaf, Iraq. Data were collected using the Depression Anxiety Stress Scales-21 (DASS-21), Mindful Attention Awareness Scale (MAAS), and the World Health Organization Quality of Life Brief Form (WHOQOL-BREF). Dual-task performance was assessed using the Nine-Hole Peg Test (NHPT) combined with a cognitive task of counting backward by threes. Correlation and multivariate regression analyses were conducted to determine the predictors of cognitive dual-task performance.

RESULTS

Among the WHOQOL domains, only physical health significantly predicted dual-task performance for both dominant and non-dominant hands (β = 0.234, p = 0.041; β = 0.263, p = 0.025, respectively), underscoring the importance of physical well-being in cognitive-motor functions. Psychological factors (depression, anxiety, and stress) measured by DASS-21 did not significantly predict dual-task performance. The model explained a small part of the variance in dual-task performance, suggesting that other factors may influence these abilities in elderly individuals.

CONCLUSION

While psychological factors measured by DASS-21 did not significantly impact dual-task performance, the overall quality of life remained essential. These insights can inform the design of elderly care programs.

Motor Assessment Timed Test (MATT): A New Timed Test to Assess Functional Mobility in Parkinson's Disease Patients

Background/Objectives: Parkinson's disease (PD) is a neurodegenerative disorder that significantly impairs motor function, leading to mobility challenges and an increased risk of falls. Current assessment tools often inadequately measure the complexities of motor impairments associated with PD, highlighting the need for a reliable tool. This study introduces the Motor Assessment Timed Test (MATT), designed to assess functional mobility in PD patients. Methods: A cross-sectional study was conducted involving 57 participants (38 men and 19 women) aged 44 to 84, diagnosed with idiopathic PD. Participants were recruited from three PD associations and underwent a series of assessments, including MATT, to evaluate gait, balance, and dual-task performance under conditions that reflect real-life challenges faced by individuals with PD. Results: MATT demonstrated excellent reliability with intra-rater reliability (ICC = 0.99), inter-rater reliability (ICC = 0.96-0.99), and test-retest reliability (ICC = 0.93-0.99). The coefficient of variation for total time and each segment ranged from 4.73% to 13.71%, indicating consistent performance across trials. The concurrent validity showed very high correlations with established tools such as the Timed Up and Go (TUG) test (ρ = 0.86, p < 0.001) and the Berg Balance Scale (BBS) (ρ = -0.83, p < 0.001), among others. Only 7.3% of participants reported difficulties in understanding the MATT, predominantly those in advanced stages of the disease. In addition, 23.6% of participants experienced significant challenges in performing the test, particularly individuals with lower Mini-Mental State Examination (MMSE) scores (≤ 26) and more advanced disease progression. Conclusions: MATT is a promising tool for assessing motor complications in PD, offering a comprehensive evaluation of functional mobility. Its implementation in clinical practice could enhance the management of PD, facilitating tailored interventions and improving patient outcomes.

Improvements in clinical signs and symptoms of Parkinson's disease using photobiomodulation: a five-year follow-up

BACKGROUND

Parkinson's disease is a progressive neurodegenerative disease characterized by clinical motor signs and non-motor symptoms that severely impact quality of life. There is an urgent need for therapies that might slow, halt or even reverse the progression of existing symptoms or delay the onset of new symptoms. Photobiomodulation is a therapy that has shown potential to alleviate some symptoms of Parkinson's disease in animal studies and in small clinical trials.

OBJECTIVE

To assess long-term effectiveness of photobiomodulation therapy in a cohort of Parkinson's disease individuals after five years of continuing therapy.

METHODS

Eight participants of the initial 12 in a previously published study agreed to be reassessed after five years. Seven of these participants had continued home-based, self-applied photobiomodulation therapy three times per week for five years. One participant had discontinued treatment after one year. Participants were assessed for a range of clinical motor signs, including MDS-UPDRS-III, measures of mobility and balance. Cognition was assessed objectively, and quality of life and sleep quality were assessed using self-reported questionnaires. A Wilcoxon Signed Ranks test was used to evaluate change in outcome measures between baseline (before treatment) and after five years, with the alpha value set to 0.05.

