Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults

Abstract

Background: Performance on complex walking tasks may provide a screen for future cognitive decline. Objective: To identify walking tasks that are most strongly associated with subsequent cognitive decline. Methods: Community-dwelling older adults with Modified Mini-Mental State (3MS) >85 at baseline (n = 223; mean age = 78.7, 52.5% women, 25.6% black) completed usual-pace walking and three complex walking tasks (fast-pace, narrow-path, visuospatial dual-task). Slope of 3MS scores for up to 9 subsequent years (average = 5.2) were used to calculate a cognitive maintainer (slope ≥0) or decliner (slope <0) outcome variable. Logistic regression models assessed associations between gait speeds and being a cognitive decliner. A sensitivity analysis in a subsample of individuals (n = 66) confirmed results with adjudicated mild cognitive impairment (MCI) or dementia at 8–9 years post-walking assessment. Results: Cognitive decliners were 52.5% of the sample and on average were slower for all walking tasks compared to maintainers. In models adjusted for demographic and health variables, faster fast-pace (OR = 0.87 per 0.1 m/s, 95% CI: 0.78, 0.97) and dual-task (OR = 0.84 per 0.1 m/s, 95% CI: 0.73, 0.96) gait speeds were associated with lower likelihood of being a cognitive decliner. Usual-pace gait speed was not associated (OR = 0.96 per 0.1 m/s, 95% CI: 0.85, 1.08). Results were nearly identical in analyses with adjudicated MCI or dementia as the outcome. Conclusion: Fast-pace and dual-task walking may provide simple and effective tools for assessing risk for cognitive decline in older individuals with high cognitive function. Such screening tools are important for strategies to prevent or delay onset of clinically meaningful change.

Effects of Virtual Reality-Based Physical and Cognitive Training on Executive Function and Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Control Trial

“…In addition, dual-task gait performance has been associated with progression to dementia in patients with MCI. Dual-task gait testing may be used by clinicians to assess the risk of cognitive decline (Montero-Odasso et al, 2017; Rosso et al, 2019).…”

Functional Near-Infrared Spectroscopy to Study Cerebral Hemodynamics in Older Adults During Cognitive and Motor Tasks: A Review

“…The PFC has also been implicated in performance of DT (Sala et al, 1995;Dux et al, 2006;Filmer et al, 2013), that are motor tasks performed simultaneously with a secondary, usually a cognitive task. DT increases the cognitive demand of walking and potentially results in a decrease in task performance in one or both tasks relative to when the tasks are performed separately as ST. DT performance assessment may help identify older adults at higher risk of incident cognitive decline (Ceïde et al, 2018;Rosso et al, 2019), disability, frailty and mortality (Verghese et al, 2012). One of the goals of the study of cognitive aging is to elucidate neural mechanisms that underlie the ability of the aging brain to cope with decline in cognitive functions and efficiency.…”

Complex Gait Is Related to Cognitive Functioning in Older People: A Cross-Sectional Study Providing an Innovative Test

“…In particular, walking performance is a strong biomarker of health [10]. Gait speed (GS), gait variability, and step length are the most commonly used measures to predict cognitive decline [11][12][13][14][15]. In this regard, the preferred walking speed in older people is an indicator of general health and survival, and safe walking requires intact cognition and executive control [13].…”

“…Social ambulation requires the ability to adapt walking characteristics to environmental demands [11]. In this regard, performance in daily activities including walking through obstacles, going up a curb, stepping over a crack in the ground, climbing stairs, multi-surface terrains, avoiding domestic or street hazards, avoiding injurious falls, etc., are associated with EF, motor planning, attention to relevant stimuli, and visual and spatial abilities that are essential to successfully negotiate obstacles [15,[17][18][19].…”