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Lee PA, DuMontier C, Yu W, Ask L, Zhou J, Testa MA, Kim D, Abel G, Travison T, Manor B, Lo OY. Validity and Reliability of a Smartphone Application for Home Measurement of Four-Meter Gait Speed in Older Adults. Bioengineering (Basel) 2024; 11:257. [PMID: 38534531 DOI: 10.3390/bioengineering11030257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024] Open
Abstract
The four-meter gait speed (4MGS) is a recommended physical performance test in older adults but is challenging to implement clinically. We developed a smartphone application (App) with a four-meter ribbon for remote 4MGS testing at home. This study aimed to assess the validity and reliability of this smartphone App-based assessment of the home 4MGS. We assessed the validity of the smartphone App by comparing it against a gold standard video assessment of the 4MGS conducted by study staff visiting community-dwelling older adults and against the stopwatch-based measurement. Moreover, we assessed the test-retest reliability in two supervised sessions and three additional sessions performed by the participants independently, without staff supervision. The 4MGS measured by the smartphone App was highly correlated with video-based 4MGS (r = 0.94), with minimal differences (mean = 0.07 m/s, ± 1.96 SD = 0.12) across a range of gait speeds. The test-retest reliability for the smartphone App 4MGS was high (ICC values: 0.75 to 0.93). The home 4MGS in older adults can be measured accurately and reliably using a smartphone in the pants pocket and a four-meter strip of ribbon. Leveraging existing technology carried by a significant portion of the older adult population could overcome barriers in busy clinical settings for this well-established objective mobility test.
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Affiliation(s)
- Pei-An Lee
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Clark DuMontier
- VA Boston Healthcare System, Harvard Medical School, Boston, MA 02130, USA
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Wanting Yu
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
| | - Levi Ask
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
| | - Junhong Zhou
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Marcia A Testa
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Dae Kim
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Gregory Abel
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Tom Travison
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Brad Manor
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - On-Yee Lo
- Hebrew SeniorLife, Harvard Medical School, Boston, MA 02131, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Hong Y, Bao D, Manor B, Zhou J. Characterizing the supraspinal sensorimotor control of walking using MRI-compatible system: a systematic review. J Neuroeng Rehabil 2024; 21:34. [PMID: 38443983 PMCID: PMC10913571 DOI: 10.1186/s12984-024-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The regulation of gait is critical to many activities of everyday life. When walking, somatosensory information obtained from mechanoreceptors throughout body is delivered to numerous supraspinal networks and used to execute the appropriate motion to meet ever-changing environmental and task demands. Aging and age-related conditions oftentimes alter the supraspinal sensorimotor control of walking, including the responsiveness of the cortical brain regions to the sensorimotor inputs obtained from the peripheral nervous system, resulting in diminished mobility in the older adult population. It is thus important to explicitly characterize such supraspinal sensorimotor elements of walking, providing knowledge informing novel rehabilitative targets. The past efforts majorly relied upon mental imagery or virtual reality to study the supraspinal control of walking. Recent efforts have been made to develop magnetic resonance imaging (MRI)-compatible devices simulating specific somatosensory and/or motor aspects of walking. However, there exists large variance in the design and functionality of these devices, and as such inconsistent functional MRI (fMRI) observations. METHODS We have therefore completed a systematic review to summarize current achievements in the development of these MRI-compatible devices and synthesize available imaging results emanating from studies that have utilized these devices. RESULTS The device design, study protocol and neuroimaging observations of 26 studies using 13 types of devices were extracted. Three of these devices can provide somatosensory stimuli, eight motor stimuli, and two both types of stimuli. Our review demonstrated that using these devices, fMRI data of brain activation can be successfully obtained when participants remain motionless and experience sensorimotor stimulation during fMRI acquisition. The activation in multiple cortical (e.g., primary sensorimotor cortex) and subcortical (e.g., cerebellum) regions has been each linked to these types of walking-related sensorimotor stimuli. CONCLUSION The observations of these publications suggest the promise of implementing these devices to characterize the supraspinal sensorimotor control of walking. Still, the evidence level of these neuroimaging observations was still low due to small sample size and varied study protocols, which thus needs to be confirmed via studies with more rigorous design.
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Affiliation(s)
- Yinglu Hong
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
| | - Brad Manor
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
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Ma Y, Gow BJ, Song R, Rist PM, Hausdorff JM, Lipsitz LA, Manor B, Wayne PM. Long-term Tai Chi practice in older adults is associated with "younger" functional abilities. Aging Cell 2024; 23:e14023. [PMID: 37905388 PMCID: PMC10776109 DOI: 10.1111/acel.14023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Age-related alterations in physiology lead to declines in physical function that are associated with numerous adverse outcomes among older adults. Utilizing a hybrid design, we aimed to understand whether both long-term and short-term Tai Chi (TC) training are associated with age-related decline in physical function in healthy older adults. We first conducted cross-sectional comparisons among TC-naïve older adults (n = 60, 64.2 ± 7.7 years), TC-expert older adults (n = 27, 62.8 ± 7.6 years, 24.5 ± 12 years experience), and TC-naïve younger adults (n = 15, 28.7 ± 3.2 years) to inform long-term effects of TC training on physical function, including single leg stance time with eyes closed, grip strength, Timed Up and Go, maximum walking speed, functional reach, and vertical jump for lower-extremity power. There were significant differences among the three groups on all the six tests. For most functional tests, TC-experts performed better than age-matched TC-naïve controls and were statistically indistinguishable from young healthy adult controls. Long-term TC training was associated with higher levels of physical function in older adults, suggesting a potential preventative healthy aging effect. In the randomized longitudinal trial, TC-naïve subjects were randomized (n = 31 to Tai Chi group, n = 29 to usual care control group) to evaluate the short-term effects of TC over 6 months on all outcomes. TC's short-term impacts on physical function were small and not statistically significant. The impact of short-term training in healthy adults is less clear. Both potential longer-term preventive effects and shorter-term restorative effects warrant further research with rigorous, adequately powered controlled clinical trials.
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Affiliation(s)
- Yan Ma
- Osher Center for Integrative Health, Division of Preventive MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Brian J. Gow
- Osher Center for Integrative Health, Division of Preventive MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Laboratory for Computational Physiology (LCP)Massachusetts Institute of TechnologyCambridgeMassachusettsUSA
| | - Rhayun Song
- College of NursingChungnam National UniversityDaejeonKorea
| | - Pamela M. Rist
- Division of Preventive MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Orthopedic Surgery and Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of Gerontology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of Gerontology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Peter M. Wayne
- Osher Center for Integrative Health, Division of Preventive MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
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Jiang X, Mang X, Zhou H, Chen J, Tan H, Ren H, Huang B, Zhong L, Lipsitz LA, Manor B, Guo Y, Zhou J. The physiologic complexity of beat-to-beat blood pressure is associated with age-related alterations in blood pressure regulation. Aging Cell 2024; 23:e13943. [PMID: 37615223 PMCID: PMC10776119 DOI: 10.1111/acel.13943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
The fluctuations in resting-state beat-to-beat blood pressure (BP) are physiologically complex, and the degree of such BP complexity is believed to reflect the multiscale regulation of this critical physiologic process. Hypertension (HTN), one common age-related condition, is associated with altered BP regulation and diminished system responsiveness to perturbations such as orthostatic change. We thus aimed to characterize the impact of HTN on resting-state BP complexity, as well as the relationship between BP complexity and both adaptive capacity and underlying vascular characteristics. We recruited 392 participants (age: 60-91 years), including 144 that were normotensive and 248 with HTN (140 controlled- and 108 uncontrolled-HTN). Participants completed a 10-min continuous finger BP recording during supine rest, then underwent measures of lying-to-standing BP change, arterial stiffness (i.e., brachial-ankle pulse wave velocity), and endothelial function (i.e., flow-mediated vasodilation). The complexity of supine beat-to-beat systolic (SBP) and diastolic (DBP) BP was quantified using multiscale entropy. Thirty participants with HTN (16 controlled-HTN and 14 uncontrolled-HTN) exhibited orthostatic hypotension. SBP and DBP complexity was greatest in normotensive participants, lower in those with controlled-HTN, and lowest in those in uncontrolled-HTN (p < 0.0005). Lower SBP and DBP complexity correlated with greater lying-to-standing decrease in SBP and DBP level (β = -0.33 to -0.19, p < 0.01), greater arterial stiffness (β = -0.35 to -0.18, p < 0.01), and worse endothelial function (β = 0.17-0.22, p < 0.01), both across all participants and within the control- and uncontrolled-HTN groups. These results suggest that in older adults, BP complexity may capture the integrity of multiple interacting physiologic mechanisms that regulate BP and are important to cardiovascular health.
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Affiliation(s)
- Xin Jiang
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Xiaoying Mang
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Huiting Zhou
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Jingmei Chen
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Huiying Tan
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
| | - Huixia Ren
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Baofeng Huang
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Lilian Zhong
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of GerontologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of GerontologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Yi Guo
- The Second Clinical Medical CollegeJinan UniversityShenzhenChina
- The First Affiliated HospitalSouthern University of Science and TechnologyShenzhenChina
- Department of NeurologyShenzhen People's HospitalShenzhenChina
- Shenzhen Bay LaboratoryShenzhenChina
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging ResearchHebrew SeniorLifeBostonMassachusettsUSA
- Division of GerontologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Hong Y, Bao D, Manor B, Zhou Y, Zhou J. Effects of endurance exercise on physiologic complexity of the hemodynamics in prefrontal cortex. Neurophotonics 2024; 11:015009. [PMID: 38515930 PMCID: PMC10956706 DOI: 10.1117/1.nph.11.1.015009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024]
Abstract
Significance Prefrontal cortex (PFC) hemodynamics are regulated by numerous underlying neurophysiological components over multiple temporal scales. The pattern of output signals, such as functional near-infrared spectroscopy fluctuations (i.e., fNIRS), is thus complex. We demonstrate first-of-its-kind evidence that this fNIRS complexity is a marker that captures the influence of endurance capacity and the effects of hydrogen gas (H 2 ) on PFC regulation. Aim We aim to explore the effects of different physical loads of exercise as well as the intaking of hydrogen gas on the fNIRS complexity of the PFC. Approach Twenty-four healthy young men completed endurance cycling exercise from 0 (i.e., baseline) to 100% of their physical loads after intaking 20 min of either H 2 or placebo gas (i.e., control) on each of two separate visits. The fNIRS measuring the PFC hemodynamics and heart rate (HR) was continuously recorded throughout the exercise. The fNIRS complexity was quantified using multiscale entropy. Results The fNIRS complexity was significantly greater in the conditions from 25% to 100% of the physical load (p < 0.0005 ) compared with the baseline and after intaking H 2 before exercise; this increase of fNIRS complexity was significantly greater compared with the control (p = 0.001 ∼ 0.01 ). At the baseline, participants with a greater fNIRS complexity had a lower HR (β = - 0.35 ∼ - 0.33 , p = 0.008 ∼ 0.02 ). Those with a greater increase of complexity had a lower increase of the HR (β = - 0.30 ∼ - 0.28 , p = 0.001 ∼ 0.002 ) during exercise. Conclusions These observations suggest that fNIRS complexity would be a marker that captures the adaptive capacity of PFC to endurance exercise and to the effects of interventions on PFC hemodynamics.