RESULTS

Of the seven participants who had continued photobiomodulation therapy, one had a preliminary diagnosis of multisystem atrophy and was excluded from the group analysis. For the remaining six participants, there was a significant improvement in walk speed, stride length, timed up-and-go tests, tests of dynamic balance, and cognition compared to baseline and nonsignificant improvements in all other measures, apart from MDS-UPDRS-III, which was unchanged and one measure of static balance (single leg stance, standing on the unaffected leg with eyes open) which declined. Five of six participants either improved or showed no decline in MDS-UPDRS-III score and most participants showed improvement or no decline in all other outcome measures. No adverse effects of the photobiomodulation therapy were reported.

CONCLUSIONS

This study provides a signal that photobiomodulation therapy might safely reduce important clinical motor signs and non-motor symptoms in some Parkinson's disease patients, with improvements maintained over several years. Home-based photobiomodulation therapy has the potential to complement standard therapies to manage symptoms and potentially delay Parkinson's symptom progression.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, registration number ACTRN12618000038291p, registered on 12/01/2018.

Unraveling the unparalleled benefits of orienteering versus hiking on gait performance and cognition: A randomized clinical trial

METHODS

Physical activities and sports in nature offer opportunities for leisure, health, and well-being. A randomized clinical trial (RCT) compared the effects of training, dualtask orienteering and single-task hiking in independent older adults (n = 90) allocated into three groups: orienteering group (OG), hiking group (HG) and control group (CG). Timed Up and Go (TUG) tests, including a dual-task (TUG-DT), and cognitive tests were administered. Differences were analyzed by Generalized Estimating Equations (GEE) and the effect size (ES) was calculated. Unpaired and paired tests were used for the evaluation of basic differences and after 24 weeks of intervention.

RESULTS

This RCT highlights the interaction effects between groups and time. Only the OG in TUGDT reduced by 6 s, with change of 42% (ES=0.77). Likewise, Dual TUG + cognitive stops (TUG-DT+ CS) and Dual TUG + cognitive stops + cognitive errors (TUG-DT + CS + CE), reduced 7 (ES=0.85) and 8 (ES=0.90) seconds (<0.001). The task cost improved by 75% for OG and 24% for HG (p = 0.001), with an ES of 0.56 for OG. For cognition, there was a 49.2% increase (ES=2.00) for OG and 16.5% for HG in executive functions and visuospatial skills, a 31.4% increase (ES=1.64) for OG and 14.7% for HG in processing speed, and a 39.8% increase (ES=1.62) for OG and 6.5% for HG in memory. All interactions were <0.001.

CONCLUSION

The orienteering demonstrated that has potential benefits in effectively improving gait performance and preventing cognitive decline in older adults. Brazilian Registry of Clinical Trials (ReBEC): RBR-99jmmpf.

Immersive Virtual Reality Reaction Time Test and Relationship with the Risk of Falling in Parkinson's Disease

Immersive virtual reality (IVR) uses customized and advanced software and hardware to create a digital 3D reality in which all of the user's senses are stimulated with computer-generated sensations and feedback. This technology is a promising tool that has already proven useful in Parkinson's disease (PD). The risk of falls is very high in people with PD, and reaction times and processing speed may be markers of postural instability and functionality, cognitive impairment and disease progression. An exploratory study was conducted to explore the feasibility of reaction time tests performed in IVR as predictors of falls. A total of 26 volunteers (79.2% male; 69.73 ± 6.32 years) diagnosed with PD (1.54 ± 0.90 H&Y stage; 26.92 ± 2.64 MMSE) took part in the study. IVR intervention was feasible, with no adverse effects (no Simulator Sickness Questionnaire symptoms). IVR reaction times were related (Spearman's rho) to functionality (timed up and go test (TUG) (rho = 0.537, p = 0.005); TUG-Cognitive (rho = 0.576, p = 0.020); cognitive impairment mini mental state exam (MMSE) (rho = -0.576, p = 0.002)) and the years of the patients (rho = 0.399, p = 0.043) but not with the first PD symptom or disease stage. IVR test is a complementary assessment tool that may contribute to preventing falls in the proposed sample. Additionally, based on the relationship between TUG and reaction times, a cut-off time is suggested that would be effective at predicting the risk of suffering a fall in PD patients using a simple and quick IVR test.

