Effect of dual task on balance in older adults with mild cognitive impairment
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Abstract
Background: Balance impairment is an important risk factor for falls and is associated with cognitive impairment. However, it is inconclusive whether older adults with mild cognitive impairment (MCI) have impaired balance. This may be due to the balance tests commonly used in clinical settings are not physically and/or cognitively challenged enough to identify balance impairment in this population.
Objectives: The aim of this study was to compare the balance ability between older adults with and without mild cognitive impairment (MCI and non–MCI) under different balance tests during single and dual task conditions.
Materials and methods: Twenty one older adults with MCI (mean age 71.43±1.17 years) and 21 older adults with non-MCI (mean age 69.38±1.04 years) participated. Both groups were similar in gender, age, and education level. Postural sway while standing were measured using Lord’s sway meter under 4 conditions: 1) stand on firm surface with eyes open 2) stand on firm surface with eyes closed 3) stand on foam surface with eyes open 4) stand on foam surface with eyes closed. Timed Up and Go (TUG) and Tandem walk test at fastest speed was also administered to the participants. All balance tests were randomly administered under single (balance test only) and dual (balance test in concurrent with naming test) task. Outcome measures were sway area, time taken to complete TUG and Tandem, and error of tandem walk (% of total steps). Mixed model repeated measures ANOVAs were used to determine the difference of each outcome measure between groups and tasks. Significant level was set at p≤0.05.
Results: For postural sway while standing, there was a significant group × condition × task interaction of sway area (p=0.03). Post hoc analysis (Bonferroni adjustment) identified a significant larger sway area in older adults with MCI compared to non-MCI while standing on firm surface with eyes closed under single task condition and standing on foam surface with eyes closed under dual task condition (p=0.02 and 0.03, respectively). Significant group × task interaction was found for TUG times (p=0.04). Post hoc analysis (Bonferroni adjustment) identified significant longer time taken to complete TUG in older adults with MCI compared to non-MCI for both single and dual tasks (p=0.04 and 0.01 respectively). There were no significant main effects of group, task, or group x task interaction of any outcome measures for Tandem walk test (p>0.05).
Conclusion: Findings from this study suggest that older adults with MCI had balance impairment compared to controls. However, relative physically and/or cognitively challenged balance tests (e.g. having older adults with MCI perform secondary task while evaluating their balance) are required to reveal balance impairment, an important risk factor for falls.
Journal of Associated Medical Sciences 2017; 50(3): 605-616
Article Details
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
References
2. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35: 37-41 doi: 10.1093/ageing/afl084
3. Shumway-Cook A, Woollacott M. Motor control translating research into clinical practice. 4ed. Pliladelphia: Lippincott Williams&Wilkins; 2012
4. Andersson G, Hagman J, Talianzadeh R, Svedberg A, Larsen HC. Effect of cognitive load on postural control. Brain Res Bull 2002; 58: 135-9 doi: 10.1016/S0361-9230(02)00770-0
5. McGough EL, Kelly VE, Logsdon RG, McCurry SM, Cochrane BB, Engel JM, et al. Associations between physical performance and executive function in older adults with mild cognitive impairment: gait speed and the timed “up & go” test. Phys Ther 2011; 91: 1198-207 doi: 10.2522/ptj.20100372
6. Maquet D, Lekeu F, Warzee E, Gillain S, Wojtasik V, Salmon E, et al. Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer’s disease: simple versus dual task: a preliminary report. Clin Physiol Funct Imaging 2010; 30: 51-6 doi: 10.1111/j.1475-097X.2009.00903.x
7. Smith E, Walsh L, Doyle J, Greene B, Blake C. Effect of a dual task on quantitative timed up and go performance in community-dwelling older adults: A preliminary study. Geriatr Gerontol Int 2016; x: 1-7 doi: 10.1111/ggi.12845
8. Petersen RC. Mild cognitive impairment. N Engl J Med 2011; 364: 2227-34 doi: 10.1056/NEJMcp0910237
9. Taylor ME, Lord SR, Delbaere K, Mikolaizak AS, Close JC. Physiological fall risk factors in cognitively impaired older people: a one-year prospective study. Dement Geriatr Cogn Disord 2012; 34: 181-9 doi: 10.1159/000343077
10. Borges AP, Carneiro JA, Zaia JE, Carneiro AA, Takayanagui OM. Evaluation of postural balance in mild cognitive impairment through a three-dimensional electromagnetic system. Braz J Otorhinolaryngol 2016; 82: 433–41 doi: 10.1016/j.bjorl.2015.08.023
11. Deschamps T, Beauchet O, Annweiler C, Cornu C, Mignardot JB. Postural control and cognitive decline in older adults: position versus velocity implicit motor strategy. Gait Posture 2014; 39: 628-30 doi: 10.1016/j.gaitpost.2013.07.001
12. Shin BM, Han SJ, Jung JH, Kim JE, Fregni F. Effect of mild cognitive impairment on balance. J Neurol Sci 2011; 305: 121-5 doi: 10.1016/j.jns.2011.02.031
13. Oliveira D, Goretti L, Pereira L. Performance in daily living activities and mobility among institutionalized elderly people with cognitive impairments: Pilot Study. Braz J Phys Ther 2006; 10: 91-6 doi: 10.1590/S1413-35552006000100012
