John-Ross Rizzo1, Preeti Raghavan1, J R McCrery1, Mooyeon Oh-Park2, Joe Verghese3. 1. Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation, New York University Langone Medical Center, New York, NY. 2. Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, Kessler Foundation, West Orange, NJ. 3. Division of Cognitive and Motor Aging, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY. Electronic address: joe.verghese@einstein.yu.edu.
Abstract
OBJECTIVES: To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status. DESIGN: Validation cohort. SETTING: General community. PARTICIPANTS: Ambulatory older adults without dementia (N=104). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds. RESULTS:The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5-10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences. CONCLUSIONS: Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.
RCT Entities:
OBJECTIVES: To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status. DESIGN: Validation cohort. SETTING: General community. PARTICIPANTS: Ambulatory older adults without dementia (N=104). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds. RESULTS: The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5-10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences. CONCLUSIONS: Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.
Authors: Joe Verghese; Herman Buschke; Lisa Viola; Mindy Katz; Charles Hall; Gail Kuslansky; Richard Lipton Journal: J Am Geriatr Soc Date: 2002-09 Impact factor: 5.562
Authors: John-Ross Rizzo; Todd E Hudson; Prin X Amorapanth; Weiwei Dai; Joel Birkemeier; Rosa Pasculli; Kyle Conti; Charles Feinberg; Jan Verstraete; Katie Dempsey; Ivan Selesnick; Laura J Balcer; Steven L Galetta; Janet C Rucker Journal: Brain Inj Date: 2018-09-05 Impact factor: 2.311