Cognitive Reserve Moderates Associations Between Walking Performance Under Single and Dual-Task Conditions and Incident Mobility Impairment in Older Adults

2021 ◽  
Author(s):  
Catherine O’Brien ◽  
Roee Holtzer
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Cognitive Reserve ◽  
Mobility Impairment ◽  
Gait Performance ◽  
Increased Risk ◽  
Wide Range ◽  
Walking Performance ◽  
Incident Cases

Abstract Background Among older adults, walking performance is a reliable indicator of adverse health outcomes including incident mobility impairment. Whereas, attention and executive functions have been implicated in cognitive control of locomotion, much less is known about the role of Cognitive Reserve (CR) in predicting mobility impairments among older adults. Specifically, whether CR moderates the relationship between gait performance and incident mobility impairment, has not been reported. To address this gap in the literature, we examined whether gait performance under Single-Task-Walk (STW) and Dual-Task-Walk (DTW) conditions predicted incident mobility impairment and whether CR moderated this relationship. Methods Participants were 176 (mean age=75.57; %female=53) older adults with baseline SPPB scores of 10-12. Participants completed neuropsychological testing, the SPPB, and a dual-task walking protocol. CR was evaluated using the Wide Range Achievement Test 3 rd edition (WRAT-3). Participants were followed for three years; individuals whose SPPB scores declined below 10 were defined as incident cases of mobility impairment (n=42). Results Moderation analyses revealed significant interaction effects of CR with walking velocity under STW (b = 0.09, 95% CI [0.01, 0.17], z = 2.30, p = 0.02), and DTW (b = 0.10, 95% CI [0.02, 0.17], z = 2.55, p = 0.01) conditions wherein slower gait predicted increased risk of incident mobility impairment among individuals with lower CR. Conclusion These findings extend knowledge about the interrelation of cognitive and mobility functions, revealing the critical role of CR in identifying older adults at risk of developing incident mobility impairment.

scholarly journals Predictors of Physical Resilience in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 289-290
Author(s):  
Catherine O’Brien ◽  
Roee Holtzer
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Cognitive Reserve ◽  
Neuropsychological Testing ◽  
Binary Logistic Regression ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Speed Of Processing ◽  
Wide Range Achievement Test ◽  
Wide Range

Abstract Physical resilience (PR), which denotes one’s ability to resist functional physical decline, can be operationalized through longitudinal assessments on the Short Physical Performance Battery (SPPB). Dual-task walking (DTW) is predictive of adverse outcomes but its role in predicting incident PR has not been assessed. Herein, we determined whether velocity during Single-Task-Walk (STW) and Dual-Task-Walk (DTW) conditions predicted incident loss of PR and identified moderators of this relationship. Participants were 163 (mean age=75.5; %female=52) non-demented, community-dwelling older adults with baseline SPPB scores of 10-12. At baseline, individuals completed neuropsychological testing, the SPPB and DTW paradigm. Cognitive reserve was evaluated using the Wide Range Achievement Test (WRAT-3) and speed of processing was assessed using the Symbol Digit Modalities Test (SDMT). Individuals with SPPB scores < 10 were categorized as not physically resilient. Those with scores of 10 or higher were categorized as physically resilient. At three-year follow up 75.4% (n=123) of participants remained physically resilient while 24.5% (n=40) lost PR. Binary logistic regression revealed that slower DTW (OR= 0.96, p= 0.033, 95%CI [.926, .997]), but not STW velocity (OR= 1.00, p= 0.861, 95%CI [0.962, 1.048]), was a significant predictor of PR loss. Moreover, moderation analyses revealed that DTW velocity predicted PR loss only among individuals who had lower baseline scores on the WRAT-3 (OR=0.937, p=0.004, 95%CI [.896, .979]) and SDMT (OR=0.949, p=0.018, 95%CI [.909, .991]). We propose that cognitive reserve and speed of processing influenced the utility of DTW velocity in predicting PR loss among community-residing older adults.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

scholarly journals Association of Affect and Gait Performance in Dual-Task Walking in Non-Demented Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 287-287
Author(s):  
Deepan Guharajan ◽  
Roee Holtzer
Keyword(s):  
Older Adults ◽  
Negative Affect ◽  
Positive Affect ◽  
Dual Task ◽  
Task Demands ◽  
Gait Velocity ◽  
Positive And Negative Affect ◽  
Increased Risk ◽  
Aging Populations ◽  
Task Conditions

