Background and Objectives The influence of inter-individual differences on brain activation during obstacle negotiation and the implications for walking performance are poorly understood in older adults. This study investigated the extent to which prefrontal recruitment during obstacle negotiation is explained by differences in age, executive function, and sex. These data were interpreted according to the Compensation Related Utilization of Neural Circuits Hypothesis (CRUNCH) framework of brain aging. We also tested the association between prefrontal recruitment and walking performance. Research Design and Methods Prefrontal oxygenated hemoglobin concentration (O2Hb) was measured during typical walking (Typical) and obstacle negotiation (Obstacles) tasks in fifty older adults aged ≥65 years using functional near-infrared spectroscopy. The primary outcome was change in prefrontal recruitment (∆PFR), measured as Obstacles ∆O2Hb minus Typical ∆O2Hb. Multiple regression was used to test the relationship between ∆PFR and age, executive function measured by the Trail Making Test, and sex. Pearson’s correlation coefficient was used to investigate the association between ∆PFR and the cost of Obstacles walking speed relative to Typical walking. Results Age, executive function, and their interaction significantly predicted greater ∆PFR (R2=0.34, p=0.01). Participants were subgrouped according to age and executive function to examine the interaction effects. Adults of lower age and with lower executive function exhibited greater ∆PFR during Obstacles compared to their peers with higher executive function (p=0.03). Adults of advanced age exhibited a ceiling of prefrontal recruitment during obstacle negotiation, regardless of executive function level (p=0.87). Greater ∆PFR was significantly associated with a smaller cost of Obstacles (r=0.3, p=0.03). Discussion and Implications These findings are consistent with the CRUNCH framework: neural inefficiency where a greater amount of brain activation is needed for task performance at a similar level, compensatory overactivation to prevent a steeper decline in task performance, and capacity limitation with a recruitment ceiling effect. Translational Significance In older adults, the demand on prefrontal/executive resources during walking can be affected by various factors that may alter study results and interpretation. Poor executive function may increase the perceived difficulty of complex walking leading to prefrontal brain overactivation. Older age may contribute to a reduced availability of brain recruitment resources. These factors should be considered when interpreting brain activity data, and when designing intervention studies that seek to target mechanisms of walking dysfunction in older adults.

Objective The present study aimed to determine whether specific cognitive domains part of the Montreal Cognitive Assessment (MoCA) are significantly lower in community-dwelling older adults with chronic pain compared with older adults without pain and whether these domains would be associated with self-reported pain, disability, and somatosensory function. Design Secondary data analysis, cross-sectional. Setting University of Florida. Subjects Individuals over 60 years old enrolled in the Neuromodulatory Examination of Pain and mobility Across the Lifespan (NEPAL) study were included if they completed the MoCA and other study measures (n = 62). Most participants reported pain on most days during the past three months (63%). Methods Subjects underwent a health assessment (HAS) and a quantitative sensory testing (QST) session. Health/medical history, cognitive function and self-reported pain measures were administered during the HAS. Mechanical and thermal detection, and thermal pain thresholds were assessed during the QST session. Results Older adults with chronic pain had lower MoCA scores compared with controls on domains of executive function, attention, memory, and language (P < 0.05). The attention and language domains survived adjustments for age, sex, education, depression, and pain duration (P < 0.05). Attention was significantly associated with all pain characteristics including pain intensity and disability, while executive function was associated with mechanical detection (P < 0.05). Conclusion Our results support previous findings that individuals with chronic pain tend to show poorer cognitive functioning compared with pain-free controls in domains of attention and executive function. Our findings also extend these findings to community-dwelling older adults, who are already most vulnerable to age-related cognitive declines.

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Background Chronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the USA, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions, and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited. The primary aims of the study are to assess the feasibility and acceptability of a psychologically oriented resilience intervention among aging adults with cLBP. Methods In this article, we describe the rationale and design of the Adaptability and Resilience in Aging Adults (ARIAA) study, a single-arm intervention in which 60 participants (ages ≥ 60 years) with cLBP will be recruited to participate in a 7-week group-based program aimed at enhancing psychological resilience. Intervention sessions will target positive psychology concepts (e.g., positive affect, pain acceptance, hopeful thinking, pain self-efficacy) and cognitive behavioral techniques that have established benefits in pain management. Primary study outcomes include intervention feasibility and acceptability as measured by treatment engagement, intervention credibility and satisfaction, ability to meet recruitment and retention metrics, and the feasibility of questionnaire and home activity completion. Outcomes will be assessed at baseline, immediately at posttreatment, and at the 3-month follow-up period. Discussion This study will establish the feasibility and acceptability of a novel intervention aimed at enhancing positive, psychological functioning, and resilience in older adults with cLBP. Achievement of these aims will provide a rich platform for future intervention research targeting improvements in pain and disability among geriatric populations and will serve as a foundation for a fully powered trial to examine treatment efficacy of the proposed intervention. Trial registration Clinicaltrials.gov, identifier NCT04068922. Registered 28 August 2019.