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.
Highlights
Falls are a common problem in older adults (Tinetti et al, 1988; Rubenstein and Josephson, 2002)
Dual tasks that were performed on a Straight walking path (SWP) revealed group differences similar to dual tasks that were performed on a Curved walking path (CWP) (Table 2)
When the participants walked while checking boxes, on both the SWP and the CWP, there were no statistically significant group differences in walking performance, while the box-checking speed was significantly lower for the poor Trail Making Test (TMT) performers
Summary
Falls are a common problem in older adults (Tinetti et al, 1988; Rubenstein and Josephson, 2002). Impaired executive function seems to be a relevant determinant of walking impairment and fall risk in older adults (Binder et al, 1999; Ble et al, 2005; Coppin et al, 2006; Buracchio et al, 2011; Muir-Hunter et al, 2014) This is especially true for patient populations such as patients with Parkinson’s disease (PD) (Yogev et al, 2005, 2007; Bloem et al, 2006; Heinzel et al, 2016) and elderly fallers (Springer et al, 2006; Yogev et al, 2007). The objective of this study was to investigate whether older adults demonstrate changes of prioritization during different walking paths
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