Abstract Aging populations are at increased risk to experience mobility disability, which is associated with falls, frailty, and mortality. Previous studies have not examined the concurrent associations of both positive and negative affect with gait velocity. We examined whether individual differences in positive and negative affect predicted dual-task performance decrements in velocity in a dual-task (DT) paradigm in non-demented older adults. We hypothesize that positive affect would be associated with lower DT costs, and negative affect would be associated with higher DT costs. Participants (N = 403; mean age, = 76.22 (6.55); females = 56%) completed the Positive and Negative Affect Schedule (PANAS) and a DT paradigm that involved three task conditions: Single-Task-Walk (STW), Alpha (cognitive interference requiring participants to recite alternate letters of the alphabet), and Dual-Task-Walk (DTW) requiring participant to perform the two single tasks concurrently. Gait velocity was assessed via an instrumented walkway. As expected, results of a linear mixed effects model (LME) showed a significant decline in gait velocity (cm/s) from STW to DTW (estimate = -11.79; 95%CI = -12.82 to -10.77). LME results further revealed that negative affect was associated with greater decline in gait velocity from STW to DTW (ie., worse DT cost) (estimate = -0.38; 95%CI = -0.73 to -0.03). Positive affect did not, however, predict DT costs in gait velocity (estimate = -0.09; 95%CI = -0.23 to 0.05). These findings suggest that increased negative affect interferes with the allocation of attentional resources to competing task demands inherent in the DT paradigm.

scholarly journals Likelihood of Participation in Home-Based Cognitive Assessment: The Role of Subjective Cognitive Decline and Age

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 293-294
Author(s):  
Moriah Splonskowski ◽  
Holly Cooke ◽  
Claudia Jacova
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Old Age ◽  
Cognitive Assessment ◽  
Community Dwelling ◽  
Subjective Cognitive Decline ◽  
Cognitive State ◽  
Home Based ◽  
Increased Risk

Abstract Home-based cognitive assessment (HBCA) services are emerging as a convenient alternative to in-clinic cognitive assessment and may aid in mitigating barriers to detecting cognitive impairment (CI). It is unknown which older adults would be likely to participate in HBCA. Here we investigated the role of age and Subjective Cognitive Decline (SCD). SCD has demonstrated an increased risk for progression to CI/dementia. A nation-wide community-dwelling sample of 494 adults age 50+ were recruited via Amazon Mechanical Turk to complete an online survey assessing perceptions around HBCA and SCD. Our sample was 91.9% White and 66.8% female. It consisted of 174 respondents aged 50-60, 265 aged 61- 70, and 55 aged 71-79. Age groups were comparable with respect to their acceptance of cognitive assessment (Range 4-20, higher score=higher acceptance, 7.9±3.3, 8.15±3.2, 8.05±3.43) and SCD-Q total (43.1±5.8, 43.2±5.7, 43.3±5.7). Correlation analysis revealed a relationship between SCD-QSCD total and perceived likelihood of participation in HBCA for those ages 61-70 (r(263) = .222 p = .000), but not for ages 50-60 or 71-79 (r(172) = .102 p = .152; r(53) = -.102 p = .458). Our findings suggest that SCD influences the likelihood of participation in HBCA for older adults’ transitioning to old age (61-70). Findings show that for adults transitioning into old age (61-70), perceived cognitive state influences their likelihood of participation in HBCA. Importantly, concerns about CI/dementia may generate more favorable perceptions of HBCA for this group.

scholarly journals Sleep Onset/Maintenance Difficulties and Cognitive Function in Nondemented Older Adults: The Role of Cognitive Reserve

