Upper-Extremity Dual-Task Function: An Innovative Method to Assess Cognitive Impairment in Older Adults

Abstract

Background: Difficulties in orchestrating simultaneous tasks (i.e., dual-tasking) have been associated with cognitive impairments in older adults. Gait tests have been commonly used as the motor task component for dual-task assessments; however, many older adults have mobility impairments or there is a lack of space in busy clinical settings. We assessed an upper-extremity function (UEF) test as an alternative motor task to study the dual-task motor performance in older adults.Methods: Older adults (≥65 years) were recruited, and cognitive ability was measured using the Montreal cognitive assessment (MoCA). Participants performed repetitive elbow flexion with their maximum pace, once single-task, and once while counting backward by one (dual-task). Single- and dual-task gait tests were also performed with normal speed. Three-dimensional kinematics was measured both from upper-extremity and lower-extremity using wearable sensors to determine UEF and gait parameters. Parameters were compared between the cognitively impaired and healthy groups using analysis of variance tests, while controlling for age, gender, and body mass index (BMI). Correlations between UEF and gait parameters for dual-task and dual-task cost were assessed using linear regression models.Results: Sixty-seven older adults were recruited (age = 83 ± 10 years). Based on MoCA, 10 (15%) were cognitively impaired. While no significant differences were observed in the single-task condition, within the dual-task condition, the cognitively impaired group showed significantly less arm flexion speed (62%, d = 1.51, p = 0.02) and range of motion (27%, d = 0.93, p = 0.04), and higher speed variability (88%, d = 1.82, p < 0.0001) compared to the cognitively intact group, when adjusted with age, gender, and BMI. Significant correlations were observed between UEF speed parameters and gait stride velocity for dual-task condition (r = 0.55, p < 0.0001) and dual-task cost (r = 0.28, p = 0.03).Conclusion: We introduced a novel test for assessing dual-task performance in older adults that lasts 20 s and is based on upper-extremity function. Our results confirm significant associations between upper-extremity speed, range of motion, and speed variability with both the MoCA score and the gait performance within the dual-task condition.

The execution of the Grooved Pegboard test in a Dual-Task situation: A pilot study

“…Consequently, the addition of a cognitive oriented task resulted in worse performance compared to the addition of a motor oriented task, similarly to previous studies (Brustio et al, 2020;Ghai et al, 2017;Woollacott and Shumway-Cook, 2002). Similar findings were also provided regarding DT conditions proposed involving the upper extremities (Toosizadeh et al, 2016).…”

“…Our results obtained in DT condition, even if a postural balance task was not involved, are similar to those previously described. Indeed, a correlation exists between upper and lower extremities movements (Fraser et al, 2010), also in a DT setting (Toosizadeh et al, 2016) meaning that the cognitive processes involved are similar.…”

“…The National Institutes of Health (NIH) Toolbox for the Assessment of Neurological and Behavioural Function (Gershon et al, 2010) presents two tests for manual dexterity: the 9-Hole Peg Test (9-HPT) and the 25-Hole Grooved Pegboard test (GPT). Manual dexterity has been also evaluated through a different test compared to the GPT and has also been associated with a given cognitive task (Toosizadeh et al, 2016). Furthermore, the pegboard test has been also associated with a cognitive task but evaluated under electrical stimulation (Ljubisavljevic et al, 2019).…”

Force Steadiness During a Cognitively Challenging Motor Task Is Predicted by Executive Function in Older Adults

“…However, for a contraction with the cognitive challenge, maximal strength did not improve the model to predict CV of force compared with age of the individual or Trail-making-Test results in young or older adults (step 1 in Tables 2 , 3 ). The findings of age and sex-related differences in CV of force during a cognitive challenge task expand previous observations of impaired motor function during several motor tasks of the upper extremity such as dexterity tests, finger tapping tasks and reaction time tests in young and older adults ( Zijdewind et al, 2006 ; Fraser et al, 2010 ; Toosizadeh et al, 2016 ). Physiological mechanisms driving the differences in motor performance during cognitive challenging tasks in men and women are not fully understood, but alterations in cognitive function with aging may partly explain these findings as discussed below.…”

Proprioceptive impairments in high fall risk older adults: the effect of mechanical calf vibration on postural balance

“…Vibration of muscle can cause some illusionary sensation in the brain regarding the lower-extremity position [ 8 , 11 ]. Previous studies showed deterioration in position and motion sensing of muscle spindles with aging [ 11 , 30 ], and aging-induced alterations in central nervous system, such as decreased attentional resources and a general loss of neural substrate [ 31 , 32 ]. Therefore, it has been hypothesized here that vibration would cause less illusionary disturbance within central nervous system among elders with impaired balance since messages from spindle units are weaker and the central nervous system may be less sensitive to the disturbance of these messages.…”