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Affiliation(s)
- Yinglu Hong
- Beijing Sport University, School of Sport Medicine and Physical Therapy, Beijing, China
| | - Dapeng Bao
- Beijing Sport University, China Institute of Sport and Health Science, Beijing, China
| | - Brad Manor
- Hebrew Senior Life Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
| | - Yuncong Zhou
- Beijing Sport University, School of Education, Beijing, China
| | - Junhong Zhou
- Hebrew Senior Life Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
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Li Y, Liu M, Zhou K, Dong G, Manor B, Bao D, Zhou J. The comparison between effects of Taichi and conventional exercise on functional mobility and balance in healthy older adults: a systematic literature review and meta-analysis. Front Public Health 2023; 11:1281144. [PMID: 38164444 PMCID: PMC10757983 DOI: 10.3389/fpubh.2023.1281144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
Background Taichi is beneficial for functional mobility and balance in older adults. However, such benefits of Taichi when comparing to conventional exercise (CE) are not well understood due to large variance in study protocols and observations. Methods We reviewed publications in five databases. Eligible studies that examined the effects of Taichi on the outcomes of functional mobility and balance in healthy older adults as compared to CE were included. Subgroup analyses compared the effects of different types of CE (e.g., single and multiple-type exercise) and different intervention designs (e.g., Taichi types) on those outcomes (Registration number: CRD42022331956). Results Twelve studies consisting of 2,901 participants were included. Generally, compared to CE, Taichi induced greater improvements in the performance of Timed-Up-and-Go (SMD = -0.18, [-0.33 to -0.03], p = 0.040, I2 = 59.57%), 50-foot walking (MD = -1.84 s, [-2.62 to -1.07], p < 0.001, I2 = 0%), one-leg stance with eyes open (MD = 6.00s, [2.97 to 9.02], p < 0.001, I2 = 83.19%), one-leg stance with eyes closed (MD = 1.65 s, [1.35 to 1.96], p < 0.001, I2 = 36.2%), and functional reach (SMD = 0.7, [0.32 to 1.08], p < 0.001, I2 = 86.79%) tests. Subgroup analyses revealed that Taichi with relatively short duration (<20 weeks), low total time (≤24 h), and/or using Yang-style, can induce significantly greater benefits for functional mobility and balance as compared to CE. Uniquely, Taichi only induced significantly greater improvements in Timed-Up-and-Go compared to single- (SMD = -0.40, [-0.55 to -0.24], p < 0.001, I2 = 6.14%), but not multiple-type exercise. A significant difference between the effects of Taichi was observed on the performance of one-leg stance with eyes open when compared to CE without balance (MD = 3.63 s, [1.02 to 6.24], p = 0.006, I2 = 74.93%) and CE with balance (MD = 13.90s, [10.32 to 17.48], p < 0.001, I2 = 6.1%). No other significant difference was shown between the influences of different CE types on the observations. Conclusion Taichi can induce greater improvement in functional mobility and balance in older adults compared to CE in a more efficient fashion, especially compared to single-type CE. Future studies with more rigorous design are needed to confirm the observations here.
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Affiliation(s)
- Yiting Li
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Meng Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Kaixiang Zhou
- College of Physical Education and Health Science, Chongqing Normal University, Chongqing, China
| | - Gengxin Dong
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Brad Manor
- Hebrew Senior Life Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Junhong Zhou
- Hebrew Senior Life Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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Baniassadi A, Lipsitz LA, Sailor D, Pascual-Leone A, Manor B. Heat Waves, Climate Change, and Implications for an Aging Population. J Gerontol A Biol Sci Med Sci 2023; 78:2304-2306. [PMID: 37857336 DOI: 10.1093/gerona/glad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Affiliation(s)
- Amir Baniassadi
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Lewis A Lipsitz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - David Sailor
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
| | - Alvaro Pascual-Leone
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Brad Manor
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
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Lo OY, Charest S, Margulis H, Lipsitz L, Manor B. Feasibility and Safety of Sequential Transcranial Direct Current Stimulation and Physical Therapy in Older Adults at Risk of Falling: A Randomized Pilot Study. Arch Rehabil Res Clin Transl 2023; 5:100288. [PMID: 38163031 PMCID: PMC10757166 DOI: 10.1016/j.arrct.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To establish the feasibility and safety of administering transcranial direct current stimulation (tDCS) immediately prior to physical therapy (PT) sessions in older adults at risk of falls. Design A pilot randomized controlled study. Setting Outpatient geriatric physical therapy clinic. Participants Ten older adults living within supportive housing facilities (86.8±7.9 y/o, 8F) were enrolled in the study. Interventions Participants received tDCS or sham stimulation targeting the left dorsal lateral prefrontal cortex for 20 minutes, immediately prior to up to 10 of their PT visits. Main Outcome Measures Feasibility, safety, and functional outcomes were reported to inform the design of a larger and more definitive trial. Results Six fallers (88.8±5.0 y/o, 5F) completed the study and received 82.3% of the possible stimulation sessions, suggesting adding a 20-minute session of stimulation immediately prior to PT training sessions, along with pre- and post-assessments is feasible. The blinding strategy was successful and all reported side effects were expected and transient. While feasible and safe, the trial was met with numerous challenges, including selection bias, time and energy commitment, and large variation in functional performance, that must be considered when designing and implementing larger more definitive trials. Conclusion This study provides preliminary evidence about the feasibility, safety, and challenges to combine PT and tDCS in very frail older adults.
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Affiliation(s)
- On-Yee Lo
- Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | - Lewis Lipsitz
- Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Brad Manor
- Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
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Baniassadi A, Manor B, Yu W, Travison T, Lipsitz L. Nighttime ambient temperature and sleep in community-dwelling older adults. Sci Total Environ 2023; 899:165623. [PMID: 37474050 PMCID: PMC10529213 DOI: 10.1016/j.scitotenv.2023.165623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
This longitudinal study examines the association between bedroom nighttime temperature and sleep quality in a sample of community dwelling older adults. Using wearable sleep monitors and environmental sensors, we assessed sleep duration, efficiency, and restlessness over an extended period within participants' homes while controlling for potential confounders and covariates. Our findings demonstrated that sleep was most efficient and restful when nighttime ambient temperature ranged between 20 and 25 °C, with a clinically relevant 5-10 % drop in sleep efficiency when the temperature increased from 25 °C to 30 °C. The associations were primarily nonlinear, and substantial between-subject variations were observed. These results highlight the potential to enhance sleep quality in older adults by optimizing home thermal environments and emphasize the importance of personalized temperature adjustments based on individual needs and circumstances. Additionally, our study underscores the potential impact of climate change on sleep quality in older adults, particularly those with lower socioeconomic status, and supports increasing their adaptive capacity in the face of a changing climate.
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Affiliation(s)
- Amir Baniassadi
- Marcus Institute for Aging Research, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Brad Manor
- Marcus Institute for Aging Research, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Wanting Yu
- Marcus Institute for Aging Research, Boston, MA, USA
| | - Thomas Travison
- Marcus Institute for Aging Research, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lewis Lipsitz
- Marcus Institute for Aging Research, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Cappon D, den Boer T, Yu W, LaGanke N, Fox R, Brozgol M, Hausdorff JM, Manor B, Pascual-Leone A. An Educational Program for Remote Training and Supervision of Home-Based Transcranial Electrical Stimulation: Feasibility and Preliminary Effectiveness. Neuromodulation 2023:S1094-7159(23)00671-2. [PMID: 37552152 PMCID: PMC10850429 DOI: 10.1016/j.neurom.2023.04.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES There has been recent interest in the administration of transcranial electrical stimulation (tES) by a caregiver, family member, or patient themselves while in their own homes (HB-tES). The need to properly train individuals in the administration of HB-tES is essential, and the lack of a uniform training approach across studies has come to light. The primary aim of this paper is to present the HB-tES training and supervision program, a tele-supervised, instructional, and evaluation program to teach laypersons how to administer HB-tES to a participant and to provide a standardized framework for remote monitoring of participants by teaching staff. The secondary aim is to present early pilot data on the feasibility and effectiveness of the training portion of the program based on its implementation in 379 sessions between two pilot clinical trials. MATERIALS AND METHODS The program includes instructional materials, standardized tele-supervised hands-on practice sessions, and a system for remote supervision of participants by teaching staff. Nine laypersons completed the training program. Data on the feasibility and effectiveness of the program were collected. RESULTS No adverse events were reported during the training or any of the HB-tES sessions after the training. All laypersons successfully completed the training. The nine laypersons reported being satisfied with the training program and confident in their tES administration capabilities. This was consistent with laypersons requiring technical assistance from teaching staff very infrequently during the 379 completed sessions. The average adherence rate between all administrators was >98%, with seven of nine administrators having 100% adherence to the scheduled sessions. CONCLUSIONS These findings indicate that the HB-tES program is effective and is associated with participant satisfaction. SIGNIFICANCE We hope that the remote nature of this training program will facilitate increased accessibility to HB-tES research for participants of different demographics and locations. This program, designed for easy adaptation to different HB-tES research applications and devices, also is accessible online. The adoption of this program is expected to facilitate uniformity of study methods among future HB-tES studies and thereby accelerate the pace of tES intervention discovery.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA
| | - Rachel Fox
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA
| | - Marina Brozgol
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, USA; Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
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Burton W, Ma Y, Manor B, Hausdorff JM, Kowalski MH, Bain PA, Wayne PM. The impact of neck pain on gait health: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:618. [PMID: 37516827 PMCID: PMC10385921 DOI: 10.1186/s12891-023-06721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Evidence exists demonstrating the negative impacts of chronic musculoskeletal pain on key measures of gait. Despite neck pain being the second most common musculoskeletal pain condition, there is a paucity of evidence exploring the impacts of neck pain specifically on these outcomes. The aims of this work were to systematically review the current evidence of the associations between chronic neck pain and measures of gait health and to conduct meta-analysis for quantitative assessment of the effect sizes under different walking conditions. METHODS Systematic review was conducted following PRISMA guidelines. Databases searched included MEDLINE, Embase, Web of Science, CINAHL, and PEDro. Eligible study designs included observational studies consisting of an exposure group with chronic neck pain and control group without chronic neck pain and primary outcomes relating to gait health. For outcomes amenable to meta-analysis, a random-effects model was used to derive summary estimates of Hedge's g depicted graphically with forest plots. Other gait outcomes were narratively summarized. Risk of bias was also assessed. RESULTS The original search yielded 1918 articles; 12 met final eligibility criteria including 10 cross-sectional studies. Outcomes were grouped first by the five domains of gait: pace, rhythm, asymmetry, variability, and postural control; and second by the tested walking conditions. Meta-analyses for gait speed revealed large effect-sizes indicating that individuals with chronic neck pain had slower measures of gait and lower measures of cadence. Gait outcomes that were narratively summarized supported these findings. CONCLUSION The quantitative and qualitative findings of this systematic review and meta-analysis suggest a negative impact of CNNP on measures of gait health, particularly gait speed, under various walking conditions. However, broad interpretation of these results should be cautious. Testing gait under dual task conditions may be particularly sensitive to the impact of CNNP, and future work is needed to better understand how pain disrupts this important functionality of the locomotor system. Additionally, consideration should be made to assess measures of variability and investigate these relationships in the older adult population.
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Affiliation(s)
- Wren Burton
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA.
- DC. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Yan Ma
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA
- DC. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv, Israel
- Sagol School of Neuroscience and Department of Physical Therapy, Sacker School of Medicine Tel Aviv University, Tel Aviv, Israel
- Department of Orthopedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Matthew H Kowalski
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA
- DC. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Lo OY, Manor B. Measuring Gait to Monitor Cognitive Function in Older Adults: An Important Step in the Right Direction. Neurology 2023; 101:10-11. [PMID: 37188540 DOI: 10.1212/wnl.0000000000207528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- On-Yee Lo
- From the Hinda and Arthur Marcus Institute for Aging Research (O.-Y.L., B.M.), Hebrew SeniorLife; Division of Gerontology (O.-Y.L., B.M.), Beth Israel Deaconess Medical Center; and Harvard Medical School (O.-Y.L., B.M.), Boston, MA.
