Examining Performance between Different Cognitive-Motor Dual-Task Tests in Community-Dwelling Older Adults
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Measures and Instruments
- (a)
- The Timed Up and Go (TUG) test is a simple and quick assessment tool commonly used to evaluate fall risk in the elderly population. When administered, it records the time taken for a person to rise from a straight-backed chair, walk 3 m, turn around, return to the chair, and sit back down. This is a valid and reliable test, as according to Podsiadlo & Richardson [22] it showed good test-retest reliability (ICC = 0.99) and good inter-rater reliability (ICC = 0.99). The TUG was the motor task completed during the performance of both the single activity and the DT activities in the present study. To measure the necessary distance for the TUG test, a tape measure and a plastic cone were used, which was placed at 3 m from the chair. A digital stopwatch was then employed to record the time of test completion.
- (b)
- The 30-S Chair Stand Test (30-CST) assesses the functional muscle strength of the lower limbs [23]. The participant sits in the center of a straight-backed chair, approximately 43 cm tall, with no side supports, with the back straight, feet on the floor slightly behind the knees, and arms crossed over the chest. The subject is encouraged to complete as many full raises and chair sits as possible within 30 s, while the examiner is counting the number of raises. Being able to perform more repetitions indicates higher lower limb strength. According to Jones et al. [23], the test showed excellent criterion validity: r = 0.77 (95% CI = 0.64–0.85) compared to weight-adjusted lower limb strength performance for all participants. Also, excellent test-retest reliability was recorded for the entire sample: r = 0.89 (95% CI = 0.79–0.93), and excellent inter-rater reliability in a pilot test among 15 participants: r = 0.95 (95% CI = 0.84–0.97).
- (c)
- The Four Square Step Test (FSST) assesses dynamic balance [24]. The participant is asked to step over 4 bars in a cross (+) configuration on a flat surface without touching them and to move as fast as possible in each square with both feet forward, right, backward, and left (clockwise and counterclockwise). Two trials are conducted, and the time for each is recorded in seconds. The best time is then chosen for further analysis. According to Dite & Temple [24], the FSST showed excellent concurrent validity with the Step Test (r = −0.83) and the Timed Up and Go (r = 0.88), and adequate concurrent validity with the Functional Reach Test (r = −0.47). Excellent test-retest reliability (ICC = 0.98) and excellent inter-rater reliability (ICC = 0.99) were also recorded.
- (d)
- The Activities-Specific Balance Confidence (ABC) scale is employed to evaluate older people’s balance confidence. This is a 16-question activity scale where the individual is asked to rate their confidence in performing supposed daily activities without losing balance or feeling unstable. Each question is scored from 0 (no confidence) to 100 (full confidence), and the final score is obtained by summing all the scores and then dividing by the number of questions [25]. The ABC scale has been translated and adapted for a Greek elderly population by Makri et al. [26] with high validity and reliability.
2.3. Procedure
- (a)
- Collection of demographic data characteristics. Muscle strength was evaluated with the 30-CST test, dynamic balance using the FSST test, and balance confidence using the ABC scale.
- (b)
- Performing the TUG test (simple activity): Each participant sat in a straight-backed chair, about 46 cm high, with their back touching the back of the chair. On the authors′ ‘Go′ command, the participant stood up, walked straight at a normal walking pace towards the cone (placed 3 m from the chair), walked around the cone (on either side) and returned to the chair at the same walking pace, where she was seated. The time to complete the test was recorded until the subject came into contact with the chair.
- (c)
- The simultaneous execution of TUG and cognitive tasks (DT activities) as represented in Almajid & Keshner’s study [21].
- (a)
- Mental calculation (working memory): Participants performed backward counting by threes from a randomly chosen three-digit number while simultaneously executing the TUG test (TUGMC).
- (b)
- Memory (memory recall): Participants were asked to memorize a seven-item shopping list after reading it for 15 s while seated. Then, when the DT was conducted, they tried to recall as many products from the list as possible while performing the TUG test (TUGME). This task was never given as the first task, even though the cognitive tasks were randomized. This approach was used to confirm that each participant retained the information for a significant period before recalling it, rather than just verbalizing the items immediately after reading them.
- (c)
- Verbal fluency: Participants needed to generate as many words as they could starting with the letter “L” while simultaneously performing the TUG test (TUGVF).
