Dual-task Function Research Articles

The effects of cognitive intervention on inter-joint coordination during walking in the older adults with balance impairment

BackgroundCognitive interventions are among the effective training-on-gait parameters; however, the effects of such trainings on inter-joints coordination has not been much considered. Research questionCan dual task and executive function training affect inter-joint coordination during walking in elderly with poor balance? MethodsThirty elderly men were purposefully divided into three groups: 1) dual-task training group (DTG), 2) executive function training group (EFG) and 3) control group. After the pre-test, the experimental groups participated in 24 training sessions while the control group were required to do their normal daily tasks. VICON three-dimensional motion analysis system with four T20 series cameras was used to evaluate inter-joints coordination during the experiment. Participants had to walk a 12-meter path while kinematics of their joints was recorded. The inter-joint coordination at the sagittal plane and in four phases were assessed using the vector coding technique. ResultsThe findings of this study showed that the greatest effect of the intervention on the coordination between the joints was in the loading and mid-stance phases (p < 0.05). Also, the variability in the coupling angle showed a significant decrease in most phases (p < 0.05). SignificanceBased on the obtained results, it can be argued that the loading and mid-stance are more involved in postural control and balance because the center of gravity is transferred between the legs and the person is normally on single-leg stance in these phases.

The Effect of Cognitive Task Complexity on Healthy Gait in the Walking Corsi Test.

Dual-task activities are essential within everyday life, requiring visual-spatial memory (VSM) and mobility skills. Navigational memory is an important component of VSM needed to carry out everyday activities, but this is often not included in traditional tests such as the Corsi block tapping test (CBT). The Walking Corsi Test (WalCT) allows both VSM and navigational memory to be tested together, as well as allowing measures of gait to be collected, thus providing a more complete understanding of dual-task function. The aim of this study was to investigate the effect of an increasingly complex cognitive task on gait in a healthy adult population, using the WalCT and body-worn inertial measurement unit (IMU) sensors. Participants completed both the CBT and WalCT, where they were asked to replicate increasingly complex sequences until they were no longer able to carry this out correctly. IMU sensors were worn on the shins throughout the WalCT to assess changes in gait as task complexity increased. Results showed that there were significant differences in several gait parameters between completing a relatively simple cognitive task and completing a complex task. The type of memory used also appeared to have an impact on some gait variables. This indicates that even within a healthy population, gait is affected by cognitive task complexity, which may limit function in everyday dual-task activities.

Association between dual-task function and neuropsychological testing in older adults with cognitive impairment

IntroductionDespite the current high prevalence of dementia, more than half of older adult patients never receive an evaluation. Current evaluation methods are lengthy, cumbersome, and not viable for busy clinics. This indicates that, despite recent improvements, a quick and objective routine test for screening cognitive decline in older adults is still needed. Poor dual-task gait performance has been previously associated with decreased executive and neuropsychological function. However, gait tests are not always viable for clinics or older patients. MethodsThe aim of this study was to assess the relationship between a novel upper-extremity function (UEF) dual-task performance and neuropsychological test results in older adults. For UEF dual-tasks, participants performed a consistent elbow flexion and extension, while counting backwards in increments of threes or ones. Wearable motion sensors were attached to the forearm and upper-arm to measure accuracy and speed of elbow flexion kinematics to calculate a UEF cognitive score. ResultsWe recruited older adults at three stages: cognitively normal (CN) (n = 35), mild cognitively impaired (MCI) of the Alzheimer's type (n = 34), and Alzheimer's disease (AD) (n = 22). The results demonstrate significant correlations between UEF cognitive score and mini-mental state examination (MMSE), Mini-Cog, Category fluency, Benson complex figure copy, Trail making test, and Montreal cognitive assessment (MOCA) (r values between −0.2355 and −0.6037 and p < 0.0288). DiscussionUEF dual-task was associated with executive function, orientation, repetition, abstraction, verbal recall, attention and calculation, language and visual construction. Of the associated brain domains, UEF dual-task was most significantly associated with executive function, visual construction, and delayed recall. The results from this study convey potential for UEF dual-task as a safe and convenient cognitive impairment screening method.

Impact of cognitive capacity on physical performance in chronic obstructive pulmonary disease patients: A scoping review.

Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by impaired cognitive and physical function. However, the role of cognitive function on motor control and purposeful movement is not well studied. The aim of the review was to determine the impact of cognition on physical performance in COPD. Methods: Scoping review methods were performed including searches of the databases: MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane (CENTRAL), APA PsycINFO, and CINAHL. Two reviewers independently assessed articles for inclusion, data abstraction, and quality assessment. Results: Of 11,252 identified articles, 44 met the inclusion criteria. The review included 5743 individuals with COPD (68% male) with the forced expiratory volume in one second range of 24-69% predicted. Cognitive scores correlated with strength, balance, and hand dexterity, while 6-min walk distance (n = 9) was usually similar among COPD patients with and without cognitive impairment. In 2 reports, regression analyses showed that delayed recall and the trail making test were associated with balance and handgrip strength, respectively. Dual task studies (n = 5) reported impaired balance or gait in COPD patients compared to healthy adults. Cognitive or physical Interventions (n = 20) showed variable improvements in cognition and exercise capacity. Conclusions: Cognition in COPD appears to be more related to balance, hand, and dual task function, than exercise capacity.

Validating the walking while talking test to measure motor, cognitive, and dual-task performance in ambulatory individuals with multiple sclerosis

IntroductionMultiple Sclerosis (MS) is associated with demyelination of the central nervous system that negatively impacts both motor and cognitive function, resulting in difficulty performing simultaneous motor and cognitive tasks, or dual-tasks. Declines in dual-tasking have been linked with falls in MS; thus, dual-task assessment with the Walking While Talking Test (WWTT) is commonly utilized in the clinical setting. However, the validity and minimal detectable change (MDC) of the WWTT has not been established for persons with MS. The primary objective of the study was to establish the WWTT as a valid measure of dual-task function by examining concurrent validity with other motor, cognitive and dual-task measures, and to establish the MDC for both the simple and complex conditions of the WWTT. MethodsIn a single visit, 38 adults (34 female, mean (SD) age 49.8(±9.1), Patient Determined Disease Steps (PDDS) mean 3, range 1–6) completed the WWTT simple (walk while reciting the alphabet) and complex (walk while reciting every other letter of the alphabet) conditions as well as a battery of cognitive and motor tests. Spearman correlations were used to examine concurrent validity. The sample was divided into low and high disability groups to determine the impact of disability severity on relationships among WWTT and cognitive and motor function. ResultsExcellent concurrent validity (r ≥ 0.79; p < 0.001) was observed for the WWTT simple and complex with both motor (Timed Up-and-Go, Timed 25-Foot Walk, forward and backward walking velocity, Six-Spot Step Test) and dual-task measures (Timed Up-and-Go Cognitive). The WWTT-simple demonstrated moderate concurrent validity with measures of processing speed (Symbol Digit Modalities Test, p = 0.041) and was related to all motor and dual-task measures across disability levels. The WWTT complex was only related to complex motor tasks in the low disability group. Within the low disability group, WWTT was associated with processing speed (p = 0.045) and working memory (California Verbal Learning Test, p = 0.012). The MDC values were established for WWTT simple (6.9 s) and complex (8 s) conditions. DiscussionThe WWTT is a quick, easy-to-administer clinical measure that captures both motor and cognitive aspects of performance for persons with MS. Clinicians should consider adding the WWTT to the evaluation of persons with MS to examine dual-task performance.

Combining tDCS With a Motor-Cognitive Task to Reduce the Negative Impact of Dual-Tasking on the Gait of Older Adults

The simultaneous performance of a secondary task while walking (i.e., dual tasking) increases motor-cognitive interference and fall risk in older adults. Combining transcranial direct current stimulation (tDCS) with the concurrent performance of a task that putatively involves the same brain networks targeted by the tDCS may reduce the negative impact of dual-tasking on walking. We examined whether tDCS applied while walking reduces the dual-task costs to gait and whether this combination is better than tDCS alone or walking alone (with sham stimulation). In 25 healthy older adults (aged 75.7±10.5yrs), a double-blind, within-subject, cross-over pilot study evaluated the acute after-effects of 20 minutes of tDCS targeting the primary motor cortex and the dorsal lateral pre frontal cortex during three separate sessions:1) tDCS while walking on a treadmill in a virtual-reality environment (tDCS+walking), 2) tDCS while seated (tDCS+seated), and 3) walking in the virtual-reality environment with sham tDCS (sham+walking). The complex walking condition taxed motor and cognitive abilities. During each session, single- and dual-task walking and cognitive function were assessed before and immediately after stimulation. Compared to pre-tDCS performance, tDCS+walking reduced the dual-task cost to gait speed (p=0.004) and other gait features (e.g., variability p=0.02), and improved (p<0.001) executive function (Stroop interference score). tDCS+seated and sham+walking did not affect the dual-task cost to gait speed (p>0.17). These initial findings demonstrate that tDCS delivered during challenging walking ameliorates dual-task gait and executive function in older adults, suggesting that the concurrent performance of related tasks enhances the efficacy of the neural stimulation and mobility.

