Walking While Talking and Risk of Incident Dementia

Ceïde, Mirnova E.; Ayers, Emmeline; Lipton, Richard B.; Verghese, Joe

doi:10.1016/j.jagp.2017.12.009

Cited by 28 publications

(25 citation statements)

References 53 publications

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“…Prior studies have found evidence that fast-pace and cognitive dual-task walking tasks can predict changes in cognitive function. A study of non-demented individuals compared multiple metrics obtained while dual-tasking and found that variability but not speed was associated with higher probability of converting to dementia over 2 years [7]. In a separate cohort, slower fast-pace gait speed was associated with increased risk of Alzheimer’s disease over 11 years of follow-up among initially cognitively normal older adults [25].…”

Section: Discussionmentioning

confidence: 99%

“…Dual-task walking requires a person to walk while completing a concurrent, typically cognitively challenging, task. Greater gait slowing during cognitive dual-task walking is associated with conversion from either cognitively healthy status [7] or mild cognitive impairment (MCI) [8] to dementia. However, cognitive dual-task walking may be difficult to standardize clinically due to differences in types of secondary cognitive tasks [9] and difficulty in accounting for task prioritization [10].…”

Section: Introductionmentioning

confidence: 99%

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Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults

Rosso

Faulkner

Redfern

et al. 2019

JAD

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Background: Performance on complex walking tasks may provide a screen for future cognitive decline. Objective: To identify walking tasks that are most strongly associated with subsequent cognitive decline. Methods: Community-dwelling older adults with Modified Mini-Mental State (3MS) >85 at baseline (n = 223; mean age = 78.7, 52.5% women, 25.6% black) completed usual-pace walking and three complex walking tasks (fast-pace, narrow-path, visuospatial dual-task). Slope of 3MS scores for up to 9 subsequent years (average = 5.2) were used to calculate a cognitive maintainer (slope ≥0) or decliner (slope <0) outcome variable. Logistic regression models assessed associations between gait speeds and being a cognitive decliner. A sensitivity analysis in a subsample of individuals (n = 66) confirmed results with adjudicated mild cognitive impairment (MCI) or dementia at 8–9 years post-walking assessment. Results: Cognitive decliners were 52.5% of the sample and on average were slower for all walking tasks compared to maintainers. In models adjusted for demographic and health variables, faster fast-pace (OR = 0.87 per 0.1 m/s, 95% CI: 0.78, 0.97) and dual-task (OR = 0.84 per 0.1 m/s, 95% CI: 0.73, 0.96) gait speeds were associated with lower likelihood of being a cognitive decliner. Usual-pace gait speed was not associated (OR = 0.96 per 0.1 m/s, 95% CI: 0.85, 1.08). Results were nearly identical in analyses with adjudicated MCI or dementia as the outcome. Conclusion: Fast-pace and dual-task walking may provide simple and effective tools for assessing risk for cognitive decline in older individuals with high cognitive function. Such screening tools are important for strategies to prevent or delay onset of clinically meaningful change.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults

Rosso

Faulkner

Redfern

et al. 2019

JAD

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“…The PFC has also been implicated in performance of DT (Sala et al, 1995;Dux et al, 2006;Filmer et al, 2013), that are motor tasks performed simultaneously with a secondary, usually a cognitive task. DT increases the cognitive demand of walking and potentially results in a decrease in task performance in one or both tasks relative to when the tasks are performed separately as ST. DT performance assessment may help identify older adults at higher risk of incident cognitive decline (Ceïde et al, 2018;Rosso et al, 2019), disability, frailty and mortality (Verghese et al, 2012). One of the goals of the study of cognitive aging is to elucidate neural mechanisms that underlie the ability of the aging brain to cope with decline in cognitive functions and efficiency.…”

Section: Introductionmentioning

confidence: 99%

Functional Near-Infrared Spectroscopy to Study Cerebral Hemodynamics in Older Adults During Cognitive and Motor Tasks: A Review

Udina

Avtzi

Durdurán

et al. 2020

Front. Aging Neurosci.