| | - Brad Manor
- From the Hinda and Arthur Marcus Institute for Aging Research (O.-Y.L., B.M.), Hebrew SeniorLife; Division of Gerontology (O.-Y.L., B.M.), Beth Israel Deaconess Medical Center; and Harvard Medical School (O.-Y.L., B.M.), Boston, MA
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13
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Cappon D, Fox R, den Boer T, Yu W, LaGanke N, Cattaneo G, Perellón-Alfonso R, Bartrés-Faz D, Manor B, Pascual-Leone A. Tele-supervised home-based transcranial alternating current stimulation (tACS) for Alzheimer's disease: a pilot study. Front Hum Neurosci 2023; 17:1168673. [PMID: 37333833 PMCID: PMC10272342 DOI: 10.3389/fnhum.2023.1168673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Background Over 55 million people worldwide are currently diagnosed with Alzheimer's disease (AD) and live with debilitating episodic memory deficits. Current pharmacological treatments have limited efficacy. Recently, transcranial alternating current stimulation (tACS) has shown memory improvement in AD by normalizing high-frequency neuronal activity. Here we investigate the feasibility, safety, and preliminary effects on episodic memory of an innovative protocol where tACS is administered within the homes of older adults with AD with the help of a study companion (HB-tACS). Methods Eight participants diagnosed with AD underwent multiple consecutive sessions of high-definition HB-tACS (40 Hz, 20-min) targeting the left angular gyrus (AG), a key node of the memory network. The Acute Phase comprised 14-weeks of HB-tACS with at least five sessions per week. Three participants underwent resting state electroencephalography (EEG) before and after the 14-week Acute Phase. Subsequently, participants completed a 2-3-month Hiatus Phase not receiving HB-tACS. Finally, in the Taper phase, participants received 2-3 sessions per week over 3-months. Primary outcomes were safety, as determined by the reporting of side effects and adverse events, and feasibility, as determined by adherence and compliance with the study protocol. Primary clinical outcomes were memory and global cognition, measured with the Memory Index Score (MIS) and Montreal Cognitive Assessment (MoCA), respectively. Secondary outcome was EEG theta/gamma ratio. Results reported as mean ± SD. Results All participants completed the study, with an average of 97 HB-tACS sessions completed by each participant; reporting mild side effects during 25% of sessions, moderate during 5%, and severe during 1%. Acute Phase adherence was 98 ± 6.8% and Taper phase was 125 ± 22.3% (rates over 100% indicates participants completed more than the minimum of 2/week). After the Acute Phase, all participants showed memory improvement, MIS of 7.25 ± 3.77, sustained during Hiatus 7.00 ± 4.90 and Taper 4.63 ± 2.39 Phases compared to baseline. For the three participants that underwent EEG, a decreased theta/gamma ratio in AG was observed. Conversely, participants did not show improvement in the MoCA, 1.13 ± 3.80 after the Acute Phase, and there was a modest decrease during the Hiatus -0.64 ± 3.28 and Taper -2.56 ± 5.03 Phases. Conclusion This pilot study shows that the home-based, remotely-supervised, study companion administered, multi-channel tACS protocol for older adults with AD was feasible and safe. Further, targeting the left AG, memory in this sample was improved. These are preliminary results that warrant larger more definite trials to further elucidate tolerability and efficacy of the HB-tACS intervention. NCT04783350. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04783350?term=NCT04783350&draw=2&rank=1, identifier NCT04783350.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Rachel Fox
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Ruben Perellón-Alfonso
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Bartrés-Faz
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
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Manor B, Zhou J, Lo OY. Novel Technology-driven Approaches to Enhance Mobility and Reduce Falls in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:800-801. [PMID: 37165950 PMCID: PMC10172977 DOI: 10.1093/gerona/glad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Affiliation(s)
- Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Tarbert R, Zhou J, Manor B. Potential Solutions for the Mitigation of Hip Injuries Caused by Falls in Older Adults: A Narrative Review. J Gerontol A Biol Sci Med Sci 2023; 78:853-860. [PMID: 36194471 PMCID: PMC10172985 DOI: 10.1093/gerona/glac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hip injuries caused by falling are common and often catastrophic for older adults. There is thus an urgent need to develop solutions designed to mitigate fall injuries to the hip by reducing the forces created on the body by ground impact. METHODS The goal of this narrative review was to synthesize published literature on available products developed with the expressed goal of reducing fall-related hip injuries. RESULTS Three categories were identified: passive wearables (eg, hip protectors), active wearables (eg, instrumented belts with deployable airbags), and compliant flooring. Laboratory studies indicate that each technology can reduce peak forces induced by simulated falls. Considerable preliminary data suggest that passive wearables and compliant flooring may reduce fall-related injuries within long-term care facilities. Controlled trials of specific types of these 2 technologies, however, have produced inconsistent results. While little is known about the effectiveness of active wearables, promising early data indicate the feasibility of an instrumented belt worn around the waist to effectively deploy an airbag to protect the hips prior to ground impact. Important challenges associated with one or more identified technologies included poor adherence to instructed wear as well as the potential for significant physical or time burden to caregivers or health care professionals. CONCLUSIONS Passive wearables, active wearables, and compliant flooring have shown promise in reducing fall-related hip injuries in older adults. Still, each type of product is accompanied by limited real-world data and/or significant challenges that must be overcome to maximize effectiveness and minimize unintended side effects.
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Affiliation(s)
- Rebecca J Tarbert
- ActiveProtective Technologies, Inc, Fort Washington, Pennsylvania, USA
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Zhou J, Cattaneo G, Yu W, Lo OY, Gouskova NA, Delgado-Gallén S, Redondo-Camós M, España-Irla G, Solana-Sánchez J, Tormos JM, Lipsitz LA, Bartrés-Faz D, Pascual-Leone A, Manor B. The age-related contribution of cognitive function to dual-task gait in middle-aged adults in Spain: observations from a population-based study. Lancet Healthy Longev 2023; 4:e98-e106. [PMID: 36870341 PMCID: PMC9992865 DOI: 10.1016/s2666-7568(23)00009-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Poor dual-task gait performance is associated with a risk of falls and cognitive decline in adults aged 65 years or older. When and why dual-task gait performance begins to deteriorate is unknown. This study aimed to characterise the relationships between age, dual-task gait, and cognitive function in middle age (ie, aged 40-64 years). METHODS We conducted a secondary analysis of data from community-dwelling adults aged 40-64 years that took part in the Barcelona Brain Health Initiative (BBHI) study, an ongoing longitudinal cohort study in Barcelona, Spain. Participants were eligible for inclusion if they were able to walk independently without assistance and had completed assessments of both gait and cognition at the time of analysis and ineligble if they could not understand the study protocol, had any clinically diagnosed neurological or psychiatric diseases, were cognitively impaired, or had lower-extremity pain, osteoarthritis, or rheumatoid arthritis that could cause abnormal gait. Stride time and stride time variability were measured under single-task (ie, walking only) and dual-task (ie, walking while performing serial subtractions) conditions. Dual-task cost (DTC; the percentage increase in the gait outcomes from single-task to dual-task conditions) to each gait outcome was calculated and used as the primary measure in analyses. Global cognitive function and composite scores of five cognitive domains were derived from neuropsychological testing. We used locally estimated scatterplot smoothing to characterise the relationship between age and dual-task gait, and structural equation modelling to establish whether cognitive function mediated the association between observed biological age and dual tasks. FINDINGS 996 people were recruited to the BBHI study between May 5, 2018, and July 7, 2020, of which 640 participants completed gait and cognitive assessments during this time (mean 24 days [SD 34] between first and second visit) and were included in our analysis (342 men and 298 women). Non-linear associations were observed between age and dual-task performance. Starting at 54 years, the DTC to stride time (β=0·27 [95% CI 0·11 to 0·36]; p<0·0001) and stride time variability (0·24 [0·08 to 0·32]; p=0·0006) increased with advancing age. In individuals aged 54 years or older, decreased global cognitive function correlated with increased DTC to stride time (β=-0·27 [-0·38 to -0·11]; p=0·0006) and increased DTC to stride time variability (β=-0·19 [-0·28 to -0·08]; p=0·0002). INTERPRETATION Dual-task gait performance begins to deteriorate in the sixth decade of life and, after this point, interindividual variance in cognition explains a substantial portion of dual-task performance. FUNDING La Caixa Foundation, Institut Guttmann, and Fundació Abertis.
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Affiliation(s)
- Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Natalia A Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Redondo-Camós
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Goretti España-Irla
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Solana-Sánchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences and August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Hsu CL, Manor B, Travison T, Pascual-Leone A, Lipsitz LA. Sensorimotor and Frontoparietal Network Connectivity Are Associated With Subsequent Maintenance of Gait Speed and Episodic Memory in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:521-526. [PMID: 36124711 PMCID: PMC9977250 DOI: 10.1093/gerona/glac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Slow gait is predictive of functional impairments in older adults, while concomitant slow gait and cognitive complaints are associated with a greater risk for cognitive decline and dementia. However, functional neural correlates for gait speed maintenance are unclear. As the sensorimotor network (SMN) and frontoparietal network (FPN) are integral components of these functions, this study investigated differences in SMN and FPN in older adults with/without gait speed decline over 24 months; and whether these networks were associated with the maintenance of cognitive function. METHODS We included 42 community-dwelling older adults aged >70 years from the MOBILIZE Boston Study. Resting-state fMRI was performed at the study baseline. Participant characteristics, gait speed, Mini-Mental State Examination, and Hopkins Verbal Learning Test (HVLT) were assessed at baseline and at 24-month follow-up. Decliners were identified as individuals with >0.05 meters/second decline in gait speed from baseline to 24 months. Of the 26 decliners and 16 maintainers, decliners exhibited a significant decline in delayed-recall performance on the HVLT over 24 months. RESULTS Controlling for baseline age and multiple comparisons, contrary to initial hypothesis, maintainers exhibited lower baseline primary motor and premotor connectivity (p = .01) within the SMN, and greater baseline ventral visual-supramarginal gyrus connectivity within the FPN (p = .02) compared to decliners. Lower primary motor-premotor connectivity was correlated with maintenance of delayed-recall performance on the HVLT (p = .04). CONCLUSION These findings demonstrated a potential compensatory mechanism involved in the link between the decline in gait speed and episodic memory, whereby baseline connectivity of the SMN and FPN may underlie subsequent maintenance of gait speed and cognitive function in old age.
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Affiliation(s)
- Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Travison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Zhou K, Liu M, Wang Y, Liu H, Manor B, Bao D, Zhang L, Zhou J. Effects of molecular hydrogen supplementation on fatigue and aerobic capacity in healthy adults: A systematic review and meta-analysis. Front Nutr 2023; 10:1094767. [PMID: 36819697 PMCID: PMC9934906 DOI: 10.3389/fnut.2023.1094767] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Fatigue is oftentimes induced by high-intensity exercise potentially via the exceeded amount of reactive oxygen species, leading to diminished functions (e.g., aerobic capacity) and increased risk of injuries. Studies indicate that molecular hydrogen (H2), with antioxidant and anti-inflammatory properties, may be a promising strategy to alleviate fatigue and improve aerobic capacity. However, such effects have not been comprehensively characterized. Objective To systematically assess the effects of in taking H2 on fatigue and aerobic capacity in healthy adults. Methods The search was conducted in August 2022 in five databases. Studies with randomized controlled or crossover designs that investigated the rating of perceived exertion (RPE), maximal oxygen uptake (VO2max), peak oxygen uptake (VO2peak), and endurance performance were selected. The data (mean ± standard deviation and sample size) were extracted from the included studies and were converted into the standardized mean difference (SMD). Random-effects meta-analyses were performed. Subgroup analysis was used to analyze potential sources of heterogeneity due to intervention period, training status, and type of exercise. Results Seventeen publications (19 studies) consisting of 402 participants were included. The pooled effect sizes of H2 on RPE (SMDpooled = -0.38, 95%CI -0.65 to -0.11, p = 0.006, I 2 = 33.6%, p = 0.149) and blood lactate (SMDpooled = -0.42, 95% CI -0.72 to -0.12, p = 0.006, I 2 = 35.6%, p = 0.114) were small yet significant with low heterogeneity. The pooled effect sizes of H2 on VO2max and VO2peak (SMDpooled = 0.09, 95% CI -0.10 to 0.29, p = 0.333, I 2 = 0%, p = 0.998) and endurance performance (SMDpooled = 0.01, 95% CI -0.23 to 0.25, p = 0.946, I 2 = 0%, p > 0.999) were not significant and trivial without heterogeneity. Subgroup analysis revealed that the effects of H2 on fatigue were impacted significantly by the training status (i.e., untrained and trained), period of H2 implementation, and exercise types (i.e., continuous and intermittent exercises). Conclusions This meta-analysis provides moderate evidence that H2 supplementation alleviates fatigue but does not enhance aerobic capacity in healthy adults. Systematic review registration www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022351559.