Dual‐task gait and cognitive performance in midlife type 2 diabetes mellitus (T2DM): Baseline data from ENBIND

AbstractBackgroundMidlife Type 2 Diabetes Mellitus (T2DM) is associated with an increased risk of dementia in later life. Despite this, few studies have examined the utility of midlife biomarkers to predict later cognitive decline in T2DM. We evaluated the association between dual‐task gait speed and cognitive performance in midlife T2DM as part of ENBIND Study.MethodParticipants with midlife T2DM and matched healthy controls were recruited. Participants with T2DM only included if they had no micro/macrovascular complications of T2DM. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and computerised neuropsychological assessment battery (CANTAB®). Gait was assessed using both stopwatch and accelerometry across four tasks: (i) self‐selected (usual) gait speed, (ii) maximal gait speed and (iii) dual‐task gait speed (reciting alternate letters of the alphabet). Appropriate univariate statistics in addition to Poisson and linear models were used to analyse results.Results102 cognitively‐intact middle‐aged (52 ± 7.9 years) adults with (N = 71) and without (N = 31) T2DM were recruited. T2DM was associated with a greater likelihood of error on the MoCA (IRR = 2.36, 1.53‐3.64, p&lt;0.001) which persisted after covariate adjustment. T2DM was associated with poorer performance on reaction/movement time, executive function, attention and visuospatial memory tasks, however results were attenuated by covariate adjustment. T2DM was associated with slower gait speed on all three tasks (all p&lt;0.001). Overall, self‐selected, maximal and dual‐task speed were associated with greater likelihood of error on the MoCA (all p&lt;0.001). However, after robust adjustment for covariates, only the association for Dual Task Cost (DTC) persisted (p = 0.021). A DTC*T2DM interaction was not significant.ConclusionsThe current analysis showed diminished cognitive and gait performance in midlife T2DM vs. healthy controls. We observed significant associations between gait performance on the addition of a dual task and general cognitive function. This association, whilst greater in T2DM, was not T2DM specific and adds further evidence for the association between dual task‐gait and cognitive performance in midlife. Our findings support the ongoing exploration and use of gait as a physiological biomarker of overall cognitive function and warrants longitudinal investigation in this high risk group.

The Effects of 12-Week Physical Exercise Tapping High-level Cognitive Functions.

The purpose of this study was to investigate the effects of physical exercise tapping high-level cognitive functions on both cognitive function and fitness in older adults. In total, 96 healthy older adults took part in the study. Participants were randomly assigned to four groups: a cognitive training group (CG), physical exercise group (PG), simultaneous cognitive training and physical exercise group (C+PG), and the healthy control group (HG; received physical exercise materials but did not participate in a cognitive or exercise programme). The outcomes were the changes in the 6-minute walk test (6MWT), timed up-and-go (TUG) test, and the computerized modified Stroop task, which included two conditions, a naming condition (nonexecutive) and an executive condition. The results showed that the dynamic balance, cardiorespiratory endurance, and physical activity levels of the PG and C+PG were significantly better than those of the HG after the 12-week intervention. The times of the TUG test in these two groups were also significantly faster than those in the HG. Additionally, the C+PG exhibited better dual-task function than the PG. Over 12 weeks, the CG, PG, and C+PG demonstrated improved performance of executive function, but only the C+PG showed a general facilitative effect on nonexecutive control. Physical exercise tapping high-level cognitive functions and cognitive training can thus improve executive function more quickly than physical exercise alone. Moreover, physical exercise tapping high-level cognitive functions showed better fitness improvement than cognitive training alone, especially in dynamic balance.