14. Dos Santos MCF, Dos Santos JPM, Fontanela V, Spricio SM, Gil AWdO, Pires-Oliveira DAdA. Relationship of functional balance and cognitive impairment in elderly. MTP Rehab J 2014; 12: 215 doi: 10.17784/miprehabjournal.2014.12.215
15. Mirelman A, Weiss A, Buchman AS, Bennett DA, Giladi N, Hausdorff JM. Association between performance on timed up and go subtasks and mild cognitive impairment: further insights into the links between cognitive and motor function. J Am Geriatr Soc 2014; 62: 673-8 doi: 10.1111/jgs.12734
16. Bahureksa L, Najafi B, Saleh A, Sabbagh M, Coon D, Mohler MJ, et al. The impact of mild cognitive impairment on gait and balance: A systematic review and meta-analysis of studies using instrumented assessment. Gerontology 2016; 63(1):67-83 doi: 10.1159/000445831
17. Boripuntakul S, Lord SR, Brodie MA, Smith ST, Methapatara P, Wongpakaran N, et al. Spatial variability during gait initiation while dual tasking is increased in individuals with mild cognitive impairment. J Nutr Health Aging 2014; 18(3):307-12 doi: 10.1007/s12603-013-0390-3
18. Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil 2012; 93: 293-9 doi: 10.1016/j.apmr.2011.08.026
19. Gillain S, Warzee E, Lekeu F, Wojtasik V, Maquet D, Croisier JL, et al. The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer’s disease subjects and a comparison with other clinical tests used in single and dual-task conditions. Ann Phys Rehabil Med 2009; 52: 453-74
20. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149-60 doi: 10.3758/BRM.41.4.1149
21. Thai Cognitive Test Development Committee 1999. Mini-Mental State Examination-Thai 2002. Bankok: Institute of Geriatric Medicine, Department of Medicine Services, Ministry og Public Health, Thailand; 2002
22. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment MoCA: A brief screening tool for mild cognitive impairment. JAGH 2005; 53:695-9 doi:10.1111/j.1532-5415.2005.53221.x
23. Wongpakaran N, Wongpakaran T. Prevalence of major depressive disorders and suicide in long-term care facilities: a report from northern Thailand. Psychogeriatrics 2012; 12: 11-7 doi: 10.1111/j.1479-8301.2011.00383.x
24. Loughran S, Tennant N, Kishore A, Swan IR. Interobserver reliability in evaluating postural stability between clinicians and posturography. Clin Otolaryngol 2005; 30: 255-7 doi: 10.1111/j.1365-2273.2005.00988.x
25. Weiss EM, Siedentopf C, Hofer A, Deisenhammer EA, Hoptman MJ, Kremser C, et al. Brain activation pattern during a verbal fluency test in healthy male and female volunteers: a functional magnetic resonance imaging study. Neurosci Lett 2003;352(3):191-4 doi: 10.1016/j.neulet.2003.08.071
26. Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther 2003; 83: 237-52 doi: 10.1093/ptj/83.3.237
27. Schneiders AG, Sullivan SJ, Kvarnstrom J, Olsson M, Yden T, Marshall S. The effect of footwear and sports-surface on dynamic neurological screening for sport-related concussion. J Sci Med Sport 2010; 13: 382-6 doi: 10.1016/j.jsams.2010.01.003
28. Fiky AA-RE, Helal OF. Correlation between balance and cognition in normal young and elderly subjects. Jokull 2015; 64: 46-66 doi: 10.13140/RG.2.2.21760.02567
29. Tangen GG, Engedal K, Bergland A, Moger TA, Mengshoel AM. Relationships between balance and cognition in patients with subjective cognitive impairment, mild cognitive impairment, and Alzheimer disease. Phys Ther 2014; 94: 1123-34 doi: 10.2522/ptj.20130298
30. Fujisawa C, Umegaki H, Okamoto K, Nakashima H, Kuzuya M, Toba K, et al. Physical function differences between the stages from normal cognition to moderate Alzheimer disease. J Am Med Dir Assoc 2017; 18: 368 doi: 10.1016/j.jamda.2016.12.079
31. Pettersson AF, Olsson E, Wahlund LO. Motor function in subjects with mild cognitive impairment and early Alzheimer’s disease. Dement Geriatr Cogn Disord 2005; 19: 299-304 doi: 10.1159/000084555
32. Borges Sde M, Radanovic M, Forlenza OV. Functional mobility in a divided attention task in older adults with cognitive impairment. J Mot Behav 2015; 47: 378-85 doi: 10.1080/00222895.2014.998331
33. Montero-Odasso M, Bergman H, Phillips NA, Wong CH, Sourial N, Chertkow H. Dual-tasking and gait in people with mild cognitive impairment. The effect of working memory. BMC Geriatrics 2009;9:41 doi: 10.1186/1471-2318-9-41
34. Muir SW, Speechley M, Wells J, Borrie M, Gopaul K, Montero-Odasso M. Gait assessment in mild cognitive impairment and Alzheimer’s disease: the effect of dual-task challenges across the cognitive spectrum. Gait Posture 2012;35(1):96-100 doi: 10.1016/j.gaitpost.2011.08.014
35. Taylor ME, Delbaere K, Mikolaizak AS, Lord SR, Close JC. Gait parameter risk factors for falls under simple and dual task conditions in cognitively impaired older people. Gait Posture 2013;37(1):126-30 doi: 10.1016/j.gaitpost.2012.06.024
36. Franssen EH, Souren LE, Torossian CL, Reisberg B. Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer’s disease. J Am Geriatr Soc 1999; 47: 463-9 doi: 10.1111/j.1532-5415.1999.tb07240.x
37. Lark SD, Pasupuleti S. Validity of a functional dynamic walking test for the elderly. Arch Phys Med Rehabil 2009;90(3):470-4 doi: 10.1016/j.apmr.2008.08.221
38. Vereeck L, Wuyts F, Truijen S, Van de Heyning P. Clinical assessment of balance: normative data, and gender and age effects. Int J Audiol 2008; 47: 67-75 doi: 10.1080/14992020701689688