Dual-task gait and white matter hyperintensities in Lewy body diseases: An exploratory analysis

Background

Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) are part of a spectrum of Lewy body disorders, who exhibit a range of cognitive and gait impairments. Cognitive-motor interactions can be examined by performing a cognitive task while walking and quantified by a dual task cost (DTC). White matter hyperintensities (WMH) on magnetic resonance imaging have also been associated with both gait and cognition. Our goal was to examine the relationship between DTC and WMH in the Lewy body spectrum, hypothesizing DTC would be associated with increased WMH volume.

Methods

Seventy-eight participants with PD, PD with mild cognitive impairment (PD-MCI), PD with dementia or DLB (PDD/DLB), and 20 cognitively unimpaired participants were examined in a multi-site study. Gait was measured on an electronic walkway during usual gait, counting backward, animal fluency, and subtracting sevens. WMH were quantified from magnetic resonance imaging using an automated pipeline and visual rating. A median split based on DTC was performed. Models included age as well as measures of global cognition and cardiovascular risk.

Results

Compared to cognitively unimpaired participants, usual gait speed was lower and DTC was higher in PD-MCI and PDD/DLB. Low DTC participants had higher usual gait speed. WMH burden was greater in high counting DTC participants. Frontal WMH burden remained significant after adjusting for age, cardiovascular risk and global cognition.

Conclusion

Increased DTC was associated with higher frontal WMH burden in Lewy body disorders after adjusting for age, cardiovascular risk, and global cognition. Higher DTC was associated with age.

Comparison of Dual Task Training Versus Aerobics Training in Improving Cognition in Healthy Elderly Population

Background Cognitive impairments, particularly in old age, are pervasive and occur because of both normal and pathological senescence. Engaging in some routine bodily activities combined with activities that stimulate cognitive skills appears beneficial in increasing cognitive resistance to degenerative processes of the brain. Dual-task training (DTT) by combining motor and cognitive activities causes improvement, particularly in executive function, working memory and divided attention, whereas aerobic exercise training (AET) plays an important role in improving executive function, attention, and memory. In this study, we attempted to compare the efficiency of DTT versus AT in improving cognitive function in healthy older individuals. Methods Forty healthy older adults between 60 and 70 years of age who met the inclusion criteria participated in this study. They were randomly split into two groups A and B. Group A (64.05±3.17 years) received DTT three times a week, whereas group B (65.50±3.44 years) received AT five times a week. Both training programs were conducted for six weeks. Cognitive function was assessed using Trail Making Test (TMT)-A, TMT-B, and Montreal Cognitive Assessment (MoCA). The assessment was done at baseline (first day of intervention), on completion of the third week, and again at the end of the training session i.e., the sixth week. The Chi-square test and the student's paired and unpaired t-tests were used for statistical analysis with a level of significance P<0.05. Discussion and result Betterment in cognitive functions was evident after six weeks of DTT and AET. Post-intervention improvements were noted in TMT-A, TMT-B, and MoCA scores in both groups A and B (P>0.0001). However, the difference between the pre and post-intervention scores was greater for group A compared to group B indicative of remarkable improvements in cognitive function in group A. Conclusion The current study demonstrated that both DTT and AET are notably efficient in improving cognitive function in a healthy elderly population. However, in comparison, DTT was significantly more effective than AET (P<0.05). This shows that six weeks of DTT is effective in improving cognitive function and slowing age-associated cognitive decline in older adults.

The effects of a secondary task on gait in axial spondyloarthritis

Studies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.

