Abstract
BackgroundIt is currently unclear whether the function of brain regions associated with executive cognitive processing are independently associated with reduced physiological falls risk. If these are related, it would suggest that the development of interventions targeted at improving executive neurocognitive function would be an effective new approach for reducing physiological falls risk in seniors.MethodsWe performed a secondary analysis of 73 community-dwelling senior women aged 65 to 75 years old who participated in a 12-month randomized controlled trial of resistance training. Functional MRI data were acquired while participants performed a modified Eriksen Flanker Task - a task of selective attention and conflict resolution. Brain volumes were obtained using MRI. Falls risk was assessed using the Physiological Profile Assessment (PPA).ResultsAfter accounting for baseline age, experimental group, baseline PPA score, and total baseline white matter brain volume, baseline activation in the left frontal orbital cortex extending towards the insula was negatively associated with reduced physiological falls risk over the 12-month period. In contrast, baseline activation in the paracingulate gyrus extending towards the anterior cingulate gyrus was positively associated with reduced physiological falls risk.ConclusionsBaseline activation levels of brain regions underlying response inhibition and selective attention were independently associated with reduced physiological falls risk. This suggests that falls prevention strategies may be facilitated by incorporating intervention components - such as aerobic exercise - that are specifically designed to induce neurocognitive plasticity.Trial RegistrationClinicalTrials.gov Identifier: NCT00426881
Highlights
Falls are a major health care problem for seniors and health care systems
The periventricular and subcortical distribution of white matter lesions could interrupt the descending motor fibers arising from medial cortical areas, which are important for lower extremity motor control [16]
Using functional magnetic resonance imaging, we previously demonstrated that reduced activity in the posterior lobe of the right cerebellum during an executive-challenging cognitive task may be an underlying neural mechanism for increased falls risk [20]
Summary
Falls are a major health care problem for seniors and health care systems. They are the third leading cause of chronic disability worldwide [1] and approximately 30% of community-dwellers over the age of 65 years experience one or more falls every year [2]. While the results of these neuroimaging studies contribute to our appreciation of the importance of brain structure to physiological falls risk, they do not provide specific guidance for refining or developing falls prevention strategies because white matter lesions are not currently modifiable once they present. Reduced grey matter volume within sensorimotor and frontal parietal regions of the brain is associated with both reduced gait speed and impaired balance [17,18]. It is currently unclear whether the function of brain regions associated with executive cognitive processing are independently associated with reduced physiological falls risk. It would suggest that the development of interventions targeted at improving executive neurocognitive function would be an effective new approach for reducing physiological falls risk in seniors
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