Evidence for a Selectively Regulated Prioritization Shift Depending on Walking Situations in Older Adults

Abstract

Background: Older adults have increased risks of balance issues and falls when walking and performing turns in daily situations. Changes of prioritization during different walking situations associated with dual tasking may contribute to these deficits. The objective of this study was therefore to investigate whether older adults demonstrate changes of prioritization during different walking paths.Methods: In total, 1,054 subjects with an age range from 50 to 83 years were selected from the first follow-up visit of the TREND (Tuebinger evaluation of Risk factors for Early detection of Neurodegenerative Disorders) study. They were classified according to their performance on the Trail Making Test (TMT) into good and poor TMT performers (based on recent results showing that cognitive flexibility affects prioritization strategies during straight walking). Absolute dual-task performance and relative dual-task costs (DTC, relative performance under dual-task conditions compared with single-task conditions) were assessed in two paradigms: walking while subtracting serial 7 s and walking while checking boxes on a clipboard. Both tasks were performed on straight and curved paths.Results: Overall, the poor TMT performers group performed worse in all single and dual tasks. Interestingly, the relative change in performance measured by dual-task costs differed in the groups between the two walking paths. On straight paths, poor TMT performers had a similar DTC of walking to that of good performers (p = 0.10) but had a significantly lower DTC of subtracting (p = 0.02). On curved paths, poor performers had a similar DTC of subtracting (p = 0.10), but their DTC of walking was significantly higher (p < 0.0001).Conclusion: Given that walking on curved paths is considered more difficult than that on straight paths and that the serial subtracting dual task is more difficult than the box checking dual task, this study in older adults provides evidence for the existence of a (walking) situation-dependent change of prioritization. If confirmed in other studies, situation-dependent change of prioritization should be included as a potential factor contributing to gait and balance impairments, and increased fall risk in older adults.

Cognitive-Motor Interference during Walking in Older Adults with Probable Mild Cognitive Impairment

“…Higher cognitive-related motor DTEs were found for the task with higher cognitive load (the greater the cognitive load, the higher the motor interferences). The magnitude of the motor interference is comparable to the results of Salkovic et al ( 2017 ), where subjects had to walk around a circle on the floor. The cognitive interferences, however, are many times higher in our dual task paradigm.…”

“…Hence, the measure of change of direction walking provides different and meaningful information about daily life walking ability than walking on straight pathways alone (Lowry et al, 2012 ). Salkovic et al ( 2017 ) were able to demonstrate that a priorization of resource allocation is influenced by the walking situation. According to their results older adults with poor cognitive flexibility exhibit a tendency to riskier walking behavior during more complex walking situations, compared to older adults with good cognitive flexibility.…”

Complex Gait Is Related to Cognitive Functioning in Older People: A Cross-Sectional Study Providing an Innovative Test

“…According to a previous study [39], these findings demonstrated that even in healthy older people additional attention resources are required for obstacle crossing and recovering from an obstacle crossing step. Whereas walking on curved paths is considered more difficult than that on straight paths, older adults with poor cognitive flexibility tend to exhibit risky walking behavior during more complex walking situations compared to older adults with good cognitive flexibility [40]. In this sense, deficits in higher-order cognitive processing may limit obstacle negotiation abilities in people with MCI, being a potential falls risk [41].…”

Less Is More – Estimation of the Number of Strides Required to Assess Gait Variability in Spatially Confined Settings

“…The second dataset (HE dataset) consisted of 172 healthy elderly individuals (78 females, average age 70.1 years ± 6.2) assessed during the third visit (2013/14) of the TREND study (Salkovic et al, 2017). Only subjects without functionally relevant disturbance of balance or locomotor function were included.…”