Dual-Task Complexity Affects Gait in People With Mild Cognitive Impairment: The Interplay Between Gait Variability, Dual Tasking, and Risk of Falls

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

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183 THE COMPLEXITY OF DUAL-TASKING AFFECTS GAIT VARIABILITY IN PEOPLE WITH MILD COGNITIVE IMPAIRMENT

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(10)70184-x ◽

2010 ◽

Vol 16 ◽

pp. S53

Author(s):

S. Muir ◽

M. Speechley ◽

M. Borrie ◽

M. Montero-Odasso

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Gait Variability ◽

Dual Tasking

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Impairment of dual-task gait dynamics in older adults with mild cognitive impairment: Relationships to neuropsychological status, fitness and brain morphology

10.1101/19005249 ◽

2019 ◽

Author(s):

Tess C Hawkins ◽

Rebecca Samuel ◽

Maria A Fiatarone Singh ◽

Nicola Gates ◽

Guy C Wilson ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Performance ◽

Dual Task ◽

Well Being ◽

Gait Variability ◽

Time Variability ◽

Stride Time ◽

Gait Dynamics ◽

Dual Tasking ◽

Task Conditions

ABSTRACTBackgroundIndividuals with Mild Cognitive Impairment (MCI) have more gait variability under dual-task conditions than cognitively healthy adults. However, characteristics associated with this susceptibility of gait to dual-task stress are unknown.MethodsTesting was performed at baseline in the Study of Mental And Resistance Training (SMART). Ninety-three adults with MCI (age 70±6.8 years; 66.6% female) performed a single- and dual-task walk (cognitive distractor=letter fluency), in random order. Linear and non-linear gait variability were measured using force-sensitive insoles. Cognitive performance during dual-tasking was assessed by the number of correct words vocalized. Cognitive function, brain Magnetic Resonance Imaging (MRI), muscle strength, aerobic capacity, body composition, physical and psychosocial function were also assessed as potential correlates of gait dynamics.ResultsGait dynamics worsened during dual-tasking, with decrements in both stride time variability (p<0.001) and detrended fluctuation analysis (DFA) (p=0.001). Lower aerobic capacity and thinner posterior cingulate cortex were associated with greater decrements in DFA (p<0.05). Smaller hippocampal volume, worse psychological well-being and poorer static balance were associated with greater decrements in stride time variability (p<0.05). By contrast, cognitive performance did not change under dual-task conditions compared to seated testing (p=0.13).ConclusionsUnder dual-task conditions, participants with MCI preserved their cognitive performance at the expense of gait stability. Decrements in dual-tasking gait were associated with lower aerobic fitness, balance, psychological well-being, and brain volume in cognitively-relevant areas of the posterior cingulate and hippocampus, all potentially modifiable characteristics. Trials of targeted interventions are needed to determine the potential plasticity of gait variability in high-risk cohorts.

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Dual Task Impairments in Vascular Dementia

Behavioural Neurology ◽

10.1155/2010/604919 ◽

2010 ◽

Vol 22 (1-2) ◽

pp. 45-52 ◽

Cited By ~ 2

Author(s):

Kate Inasaridze ◽

Jennifer A. Foley ◽

Robert H. Logie ◽

Sergio Della Sala

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Episodic Memory ◽

Vascular Dementia ◽

Task Performance ◽

Dual Task ◽

Dual Tasking ◽

Dual Task Performance ◽

Significant Impairment ◽

Normal Ageing

Several studies have shown that people with Alzheimer's disease (AD) demonstrate difficulties in doing two things at once or 'dual-tasking' and that this dual task impairment is insensitive to normal ageing, chronic depression or prodromal conditions like Mild Cognitive Impairment. It is not known, however, if this impairment is specific to AD, or also present in other dementias, such as vascular dementia (VaD). In this study 15 people with VaD, 25 healthy age-matched and 25 healthy young controls were assessed using a paper and pencil dual tasking paradigm and several measures of working and episodic memory. Age had no effect on dual task performance, but the VaD patients demonstrated a significant impairment in dual tasking ability. Performance on the memory measures was instead affected by age with a further deterioration in the VaD patients. Both dual tasking and memory ability were significantly correlated with disease severity, as assessed by the MMSE. These results indicate that performance on the dual task could be a specific indicator of pathological ageing.

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Does the Presence of Cognitive Impairment Exacerbate the Risk of Falls in People with Peripheral Neuropathy? An Application of Body-Worn Inertial Sensors to Measure Gait Variability

Sensors ◽

10.3390/s20051328 ◽

2020 ◽

Vol 20 (5) ◽

pp. 1328 ◽

Cited By ~ 1

Author(s):

Gu Eon Kang ◽

Jacqueline Yang ◽

Bijan Najafi

Keyword(s):

Cognitive Impairment ◽

Peripheral Neuropathy ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Gait Variability ◽

Group Differences ◽

Risk Of Falling ◽

Single Task ◽

Risk Of Falls

People with peripheral neuropathy (PN) are at risk of falling. Many people with PN have comorbid cognitive impairment, an independent risk factor of falls, which may further increase the risk of falling in people with PN. However, the negative synergic effect of those factors is yet to be reported. We investigated whether the presence of cognitive impairment exacerbates the risk of falls in people with PN by measuring gait variability during single-task walking and dual-task walking. Forty-four adults with PN were recruited. Based on the Montreal Cognitive Assessment (MoCA) scores, 19 and 25 subjects were cognitively impaired and intact, respectively. We measured coefficients of variation of gait speed, stride length, and stride time using validated body-worn sensors. During single-task walking, no between-group differences were observed (all p > 0.05). During dual-task walking, between-group differences were significant for gait variability for gait speed and stride length (51.4% and 71.1%, respectively; p = 0.014 and 0.011, respectively). MoCA scores were significantly correlated with gait variability for gait speed (r = 0.319, p = 0.035) and stride length (r = 0.367, p = 0.014) during dual-task walking. Our findings suggest that the presence of cognitive impairment exacerbates the risk of falls in people with PN.

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