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Affiliation(s)
- Kaixiang Zhou
- College of Sports and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Meng Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Yubo Wang
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Haoyang Liu
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Brad Manor
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China,*Correspondence: Dapeng Bao ✉
| | - Luyu Zhang
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China,Luyu Zhang ✉
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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19
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Zhou J, Manor B, McCarten JR, Wade MG, Jor’dan AJ. The effects of cognitive impairment on the multi-scale dynamics of standing postural control during visual-search in older men. Front Aging Neurosci 2023; 15:1068316. [PMID: 36761178 PMCID: PMC9905142 DOI: 10.3389/fnagi.2023.1068316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Background Cognitive impairment disrupts postural control, particularly when standing while performing an unrelated cognitive task (i.e., dual-tasking). The temporal dynamics of standing postural sway are "complex," and such complexity may reflect the capacity of the postural control system to adapt to task demands. We aimed to characterize the impact of cognitive impairment on such sway complexity in older adults. Methods Forty-nine older adult males (Alzheimer's disease (AD): n = 21; mild cognitive impairment (MCI): n = 13; cognitively-intact: n = 15) completed two 60-s standing trials in each of single-task and visual-search dual-task conditions. In the dual-task condition, participants were instructed to count the frequency of a designated letter in a block of letters projected on screen. The sway complexity of center-of-pressure fluctuations in anterior-posterior (AP) and medial-lateral (ML) direction was quantified using multiscale entropy. The dual-task cost to complexity was obtained by calculating the percent change of complexity from single- to dual-task condition. Results Repeated-measures ANOVAs revealed significant main effects of group (F > 4.8, p < 0.01) and condition (F = 7.7, p < 0.007) on both AP and ML sway complexity; and significant interaction between group and condition for ML sway complexity (F = 3.7, p = 0.03). The AD group had the lowest dual-task ML complexity, as well as greater dual-task cost to ML (p = 0.03) compared to the other two groups. Visual-search task accuracy was correlated with ML sway complexity in the dual-task condition (r = 0.42, p = 0.007), and the dual-task cost to ML sway complexity (r = 0.39, p = 0.01) across all participants. Conclusion AD-related cognitive impairment was associated with a greater relative reduction in postural sway complexity from single- to dual-tasking. Sway complexity appears to be sensitive to the impact of cognitive impairment on standing postural control.
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Affiliation(s)
- Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States,*Correspondence: Junhong Zhou,
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - John Riley McCarten
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Health Care System, Minneapolis, MN, United States,School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Michael G. Wade
- School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Azizah J. Jor’dan
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
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20
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Zhou J, Cattaneo G, Yu W, Gouskova N, Lipsitz L, Pascual-Leone A, Bartres-Faz D, Manor B. COGNITIVE FUNCTION CONTRIBUTES TO THE NONLINEAR RELATIONSHIP BETWEEN AGE AND DUAL-TASK GAIT IN MID-AGED POPULATION. Innov Aging 2022. [PMCID: PMC9766006 DOI: 10.1093/geroni/igac059.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The capacity to maintain safe walking is critical to functional independence in older adults. However, the timing/stage when such capacity starts to diminish, and its potential contributors have not been well characterized. To explore that, we here conducted analysis based upon the data of 651 participants of age between 40 and 65 years from Barcelona Brain Health Initiative Study. Each participants completed: 1) one 45-second trial of walking normally (single-task) and while performing a serial-subtraction-by-three task (dual-task), of which gait was measured using a smartphone-based gait-assessment application; and 2) a battery of cognitive tests. The dual-task cost (DTC) (i.e., percent changes from single- to dual-task condition) to mean stride time (ST) and stride time variability (STV) and the score of global cognitive function were obtained. The LOESS analyses demonstrated nonlinear relationships between age and DTCs with a turning point at age of 54 years (R2>3%). Regression models showed significantly greater associations (p=0.01~0.03) between age and DTCs (i.e., older age, worse gait) (β=0.22~0.28, p< 0.006), as well as between global cognitive function and DTCs (β=-0.28~-0.18, p< 0.002), in older group (i.e., age≥54 years) compared to younger group. The structural-equation-modeling suggested that in older group, cognitive function mediated the relationship between age and dual-task gait (p< 0.02) with a contribution of 43~47% to such relationship. The observations here revealed that as early at age of 54 years, dual-task gait starts to significantly diminish, and its dependence on cognitive function dramatically increases, providing critical knowledge for the management of mobility and cognitive aging in mid-age population.
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Affiliation(s)
- Junhong Zhou
- Harvard Medical School/Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | | | - Wanting Yu
- Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | | | - Lewis Lipsitz
- Hebrew SeniorLife, Brookline, Massachusetts, United States
| | | | - David Bartres-Faz
- Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Catalonia, Spain
| | - Brad Manor
- Hebrew SeniorLife/Harvard Medical School, Roslindale, Massachusetts, United States
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21
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Kahya M, Gouskova N, Lo OY, Zhou J, Cappon D, Pascual-Leone A, Lipsitz L, Manor B. BRAIN ACTIVITY DURING DUAL-TASK STANDING IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT. Innov Aging 2022. [PMCID: PMC9766929 DOI: 10.1093/geroni/igac059.2680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Performance of a cognitive task while standing disrupts balance in older adults. This disruption is exaggerated in those with mild cognitive impairment (MCI). Moreover, older adults with MCI who exhibit greater dual-task ‘cost’ are more likely to develop falls and dementia. EEG studies suggest that cognitive-motor dual-tasking is associated with brain activity fluctuations originating from central brain regions at specific frequencies, particularly in the alpha-band (8–13 Hz). We hypothesized that older adults with MCI would demonstrate decreased EEG alpha power during dual-task standing compared to healthy controls, and that decreased alpha power would be associated with elevated dual-task cost. We recorded postural sway and EEG in 14 participants with MCI [Montreal Cognitive Assessment (MoCA) < 25] and 16 healthy older adults [MoCA>25] as they completed trials of standing with and without serial subtractions. Postural sway metrics were derived, and from EEG we calculated absolute alpha-, theta-, and beta-band powers within a-priori defined regions-of-interest: the left and right anterior, central, and posterior regions. Repeated Measures ANOVA demonstrated that participants with MCI exhibited decreased alpha power in the central regions during dual-task standing compared to healthy controls (p= 0.01). No significant difference was observed for theta and beta-band powers between participants with MCI and healthy controls. In those with MCI, lower alpha power during dual-task standing correlated with increased dual-task cost to postural sway path (worse balance) (r=-0.4, p=0.03). These results provide preliminary evidence that specific patterns of brain activity during dual-tasking are disrupted in MCI and this is associated with elevated dual-task costs.
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Affiliation(s)
- Melike Kahya
- Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
| | | | - On-Yee Lo
- Marcus Institute for Aging Research, Boston, Massachusetts, United States
| | - Junhong Zhou
- Harvard Medical School/Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | - Davide Cappon
- Marcus Institute for Aging Research, Boston, Massachusetts, United States
| | | | - Lewis Lipsitz
- Hebrew SeniorLife, Brookline, Massachusetts, United States
| | - Brad Manor
- Hebrew SeniorLife/Harvard Medical School, Roslindale, Massachusetts, United States
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22
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Jason K, Zhou J, Yu W, Manor B, Jor’dan A. THE EFFECTS OF VISUAL SEARCH ON POSTURAL SWAY COMPLEXITY IN OLDER ADULTS WITH AND WITHOUT TYPE 2 DIABETES. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Type II diabetes mellitus (T2DM) is linked to impairments in the interconnecting and interacting components (e.g., cognitive-motor demand) essential for standing postural control. The temporal dynamics of postural sway are complex, thus higher complexity reflects the system’s capacity to adapt to cognitive-motor demands. We aimed to characterize the effects of T2DM on postural sway complexity during visual search tasks (VST). Twenty-four older adults without T2DM (OA) (age=67–93 years) and 20 older adults with T2DM (age=70–90 years) performed multiple trials of quiet standing with and without a VST. The VST consisted of low difficulty (LD) (i.e., counting the frequency of one designated letter in a random grid of letters) and high difficulty (HD) (i.e., counting two different letters). The complexity of the postural sway acceleration signals in the anterior-posterior (AP) and medial-lateral (ML) directions were quantified using multiscale entropy. Across participants, matched-pairs analyses revealed that both AP and ML sway complexity increased during the LD condition, compared to control (p < 0.007). During HD, only the AP sway complexity increased, compared to control (p=0.0001). Within the OA, both AP and ML sway complexity increased during the LD condition (p < 0.009), while performance of the HD task showed an increase in AP sway complexity compared to control (p=0.0002). Within the T2DM, AP sway complexity increased only during LD, compared to control (p=0.03). The multi-scale dynamics of postural control when standing while performing VSTs differ among older adults with and without T2DM, reflected by diminished capacity to increase complexity during the visual search conditions.
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Affiliation(s)
- Kellyn Jason
- University of Massachusetts Boston , Boston, Massachusetts , United States
| | - Junhong Zhou
- Harvard Medical School/Hebrew SeniorLife , Roslindale, Massachusetts , United States
| | - Wanting Yu
- Hebrew SeniorLife , Roslindale, Massachusetts , United States
| | - Brad Manor
- Hebrew SeniorLife/Harvard Medical School , Roslindale, Massachusetts , United States
| | - Azizah Jor’dan
- University of Massachusetts , Boston, Massachusetts , United States
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Baniassadi A, Yu W, Day R, Wong A, Travison T, Lipsitz L, Manor B. IMPACT OF HOME AMBIENT TEMPERATURE ON SELF-REPORTED MOOD AND ATTENTION IN COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9767294 DOI: 10.1093/geroni/igac059.3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Many older adults experience variations in daily mood and/or attention. Lab-based studies show that, among other variables, ambient temperature can influence both. The objective of this study was to determine if and how habitual home temperature influences self-reported mood and attention in this population. Methods Ambient temperature and humidity data were collected from the homes of 41 community-dwelling older adults (age=78±7, 35 females) living in Boston from June 1st to Aug 15th. Participants received two time-stamped smartphone-based questionnaires each day to report their mood and attention. Results On average, participants completed 86(±29) questionnaires. Those with most variations in subjective outcomes (top quartile of % of time reporting “feeling down/depressed” or “difficult keeping attention”), compared to the rest of the sample, tended to reside in homes with both higher mean ambient temperature (p=0.01) and greater deviation in temperature over time (p=0.10). Logistic regression analysis combining data from all participants revealed that ambient temperature at the time of response did not predict either self-reported outcome. However, within-subject analyses indicated that of the 17 participants who reported at least some variation in attention or mood, the likelihood of experiencing poor mood and/or attention was correlated with time-synced ambient temperature in six individuals. Gender, age, or housing type (affordable vs. private) did not predict the presence of such associations. Conclusion Variations in self-reported mood and attention are at least partially explained by the home thermal environment in a non-trivial fraction of older adults.
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Affiliation(s)
- Amir Baniassadi
- Harvard Medical School, Boston, Massachusetts, United States
| | - Wanting Yu
- Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | - Ryan Day
- Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, United States
| | - Angel Wong
- Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, United States
| | - Thomas Travison
- Harvard Medical School, Boston, Massachusetts, United States
| | - Lewis Lipsitz
- Hebrew SeniorLife, Brookline, Massachusetts, United States
| | - Brad Manor
- Hebrew SeniorLife/Harvard Medical School, Roslindale, Massachusetts, United States
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24
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Jason K, Zhou J, Yu W, Manor B, Jor’dan A. EFFECTS OF REMOVING VISUAL INPUTS ON POSTURAL SWAY COMPLEXITY IN YOUNG ADULTS AND OLDER ADULTS WITH AND WITHOUT T2D. Innov Aging 2022. [PMCID: PMC9766994 DOI: 10.1093/geroni/igac059.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Standing postural control is complex and involves sensory inputs from the visual, vestibular, and somatosensory systems. Postural sway complexity, as often assessed by multiscale entropy, has been linked to the ability of the postural control system to adapt to “stressors,” including the removal of visual inputs. We aimed to determine the effects of removing visual inputs (i.e., eyes closed, EC) on postural sway complexity in young adults (YA), and older adults (OA) with and without type 2 diabetes mellitus (T2DM). Twenty-five YA (age=21–30 years), 25 OA (age=70–90 years), and 19 T2DM (age=67–93 years) stood for 30 seconds under two conditions – eyes open (EO), and EC for three trials. Postural sway acceleration was measured in the medial-lateral (ML) and anterior-posterior (AP) direction during EO and EC conditions. Sway complexity was quantified using multi-scale entropy. The YA group had a significant reduction in ML and AP sway complexity during EC when compared to EO (p=0.04 and p < 0.001, respectively). Though not significant, the OA group exhibited a trend towards increased ML sway complexity during EC compared to EO standing (p=0.07). No significant changes in AP sway complexity were observed in OA or T2DM, or in ML sway complexity in T2DM. The dynamics of postural control differ between YA, OA, and T2DM groups. There was a significant difference in postural sway complexity between the EO and EC among YA, with no differences in OA and T2DM between conditions. The lack of change suggests maladaptation to stressors, such as vision loss.