Effects of a Multicomponent Exercise Program on Groups of Community-Dwelling Older Adults with Low Schooling: A Pilot Study

The aim of this study was to analyze the effects of a multicomponent exercise program on the physical and hemodynamic functions of community-dwelling older adults with low schooling levels in relation to simple multicomponent group exercises. Twenty-one older people were randomly assigned to two groups: G1 (n = 11) and G2 (n = 10); sixteen of whom completed the sixteen sessions over a six-week period, three times a week. During eight sessions, G1 performed adapted dual-task multicomponent exercises (strengthening, balance, and cognition) and G2 simple multicomponent exercises (strengthening and balance), and both groups engaged in eight additional sessions of simple multicomponent exercises. The dual-task multicomponent exercises exhibited similar effects to those of their simple multicomponent counterparts. The older adults from both groups improved mobility, frailty, static postural control, balance, and hemodynamic stability. The adapted program was beneficial to the community-dwelling older people with low schooling in the group intervention.

MoCA vs. MMSE of Fibromyalgia Patients: The Possible Role of Dual-Task Tests in Detecting Cognitive Impairment

Fibromyalgia is a syndrome that is characterized by widespread pain; fatigue; stiffness; reduced physical fitness; sleep disturbances; psychological symptoms, such as anxiety and depression; and deficits in cognitive functions, such as attention, executive function, and verbal memory deficits. It is important to analyze the potentially different performance on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) test in patients with fibromyalgia as well as examine the relationship of that performance with physical and cognitive performance. A total of 36 women with fibromyalgia participated in the study. Participants completed the MoCA test, the MMSE, and the TUG physical fitness test under dual-task conditions. The results obtained on cognitive tests were 28.19 (1.74) on the MMSE and 25.17 (2.79) on the MoCA. The participants' performance on cognitive tests was significantly related to the results of the TUG dual-task test. In this way, cognitive performance on a dual-task test can be used to support the diagnosis of cognitive impairment in patients with fibromyalgia. The MoCA test may be a more sensitive cognitive screening tool than the MMSE for patients with fibromyalgia.

Differences between two types of dual tasks according to the educational level in older adults

INTRODUCTION

For dual-task paradigms, the timed up and go (TUG) test along with other cognitive or motor tasks has been used to evaluate and predict the risk of falling in older adults. However, the interference between motor-cognitive tasks can differ by the cognitive task.

OBJECTIVE

To evaluate the performance of the TUG test under a single task condition and two dual-task conditions in older adults and to explore the effect of educational level on task performance.

METHODS

A total of 418 older adults (328 females) voluntarily participated in this study. The TUG test was administered as a single task and a dual task with one secondary simultaneous task: counting aloud backward from 100 or naming animals. Comparisons were performed to determine the interference caused by each cognitive task on the motor task, and correlation analysis was performed to explore the role of educational level.

RESULTS

The animal task led to a poorer TUG performance and a higher dual-task cost than did the counting task. Furthermore, the motor task led to a higher percentage of errors and cognitive stops in the animal task. Educational level plays a significant role in the interaction between tasks.

CONCLUSIONS

Between-task interference differs by the type of cognitive task performed and the educational level of the participants. The results of the present study should be considered when dual-task assessments are planned for older adults.

A 10-week yoga practice has no effect on cognition, but improves balance and motor learning by attenuating brain-derived neurotrophic factor levels in older adults

Despite studies investigating the effect of yoga on cognitive and motor functioning in older adults, the effect on dual-task performance and motor learning and the specific mechanisms underlying the positive effect of yoga remain unclear. Thus, the aim of this study was to investigate the effects of yoga on cognition, balance under single- and dual-task conditions, and motor learning. The potential role of brain-derived neurotrophic factor (BDNF) in induced improvement was also explored. Participants aged 60-79 years were randomized to either a control group (n = 15) or a yoga group (n = 18) for a 10-week period. The yoga group received 90-min duration yoga classes two times per week. Changes in cognition, balance under single- and dual-task conditions, and learning fast and accurate reaching movements were assessed. Yoga practice decreased (P < 0.05) the velocity vector of the center of pressure under single- and dual-task conditions, whereas no changes in cognitive performance were observed. Although reaction and movement times during learning were decreased in both groups (P < 0.05), a faster reaction time (P < 0.05) and shorter movement time (P < 0.05) were observed in the yoga group than in the control group. Significant moderate relationships (P < 0.05) between changes in BDNF levels and functional improvements were observed. Thus, 10 weeks of yoga practice resulted in improved balance and learning in the speed-accuracy motor task that were mediated by increased BDNF levels, but had no impact on cognition in older adults.

