The Comparison of Dual-Tasking and Functional Fitness in Older Females

Context: America’s aging population is growing faster than ever, resulting in increasing challenges for healthcare providers and caregivers. Over 33% of adults aged 65 and older fall annually, and falls are the number one cause of injury-related death in this age group. Assessing fall risk is difficult due to its multifactorial nature, but functional fitness serves as a proxy measure. Women are at a particularly high risk for fall-related injury due to lower bone mineral density and higher fall frequency when compared to males. Fear of falling is also a serious contributor to fall risk, and it affects up to 89% of older adults. Objective: This study investigated the effects of functional fitness on walking speed under dual-tasking conditions. We hypothesized that women who were less functionally fit would experience greater declines in dual-task walking speed. Design: This experiment had a cross-sectional design. Setting: Tests were conducted at a retirement community in northwest Arkansas. Participants: Participants were females over the age of 65 y, with a mean age of 79.6 y. They were recruited on a volunteer basis and divided in two groups of 13 based on functional fitness levels. Interventions: Functional fitness was determined using the 8-foot up-and-go, a measure of agility and dynamic balance. For walking speed assessments, subjects walked a 10-meter distance with 3 meters extra on each end to account for acceleration and deceleration. Speed was measured with a laser timer. Dual-task assessment required subjects to count backwards by threes from a predetermined number. Four protocols with two trials each were used: single-task walking at habitual and maximal speeds, and dual-task walking at habitual and maximal speeds. Main Outcome Measures: The independent variable was functional fitness level (moderate or high). The dependent variables were dual-task walking time and Dual-Task Cost, calculated by subtracting single-task from dual-task walking time. A one-way ANOVA determined differences between dual-task decrement of the habitual and maximal walking speed trials. Statistical significance was set at α=.05. Results: Average 8-foot up-and-go time for the high functioning group was 5.74 seconds. The average time for the moderate functioning group was 8.33 seconds. Dual-task time difference between the two groups for habitual walking was statistically insignificant (p =.789). For maximal speed, dual-task time difference was statistically significant (p =.04). The moderate group exhibited smaller Dual-Task Costs than the high group for both habitual (difference of 1.3 ± 1.5 s) and maximal (difference of 0.3 ± 0.3 s) conditions. These Dual-Task Cost differences were insignificant for usual speed (p = .11) and maximal speed (p = .38) Discussion: The results did not support the hypothesis of Dual-Task Costs being related to functional fitness level. However, there was a significant difference in maximal dual-task speed between the groups. This shows that maximal dual-task walking speed is more closely linked to functional fitness than is habitual dual-task speed

Balancing the demands of two tasks: an investigation of cognitive–motor dual-tasking in relapsing remitting multiple sclerosis

Background: People with relapsing remitting multiple sclerosis (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance. Objectives: This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls, and (2) dual-task decrements are associated with everyday dual-tasking difficulties. The impact of mood, fatigue, and disease severity on dual-tasking was also examined. Methods: A total of 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of center of pressure on Biosway on stable and unstable surfaces) tasks under single- and dual-task conditions. Everyday dual-tasking was measured using the Dual-Tasking Questionnaire. Mood was measured by the Hospital Anxiety & Depression Scale. Fatigue was measured via the Modified Fatigue Index Scale. Results: No differences in age, gender, years of education, estimated pre-morbid IQ, or baseline digit span between groups. Compared with controls, PwRRMS showed significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=.007), but not a stable surface (p=.679). Balance decrement scores were not correlated with everyday dual-tasking difficulties or fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527; p=.001) and depression (rho=0.451; p=.007). Conclusions: RRMS causes dual-tasking difficulties, impacting balance under challenging conditions, which may contribute to increased risk of gait difficulties and falls. The relationship between anxiety/depression and dual-task decrement suggests that emotional factors may be contributing to dual-task difficulties

Dual task impairments in vascular dementia

Several studies have shown that people with Alzheimer's disease (AD) demonstrate difficulties in doing two things at once or 'dual-tasking' and that this dual task impairment is insensitive to normal ageing, chronic depression or prodromal conditions like Mild Cognitive Impairment. It is not known, however, if this impairment is specific to AD, or also present in other dementias, such as vascular dementia (VaD). In this study 15 people with VaD, 25 healthy age-matched and 25 healthy young controls were assessed using a paper and pencil dual tasking paradigm and several measures of working and episodic memory. Age had no effect on dual task performance, but the VaD patients demonstrated a significant impairment in dual tasking ability. Performance on the memory measures was instead affected by age with a further deterioration in the VaD patients. Both dual tasking and memory ability were significantly correlated with disease severity, as assessed by the MMSE. These results indicate that performance on the dual task could be a specific indicator of pathological ageing

Dual-Task Does Not Increase Slip and Fall Risk in Healthy Young and Older Adults during Walking

abstract: Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants’ fall risks are modified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task walking have no destabilizing effect on gait and slip responses in healthy individuals. We also found that, during dual-tasking, healthy individuals adopted cautious gait mode (CGM) strategy that is characterized by reduced walking speed, shorter step length, increased step width, and reduced heel contact velocity and is likely to be an adaptation to minimize attentional demand and decrease slip and fall risk during limited available attentional resources. Exploring interactions between gait variability and cognitive functions while walking may lead to designing appropriate fall interventions among healthy and patient population with fall risk.The article is published at https://www.hindawi.com/journals/abb/2017/1014784

The relationship between habitual dietary protein intake and dual task performance in sedentary, recreationally active, and masters athlete older adults