- (d)
- Reaction time: Participants were asked to respond verbally to an auditory stimulus while they were performing the TUG test (TUGRE). Throughout the TUG, they heard the word “book” as a prerecorded auditory stimulus of the same intensity and at a random rate, to which they responded as quickly as possible by uttering the word “top”. The intensity and tempo of the word signal was the same for all participants.
2.4. Statistical Analysis
3. Results
4. Discussion
4.1. Comparisons of Motor Performance between the DT and TUG Tests
4.2. Examining the Relationship of Additional Characteristics with the TUG Tests
4.3. Limitations and Recommendations for Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- McIsaac, T.L.; Lamberg, E.M.; Muratori, L.M. Building a Framework for a Dual Task Taxonomy. BioMed Res. Int. 2015, 2015, 591475. [Google Scholar] [CrossRef] [PubMed]
- Kahya, M.; Moon, S.; Ranchet, M.; Vukas, R.R.; Lyons, K.E.; Pahwa, R.; Akinwuntan, A.; Devos, H. Brain Activity during Dual Task Gait and Balance in Aging and Age-Related Neurodegenerative Conditions: A Systematic Review. Exp. Gerontol. 2019, 128, 110756. [Google Scholar] [CrossRef]
- Arpaia, P.; Cuocolo, R.; Fullin, A.; Gargiulo, L.; Mancino, F.; Moccaldi, N.; Vallefuoco, E.; De Blasiis, P. Executive Functions Assessment Based on Wireless EEG and 3D Gait Analysis During Dual-Task: A Feasibility Study. IEEE J. Transl. Eng. Health Med. 2024, 12, 268–278. [Google Scholar] [CrossRef] [PubMed]
- Plummer, P.; Eskes, G. Measuring Treatment Effects on Dual-Task Performance: A Framework for Research and Clinical Practice. Front. Hum. Neurosci. 2015, 9, 225. [Google Scholar] [CrossRef]
- Pasquetti, P.; Apicella, L.; Mangone, G. Pathogenesis and Treatment of Falls in Elderly. Clin. Cases Miner. Bone Metab. 2014, 11, 222–225. [Google Scholar] [CrossRef] [PubMed]
- Boisgontier, M.P.; Beets, I.A.M.; Duysens, J.; Nieuwboer, A.; Krampe, R.T.; Swinnen, S.P. Age-Related Differences in Attentional Cost Associated with Postural Dual Tasks: Increased Recruitment of Generic Cognitive Resources in Older Adults. Neurosci. Biobehav. Rev. 2013, 37, 1824–1837. [Google Scholar] [CrossRef]
- Menant, J.C.; Schoene, D.; Sarofim, M.; Lord, S.R. Single and Dual Task Tests of Gait Speed Are Equivalent in the Prediction of Falls in Older People: A Systematic Review and Meta-Analysis. Ageing Res. Rev. 2014, 16, 83–104. [Google Scholar] [CrossRef] [PubMed]
- Ponti, M.; Bet, P.; Oliveira, C.L.; Castro, P.C. Better than Counting Seconds: Identifying Fallers among Healthy Elderly Using Fusion of Accelerometer Features and Dual-Task Timed Up and Go. PLoS ONE 2017, 12, e0175559. [Google Scholar] [CrossRef]
- Vance, R.C.; Healy, D.G.; Galvin, R.; French, H.P. Dual Tasking With the Timed “Up & Go” Test Improves Detection of Risk of Falls in People With Parkinson Disease. Phys. Ther. 2015, 95, 95–102. [Google Scholar] [CrossRef]
- Verhaeghen, P.; Geigerman, S.; Yang, H.; Montoya, A.C.; Rahnev, D. Resolving Age-Related Differences in Working Memory: Equating Perception and Attention Makes Older Adults Remember as Well as Younger Adults. Exp. Aging Res. 2019, 45, 120–134. [Google Scholar] [CrossRef]