Timed Up-and-Go Dual-Task Testing in the Assessment of Cognitive Function: A Mixed Methods Observational Study for Development of the UDDGait Protocol

New methods to screen for and identify early-stage dementia disorders are highly sought after. The purpose of this pilot study is to develop a study protocol for a dual-task test aimed at aiding the early detection of dementia disorders. We used the Timed Up-and-Go (TUG) test, which is a mobility task involving starting in a sitting position, standing up, walking three meters to cross a line on the floor, turning around, walking back and sitting down again. We combined TUG with the verbal task of naming different animals. Pilot study participants were 43 individuals with and without established dementia diagnoses who attended a clinic for memory assessment. Video-recorded test performances were systematically analysed. Deviant test performances concerning the interplay between test administration and participants' responses to the assessment instructions were revealed and led to refinements being made to the final study protocol. Exploration of the dual-task test outcome measures in a sub-sample of 22 persons, ten with and twelve without dementia, indicated that step-length and number of named animals after the turning point of the dual-task test might constitute appropriate measures for examining this kind of sample. We concluded that the refined study protocol is feasible for testing individuals undergoing initial memory assessments and healthy controls. Follow-up studies with larger samples are being carried out and will bring new knowledge to this area of research. It may also provide an opportunity for further studies exploring possibilities for broad clinical implementation.

Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals

BACKGROUND

Hypertension (HT) contributes substantially to poor physical function, cognitive dysfunction, cardiovascular problems and to all-cause mortality. Performance in activities requiring attention, speed and coordination might also be affected in individuals with HT.

OBJECTIVE

This study compared the processing speed, static and dynamic balance, functional mobility and fear of falling between individuals with hypertension (HT group) and normotensive individuals (NT group).

METHODS

One-hundred and twenty-eight individuals were included: NT group (n = 64) and HT group (n = 64). The Choice Stepping Reaction Time Test was used for the evaluation of processing speed, Single Leg Stance test for static balance evaluation, "Y" Balance Test for dynamic balance evaluation, Timed Up and Go test with single and dual tasking for the evaluation of functional mobility and Falls Efficacy Scale for assessing fear of falling.

RESULTS

The processing speed of the HT group was slower than that of the NT group; the total response time (RsT) in Stepping Reaction Test (SRT) (mean difference [MD] = -0.2, 95% CI = -0.3, 0), and Stroop Test (ST) [ST-A (MD = -0.4, 95% CI = -0.5, -0.2), ST-B (MD = -0.5, 95% CI = -0.7, -0.2) and ST-C (MD = -0.6, 95% CI = -0.8, -0.3). Additionally, the static [single leg stance, eyes open, right side (MD = 12.7, 95% CI = 6.3, 19.0) and left side (MD = 13.6, 95% CI = 7.2, 19.9)] and dynamic balance [Y balance test, composite score, right lower extremity (MD = 8.5, 95% CI = 4.4, 12.5) and left lower extremity (MD = 5.2, 95% CI = 1.5, 8.8) scores of the HT group were lower than those of the NT group. The HT group required a longer time to complete the functional mobility test measured with Timed Up And Go Test during both single task (MD = -0.8, 95% CI = -1.1, -0.4), cognitive dual task (MD = -1.5, 95% CI = -2.4, -0.5) and manual dual task (MD = -0.9, 95% CI = -1.3, -0.4) in comparison to the NT group. Also, the HT group had higher levels of fear of falling (MD = -7.6, 95% CI = -10.9, -4.2).

CONCLUSION

Hypertensive individuals present slower processing speed, reduced static and dynamic balance, decreased functional mobility and higher fear of falling in comparison to normotensive individuals.