Differences in dual task paradigms and executive function ability for recreational athletes in United Arab Emirates.

[Purpose] The purpose of this study to measure four components of executive function: (1) cognitive flexibility, (2) inhibition, (3) working memory and (4) processing speed, along with the ability to dual task in recreational athletes. [Participants and Methods] This was a cross-sectional study of (n=102) male and female participants, between the ages of 18–40 years of age across different levels and types of sport related physical activity. The International Physical Activity Questionnaire (IPAQ), short version, Dual Task Abilities (DTA) were measured utilizing a quantitative, dual task, gait test and Executive Function (EF) was measured through Stroop Color Word Test and Trail Making Test. [Results] Differences in EF and Dual Task-Interference (DTI) in recreational athletes did not show a significant difference between varying types of sport and level of sport related activity, with reported values high across all groups. Males reported better dual task interference abilities than females, though there were no significant differences in executive function between males and females. Executive function performance was the highest among the age group (18–24 years) population, but there were no significant differences between those in the higher age groups (25–34 years) and (35–40 years). [Conclusion] Overall, those participating in the study exhibited high prevalence of strong EF ability, regardless of sport activity type or level. This may suggest that type and level of sport activity may not be important when considering executive function performance maintenance for recreational athletes.

Physiological responses and enjoyment of Kinect-based exergames in older adults at risk for falls: A feasibility study.

Exergaming has the potential to improve physical function, cognition and dual-task function, and could be an effective new strategy for reducing risk of falling in older adults. To evaluate and test custom Microsoft Kinect-based motion-tracking exergames in older adults at risk for falls. Community-dwelling older adults who reported mobility difficulties or had fallen in the past year played three newly developed exergames (Target Trackers, Double Decision, and Visual Sweeps, 5 minutes each) in random order. Heart rate (HR) was measured during, and blood pressures (BPs), rating of perceived exertion (RPE), and rating of the enjoyment were recorded immediately after each exergame. Seven participants (median age 75 y; 4 females) completed the study. There were no adverse events reported during the exergaming session. Exercise HRs and RPEs were statistically significantly higher than resting for all exergames (p< 0.05). The differences were not significant for BPs. Enjoyment ratings ranged from 79.6-90.6% and there were no statistically significant differences between the exergames. The newly developed exergames were light in exercise intensity and enjoyable for older adults at risk for falls. Future intervention studies are warranted to examine the benefits of exergames for this special population.

Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management.

This paper provides a narrative review of cognitive motor interference in neurodegeneration, including brain imaging findings specific to interference effects in neurodegenerative disease, and dual task assessment and intervention in Parkinson’s disease (PD), multiple sclerosis (MS), and Huntington’s disease (HD). In a healthy central nervous system the ability to process information is limited. Limitations in capacity to select and attend to inputs influence the ability to prepare and perform multiple tasks. As a result, the system balances demands, switching attention to the most task-relevant information as it becomes available. Limitations may become more apparent in persons with neurodegenerative diseases (ND) with system-specific impairments in PD, MS, and HD. These ND affect both cognitive and motor function and are thus particularly susceptible to dual task interference. Issues related to performer and task characteristics and implications of these findings for both the standard assessment of dual task abilities as well as development and evaluation of interventions aimed at improving dual task ability are discussed. In addition, we address the need for optimizing individualized assessment, intervention and evaluation of dual task function by choosing cognitive and motor tasks and measures that are sensitive to and appropriate for the individual’s level of function. Finally, we use current evidence to outline a 5-step process of clinical decision making that uses the dual task taxonomy as a framework for assessment and intervention.

Safety, Enjoyment, And Physiological Responses Of Kinect-based Exergames In Older Adults At Risk For Falls