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Affiliation(s)
- Kellyn Jason
- University of Massachusetts Boston, Boston, Massachusetts, United States
| | - Junhong Zhou
- Harvard Medical School/Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | - Wanting Yu
- Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | - Brad Manor
- Hebrew SeniorLife/Harvard Medical School, Roslindale, Massachusetts, United States
| | - Azizah Jor’dan
- University of Massachusetts, Boston, Massachusetts, United States
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25
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Wolfe A, You T, Leveille S, Manor B, Jor’dan A. THE EFFECTS OF TYPE 2 DIABETES MELLITUS ON POSTURAL ADAPTATION DURING A VISUAL SEARCH TASK IN OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9766677 DOI: 10.1093/geroni/igac059.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Type II diabetes mellitus (T2DM) is associated with a reduction in sensory integration capacity that often results in cognition and postural control deficits. The effects of T2DM on the ability to adapt one’s postural sway while standing and performing a visual search task (VST) are unknown. Twenty-three healthy older adults (HOA) (70–90 years) and 20 older adults with T2DM (67–93 years) performed multiple trials of quiet standing with and without a VST (i.e., counting 1 target letter in a grid of random letters). Postural sway acceleration measures were jerk, velocity, range, and pathlength in the anterior-posterior (AP) and medial-lateral (ML) direction, as well as elliptical area. Postural adaptation to the VST was defined as the absolute change between conditions. VST accuracy (%) was defined as the percentage of participant-reported target letters compared to total target letters. In general, for both groups, performing the VST resulted in an average reduction in sway jerk, velocity, pathlength, and range when performing the VST, compared to control (T2DM & HOA, p < 0.04). VST accuracy and the magnitude of postural adaptation to the VST were similar between groups (p>0.15). Within the T2DM group, those who performed worse on the VST exhibited less adaptation (i.e., smaller decrease) in ML velocity (r=0.47, p=0.04). No other differences or associations were observed. Compared to healthy older adults, those with T2DM demonstrated a similar capacity to adapt their postural control in response to a VST. However, this group exhibited different characteristic changes in sway which were linked to task performance.
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Affiliation(s)
- Alexander Wolfe
- University of Massachusetts Boston, Dorchester, Massachusetts, United States
| | - Tongjian You
- University of Massachusetts Boston, Boston, Massachusetts, United States
| | - Suzanne Leveille
- University of Massachusetts Boston, Boston, Massachusetts, United States
| | - Brad Manor
- Hebrew SeniorLife/Harvard Medical School, Roslindale, Massachusetts, United States
| | - Azizah Jor’dan
- University of Massachusetts, Boston, Massachusetts, United States
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26
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Sayig-Keren RM, Dagan M, Cornejo Thumm P, Brozgol M, Gazit E, Manor B, Hausdorff JM. The Potential of Transcranial Alternating Current Stimulation to Alleviate Dual-Task Gait Costs in Older Adults: Insights from a Double-Blinded Pilot Study. Gerontology 2022; 69:513-518. [PMID: 36470231 PMCID: PMC10073237 DOI: 10.1159/000527171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/04/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND The performance of an attention-demanding task while walking, i.e., dual-tasking, leads to dual-task costs (e.g., reduced gait speed) in older adults. Previous studies have shown that dual-task costs in gait are associated with future falls and cognitive decline. According to the communication through coherence hypothesis, transcranial alternating current stimulation (tACS) might help alleviate this problem. OBJECTIVE The aim of this study was to examine the effects of a single session of theta-tACS targeting the left fronto-parietal network (L-FPN) on dual-task walking and cognitive function compared to sham stimulation and transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex, a node within the L-FPN. METHODS Twenty older adults completed a four-visit, double-blinded, within-subject, cross-over study in which usual-walking, dual-task walking, and cognitive function were evaluated before and immediately after 20 min of tACS, tDCS, or sham (order randomized) stimulation. Dual-task costs to gait speed (primary outcome) and other measures were analyzed. RESULTS The dual-task cost to gait speed tended to be lower (i.e., better) after tACS (p = 0.067, Cohen's d = 0.433∼small); tDCS significantly reduced this dual-task cost (p = 0.012, Cohen's d = 0.618∼medium), and sham stimulation had no effect (p = 0.467). tACS significantly reduced the dual-task cost to step length (p = 0.037, Cohen's d = 0.502∼medium); a trend was seen after tDCS (p = 0.069, Cohen's d = 0.443∼small). No statistical differences were found for other measures of gait or cognitive function. CONCLUSIONS The positive effects of tACS on dual-task gait speed and step length were roughly similar to those seen with tDCS. These results suggest that tACS affects the fronto-parietal network and, similar to tDCS, tACS may improve dual-tasking. Nonetheless, to achieve larger benefits and differentiate the effects of tACS and tDCS on brain function and dual-task walking in older adults, other stimulation montages and protocols should be tested.
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Affiliation(s)
- Rony M Sayig-Keren
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Moria Dagan
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Cornejo Thumm
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marina Brozgol
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Physical Therapy, Sacker School of Medicine, Tel Aviv, Israel
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27
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Kahya M, Gouskova NA, Lo OY, Zhou J, Cappon D, Finnerty E, Pascual-Leone A, Lipsitz LA, Hausdorff JM, Manor B. Brain activity during dual-task standing in older adults. J Neuroeng Rehabil 2022; 19:123. [PMID: 36369027 PMCID: PMC9652829 DOI: 10.1186/s12984-022-01095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background In older adults, the extent to which performing a cognitive task when standing diminishes postural control is predictive of future falls and cognitive decline. The neurophysiology of such “dual-tasking” and its effect on postural control (i.e., dual-task cost) in older adults are poorly understood. The purpose of this study was to use electroencephalography (EEG) to examine the effects of dual-tasking when standing on brain activity in older adults. We hypothesized that compared to single-task “quiet” standing, dual-task standing would decrease alpha power, which has been linked to decreased motor inhibition, as well as increase the ratio of theta to beta power, which has been linked to increased attentional control. Methods Thirty older adults without overt disease completed four separate visits. Postural sway together with EEG (32-channels) were recorded during trials of standing with and without a concurrent verbalized serial subtraction dual-task. Postural control was measured by average sway area, velocity, and path length. EEG metrics included absolute alpha-, theta-, and beta-band powers as well as theta/beta power ratio, within six demarcated regions-of-interest: the left and right anterior, central, and posterior regions of the brain. Results Most EEG metrics demonstrated moderate-to-high between-day test–retest reliability (intra-class correlation coefficients > 0.70). Compared with quiet standing, dual-tasking decreased alpha-band power particularly in the central regions bilaterally (p = 0.002) and increased theta/beta power ratio in the anterior regions bilaterally (p < 0.001). A greater increase in theta/beta ratio from quiet standing to dual-tasking in numerous demarcated brain regions correlated with greater dual-task cost (i.e., absolute increase, indicative of worse performance) to postural sway metrics (r = 0.45–0.56, p < 0.01). Lastly, participants who exhibited greater alpha power during dual-tasking in the anterior-right (r = 0.52, p < 0.01) and central-right (r = 0.48, p < 0.01) regions had greater postural sway velocity during dual-tasking. Conclusion In healthy older adults, alpha power and theta/beta power ratio change with dual-task standing. The change in theta/beta power ratio in particular may be related to the ability to regulate standing postural control when simultaneously performing unrelated, attention-demanding cognitive tasks. Modulation of brain oscillatory activity might therefore be a novel target to minimize dual-task cost in older adults.
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Hsu CL, Manor B, Iloputaife I, Oddsson LIE, Lipsitz L. Six month lower-leg mechanical tactile sensory stimulation alters functional network connectivity associated with improved gait in older adults with peripheral neuropathy – A pilot study. Front Aging Neurosci 2022; 14:1027242. [PMID: 36408098 PMCID: PMC9669982 DOI: 10.3389/fnagi.2022.1027242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. Walkasins, a lower-limb sensory prosthesis, has been shown to improve gait and mobility in people with PN by providing afferent input related to foot sole pressure distributions via lower-leg mechanical tactile stimulation. Given that gait and mobility are regulated by sensorimotor and cognitive brain networks, it is plausible improvements in gait and mobility from wearing the Walkasins may be associated with elicited neuroplastic changes in the brain. As such, this study aimed to examine changes in brain network connectivity after 26 weeks of daily use of the prosthesis among individuals with diagnosed PN and balance problems. In this exploratory investigation, assessments of participant characteristics, Functional Gait Assessment (FGA), and resting-state functional magnetic resonance imaging were completed at study baseline and 26 weeks follow-up. We found that among those who have completed the study (N = 8; mean age 73.7 years) we observed a five-point improvement in FGA performance as well as significant changes in network connectivity over the 26 weeks that were correlated with improved FGA performance. Specifically, greater improvement in FGA score over 26 weeks was associated with increased connectivity within the Default Mode Network (DMN; p < 0.01), the Somatosensory Network (SMN; p < 0.01), and the Frontoparietal Network (FPN; p < 0.01). FGA improvement was also correlated with increased connectivity between the DMN and the FPN (p < 0.01), and decreased connectivity between the SMN and both the FPN (p < 0.01) and cerebellum (p < 0.01). These findings suggest that 26 weeks of daily use of the Walkasins device may provide beneficial neural modulatory changes in brain network connectivity via the sensory replacement stimulation that are relevant to gait improvements among older adults with PN.
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Affiliation(s)
- Chun Liang Hsu
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Roslindale, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Chun Liang Hsu,
| | - Brad Manor
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Roslindale, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ikechkwu Iloputaife
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Roslindale, MA, United States
| | - Lars I. E. Oddsson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- RxFunction Inc., Eden Prairie, MN, United States
| | - Lewis Lipsitz
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Roslindale, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
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DuMontier C, Jaung T, Bahl NE, Manor B, Testa M, Dieli-Conwright CM, Kim D, Hshieh T, Driver JA, Abel GA. Virtual frailty assessment for older adults with hematologic malignancies. Blood Adv 2022; 6:5360-5363. [PMID: 35616435 PMCID: PMC9631705 DOI: 10.1182/bloodadvances.2022007188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clark DuMontier
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
| | - Tim Jaung
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Brad Manor
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Marcia Testa
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA; and
| | - Christina M. Dieli-Conwright
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Dae Kim
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Tammy Hshieh
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
- Dana-Farber Cancer Institute, and
| | - Jane A. Driver
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
- Geriatrics and Extended Care, VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, MA
| | - Gregory A. Abel
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA
- Dana-Farber Cancer Institute, and
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Oddsson LIE, Bisson T, Cohen HS, Iloputaife I, Jacobs L, Kung D, Lipsitz LA, Manor B, McCracken P, Rumsey Y, Wrisley DM, Koehler-McNicholas SR. Extended effects of a wearable sensory prosthesis on gait, balance function and falls after 26 weeks of use in persons with peripheral neuropathy and high fall risk—The walk2Wellness trial. Front Aging Neurosci 2022; 14:931048. [PMID: 36204554 PMCID: PMC9531134 DOI: 10.3389/fnagi.2022.931048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/23/2022] [Indexed: 01/14/2023] Open
Abstract
Background We recently reported that individuals with impaired plantar sensation and high fall risk due to sensory peripheral neuropathy (PN) improved gait and balance function following 10 weeks of use of Walkasins®, a wearable lower limb sensory prosthesis that provides directional specific mechanical tactile stimuli related to plantar pressure measurements during standing and walking (RxFunction Inc., Eden Prairie, MN, United States). Here, we report 26-week outcomes and compare pre- and in-study fall rates. We expected improvements in outcomes and reduced fall rates reported after 10 weeks of use to be sustained. Materials and methods Participants had clinically diagnosed PN with impaired plantar sensation, high fall risk (Functional Gait Assessment, FGA score < 23) and ability to sense tactile stimuli above the ankle at the location of the device. Additional outcomes included 10 m Gait Speed, Timed Up and Go (TUG), Four-Stage Balance Test, and self-reported outcomes, including Activities-Specific Balance Confidence scale and Vestibular Disorders Activities of Daily Living Scale. Participants tracked falls using a calendar. Results We assessed falls and self-reported outcomes from 44 individuals after 26 weeks of device use; 30 of them conducted in-person testing of clinical outcomes. Overall, improvements in clinical outcomes seen at 10 weeks of use remained sustained at 26 weeks with statistically significant increases compared to baseline seen in FGA scores (from 15.0 to 19.2), self-selected gait speed (from 0.89 to 0.97 m/s), and 4-Stage Balance Test (from 25.6 to 28.4 s), indicating a decrease in fall risk. Non-significant improvements were observed in TUG and fast gait speed. Overall, 39 falls were reported; 31 of them did not require medical treatment and four caused severe injury. Participants who reported falls over 6 months prior to the study had a 43% decrease in fall rate during the study as compared to self-report 6-month pre-study (11.8 vs. 6.7 falls/1000 patient days, respectively, p < 0.004), similar to the 46% decrease reported after 10 weeks of use. Conclusion A wearable sensory prosthesis can improve outcomes of gait and balance function and substantially decreases incidence of falls during long-term use. The sustained long-term benefits in clinical outcomes reported here lessen the likelihood that improvements are placebo effects. Clinical trial registration ClinicalTrials.gov, identifier #NCT03538756.