A Simple Target Interception Task as Test for Activities of Daily Life Performance in Older Adults

Previous research showed that a simple target interception task reveals differences between younger adults (YA) and older adults (OA) on a large screen under laboratory conditions. Participants intercept downward moving objects while a horizontally moving background creates an illusion of the object moving in the opposite direction of the background. OA are more influenced by this illusory motion than YA. OA seem to be less able to ignore irrelevant sensory information than YA. Since sensory integration relates to the ability to perform Activities of Daily Living (ADL), this interception task can potentially signal ADL issues. Here we investigated whether the results of the target interception task could be replicated using a more portable setup, i.e., a tablet instead of a large touch screen. For YA from the same, homogeneous population, the main effects were replicated although the task was more difficult in the tablet set-up. After establishing the tablet's validity, we analyzed the response patterns of OA that were less fit than the OA in previous research. We identified three different illusion patterns: a (large) illusion effect (indicating over integration), a reverse illusion effect, and no illusion effect. These different patterns are much more nuanced than previously reported for fit OA who only show over integration. We propose that the patterns are caused by differences in the samples of OA (OA in the current sample were older and had lower ADL scores), possibly modulated by increased task difficulty in the tablet setup. We discuss the effects of illusory background motion as a function of ADL scores using a transitional model. The first pattern commences when sensory integration capability starts to decrease, leading to a pattern of over-integration (illusion effect). The second pattern commences when compensatory mechanisms are not sufficient to counteract the effect of the background motion, leading to direction errors in the same direction as the background motion (reverse illusion). The third pattern commences when the task requirements are too high, leading OA to implement a probabilistic strategy by tapping toward the center of the screen.

The Correlation between Cognition Screening Scores and Gait Status from Three-Dimensional Gait Analysis

Background and Purpose

Gait impairment in patients with cognitive decline has received considerable attention over the past several decades. However, gait disturbance in dementia is often underdiagnosed. The Mini Mental State Examination (MMSE) is the most widely used screening test for dementia, and the Montreal Cognitive Assessment (MoCA) has been developed for more accurate assessments of mild cognitive impairment (MCI). The purpose of this study was to determine the correlation between gait status and the scores on these screening tests for dementia.

Methods

We recruited 18 patients with MCI and 19 patients with early-stage dementia. All of the participants were examined using the Korean versions of the MMSE and MoCA developed for screening dementia (MMSE-DS and MoCA-K, respectively) and a neuropsychological test to determine cognitive function. A three-dimensional motion-capture system was used to perform objective measurements of gait in all participants. We evaluated the correlation between the screening scores and gait parameters.

Results

The MoCA-K score was significantly correlated with the walking speed (r=0.408, p<0.05) and stride length (r=0.334, p<0.05). After adjusting for age, the MoCA-K score remained correlated with the walking speed (r=0.331, p<0.05), whereas the MMSE-DS score (r=0.264, p=0.11) and stride length (r=0.206, p=0.22) were not. The neuropsychological test revealed that walking speed and stride length were significantly correlated with memory and frontal lobe function.

Conclusions

We found that the MoCA-K reflects the gait status in patients with cognitive decline more accurately than does the MMSE-DS. Our results suggest that the MoCA-K has more advantages than the MMSE-DS as a screening tool for dementia.

Dual task performance and history of falls in community-dwelling older adults

INTRODUCTION

Falls are a common problem for older adults, and the identification of people at high risk of falling is a major challenge to health systems.

OBJECTIVE

To evaluate the association between the history of falls and single-task Timed Up and Go Test (single TUG) or dual-task TUG variables.

METHODS

Three hundred seventy seven community-dwelling older persons, with ages ranging from 65 and 92 years, participated in this cross-sectional study. Each participant performed two tests: single TUG and dual TUG. The cognitive task for dual TUG consisted of counting backward by one from 100 while performing the test. The number of cognitive errors, cognitive stops and motor stops were recorded. A new variable comprising time, errors and stops in the dual TUG was computed.

RESULTS

The number of falls was significantly associated with mean single and dual TUG performance, mean cognitive errors, mean cognitive stops and mean motor stops. The score in the single TUG time was not able to significantly classify participants as fallers or non-fallers in any of the sexes. On the other hand, the variable "dual TUG time spent adding cognitive stops and cognitive errors" achieved the best ability to classify women as fallers or non-fallers, while "dual task cost" and "dual TUG time spent adding cognitive stops" were the best variables to classify men.