- Diamond, A. Executive Functions. Annu. Rev. Psychol. 2013, 64, 135–168. [Google Scholar] [CrossRef]
- Al-Yahya, E.; Dawes, H.; Smith, L.; Dennis, A.; Howells, K.; Cockburn, J. Cognitive Motor Interference While Walking: A Systematic Review and Meta-Analysis. Neurosci. Biobehav. Rev. 2011, 35, 715–728. [Google Scholar] [CrossRef]
- Beurskens, R.; Bock, O. Does the Walking Task Matter? Influence of Different Walking Conditions on Dual-Task Performances in Young and Older Persons. Hum. Mov. Sci. 2013, 32, 1456–1466. [Google Scholar] [CrossRef]
- Bayot, M.; Dujardin, K.; Dissaux, L.; Tard, C.; Defebvre, L.; Bonnet, C.T.; Allart, E.; Allali, G.; Delval, A. Can Dual-Task Paradigms Predict Falls Better than Single Task?—A Systematic Literature Review. Neurophysiol. Clin. 2020, 50, 401–440. [Google Scholar] [CrossRef] [PubMed]
- Odonkor, C.A.; Thomas, J.C.; Holt, N.; Latham, N.; van Swearingen, J.; Brach, J.S.; Leveille, S.G.; Jette, A.; Bean, J. A Comparison of Straight- and Curved-Path Walking Tests Among Mobility-Limited Older Adults. J. Gerontol. Ser. A 2013, 68, 1532–1539. [Google Scholar] [CrossRef] [PubMed]
- Chan, W.; Tsang, W.W. The Performance of Stroke Survivors in Turning-While-Walking While Carrying out a Concurrent Cognitive Task Compared with Controls. PLoS ONE 2017, 12, e0189800. [Google Scholar] [CrossRef]
- Brooks, D.; Davis, A.M.; Naglie, G. Validity of 3 Physical Performance Measures in Inpatient Geriatric Rehabilitation. Arch. Phys. Med. Rehabil. 2006, 87, 105–110. [Google Scholar] [CrossRef] [PubMed]
- Barry, E.; Galvin, R.; Keogh, C.; Horgan, F.; Fahey, T. Is the Timed Up and Go Test a Useful Predictor of Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-Analysis. BMC Geriatr. 2014, 14, 14. [Google Scholar] [CrossRef]
- Hofheinz, M.; Mibs, M. The Prognostic Validity of the Timed Up and Go Test with a Dual Task for Predicting the Risk of Falls in the Elderly. Gerontol. Geriatr. Med. 2016, 2, 2333721416637798. [Google Scholar] [CrossRef]
- Asai, T.; Oshima, K.; Fukumoto, Y.; Yonezawa, Y.; Matsuo, A.; Misu, S. Association of Fall History with the Timed Up and Go Test Score and the Dual Task Cost: A Cross-Sectional Study among Independent Community-Dwelling Older Adults. Geriatr. Gerontol. Int. 2018, 18, 1189–1193. [Google Scholar] [CrossRef]
- Almajid, R.; Keshner, E. Role of Gender in Dual-Tasking Timed Up and Go Tests: A Cross-Sectional Study. J. Mot. Behav. 2019, 51, 681–689. [Google Scholar] [CrossRef] [PubMed]
- Podsiadlo, D.; Richardson, S. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. J. Am. Geriatr. Soc. 1991, 39, 142–148. [Google Scholar] [CrossRef]
- Jones, C.J.; Rikli, R.E.; Beam, W.C. A 30-s Chair-Stand Test as a Measure of Lower Body Strength in Community-Residing Older Adults. Res. Q. Exerc. Sport 1999, 70, 113–119. [Google Scholar] [CrossRef]
- Dite, W.; Temple, V.A. A Clinical Test of Stepping and Change of Direction to Identify Multiple Falling Older Adults. Arch. Phys. Med. Rehabil. 2002, 83, 1566–1571. [Google Scholar] [CrossRef]
- Powell, L.E.; Myers, A.M. The Activities-Specific Balance Confidence (ABC) Scale. J. Gerontol. Ser. A 1995, 50, M28–M34. [Google Scholar] [CrossRef]