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Affiliation(s)
- Lars I. E. Oddsson
- RxFunction Inc., Eden Prairie, MN, United States
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Recanati School for Community Health Professions, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
- *Correspondence: Lars I. E. Oddsson,
| | - Teresa Bisson
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- M Health Fairview, Minneapolis, MN, United States
| | | | - Ikechukwu Iloputaife
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
| | - Laura Jacobs
- RxFunction Inc., Eden Prairie, MN, United States
| | - Doris Kung
- Baylor College of Medicine, Houston, TX, United States
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Patricia McCracken
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, United States
| | | | | | - Sara R. Koehler-McNicholas
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, United States
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Grabowska W, Burton W, Kowalski MH, Vining R, Long CR, Lisi A, Hausdorff JM, Manor B, Muñoz-Vergara D, Wayne PM. A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research. BMC Musculoskelet Disord 2022; 23:844. [PMID: 36064383 PMCID: PMC9442928 DOI: 10.1186/s12891-022-05783-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis. CONCLUSION Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.
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Affiliation(s)
- Weronika Grabowska
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Wren Burton
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA.
| | - Matthew H Kowalski
- Osher Clinical Center for Integrative Medicine, Brigham and Women's Healthcare Center, 850 Boylston Street, Suite 422, Chestnut Hill, MA, 02445, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Anthony Lisi
- Yale University Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Dennis Muñoz-Vergara
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
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Hsu CL, Falck RS, Backhouse D, Chan P, Dao E, Ten Brinke LF, Manor B, Liu-Ambrose T. Objective Sleep Quality and the Underlying Functional Neural Correlates Among Older Adults with Possible Mild Cognitive Impairment. J Alzheimers Dis 2022; 89:1473-1482. [PMID: 36057822 DOI: 10.3233/jad-220457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Poor sleep quality is common among older individuals with mild cognitive impairment (MCI) and may be a consequence of functional alterations in the brain; yet few studies have investigated the underlying neural correlates of actigraphy-measured sleep quality in this cohort. OBJECTIVE The objective of this study was to examine the relationship between brain networks and sleep quality measured by actigraphy. METHODS In this cross-sectional analysis, sleep efficiency and sleep fragmentation were estimated using Motionwatch8 (MW8) over a period of 14 days in 36 community-dwelling older adults with possible MCI aged 65-85 years. All 36 participants underwent resting-state functional magnetic resonance imaging (fMRI) scanning. Independent associations between network connectivity and MW8 measures of sleep quality were determined using general linear modeling via FSL. Networks examined included the somatosensory network (SMN), frontoparietal network (FPN), and default mode network (DMN). RESULTS Across the 36 participants (mean age 71.8 years; SD = 5.2 years), mean Montreal Cognitive Assessment score was 22.5 (SD = 2.7) and Mini-Mental State Examination score was 28.3 (SD = 1.5). Mean sleep efficiency and fragmentation index was 80.1% (SD = 10.0) and 31.8 (SD = 10.4) respectively. Higher sleep fragmentation was significantly correlated with increased connectivity between the SMN and insula, the SMN and posterior cingulate, as well as FPN and primary motor area (FDR-corrected, p < 0.004). CONCLUSION Functional connectivity between brain regions involved in attentional and somatosensory processes may be associated with disrupted sleep in older adults with MCI.
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Affiliation(s)
- Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Daniel Backhouse
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Patrick Chan
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Elizabeth Dao
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Lisanne F Ten Brinke
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Zhou R, Zhou J, Xiao Y, Bi J, Biagi MC, Ruffini G, Gouskova NA, Manor B, Liu Y, Lü J, Lo OY. Network-Based Transcranial Direct Current Stimulation May Modulate Gait Variability in Young Healthy Adults. Front Hum Neurosci 2022; 16:877241. [PMID: 35754767 PMCID: PMC9220095 DOI: 10.3389/fnhum.2022.877241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Previous studies have linked gait variability to resting-state functional connectivity between the dorsal attention network (DAN) and the default network (DN) in the brain. The purpose of this study was to examine the effects of a novel transcranial direct current stimulation (tDCS) paradigm designed to simultaneously facilitate the excitability of the DAN and suppress the excitability of the DN (i.e., DAN+/DN-tDCS) on gait variability and other gait characteristics in young healthy adults. Methods In this double-blinded randomized and sham-controlled study, 48 healthy adults aged 22 ± 2 years received one 20-min session of DAN+/DN-tDCS (n = 24) or no stimulation (the Sham group, n = 24). Immediately before and after stimulation, participants completed a gait assessment under three conditions: walking at self-selected speed (i.e., normal walking), walking as fast as possible (i.e., fast walking), and walking while counting backward (i.e., dual-task walking). Primary outcomes included gait stride time variability and gait stride length variability in normal walking conditions. Secondary outcomes include gait stride time and length variability in fast and dual-task conditions, and other gait metrics derived from the three walking conditions. Results Compared to the Sham group, DAN+/DN-tDCS reduced stride length variability in normal and fast walking conditions, double-limb support time variability in fast and dual-task walking conditions, and step width variability in fast walking conditions. In contrast, DAN+/DN-tDCS did not alter average gait speed or the average value of any other gait metrics as compared to the sham group. Conclusion In healthy young adults, a single exposure to tDCS designed to simultaneously modulate DAN and DN excitability reduced gait variability, yet did not alter gait speed or other average gait metrics, when tested just after stimulation. These results suggest that gait variability may be uniquely regulated by these spatially-distinct yet functionally-connected cortical networks. These results warrant additional research on the short- and longer-term effects of this type of network-based tDCS on the cortical control of walking in younger and older populations.
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Affiliation(s)
- Rong Zhou
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Yanwen Xiao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Jiawei Bi
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | | | | | - Natalia A Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Jiaojiao Lü
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
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Affiliation(s)
- On-Yee Lo
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Melike Kahya
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Brad Manor
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Song Q, Sun M, Lewis K, Choi JH, Manor B, Li L. Hoffmann Reflex Measured From Lateral Gastrocnemius Is More Reliable Than From Soleus Among Elderly With Peripheral Neuropathy. Front Aging Neurosci 2022; 14:800698. [PMID: 35360201 PMCID: PMC8963420 DOI: 10.3389/fnagi.2022.800698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/09/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Peripheral neuropathy (PN) affects up to 20% of the population over the age of 60. Hoffmann reflex (H-reflex) may assess PN adaptation by measuring the function of the peripheral neural system and central nervous system (CNS) modulation. This project aimed to find a reliable muscle among triceps surae muscles during standing and walking among the PN population. Materials and Methods Sixteen older adults (> 65 years of age) diagnosed with PN were recruited in this study. The H-reflex test was conducted on the muscle belly of the soleus (SOL), the medial (MG), and lateral gastrocnemius (LG) during standing and walking (heel contact, midstance, and toe-off phases). All measurements were collected on two occasions, separated by at least 7 days. Intraclass correlation coefficients (ICCs) and their confidence intervals (CIs) were used to examine the consistency of the H-reflex outcome variables in the repeated tests for all three tested muscles. Results The ICCs of H-index during standing and the three walking phases were poor to moderate in SOL (0.486∼0.737) and MG (0.221∼0.768), and moderate to high in LG (0.713∼0.871). The ICCs of H/M ratio were poor to moderate in SOL (0.263∼0.702) and MG (0.220∼0.733), and high in LG (0.856∼0.958). Conclusion The H-reflex of LG was more reliable than SOL and MG during standing and walking among older adults with peripheral neuropathy. It is crucial for future studies in this population to study H-reflex of LG, not SOL and MG, for more reliable results.
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Affiliation(s)
- Qipeng Song
- Biomechanics Laboratory, College of Sports and Health, Shandong Sport University, Jinan, China
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, United States
| | - Mengzi Sun
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, United States
- Biomechanics Laboratory, Beijing Sport University, Beijing, China
| | - Kelsey Lewis
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, United States
| | - Jung Hun Choi
- Department of Mechanical Engineering, Georgia Southern University, Statesboro, GA, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Li Li
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, United States
- *Correspondence: Li Li,
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Jor’dan AJ, Bernad-Elazari H, Mirelman A, Gouskova NA, Lo OY, Hausdorff JM, Manor B. Transcranial Direct Current Stimulation May Reduce Prefrontal Recruitment During Dual Task Walking in Functionally Limited Older Adults – A Pilot Study. Front Aging Neurosci 2022; 14:843122. [PMID: 35360209 PMCID: PMC8963782 DOI: 10.3389/fnagi.2022.843122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex (dlPFC) improves dual task walking in older adults, when tested just after stimulation. The acute effects of tDCS on the cortical physiology of walking, however, remains unknown. Methods In a previous study, older adults with slow gait and executive dysfunction completed a dual task walking assessment before and after 20 min of tDCS targeting the left dlPFC or sham stimulation. In a subset of seven participants per group, functional near-infrared spectroscopy (fNIRS) was used to quantify left and right prefrontal recruitment defined as the oxygenated hemoglobin response to usual and dual task walking (ΔHbO2), as well as the absolute change in this metric from usual to dual task conditions (i.e., ΔHbO2cost). Paired t-tests examined pre- to post-stimulation differences in each fNIRS metric within each group. Results The tDCS group exhibited pre- to post-stimulation reduction in left prefrontal ΔHbO2cost (p = 0.03). This mitigation of dual task “cost” to prefrontal recruitment was induced primarily by a reduction in left prefrontal ΔHbO2 specifically within the dual task condition (p = 0.001), an effect that was observed in all seven participants within this group. Sham stimulation did not influence ΔHbO2cost or ΔHbO2 in either walking condition (p > 0.35), and neither tDCS nor sham substantially influenced right prefrontal recruitment (p > 0.16). Discussion This preliminary fNIRS data suggests that tDCS over the left dlPFC may modulate prefrontal recruitment, as reflected by a relative reduction in the oxygen consumption of this brain region in response to dual task walking.
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Affiliation(s)
- Azizah J. Jor’dan
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Azizah J. Jor’dan,
| | - Hagar Bernad-Elazari
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia A. Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Zhou J, Cattaneo G, Yu W, Tormos J, Lipsitz L, Bartres-Faz D, Pascual-Leone A, Manor B. Effects of Age on Dual Task Walking Performance as Measured Using a Smartphone Application in Middle-Aged Adults. Innov Aging 2021. [PMCID: PMC8682437 DOI: 10.1093/geroni/igab046.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
After the age of 65, one’s ability to walk while performing an additional cognitive task (i.e., dual-tasking) is predictive of both future falls and cognitive decline. However, while it is well-known that older adults exhibit diminished dual-task performance, the time course of age-related dual-task decline has not been established. We thus conducted an analysis of data collected within the ongoing Barcelona Brain Health Initiative, a prospective population-based study characterizing the determinants of brain health maintenance in middle-aged adults. Cognitively-unimpaired participants (n=655) aged 40-65 years without neuro-psychiatric disease completed laboratory-based trials of walking normally (single-task) and walking while performing a verbalized serial subtraction task (dual-task). A smartphone-based gait assessment application was used to capture data and derive both the mean stride time (ST) and stride time variability (STV, defined as the coefficient of variation about the mean stride time) of each trial. The dual-task costs (DTC) to each gait metric were obtained by calculating the percent change from single- to dual-task conditions. We categorized participants into five groups according to age (e.g. Group 1: 40-45 years; Group 5: 60-65 years). Age group did not have an effect on single-task gait outcomes (p>0.51). However, the oldest age group, as compared to each of the other groups, exhibited greater DTC to both ST and STV (p<0.03). These results indicate that dual-task walking performance in particular may begin to diminish in late middle age even in the absence of detectable cognitive issues, DTC may offer a sensitive metric to age-related change in cognitive function.