Exergaming has the potential to improve physical function, cognition and dual-task function, and could be an effective new strategy for reducing risk of falling in older adults. PURPOSE: To evaluate and test the safety, enjoyment, and physiological responses on custom Microsoft Kinect-based motion-tracking games that train specific dual-task function in older adults at risk for falls. METHODS: Community-dwelling older adults who reported current mobility difficulties or falling in the past year were included in the study. Participants played three newly developed exergames (Double Decision, Target Trackers, and Visual Sweeps, 5 minutes each) in random order. Heart rate (HR) was measured during each exergame, and blood pressure (BP), rating of perceived exertion (RPE) and rating of the Physical Activity Enjoyment Scale were recorded immediately after each exergame. Student t-tests were used to examine the differences in variables at resting state and during/after exercise. Repeated measure analyses of variance were used to examine the differences in variables among the three exergames. RESULTS: Seven participants (aged 76±6 years; 4 females) completed the study. The exergames did not cause any injuries. Average exercise HRs for Double Decision, Target Tracker, and Visual Sweeps were 87.57±6.58 bpm, 84.71±8.48 bpm, and 82.00±9.72 bpm; post- exercise BPs were 129.29±12.35/78.14±9.06 mmHg, 129.86±7.99/81.86±13.28 mmHg, 132.86±14.31/79.43±13.01 mmHg; post-exercise RPEs were 11.14±1.07, 10.14±1.21, and 9.86±1.86; and post-exercise enjoyment ratings were 81.22±0.14%, 90.61±0.18%, and 79.59±0.16%, respectively. Average exercise HRs were significantly higher than resting HRs for all three exergames (p<0.01). Visual Sweep had significantly lower average exercise HR compared to Double Decision (p<0.05) and Target Tracker (p<0.05), and there was a significant difference in post-exercise RPE between Double Decision and Target Tracker (p<0.05). There was a significant difference between Target Tracker and Double Decision in post-exercise enjoyment ratings (p<0.05). CONCLUSION: The newly developed exergames were safe, enjoyable, and light for older adults who are at risk for falls. Future intervention studies are needed to examine the benefits of exergames for this special population.

Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review.

An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.

Attentional Demands of Locomotor and Balance Tasks in Individuals Aging with and without a Stroke

Background: The purpose of this study was to examine the cognitive-motor interference pattern while concurrently performing a higher cognitive task with three dynamic postural tasks – limits of stability (intentional balance), compensatory stepping during (reactive balance -RB) and walking tasks across younger adults (YA), older adults (OA) and older chronic stroke survivors. Methods: Thirty-six individuals in each group performed either of the three postural tasks – forward limits of stability (LOS, intentional balance), forward compensatory stepping (reactive balance - RB) and walking task (gait) with (dual-task) and without (single-task) performing a serial subtraction (SS) task. The SS tasks was also performed in isolation. Maximum center of pressure excursion (MXE) for LOS, center of mass position relative to base of support at step touchdown for RB, gait velocity and number of correct responses for SS task were measured. Motor and cognitive costs were calculated. Results: The healthy adults showed higher motor cost for more dynamic gait and RB tasks compared with the LOS task however, motor costs were similar for all the tasks in the stroke group. Although the motor cost for OA and stroke groups were more than YAs for all postural tasks, motor cost was significantly greater in stroke group than OA group only for the LOS task. Conclusion: The attentional demands are higher for postural task that are biomechanically unstable in healthy adults. Chronic stroke survivors show disproportionate ability to divide attention seen by higher motor cost during LOS task. Nevertheless, in chronic phase of recovery, stroke survivors may regain some dual-task function displaying similar strategies as healthy counterparts.

Upper-Extremity Dual-Task Function: An Innovative Method to Assess Cognitive Impairment in Older Adults.

Background: Difficulties in orchestrating simultaneous tasks (i.e., dual-tasking) have been associated with cognitive impairments in older adults. Gait tests have been commonly used as the motor task component for dual-task assessments; however, many older adults have mobility impairments or there is a lack of space in busy clinical settings. We assessed an upper-extremity function (UEF) test as an alternative motor task to study the dual-task motor performance in older adults.Methods: Older adults (≥65 years) were recruited, and cognitive ability was measured using the Montreal cognitive assessment (MoCA). Participants performed repetitive elbow flexion with their maximum pace, once single-task, and once while counting backward by one (dual-task). Single- and dual-task gait tests were also performed with normal speed. Three-dimensional kinematics was measured both from upper-extremity and lower-extremity using wearable sensors to determine UEF and gait parameters. Parameters were compared between the cognitively impaired and healthy groups using analysis of variance tests, while controlling for age, gender, and body mass index (BMI). Correlations between UEF and gait parameters for dual-task and dual-task cost were assessed using linear regression models.Results: Sixty-seven older adults were recruited (age = 83 ± 10 years). Based on MoCA, 10 (15%) were cognitively impaired. While no significant differences were observed in the single-task condition, within the dual-task condition, the cognitively impaired group showed significantly less arm flexion speed (62%, d = 1.51, p = 0.02) and range of motion (27%, d = 0.93, p = 0.04), and higher speed variability (88%, d = 1.82, p < 0.0001) compared to the cognitively intact group, when adjusted with age, gender, and BMI. Significant correlations were observed between UEF speed parameters and gait stride velocity for dual-task condition (r = 0.55, p < 0.0001) and dual-task cost (r = 0.28, p = 0.03).Conclusion: We introduced a novel test for assessing dual-task performance in older adults that lasts 20 s and is based on upper-extremity function. Our results confirm significant associations between upper-extremity speed, range of motion, and speed variability with both the MoCA score and the gait performance within the dual-task condition.

