A Dual-Task Paradigm Using the Oral Trail Making Test While Walking to Study Cognitive-Motor Interactions in Older Adults.

Antoine Langeard,Jean-Jacques Temprado,Marta Maria Torre

doi:10.3389/fnagi.2021.712463

Abstract

Objective: With aging, gait becomes more dependent on executive functions, especially on switching abilities. Therefore, cognitive-motor dual-task (DT) paradigms should study the interferences between gait and switching tasks. This study aimed to test a DT paradigm based on a validated cognitive switching task to determine whether it could distinguish older-old adults (OO) from younger-old adults (YO).Methods: Sixty-five healthy older participants divided into 29 younger-old (<70 years) and 36 older-old (≥70 years) age groups were evaluated in three single-task (ST) conditions as follows: a cognitive task including a processing speed component [Oral Trail Making Test part A (OTMT-A)], a cognitive task including a switching component [Oral Trail Making Test part B (OTMT-B)], and a gait evaluation at normal speed. They were also evaluated under two DT conditions, i.e., one associating gait with OTMT-A and the other associating gait with OTMT-B. Cognitive and gait performances were measured. The comparison of cognitive and gait performances between condition, logistic regression, and receiver operating characteristic (ROC) analyses were performed.Results: The cognitive and gait performances were differently affected by the different conditions (i.e., ST, DT, OTMT-A, and OTMT-B). The OTMT-B produced higher interference on gait and cognitive performances. Moreover, a higher number of errors on the OTMT-B performed while walking was associated with the older-old age group.Conclusion: Using validated cognitive flexibility tasks, this DT paradigm confirms the high interference between switching tasks and gait in older age. It is easily implemented, and its sensitivity to age may highlight its possible usefulness to detect cognitive or motor declines.

Highlights

With aging, the cognitive and motor function impairments coexist and are often the early markers on the pathway to neurodegeneration, loss of autonomy in the activities of daily living, decrease in mobility, and risk of falls
The repeated measure ANOVAs tested the interferences produced on gait spatiotemporal parameters and cognitive scores of the whole sample when performing the W-Oral TMT (OTMT)
The number of errors performed at OTMT-B while walking differentiated between older-old adults (OO) and younger-old adults (YO), and between the DT costs and switching cost on errors. These results suggest that the number of errors at the OTMT-B was related to the switching component of the task

Summary

Introduction

The cognitive and motor function impairments coexist and are often the early markers on the pathway to neurodegeneration, loss of autonomy in the activities of daily living, decrease in mobility, and risk of falls. DT Walking Oral TMT are powerful indicators of the declines in motor capacities and the risks of falls in older age (Langeard et al, 2019a, 2020) and, on the other hand, mobility impairments (e.g., slowing of gait speed) are more likely to increase the risk of fall when they are associated with the alterations of cognitive performance (Montero-Odasso et al, 2012) These findings are consistent with the hypothesis that cognitive and motor functions become more and more interrelated in older adults so that the alterations of motor behavior (e.g., slowing of movement execution) share common causes with cognitive declines by virtue of the dedifferentiation process (Baltes and Lindenberger, 1997; Sleimen-Malkoun et al, 2013, 2014). Identifying a valid DT paradigm that could be incorporated into clinical and research settings is an important issue

Methods

Results

Discussion

Conclusion