2012 ◽  
Vol 18 (03) ◽  
pp. 461-470 ◽  
Author(s):  
Molly E. Zimmerman ◽  
Marcelo E. Bigal ◽  
Mindy J. Katz ◽  
Adam M. Brickman ◽  
Richard B. Lipton
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Reserve ◽  
Sleep Onset

scholarly journals The Role of Cognitive Factors in Old Age Balance Impairments

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Priyanka Yadav
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Sensory System ◽  
T Test ◽  
Cognitive Factors ◽  
Attention And Memory ◽  
Mobility Assessment ◽  
Task Training ◽  
Dual Task Training

The ability of human beings to perform more than one task at a time has long been focus of study in the literature on human attention and memory. Older adults are more penalized when they must divide their attention between two input resources i.e input and holding or holding and responding. Falls have potentially devastating physical, social and psychological consequences. Falling is one of the most serious problems associated with ageing. Sensory system deteriorates with age, increased attention is allocated to “HIGHTEN” the signal coming from this system in order to gain necessary information for postural control. Older adults show marked reduction in the ability to perform the postural and cognitive task simultaneously. A study was conducted by physiotherapy and psychology students in a small town of Haryana on institutionalized older adults in which Dual task training under various sets of instruction that is Fixed priority and Variable priority instruction sets effects the balance who are living in residential care facilities. Tinneti Performance Oriented Mobility Assessment (POMA) and Mini mental status examination were used as tools to assess balance and cognitive abilities. Various studies related to the role of cognitive factors in balance impairments were reviewed. Data was analyzed using SPSS 13.0 software packages and paired sample t –test within the group and independent sample t – test between the groups with p – value at a significance level of p < 0.05 was used. The result of the study supported the hypothesis that there is significant improvement in balance of institutionalized elderly people who received dual task training with variable priority instruction set. (p < 0.001). The use of validated measurement tool like Tinnetti performance oriented mobility assessment on balance allowed clearer interpretation of the results. There is improvement in TPOMA Scores after 4 weeks training program in both groups. This shows that cognitive factors do play an important role in maintaining balance and coordination. Any impairment related to sensory system or cognition leads to balance impairments and increased risk for falls.

scholarly journals PREFRONTAL CORTICAL ACTIVITY DIFFERENCES WHILE DUAL-TASK WALKING IN OLDER ADULTS WITH IMPAIRED MOBILITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S793-S794
Author(s):  
Manuel E Hernandez
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Near Infrared ◽  
Local Community ◽  
Cognitive Task ◽  
Mobility Impairment ◽  
Functional Near Infrared Spectroscopy ◽  
Mobility Impairments ◽  
Prefrontal Cortical ◽  
Walking Difficulty

Abstract Mobility impairments are prevalent in older adults. Whereas walking had traditionally been viewed as an autonomous process, evidence over the last decade has shown that cognitive processes such as attention and executive function have a significant impact on gait function in older adults. However, the exact neural mechanisms underlying difficulties in the control of mobility in older adults remains an open question. We examine the changes in the executive control of mobility in older adults with mobility impairments using functional near-infrared spectroscopy, as operationalized by performance in the community balance and mobility scale (CB&M). We hypothesized that prefrontal cortical (PFC) activity increases would be higher in older adults with mobility impairments, compared with older adults without mobility impairment, as dual-task walking difficulty increased. Older adults with (n=10, mean±SD age: 77±8 years, 8 females, CB&M= 58±12) and without mobility impairment (n=14, mean±SD age: 63±9 years, 11 females, CB&M= 87±6) were recruited from the local community. Dual-task walking was performed at a comfortable pace, while the difficulty of the concurrent cognitive task was increased using the modified Stroop test. PFC activity was measured using measures of oxygenated hemoglobin across the PFC. Older adults with mobility impairments demonstrated disproportionate increases in PFC activity, in comparison to those without mobility impairments, as the difficulty of the concurrent cognitive task increased (P&lt;.001), even after controlling for age. In conclusion, these data suggest that older adults with mobility impairments may require greater attentional resources than those without mobility impairments when concurrently performing thinking and walking tasks.