- World Congress on Osteoporosis. Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2019): Posters Abstracts. Osteoporos. Int. 2019, 30, 253–773. [Google Scholar] [CrossRef] [PubMed]
- Porciuncula, F.S.; Rao, A.K.; McIsaac, T.L. Aging-Related Decrements during Specific Phases of the Dual-Task Timed Up-and-Go Test. Aging Clin. Exp. Res. 2016, 28, 121–130. [Google Scholar] [CrossRef] [PubMed]
- Miyai, I.; Tanabe, H.C.; Sase, I.; Eda, H.; Oda, I.; Konishi, I.; Tsunazawa, Y.; Suzuki, T.; Yanagida, T.; Kubota, K. Cortical Mapping of Gait in Humans: A Near-Infrared Spectroscopic Topography Study. NeuroImage 2001, 14, 1186–1192. [Google Scholar] [CrossRef]
- Haupt, S.; Axmacher, N.; Cohen, M.X.; Elger, C.E.; Fell, J. Activation of the Caudal Anterior Cingulate Cortex Due to Task-Related Interference in an Auditory Stroop Paradigm. Hum. Brain Mapp. 2009, 30, 3043–3056. [Google Scholar] [CrossRef]
- van Iersel, M.B.; Kessels, R.P.C.; Bloem, B.R.; Verbeek, A.L.M.; Olde Rikkert, M.G.M. Executive Functions Are Associated with Gait and Balance in Community-Living Elderly People. J. Gerontol. Ser. A 2008, 63, 1344–1349. [Google Scholar] [CrossRef]
- Verghese, J.; Kuslansky, G.; Holtzer, R.; Katz, M.; Xue, X.; Buschke, H.; Pahor, M. Walking While Talking: Effect of Task Prioritization in the Elderly. Arch. Phys. Med. Rehabil. 2007, 88, 50–53. [Google Scholar] [CrossRef] [PubMed]
- Li, C.; Verghese, J.; Holtzer, R. A Comparison of Two Walking While Talking Paradigms in Aging. Gait Posture 2014, 40, 415–419. [Google Scholar] [CrossRef] [PubMed]
- Tombu, M.; Jolicœur, P. A Central Capacity Sharing Model of Dual-Task Performance. J. Exp. Psychol. Hum. Percept. Perform. 2003, 29, 3–18. [Google Scholar] [CrossRef] [PubMed]
- Hartley, A.A. Age Differences in Dual-Task Interference Are Localized to Response-Generation Processes. Psychol. Aging 2001, 16, 47–54. [Google Scholar] [CrossRef]
- Goh, H.-T.; Pearce, M.; Vas, A. Task Matters: An Investigation on the Effect of Different Secondary Tasks on Dual-Task Gait in Older Adults. BMC Geriatr. 2021, 21, 510. [Google Scholar] [CrossRef]
- Smith, E.; Cusack, T.; Blake, C. The Effect of a Dual Task on Gait Speed in Community Dwelling Older Adults: A Systematic Review and Meta-Analysis. Gait Posture 2016, 44, 250–258. [Google Scholar] [CrossRef]
- St George, R.J.; Jayakody, O.; Healey, R.; Breslin, M.; Hinder, M.R.; Callisaya, M.L. Cognitive Inhibition Tasks Interfere with Dual-Task Walking and Increase Prefrontal Cortical Activity More than Working Memory Tasks in Young and Older Adults. Gait Posture 2022, 95, 186–191. [Google Scholar] [CrossRef]
- Ansai, J.H.; Aurichio, T.R.; Rebelatto, J.R. Relationship between Balance and Dual Task Walking in the Very Elderly. Geriatr. Gerontol. Int. 2016, 16, 89–94. [Google Scholar] [CrossRef]
- Herman, T.; Mirelman, A.; Giladi, N.; Schweiger, A.; Hausdorff, J.M. Executive Control Deficits as a Prodrome to Falls in Healthy Older Adults: A Prospective Study Linking Thinking, Walking, and Falling. J. Gerontol. Ser. A 2010, 65, 1086–1092. [Google Scholar] [CrossRef]
- Goto, S.; Sasaki, A.; Takahashi, I.; Mitsuhashi, Y.; Nakaji, S.; Matsubara, A. Relationship between Cognitive Function and Balance in a Community-Dwelling Population in Japan. Acta Oto-Laryngol. 2018, 138, 471–474. [Google Scholar] [CrossRef]