CONCLUSIONS

Dual TUG including cognitive stops and cognitive errors may be more capable than the single TUG to detect differences and accurately classify fallers and non-fallers in the elderly.

The JFK BIG study: the impact of LSVT BIG® on dual task walking and mobility in persons with Parkinson's disease

[Purpose] The aim of this study was to test the hypothesis that Lee Silverman Voice Treatment-BIG decreases the negative impact of hypokinesia on dual task performance in persons with Parkinson's disease. [Subjects and Methods] The records of 114 patients with Parkinson's admitted to outpatient rehabilitation at a suburban hospital were reviewed. Demographics and data for 8 outcome measures were extracted for subjects that completed 14 of 16 sessions of BIG. 93 of these subjects had records of pre and post-test Timed Up and Go, Timed Up and Go Motor, and Timed Up and Go Cognitive scores. Average age was 68.4 years (SD=10.6) and average disease duration was 4.9 years (SD=5.3). [Results] Subjects demonstrated statistically significant improvements for Timed Up and Go (3.3 SD=4.5), Timed Up and Go Motor (4.4 SD=5.8) and Timed Up and Go Cognitive (4.7 SD=5.4). Concurrent motor and cognitive performance remained stable. Dual task cost decreased at a statistically significant level for Timed Up and Go Cognitive (7% SD=31%) but not Motor (4% SD=32%). [Conclusion] These findings suggest that cueing strategies associated with LSVT BIG become internalized and decrease the negative impact of hypokinesia on mobility and cognitive performance while performing two tasks simultaneously in persons with Parkinson's.

Avaliação da musculatura flexora dos artelhos de idosos institucionalizados e comunitários: aspectos biomecânicos, mobilidade e quedas

RESUMO As mudanças morfológicas, biomecânicas e funcionais nos pés podem aumentar o risco de queda nos idosos. Os idosos institucionalizados apresentam menor mobilidade e maior risco de queda. O objetivo deste trabalho é verificar as relações das características dos pés com a mobilidade e quedas de idosos institucionalizados e ativos da comunidade. Participaram deste estudo 15 idosos institucionalizados e 15 idosos ativos da comunidade, que foram avaliados quanto à incidência de quedas e por meio do Timed Up and Go Test; presença de hálux valgo e pico de força muscular de flexores do hálux e dos artelhos pela plataforma de pressão. utilizou-se a análise de variância para comparar os grupos. Como resultado, os idosos comunitários apresentaram maior força muscular de flexores dos artelhos que os idosos institucionalizados (p<0,05) e melhor mobilidade funcional. Observou-se risco de queda nos idosos institucionalizados. O hálux valgo grau leve foi a deformidade mais comum. O teste de Pearson não mostrou correlação entre as variáveis analisadas e a incidência de quedas. Conclui-se que a força muscular de flexores dos artelhos é maior nos idosos comunitários, assim como a mobilidade funcional, quando comparados com idosos institucionalizados.

Association Between Gait and Dual Task With Cognitive Domains in Older People With Cognitive Impairment

The authors investigated whether impaired gait and dual-task performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). The sample comprised 40 older adults with PC, 40 with MCI, and 38 with mild AD. The assessment consisted of gait (measured by 10-m walk test and Timed Up and Go Test [TUGT]), dual task (measured by TUGT associated with a cognitive-motor task of calling a phone number), and cognition (domains of the Addenbrooke Cognitive Examination-Revised and Frontal Assessment Battery [FAB]). For data analysis, the Pearson product-moment correlation and the backward stepwise linear regression were conducted. Language, fluency, and visuospatial domains predicted the 10-m walk test measure specifically in PC, MCI, and AD groups. Only the visuospatial domain was independently associated with the TUGT measure in the MCI and AD groups. FAB score, language domain, and FAB score and fluency domain were the strongest predictors for the isolated cognitive-motor task measure in the PC, MCI, and AD groups, respectively. The visuospatial domain was independently associated with the dual-task test measure in all 3 groups. The study findings demonstrate the influence of specific cognitive domains in daily mobility tasks in people with different cognitive profiles.