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Affiliation(s)
- Junhong Zhou
- Harvard Medical School/Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | | | - Wanting Yu
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | - Jose Tormos
- University of Barcelona, Barcelona, Catalonia, Spain
| | - Lewis Lipsitz
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | | | | | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
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Hsu CL, Iloputaife I, Oddsson L, Manor B, Lipsitz L. Six-Month Lower-Leg Sensory Stimulation Augments Neural Network Connectivity Associated With Improved Gait. Innov Aging 2021. [PMCID: PMC8682339 DOI: 10.1093/geroni/igab046.3439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. A lower-limb sensory prosthesis providing afferent input related to foot sole pressure distributions via lower-leg vibrotactile stimulation has been demonstrated to improve gait in people with PN. The effects of this device on brain function related to motor control, however, remains equivocal. This study aimed to explore changes in brain network connectivity after six months of daily use of the prosthesis among individuals with diagnosed PN and balance problems. Functional Gait Assessment (FGA) and resting-state functional magnetic resonance imaging were completed before and after the intervention. Preliminary analysis on participants who have completed the study to date (N=5; mean age 76 years) indicated altered connectivity of the sensorimotor network (SMN), frontoparietal network (FPN), and the default mode network (DMN) post-intervention (Z>3.11, unadjusted p<0.05). Participants displayed an average improvement of 5.5 point in the FGA (Minimal Clinically Important Differences>4 for community-dwelling older adults) that was correlated with connectivity changes (unadjusted p<0.05). Specifically, improved FGA was associated with: 1) increased connectivity between the SMN, cerebellum, and occipital cortex; 2) increased connectivity between the FPN, cerebellum, calcarine and intracalcarine; and 3) decreased connectivity between DMN and intracalcarine. These early findings suggest that long-term use of a lower-limb sensory prosthesis may induce neuroplastic changes in brain network connectivity reflecting enhanced bottom-up sensory-attentional processing and suppression of the DMN that are relevant to gait improvements among older adults with PN.
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Affiliation(s)
- Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Burnaby, British Columbia, Canada
| | | | - Lars Oddsson
- RxFunction, Eden Prairie, Minnesota, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
| | - Lewis Lipsitz
- Hebrew SeniorLife, Boston, Massachusetts, United States
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Hsu CL, Falck R, Backhouse D, Chan P, Dao E, ten Brinke L, Manor B, Liu-Ambrose T. Objective Sleep Quality and the Underlying Functional Neural Correlates Among Older Adults With Probable MCI. Innov Aging 2021. [PMCID: PMC8970561 DOI: 10.1093/geroni/igab046.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Poor sleep is a strong risk factor for dementia and is commonly reported among older adults with mild cognitive impairment (MCI). However, the neural underpinnings of poor sleep among older adults with MCI remains equivocal. The goal of this cross-sectional analysis was to explore the relationship between resting-state functional connectivity in the brain and sleep quality as measured by actigraphy. We hypothesize lower sleep efficiency and higher sleep fragmentation may be associated with aberrant functional connectivity of brain regions involved in somatosensory, somatomotor, and attentional processing. Thirty-six community-dwelling older adults with probable MCI between 65-85 years (mean=71.8 years) were assessed for sleep quality using a motion watch to quantify sleep efficiency and fragmentation over 14 days. All participants completed resting-state functional magnetic resonance imaging (fMRI) within 14 days of sleep monitoring. Independent associations between network connectivity and sleep quality were determined using general linear models. Examined networks included the somatosensory network (SMN), dorsal attention network (DAN), ventral attention network (VAN), frontoparietal network (FPN), and default mode network (DMN). Mean Montreal Cognitive Assessment score was 22.5 (SD=2.7) and Mini-Mental State Examination score was 28.3 (SD=1.5). Mean sleep efficiency and fragmentation index was 80.1% and 31.8 respectively. Higher sleep fragmentation correlated with increased connectivity between the SMN and insula, the SMN and posterior cingulate, as well as FPN and primary motor area (Z=3.1; p<0.05). These results suggest aberrant functional connectivity between brain regions involved in attentional and somatosensory processes may be associated with disrupted sleep mechanisms in older adults with MCI.
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Affiliation(s)
- Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Burnaby, British Columbia, Canada
| | - Ryan Falck
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Backhouse
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Dao
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
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Hsu CL, Manor B, Lipsitz L. Gait Speed Maintenance Is Associated With Sensorimotor and Frontoparietal Network Connectivity Among Older Adults. Innov Aging 2021. [PMCID: PMC8680536 DOI: 10.1093/geroni/igab046.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Mobility impairment is a geriatric giant. Particularly, slow gait is associated with elevated risk for cognitive decline, disabilities and dementia. Gait is the product of complex neural network interactions and changes in their connectivity pattern may negatively impact gait speed. However, mechanistic neural correlates for gait speed maintenance and decline remained unclear. As such, the aim of this study is to investigate differences in neural network connectivity in older adults with and without gait speed decline over 24 months. This sub-analysis included 35 community-dwelling older adults age >70 years from the MOBILIZE Boston Study. Baseline assessments included four-meter gait speed test and resting-state fMRI. Gait speed was reassessed at a 24-month follow-up. Participants were stratified to “Maintainer” and “Decliner” groups based upon a cut-off of >0.05 m/s decline in gait speed from baseline to follow-up. A priori selected functional network included sensori-motor network (SMN) and frontoparietal network (FPN). Multivariate analysis of variance was performed to determine between group differences in network connectivity. Discriminant analysis was conducted to identify relative contribution of network connectivity to group classification. Between the 14 Maintainers and 21 Decliners (mean age 83.9 years), Maintainers were younger (p=0.088). After adjusting for age, Maintainers exhibited lower SMN premotor-precentral gyrus connectivity (p=0.023), greater FPN ventral visual-supramarginal gyrus connectivity (p=0.025), and trend level greater SMN-FPN cerebellum-occipital connectivity (p=0.053). Premotor-precentral gyrus connectivity showed greatest contribution to discriminant function. These preliminary findings suggest aberrant connectivity patterns of the SMN and FPN may be predictive of older adults’ ability to maintain gait speed.
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Affiliation(s)
- Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Burnaby, British Columbia, Canada
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
| | - Lewis Lipsitz
- Hebrew SeniorLife, Boston, Massachusetts, United States
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Kahya M, Lo OY, Zhou J, Pascual-Leone A, Lipsitz L, Hausdorff J, Michel C, Manor B. The Cortical Dynamics of Dual-Task Standing in Older Adults. Innov Aging 2021. [PMCID: PMC8680815 DOI: 10.1093/geroni/igab046.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In older adults, the extent to which performing a cognitive task when standing diminishes postural control is predictive of future falls and cognitive decline. The cortical control of such “dual-tasking,” however, remains poorly understood. Electroencephalogram (EEG) studies have demonstrated that the level of attention and cognitive inhibitory activity during cognitive task performance can be quantified by changes in brain activity in specific frequency bands; namely, an increase in theta/beta ratio and a decrease in alpha-band power, respectively. We hypothesized that in older adults, dual-tasking would increase theta/beta ratio and decrease alpha-band power, and, that greater alpha-band power during quiet standing would predict worse dual-task performance. To test this hypothesis, we recorded postural sway and EEG (32-channels) in 30 older adults without overt disease as they completed trials of standing, with and without verbalized serial subtractions, on four separate visits. Postural sway speed, as well as absolute theta/beta power ratio and alpha-band power, were calculated. The theta/beta power ratio and alpha-band power demonstrated high test-retest reliability during quiet and dual-task standing across visits (intra-class correlation coefficients >0.70). Compared with quiet standing, dual-tasking increased theta/beta power ratio (p<0.0001) and decreased alpha-band power (p=0.002). Participants who exhibited greater alpha-band power during quiet standing demonstrated a greater dual-task cost (i.e., percent increase, indicative of worse performance) to postural sway speed (r=0.3, p=0.01). These results suggest that in older adults, dual-tasking while standing increases EEG-derived metrics related to attention, and, that greater cognitive inhibitory activity during quiet standing is associated with worse dual-task standing performance.
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Affiliation(s)
- Melike Kahya
- Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
| | - On-Yee Lo
- Hebrew SeniorLife/Harvard Medical School, Boston, Massachusetts, United States
| | - Junhong Zhou
- Harvard Medical School/Hebrew SeniorLife, Roslindale, Massachusetts, United States
| | | | - Lewis Lipsitz
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | | | | | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
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Lo OY(A, Mulvey C, Lee C, Gagnon M, Lipsitz L, Manor B. Feasibility of combining noninvasive brain stimulation and personalized counseling to increase physical activity. Innov Aging 2021. [PMCID: PMC8682079 DOI: 10.1093/geroni/igab046.3698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Few older adults meet recommended physical activity guidelines. Behavioral interventions may be more effective when combined with other modalities to promote activity. Transcranial direct current stimulation (tDCS) designed to increase the excitability of the left dorsolateral prefrontal cortex (dlPFC) — a brain region subserving motivation and executive function — has the potential to augment behavioral interventions. We designed a randomized, double-blinded trial to examine the feasibility of combining personalized behavioral counseling and tDCS targeting the left dlPFC to improve physical activity and related outcomes in sedentary older adults living within the supportive housing. Participants wore a Fit-Bit throughout the study period. Baseline step counts were determined for two weeks, then participants completed four bi-weekly personalized counseling sessions over eight weeks. They were also randomized to receive 10 sessions of tDCS or sham stimulation over the two weeks after the baseline. Physical, cognitive, and patient-reported outcomes were assessed at baseline, after ten brain stimulation sessions, and after four behavioral sessions. 33 individuals were screened and 16 enrolled (age=80±7, 13 females). 13 participants completed the study, including 100% of study assessments, 99±5% of brain stimulation sessions, and 98±7% of behavioral sessions. Fit-Bit adherence rate was 93±13%. Daily step counts were 3197±1480 at baseline and 4722±2553 over the last two weeks of the intervention. While the study is ongoing and blinded, these preliminary results indicate that it is feasible to conduct a controlled study of tDCS combined with personalized behavioral counseling to increase physical activity in sedentary older adults living within supportive housing.
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Affiliation(s)
- On-Yee (Amy) Lo
- Hebrew SeniorLife/Harvard Medical School, Boston, Massachusetts, United States
| | - Connor Mulvey
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | - Christine Lee
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | | | - Lewis Lipsitz
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
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Baniassadi A, Manor B, Yu W, Lipsitz L, Pascual-Leone A. A Platform to Study the Effects of Home Environment on Health and Wellbeing of Older Adults. Innov Aging 2021. [PMCID: PMC8682721 DOI: 10.1093/geroni/igab046.3453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Abstract
While older adults’ living environment is rarely well-tuned to their specific needs, technological advances provide new opportunities to understand, and ultimately optimize, the relationship between the home environment and health outcomes. We aimed to establish proof-of-concept and feasibility of a platform enabling real-time, high-frequency, and simultaneous monitoring of environment, biological variables, and outcomes related to health and wellbeing in older adults. We recruited 7 participants (6 females, 1 male, aged 78-90, MoCA scores 14–28), installed environmental sensors measuring temperature, humidity, and CO2 inside their homes, provided them with wearables that measure sleep, activity, body temperature, and heart rhythms, and asked them to use a tablet to complete four sets of questionnaires and cognitive tests per day for three consecutive weeks. Environmental sensors collected data with no disruption or complaint from participants. Average compliance with the wearables was 81% (ring) and 60% (watch). All participants preferred the ring due to ease-of-use. Compliance was better in those with higher MoCA scores. Three participants were able to use the tablet successfully and completed 90% of prescribed questionnaires and cognitive tests. Cognitive and/or motor issues prevented the other participants from using the tablet. Exit interviews revealed that participants would prefer to complete a maximum of two sets of daily questionnaires and cognitive tests (five minutes each) in longer-term studies. These results suggest that it is feasible to study the impact of the environment on biological rhythms, cognition, and other outcomes in older adults and provide recommendations for ensuring long-term compliance with the protocol.