scholarly journals Dietary Patterns, Skeletal Muscle Health, and Sarcopenia in Older Adults

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 745 ◽  
Author(s):  
Antoneta Granic ◽  
Avan Sayer ◽  
Sian Robinson
Keyword(s):  
Older Adults ◽  
Skeletal Muscle ◽  
Dietary Patterns ◽  
Healthy Eating Index ◽  
Muscle Disease ◽  
Nutritional Epidemiology ◽  
Societal Implications ◽  
Increased Risk ◽  
Muscle Health

In recent decades, the significance of diet and dietary patterns (DPs) for skeletal muscle health has been gaining attention in ageing and nutritional research. Sarcopenia, a muscle disease characterised by low muscle strength, mass, and function is associated with an increased risk of functional decline, frailty, hospitalization, and death. The prevalence of sarcopenia increases with age and leads to high personal, social, and economic costs. Finding adequate nutritional measures to maintain muscle health, preserve function, and independence for the growing population of older adults would have important scientific and societal implications. Two main approaches have been employed to study the role of diet/DPs as a modifiable lifestyle factor in sarcopenia. An a priori or hypothesis-driven approach examines the adherence to pre-defined dietary indices such as the Mediterranean diet (MED) and Healthy Eating Index (HEI)—measures of diet quality—in relation to muscle health outcomes. A posteriori or data-driven approaches have used statistical tools—dimension reduction methods or clustering—to study DP-muscle health relationships. Both approaches recognise the importance of the whole diet and potential cumulative, synergistic, and antagonistic effects of foods and nutrients on ageing muscle. In this review, we have aimed to (i) summarise nutritional epidemiology evidence from four recent systematic reviews with updates from new primary studies about the role of DPs in muscle health, sarcopenia, and its components; (ii) hypothesise about the potential mechanisms of ‘myoprotective’ diets, with the MED as an example, and (iii) discuss the challenges facing nutritional epidemiology to produce the higher level evidence needed to understand the relationships between whole diets and healthy muscle ageing.

scholarly journals WEARABLES REVEAL A GAP BETWEEN GAIT PERFORMANCE IN THE LAB AND DURING 24/7 MONITORING IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S335-S335
Author(s):  
Inbar Hillel ◽  
Laura Avanzino ◽  
Andrea Cereatti ◽  
Marcel Olde Rikkert ◽  
Silvia Del Din ◽  
...  
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Gait Speed ◽  
Daily Living ◽  
Laboratory Setting ◽  
Gait Performance ◽  
Lower Back ◽  
Gait Features

Abstract We compared in-lab usual-walking (UW) and dual-task walking (DTW) to daily-living measures of gait obtained during 24/7 monitoring. In-lab gait features (e.g., gait speed, step and stride regularity) derived from UW and DTW were compared to the same gait features during daily-living in 150 elderly fallers (age: 76.5±6.3 years, 37.6% men). Features were extracted from a lower-back accelerometer. In daily-living setting, subjects wore the device for one week and pre-processing detected 30-second walking bouts. A histogram of all walking bouts was determined for each walking feature for each subject, then each subject’s typical, worst and best values were determined. Statistics of reliability were assessed using ICC and Bland-Altman. As expected, in-lab gait speed, step regularity, and stride regularity were worse during DTW, compared to UW. Gait speed, step regularity, and stride regularity during UW were significantly higher (i.e., better) from the typical daily-living values (p&lt;0.0001) and different (p&lt;0.000) from the worst and best values. DTW values tended to be similar to typical daily-living values (p=0.205, p=0.053, p=0.013 respectively). ICC assessment and Bland-Altman plots indicated that in-lab values do not reliably reflect the daily-walking values. Gait values during relatively long daily-living walking bouts are more similar to the corresponding values obtained in the lab during DTW, as compared to UW. Still, gait performance during most daily-living walking bouts are worse than that measured in-lab and do not reliably reflect each other. That is, an older adult’s typical daily-living gait cannot be estimated by simply measuring walking in a structured, laboratory setting.

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