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The integrity of the frontal areas of the brain, specifically the prefrontal cortex, are critical to preserve cognition and mobility in late life. Prefrontal cortex regions are involved in executive functions and gait control and have been related to the performance of dual-tasks. Dual-task performance assessment may help identify older adults at risk of negative health outcomes. As an alternative to neuroimaging techniques that do not allow assessment during actual motion, functional Near-Infrared Spectroscopy (fNIRS) is a non-invasive technique that can assess neural activation through the measurement of cortical oxygenated and deoxygenated hemoglobin levels, while the person is performing a motor task in a natural environment as well as during cognitive tasks. The aim of this review was to describe the use of fNIRS to study frontal lobe hemodynamics during cognitive, motor and dual-tasks in older adults. From the 46 included publications, 20 studies used only cognitive tasks, three studies used motor tasks and 23 used dual-tasks. Our findings suggest that fNIRS detects changes in frontal activation in older adults (cognitively healthy and mild cognitive impairment), especially while performing cognitive and dual-tasks. In both the comparison between older and younger adults, and in people with different neurological conditions, compared to healthier controls, the prefrontal cortex seems to experience a higher activation, which could be interpreted in the context of proposed neural inefficiency and limited capacity models. Further research is needed to establish standardized fNIRS protocols, study the cerebral hemodynamic in different neurological and systemic conditions that might influence cortical activation and explore its role in predicting incident health outcomes such as dementia.

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“…Dual‐task costs (DTCs) are exceptionally high in older adults with mild cognitive impairment and dementia (Odden et al, ) but they also affect relatively healthy older adults. Among these older adults without dementia, the walking‐while‐talking test (walking while reciting alternate letters of the alphabet; WWT), a mobility stress test, is a reliable predictor of falls, frailty, disability, incident dementia, and mortality (Ayers, Tow, Holtzer, & Verghese, ; Ceïde, Ayers, Lipton, & Verghese, ; Verghese et al, ; Verghese, Holtzer, Lipton, & Wang, ).…”

Section: Introductionmentioning

confidence: 99%

Gray matter volume covariance networks associated with dual‐task cost during walking‐while‐talking

Tripathi

Verghese

Blumen

2019

Human Brain Mapping

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We studied gray matter volume covariance networks associated with normal pace walking (NPW) speed and dual‐task costs (DTCs) during walking‐while‐talking (WWT)—a mobility stress test that involves walking while reciting alternate letters of the alphabet. Using a multivariate covariance‐based analytic approach, we identified gray matter networks associated with NPW speed (mean 102.1 cm/s ±22.5 cm/s) and DTC (percent difference in gait speed between NPW and WWT, mean 25.9% ± 18.8%) in 139 older adults without dementia (M = 75.3 ± 6.1 years). The gray matter network associated with NPW was primarily composed of supplementary motor area, precuneus cortex, and the middle frontal gyrus. Greater expression of this NPW network was associated with better processing speed (trail‐making test A [r = −0.30, p = 0.005]) and executive function (trail‐making test B − A [r = −0.43, p < 0.0001]). The gray matter network associated with DTC was primarily composed of medial prefrontal, cingulate, and thalamic regions. Greater expression of this DTC network was associated with better episodic memory performance on the free and cued selective reminding test (r = 0.30, p = 0.007). These results suggest that NPW speed and DTC are supported by different networks, and are associated with different cognitive domains.

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Walking While Talking and Risk of Incident Dementia

Abstract: Complex walking as assessed by the WWT task is a simple and pragmatic tool for assessing risk of developing dementia, especially VaD, in older adults.

Cited by 28 publications

References 53 publications

Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults

Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults

Functional Near-Infrared Spectroscopy to Study Cerebral Hemodynamics in Older Adults During Cognitive and Motor Tasks: A Review

Gray matter volume covariance networks associated with dual‐task cost during walking‐while‐talking

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