Potential Benefits of Exergaming for Cognition and Dual-Task Function in Older Adults: A Systematic Review.

This paper provides a systematic review of current research findings using exergaming as a treatment for improving cognition and dual-task function in older adults. A literature search was conducted to collect exergaming intervention studies that were either randomized controlled or uncontrolled studies. Of the seven identified studies (five randomized controlled studies and two uncontrolled studies), three studies focused on cognitive function alone, two studies focused on dual-task function alone, and two studies measured both cognitive function and dual-task function. Current evidence supports that exergaming improves cognitive function and dual-task function, which potentially leads to fall prevention. However, it is unclear whether exergaming, which involves both cognitive input and physical exercise, has additional benefits compared with traditional physical exercise alone. Further studies should include traditional exercise as a control group to identify these potential, additional benefits.

The Altered Brain Activation of Phonological Working Memory, Dual Tasking, and Distraction Among Participants With Adult ADHD and the Effect of the MAOA Polymorphism

Objective: The present study aimed to reveal the brain correlates of phonological working memory (WM), dual tasking, and distraction in adult ADHD combined with the effect of polymorphisms of monoamine oxidase A (MAOA rs1137070 Asp470Asp). Method: A total of 29 participants with adult ADHD and 21 controls were recruited. They completed 0-back and 2-back tasks, as wells as 2-back tasks with a dual-task effect or a distracting effect, during functional magnetic resonance imaging scanning. Results: The brain activation of WM in the bilateral inferior frontal lobe, pars opercularis, was higher among the adult ADHD group. The genotype of MAOA significantly interacted with the ADHD effect in the left inferior frontal lobe, pars opercularis. Adults with ADHD had higher activation in the left lingual area in response to the dual-tasking effect. Conclusion: The MAOA polymorphism moderated the altered activation in pars opercularis for WM among adults with ADHD. The higher lingual gyrus activation might indicate that higher attention resources are demanded to sustain the dual-task function of adults with ADHD.

The Effect of Aquatic Exercise and Education on Lowering Fall Risk in Older Adults With Hip Osteoarthritis

To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis (OA). Seventy-nine adults, 65 years of age or older with hip OA and at least 1 fall risk factor, were randomly assigned to 1 of 3 groups: aquatics and education (AE; aquatic exercise twice a wk with once-a-wk group education), aquatics only (A; 2 wk aquatic exercise) and control (C; usual activity). Balance, falls efficacy, dual-task function, functional performance (chair stands), and walking performance were measured pre- and postintervention or control period. There was a significant improvement in fall risk factors (full-factorial MANCOVA, baseline values as covariates; p = .038); AE improved in falls efficacy compared with C and in functional performance compared with A and C. The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis.

Does Falls-Efficacy Predict Balance Performance in Older Adults with Hip Osteoarthritis?

This cross-sectional study evaluated the relationship of falls-efficacy to physical performance of functional balance tasks in older adults with hip osteoarthritis (OA). Older adults with hip OA experience several factors associated with fall risk: loss of movement, loss of strength, and increased fear of falls. Seventy-nine men and women age 65 or older were measured for balance, dual task function, and falls-efficacy. Using hierarchical regression, falls-efficacy was a significant predictor of balance when number of medications, age, use of a walking aid, health status, and physical activity level were controlled for. Understanding the role of falls-efficacy in predicting fall risk helps clinicians develop falls screening and prevention programs.