As the body ages, physical and cognitive declines can result in balance and mobility deficits, but research has shown that proper nutrition and exercise can help maintain physical and mental capacity. The purpose of this study was to analyze the relationship between habitual dietary protein intake and dual task performance in sedentary (SED), recreationally active (RA), and masters athletes (MA). To measure physical activity levels, the Rapid Physical Activity Questionnaire (RAPA) was completed by all participants. The participants were placed into a high or low protein group using the ASA-24 hour dietary recall. If the participant consumed less than 0.8 g/kg of protein per day, they were placed in the low protein group; if the participant consumed more than 0.8 g/kg of protein per day, they were placed in the high protein group. Participants completed four different walking tasks: habitual speed, maximal speed, dual-task habitual speed, and dual-task maximal speed. Gait speed was measured over a distance of 10 meters. SED, RA, and MA consumed a mean of 0.84, 1.13, and 1.57 grams of protein per kilogram body weight per day, respectively. MA consumed significantly more protein than SED or RA participants (α \u3c .05). The low protein group consumed 0.84 g/kg of protein ± 0.39 while the high protein group consumed 1.30 g/kg of protein ± 0.50. There was no significant correlation between amount of protein consumed and dual task performance. While the results were for dual task performance not statistically significant, they may have clinical significance; when comparing the high and low protein groups for the dual task habitual trial, the high protein group covered the 10-m distance 0.73 seconds faster than the low protein group. Clinically, the higher protein group may be able to perform activities of daily living more efficiently

Stepping over obstacles: Attention demands and aging

Older adults have been shown to trip on obstacles despite taking precautions to step carefully. It has been demonstrated in dual-task walking that age-related decline in cognitive and attentional mechanisms can compromise postural management. This is yet to be substantiated during obstacle negotiation when walking. Forty-six healthy volunteers (aged 20-79 years) stepped over obstacles in their path whilst walking and performing a verbal fluency task. Using 3D kinematic analysis we compared obstacle crossing during single (obstacle crossing only) and dual-task (obstacle crossing with verbal task) conditions. We grouped the participants into three age groups and examined age-related changes to cognitive interference on obstacle crossing. During dual-task trials, the 20-29 and 60-69 groups stepped closer to the obstacles prior to crossing, increased vertical toe-obstacle clearance, and had reduced gait variability. In these two groups there was a small dual-task decrease in verbal output. The 70-79 group applied similar dual-task stepping strategies during pre-crossing. However, during crossing they showed reduced vertical toe-to-obstacle clearance and increased variability of obstacle-to-heel distance. Additionally, this group did not show any significant change to verbal output across trials. These results suggest that with advanced age, increased cognitive demands are more likely to have a detrimental impact on motor performance, leading to compromised safety margins and increased variability in foot placement. We conclude that younger adults utilise a posture-preserving strategy during complex tasks but the likelihood of this strategy being used decreases with advanced age

Working Memory in Writing: Empirical Evidence From the Dual-Task Technique

The dual-task paradigm recently played a major role in understanding the role of working memory in writing. By reviewing recent findings in this field of research, this article highlights how the use of the dual-task technique allowed studying processing and short-term storage functions of working memory involved in writing. With respect to processing functions of working memory (namely, attentional and executive functions), studies investigated resources allocation, step-by-step management and parallel coordination of the writing processes. With respect to short-term storage in working memory, experiments mainly attempted to test Kellogg's (1996) proposals on the relationship between the writing processes and the slave systems of working memory. It is concluded that the dual-task technique revealed fruitful in understanding the relationship between writing and working memory

Creativity Enhancing Performance on Dual-Task Tests

There has been extensive research conducted exploring the connections between creativity and cognitive functioning. However, little research has examined various subtypes of creativity and their influences on specific cognitive tasks. The present study found that Self/Everyday had a negative impact on the controlled-processing task in a dual-task. This negative impact finding is not yet fully understood and more research is needed in elaborating the construct of Self/Everyday creativity. The current study also found evidence to support the proposition of various distinct types of creativity. There were also strong correlations between the subtypes of creativity and overall creativity

Face-gender discrimination is possible in the near-absence of attention

The attentional cost associated with the visual discrimination of the gender of a face was investigated. Participants performed a face-gender discrimination task either alone (single-task) or concurrently (dual-task) with a known attentional demanding task (5-letter T/L discrimination). Overall performance on face-gender discrimination suffered remarkably little under the dual-task condition compared to the single-task condition. Similar results were obtained in experiments that controlled for potential training effects or the use of low-level cues in this discrimination task. Our results provide further evidence against the notion that only low-level representations can be accessed outside the focus of attention

Testing the limits of optimizing dual-task performance in younger and older adults

Impaired dual-task performance in younger and older adults can be improved with practice. Optimal conditions even allow for a (near) elimination of this impairment in younger adults. However, it is unknown whether such (near) elimination is the limit of performance improvements in older adults. The present study tests this limit in older adults under conditions of (a) a high amount of dual-task training and (b) training with simplified component tasks in dual-task situations. The data showed that a high amount of dual-task training in older adults provided no evidence for an improvement of dual-task performance to the optimal dual-task performance level achieved by younger adults. However, training with simplified component tasks in dual-task situations exclusively in older adults provided a similar level of optimal dual-task performance in both age groups. Therefore through applying a testing the limits approach, we demonstrated that older adults improved dual-task performance to the same level as younger adults at the end of training under very specific conditions