The role of executive function and attention in gait

Abstract

Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk. © 2007 Movement Disorder Society Key words: gait; executive function; attention; Parkinson's disease; Alzheimer's disease; aging; dual task; review article The relationship between higher-level cognitive function and gait disturbances has received considerable attention in recent years. Gait is no longer considered as merely an automated motor activity that utilizes minimal higher-level cognitive input. Instead, the multifaceted neuropsychological influences on walking and the interactions between the control of mobility and related behaviors are increasingly appreciated. This is manifest in part by an individual's awareness of a destination, the ability to appropriately control the limb movements that produce gait, and the ability to navigate within often complex environs to successfully reach the desired location. Studies on cognitive function and gait now include many areas of research, ranging from physiology and biomechanics to brain mapping, physics and neuropsychology. For example, imaging studies have demonstrated frontal and parietal activity during locomotion. 1,2 This review covers the importance and relevance of two specific cognitive functions, executive function (EF) and attention, to the performance of gait during normal walking, as well as in aging and in pathological conditions. We review the physiology underlying these cognitive processes, describe the clinical findings and consequences of these relationships and discuss the physiological mechanisms that are brought into play. Finally, we summarize the implications of these associations for the daily lives of individuals affected by impaired function of one or more or these elements and provide suggestions for applying these insights to augment the diagnosis of gait disorders in the clinic. This review article is based on a systematic literature search for reviews and trials reported in English in the electronic databases of Medline and Psychinfo up to April, 2007. Relevant s...

Agency, gait and self-consciousness

“…Although gait has initially been considered a largely automatic action regulated mainly by subcortical control mechanisms including the brainstem and spinal cord (Armstrong, 1988;Grillner and Wallen, 1985), recent work has highlighted the influence of attention, executive function and other cognitive mechanisms (Hausdorff, 2005;Shaw, 2002;Yogev-Seligmann et al, 2008). Walking is a complex task involving the integration of locomotion, balance, and adaptation in an ever-changing environment (Armstrong, 1988;Blanc et al, 1999;Drew et al, 2004).…”

“…This is important as humans may perform many perceptual, motor, and cognitive tasks while walking, potentially causing performance in these tasks to decline or change. Additionally these secondary tasks have been shown to alter gait characteristics and even lead to freezing or falls (for comprehensive reviews see Woollacott and Shumway-Cook, 2002;and Yogev-Seligmann et al, 2008). Thus, cognitive tasks such as verbal fluency (Dubost et al, 2006), fine-motor movements (Yang et al, 2007), and arithmetics (van Iersel et al, 2007) have been shown to alter gait characteristics ranging from walking velocity, over stride-variability in length, time, or width, to stride-asymmetry ( (Dubost et al, 2006;Yang et al, 2007); van Iersel et al, 2007).…”

Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment

“…Our study adds further evidence along these lines, showing that trunk stability in people with MCI is affected during dual-task walking. Dual-task-related changes in gait performance were thought to occur because gait control requires cognition (Al-Yahya et al 2011;Yogev-Seligmann et al 2008). Dual-task walking has been shown to be associated with cognitive function, particularly executive function, among cognitively normal older adults and those with cognitive impairment (Doi et al 2014;Hausdorff et al 2008;van Iersel et al 2008).…”

“…To examine the requirement, numerous studies have used a dualtask paradigm, i.e., dual-task walking, that requires more attentional resources and executive functions than normal walking (for reviews, see Al-Yahya et al 2011;Yogev-Seligmann et al 2008). Executive function is achieved primarily through prefrontal cortex and refers to a variety of higher cognitive processes, including components of volition, planning, purposive action, and effective performance (Lezak 2004).…”

Frailty and cognition: Linking two common syndromes in older persons

“…In addition, in persons with diabetes who develop cognitive frailty, this will worsen the ability to adequately manage diabetes and thus accelerate physical frailty (26). Dual tasking is a condition in which persons with an executive function deficit have decreased control over their walking when required to carry out another task (27,28). Dual tasking represents one obvious interaction where both cognitive and physical frailty are synergistic with one another.…”