Executive Control Deficits as a Prodrome to Falls in Healthy Older Adults: A Prospective Study Linking Thinking, Walking, and Falling

Herman, Talia; Mirelman, Anat; Giladi, Nir; Schweiger, Avraham; Hausdorff, Jeffrey M.

doi:10.1093/gerona/glq077

Cited by 404 publications

(389 citation statements)

References 47 publications

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“…The decline in performance of either gait or cognitive processing relative to either task performed alone gives evidence that the concurrent tasks compete for attentional resources with aging. Importantly, the dual-task-related changes in gait variability were found to be predictors of falls in older adults (Kressig et al 2008;Herman et al 2010). However, not all studies reported such age-related interference effects in dualtask walking (Yogev et al 2005;Springer et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Effects of aging on the relationship between cognitive demand and step variability during dual-task walking

Decker

Cignetti

Hunt

et al. 2016

AGE

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A U-shaped relationship between cognitive demand and gait control may exist in dual-task situations, reflecting opposing effects of external focus of attention and attentional resource competition. The purpose of the study was twofold: to examine whether gait control, as evaluated from step-to-step variability, is related to cognitive task difficulty in a U-shaped manner and to determine whether age modifies this relationship. Young and older adults walked on a treadmill without attentional requirement and while performing a dichotic listening task under three attention conditions: nonforced (NF), forced-right (FR), and forced-left (FL). The conditions increased in their attentional demand and requirement for inhibitory control. Gait control was evaluated by the variability of step parameters related to balance control (step width) and rhythmic stepping pattern (step length and step time). A Ushaped relationship was found for step width variability in both young and older adults and for step time variability in older adults only. Cognitive performance during dual tasking was maintained in both young and older adults. The U-shaped relationship, which presumably results from a trade-off between an external focus of attention and competition for attentional resources, implies that higher-level cognitive processes are involved in walking in young and older adults. Specifically, while these processes are initially involved only in the control of (lateral) balance during gait, they become necessary for the control of (fore-aft) rhythmic stepping pattern in older adults, suggesting that attentional resources turn out to be needed in all facets of walking with aging. Finally, despite the cognitive resources required by walking, both young and older adults spontaneously adopted a Bposture second^strategy, prioritizing the cognitive task over the gait task.

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Section: Introductionmentioning

confidence: 99%

Effects of aging on the relationship between cognitive demand and step variability during dual-task walking

Decker

Cignetti

Hunt

et al. 2016

AGE

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“…Such multi-tasking is, of its own right, a source of risk for falls in older adults (Hsu et al (2012) Beauchet et al (2009) Chu et al (2012) Herman et al (2010) ) and older adults generally show greater dual task effects that are environment and task dependent, whether due to increased caution, decreased physical and cognitive function or both (Woollacott and Shumway-Cook (2002) ). Yet, to our knowledge, few studies have used the dual task paradigm with stair gait and particularly for decent where inattention from everyday stimuli has a heighten risk of leading to serious injury or even death.…”

Section: Introductionmentioning

confidence: 99%

The division of visual attention affects the transition point from level walking to stair descent in healthy, active older adults

Telonio

Blanchet

Maganaris

et al. 2014

Experimental Gerontology

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The division of visual attention affects the transition point from level walking to stair descent in healthy, active older adults http://researchonline.ljmu.ac.uk/4609/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. Methods: Sixteen young and sixteen healthy older subjects walked down a 5-step staircase, performing a simultaneous visual Stroop task during the approach, transition and steady state descent phases of stair descent (i.e., a dual task) in some trials. Three dimensional kinematics of trunk and foot motion were recorded along with the accuracy and dual task costs (DTCs) for responses to the Stroop stimuli.Results : Dual tasking influenced both gait and cognitive performance for all subjects, and older adults generally walking slower with higher foot clearances and had greater DTCs. Specific age differences were found at stair transition where older adults showed more attentional affects. Conclusions:Healthy, active older adults showed changes to attention and planning due to normal aging specifically associated with a crucial point of fall risk for stair descent. RESEARCH HIGHLIGHTS We compared combined locomotor and cognitive functioning during stair descent between healthy older and young adults  Dual tasking influenced both gait and cognitive performance for all subjects  Older adults show more attentional effects at the transition to stair descent when fall risk is greatest 3 KEYWORDS Dual task, stair descent, elderly, executive function ABBREVIATIONS DTCs = Dual Task Costs

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“…Other studies also examined the role of executive function and gait stability or falls risk. (Ijmker and Lamoth 2011;Herman et al 2010;Sheridan and Hausdorff 2007). In a prospective study, participants who reported no previous falls, but were in the worst executive function quartile were three times more likely to fall during the 2 years of followup, and they were more likely to transition from non-fallers to faller sooner (Herman et al 2010).…”

Section: Discussionmentioning

confidence: 99%

Pilot study into impaired judgement, self-toileting behaviour in fallers and non-fallers

et al. 2013

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Falls are a significant cause of morbidity and mortality in older people. There is an increased frequency of falls in older adults with cognitive impairment and dementia which may be due to impaired judgement of self capability to mobilise safely. This case control study assessed 53 Aged Care subjects aged 75? years that were hospitalised post fall, from January 2008-December 2009, and compared these subjects' responses to those of 26 non-fallers to a standard question: 'While you are in the hospital, what would you do if you need to go to the toilet later?' This hypothetical scenario question was designed to assess judgement based on selftoileting behaviour and mobility. The study group and control group were similar in age (83.9 ± 4.7 vs. 82.0 ± 4.6 years respectively, p = 0.081) but the study group had statistically lower MMSE results when compared to controls (median 23 vs. 26.5 respectively, p = 0.031). Impaired judgement, defined as an unsafe/inappropriate response to the scenario question, was significantly more prevalent in the study group (fallers) compared to the control group (nonfallers) (41.5 vs. 15.4 %, p = 0.020). Impaired judgement was also more common with lower MMSE scores with 80.9 % of unsafe/inappropriate responses given by participants with MMSE of B20. The authors suggest there may be an association between impaired judgement, evidenced by responses to a standardised question, and falls history in older subjects, particularly in those with cognitive impairment or dementia. Ultimately, this may lead to identification of people at increased risk of falls and possibly effective falls prevention strategies in this population.

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Executive Control Deficits as a Prodrome to Falls in Healthy Older Adults: A Prospective Study Linking Thinking, Walking, and Falling

Cited by 404 publications

References 47 publications

Effects of aging on the relationship between cognitive demand and step variability during dual-task walking

Effects of aging on the relationship between cognitive demand and step variability during dual-task walking

The division of visual attention affects the transition point from level walking to stair descent in healthy, active older adults

Pilot study into impaired judgement, self-toileting behaviour in fallers and non-fallers

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