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Affiliation(s)
- Amir Baniassadi
- Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, United States
| | - Brad Manor
- Harvard Medical School, Boston, Massachusetts, United States
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
| | - Lewis Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, United States
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Cai Y, Hausdorff JM, Bean JF, Manor B, You T, Leveille SG. Participation in cognitive activities is associated with foot reaction time and gait speed in older adults. Aging Clin Exp Res 2021; 33:3191-3198. [PMID: 32415668 PMCID: PMC9514892 DOI: 10.1007/s40520-020-01583-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Given the evidence of the links between cognition and mobility, participation in cognitive activities may benefit neuromotor performance and mobility in older adults. AIMS To examine the association between participation in cognitive activities and foot reaction time (RT) and gait speed in community-dwelling older adults. METHODS The MOBILIZE Boston Study II (MBSII) re-enrolled 354 community-dwelling older adults aged ≥ 70 years from the original MBS cohort. Of these, 310 completed the performance testing and we excluded three participants who had Parkinson's disease. Cognitive Activities Scale (CAS) assessed participation in 17 cognitive activities. Simple and Choice foot RT (SRT, CRT, msec) and gait speed (m/s) were measured using a sensored GAITRite® gait mat. RESULTS The average age of the 307 participants was 84 years; 79% were white and 65% were women. The average CAS score was 25.5 ± 11.7, indicating participation in approximately 26 activities per week on average. The average foot SRT was 245 ± 57msec and average CRT was 323 ± 85msec. Usual-paced gait speed was 0.9 ± 0.3 m/s on average. More frequent participation in cognitive activities was associated with shorter SRT (β = - 0.759, p = 0.015) and CRT (β = - 1.125, p = 0.013), and faster gait speed (β = 0.003, p = 0.026), after adjusting for potential confounders. DISCUSSION Participation in cognitively stimulating activities may be beneficial for neuromotor performance and mobility in older adults. CONCLUSIONS Prospective and intervention studies are needed to determine whether participation in cognitive activities may prevent mobility decline over time, and thus reduce fall risk.
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Affiliation(s)
- Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Rush Alzheimer’s Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center; Chicago, II
| | - Jonathan F. Bean
- New England Geriatric, Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA,Spaulding Rehabilitation Hospital, Boston, MA
| | - Brad Manor
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA,Department of Medicine, Harvard Medical School, Boston, MA,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Tongjian You
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA
| | - Suzanne G. Leveille
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA,Department of Medicine, Harvard Medical School, Boston, MA
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Acker L, Ha C, Zhou J, Manor B, Giattino CM, Roberts K, Berger M, Wright MC, Colon-Emeric C, Devinney M, Au S, Woldorff MG, Lipsitz LA, Whitson HE. Electroencephalogram-Based Complexity Measures as Predictors of Post-operative Neurocognitive Dysfunction. Front Syst Neurosci 2021; 15:718769. [PMID: 34858144 PMCID: PMC8631543 DOI: 10.3389/fnsys.2021.718769] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to the interaction of multiple control processes operating over different time scales. The complexity of this behavior can be quantified using multi-scale entropy (MSE). High physiologic complexity denotes health, and a loss of complexity can predict adverse outcomes. Since postoperative delirium is particularly hard to predict, we investigated whether the complexity of preoperative and intraoperative frontal EEG signals could predict postoperative delirium and its endophenotype, inattention. To calculate MSE, the sample entropy of EEG recordings was computed at different time scales, then plotted against scale; complexity is the total area under the curve. MSE of frontal EEG recordings was computed in 50 patients ≥ age 60 before and during surgery. Average MSE was higher intra-operatively than pre-operatively (p = 0.0003). However, intraoperative EEG MSE was lower than preoperative MSE at smaller scales, but higher at larger scales (interaction p < 0.001), creating a crossover point where, by definition, preoperative, and intraoperative MSE curves met. Overall, EEG complexity was not associated with delirium or attention. In 42/50 patients with single crossover points, the scale at which the intraoperative and preoperative entropy curves crossed showed an inverse relationship with delirium-severity score change (Spearman ρ = -0.31, p = 0.054). Thus, average EEG complexity increases intra-operatively in older adults, but is scale dependent. The scale at which preoperative and intraoperative complexity is equal (i.e., the crossover point) may predict delirium. Future studies should assess whether the crossover point represents changes in neural control mechanisms that predispose patients to postoperative delirium.
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Affiliation(s)
- Leah Acker
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
| | - Christine Ha
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life and Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life and Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Charles M Giattino
- Center for Cognitive Neuroscience, Duke University, Durham, NC, United States
| | - Ken Roberts
- Center for Cognitive Neuroscience, Duke University, Durham, NC, United States
| | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
- Center for Cognitive Neuroscience, Duke University, Durham, NC, United States
| | - Mary Cooter Wright
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Cathleen Colon-Emeric
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Michael Devinney
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Sandra Au
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
| | - Marty G Woldorff
- Center for Cognitive Neuroscience, Duke University, Durham, NC, United States
- Department of Psychiatry, Duke University, Durham, NC, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life and Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Heather E Whitson
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
- Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, United States
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Bahl NE, Magnavita ES, Hshieh T, Testa M, Kim D, Manor B, Driver JA, Abel GA, DuMontier C. Objective performance tests of cognition and physical function as part of a virtual geriatric assessment. J Geriatr Oncol 2021; 12:1256-1258. [PMID: 33795206 PMCID: PMC8478966 DOI: 10.1016/j.jgo.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Nupur E Bahl
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Emily S Magnavita
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Tammy Hshieh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America; Division of Aging, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Marcia Testa
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Dae Kim
- Harvard Medical School, Boston, MA, United States of America; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America; Gerontology Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Brad Manor
- Harvard Medical School, Boston, MA, United States of America; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America; Gerontology Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Jane A Driver
- Division of Aging, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, United States of America
| | - Gregory A Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Clark DuMontier
- Division of Aging, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America.
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Salvador R, Biagi MC, Manor B, Ruffini G. Group level montage optimization in transcranial electrical stimulation. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lo OY, Halko MA, Devaney KJ, Wayne PM, Lipsitz LA, Manor B. Gait Variability Is Associated With the Strength of Functional Connectivity Between the Default and Dorsal Attention Brain Networks: Evidence From Multiple Cohorts. J Gerontol A Biol Sci Med Sci 2021; 76:e328-e334. [PMID: 34244725 PMCID: PMC8436983 DOI: 10.1093/gerona/glab200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In older adults, elevated gait variability when walking has been associated with both cognitive impairment and future falls. This study leveraged 3 existing data sets to determine relationships between gait variability and the strength of functional connectivity within and between large-scale brain networks in healthy older adults, those with mild-to-moderate functional impairment, and those with Parkinson's disease (PD). METHOD Gait and resting-state functional magnetic resonance imaging data were extracted from existing data sets on: (i) 12 older adults without overt disease yet with slow gait and mild executive dysfunction; (ii) 12 older adults with intact cognitive-motor function and age- and sex-matched to the first cohort; and (iii) 15 individuals with PD. Gait variability (%, coefficient of variation of stride time) during preferred walking speed was measured and correlated with the degree of functional connectivity within and between 7 established large-scale functional brain networks. RESULTS Regression models adjusted for age and sex revealed that in each cohort, those with less gait variability exhibited greater negative correlation between fluctuations in resting-state brain activity between the default network and the dorsal attention network (functionally limited older: β = 4.38, p = .027; healthy older: β = 1.66, p = .032; PD: β = 1.65, p = .005). No other within- or between-network connectivity outcomes were consistently related to gait variability across all 3 cohorts. CONCLUSION These results provide strong evidence that gait variability is uniquely related to functional connectivity between the default network and the dorsal attention network, and that this relationship may be independent of both functional status and underlying brain disease.
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Affiliation(s)
- On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: On-Yee Lo, PhD, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Harvard Medical School, 1200 Centre St., Boston, MA 02131, USA. E-mail:
| | - Mark A Halko
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Kathryn J Devaney
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Peter M Wayne
- Harvard Medical School, Boston, Massachusetts, USA
- Osher Center for Integrative Medicine, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Manor B, Dagan M, Herman T, Gouskova NA, Vanderhorst VG, Giladi N, Travison TG, Pascual-Leone A, Lipsitz LA, Hausdorff JM. Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial. Mov Disord 2021; 36:2693-2698. [PMID: 34406695 DOI: 10.1002/mds.28759] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatments of freezing of gait (FOG) in Parkinson's disease are suboptimal. OBJECTIVE The aim of this study was to evaluate the effects of multiple sessions of transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex and primary motor cortex (M1) on FOG. METHODS Seventy-seven individuals with Parkinson's disease and FOG were enrolled in a double-blinded randomized trial. tDCS and sham interventions comprised 10 sessions over 2 weeks followed by five once-weekly sessions. FOG-provoking test performance (primary outcome), functional outcomes, and self-reported FOG severity were assessed. RESULTS Primary analyses demonstrated no advantage for tDCS in the FOG-provoking test. In secondary analyses, tDCS, compared with sham, decreased self-reported FOG severity and increased daily living step counts. Among individuals with mild-to-moderate FOG severity, tDCS improved FOG-provoking test time and self-report of FOG. CONCLUSIONS Multisession tDCS targeting the left dorsolateral prefrontal cortex and M1 did not improve laboratory-based FOG-provoking test performance. Improvements observed in participants with mild-to-moderate FOG severity warrant further investigation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Moria Dagan
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Natalia A Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Veronique G Vanderhorst
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nir Giladi
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Tel Aviv University, Tel Aviv, Israel
| | - Thomas G Travison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Guttman Brain Health Institute, Institut Guttmann de Neurorehabilitació, Barcelona, Spain.,Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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50
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Zhou J, Manor B, Yu W, Lo OY, Gouskova N, Salvador R, Katz R, Cornejo Thumm P, Brozgol M, Ruffini G, Pascual-Leone A, Lipsitz LA, Hausdorff JM. Targeted tDCS Mitigates Dual-Task Costs to Gait and Balance in Older Adults. Ann Neurol 2021; 90:428-439. [PMID: 34216034 DOI: 10.1002/ana.26156] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Among older adults, the ability to stand or walk while performing cognitive tasks (ie, dual-tasking) requires coordinated activation of several brain networks. In this multicenter, double-blinded, randomized, and sham-controlled study, we examined the effects of modulating the excitability of the left dorsolateral prefrontal cortex (L-DLPFC) and the primary sensorimotor cortex (SM1) on dual-task performance "costs" to standing and walking. METHODS Fifty-seven older adults without overt illness or disease completed 4 separate study visits during which they received 20 minutes of transcranial direct current stimulation (tDCS) optimized to facilitate the excitability of the L-DLPFC and SM1 simultaneously, or each region separately, or neither region (sham). Before and immediately after stimulation, participants completed a dual-task paradigm in which they were asked to stand and walk with and without concurrent performance of a serial-subtraction task. RESULTS tDCS simultaneously targeting the L-DLPFC and SM1, as well as tDCS targeting the L-DLPFC alone, mitigated dual-task costs to standing and walking to a greater extent than tDCS targeting SM1 alone or sham (p < 0.02). Blinding efficacy was excellent and participant subjective belief in the type of stimulation received (real or sham) did not contribute to the observed functional benefits of tDCS. INTERPRETATION These results demonstrate that in older adults, dual-task decrements may be amenable to change and implicate L-DPFC excitability as a modifiable component of the control system that enables dual-task standing and walking. tDCS may be used to improve resilience and the ability of older results to walk and stand under challenging conditions, potentially enhancing everyday functioning and reducing fall risks. ANN NEUROL 2021.
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Affiliation(s)
- Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Natalia Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | | | | | - Pablo Cornejo Thumm
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marina Brozgol
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.,Harvard Medical School, Boston, MA.,Guttman Brain Health Institute, Institut Guttmann de Neurorehabilitació, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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