- Beauchet, O.; Barden, J.; Liu-Ambrose, T.; Chester, V.L.; Szturm, T.; Allali, G. The Relationship between Hippocampal Volume and Static Postural Sway: Results from the GAIT Study. AGE 2016, 38, 19. [Google Scholar] [CrossRef] [PubMed]
- Kido, T.; Tabara, Y.; Igase, M.; Ochi, N.; Uetani, E.; Nagai, T.; Yamamoto, M.; Taguchi, K.; Miki, T.; Kohara, K. Postural Instability Is Associated with Brain Atrophy and Cognitive Impairment in the Elderly: The J-SHIPP Study. Dement. Geriatr. Cogn. Disord. 2010, 29, 379–387. [Google Scholar] [CrossRef] [PubMed]
- Hallal, C.Z.; Marques, N.R.; Vieira, E.R.; Brunt, D.; Spinoso, D.H.; Castro, A.; Cardozo, A.C.; Gonçalves, M. Lower Limb Muscle Coactivation Levels in Healthy Younger and Older Adults during Functional Dual-Task Gait. Mot. Rev. Educ. Fís. 2013, 19, 620–626. [Google Scholar] [CrossRef]
- Kim, H.; Tobisawa, S.; Park, H.; Kim, J.; Lee, J.; Shin, D. Aging-Induced Degradation in Tracking Performance in Three-Dimensional Movement. SICE J. Control Meas. Syst. Integr. 2024, 17, 239–246. [Google Scholar] [CrossRef]
Sample Characteristics | Mean | Standard Deviation | Minimum Value | Maximum Value |
---|---|---|---|---|
Age (y) | 72.22 | 5.11 | 65 | 80 |
Hight (m) | 1.68 | 0.06 | 1.53 | 1.80 |
Weight (kg) | 69.87 | 8.63 | 49.20 | 90.20 |
BMI (kg/m2) | 24.60 | 2.08 | 20 | 30.70 |
MMSE | 28.38 | 1.19 | 25 | 30 |
30-CST (number of chair raises) | 10.58 | 1.01 | 9 | 12 |
FSST (s) | 12.01 | 1.51 | 9.00 | 15.06 |
ABC (%) | 87.87 | 7.73 | 60.62 | 98.75 |
Variable | Mean | Standard Deviation | Minimum Value | Maximum Value |
---|---|---|---|---|
TUG (s) | 10.32 | 1.16 | 7.81 | 12.21 |
TUGME (s) | 12.59 | 1.86 | 9.00 | 18.39 |
TUGMC (s) | 14.30 | 2.63 | 9.30 | 21.36 |
TUGVF (s) | 13.67 | 2.42 | 9.85 | 19.98 |
TUGRE (s) | 11.25 | 1.42 | 7.90 | 14.65 |
DTCME (%) | −20.70 | 10.48 | −46.84 | −2.38 |
DTCMC (%) | −37.26 | 19.19 | −79.97 | −4.72 |
DTCVF (%) | −30.44 | 17.43 | −70.48 | −2.98 |
DTCRE (%) | −7.91 | 6.26 | −27.70 | −0.27 |
Variables | Mean | Standard Deviation | t |
---|---|---|---|
30-CST–FSST | −1.43 | 2.28 | −4.87 ** |
30-CST–ABC | −77.28 | 7.42 | −80.60 ** |
FSST–ABC | −75.85 | 8.38 | −70.07 ** |
TUG–TUGME | −2.27 | 1.21 | −14.42 ** |
TUG–TUGMC | −3.97 | 2.09 | −14.69 ** |
TUG–TUGVF | −3.35 | 1.89 | −13.72 ** |
TUG–TUGRE | −0.92 | 0.67 | −0.75 ** |
DTCME–DTCMC | 16.56 | 18.64 | 6.88 ** |
DTCME–DTCVF | 9.74 | 16.64 | 4.53 ** |
DTCME–DTCRE | −12.78 | 10.46 | −9.46 ** |
DTCMC–DTCVF | −6.82 | 12.10 | −4.36 ** |
DTCMC–DTCRE | −29.34 | 18.05 | −12.59 ** |
DTCVF–DTCRE | −22.52 | 15.96 | −10.92 ** |
Variables | TUGME | TUGMC | TUGVF | TUGRE |
---|---|---|---|---|
TUG | 0.77 ** | 0.63 ** | 0.65 ** | 0.89 ** |
Variables | 30-CST | FSST | ABC |
---|---|---|---|
TUG | −0.24 * | 0.48 ** | −0.12 |
TUGME | −0.34 ** | 0.46 ** | −0.16 |
TUGMC | −0.23 | 0.28 * | −0.14 |
TUGVF | −0.29 * | 0.32 * | −0.08 |
TUGRE | −0.28 * | 0.41 ** | −0.22 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Georgantas, A.; Stefani, P.; Lyros, E.; Chytas, D.; Christakou, A. Examining Performance between Different Cognitive-Motor Dual-Task Tests in Community-Dwelling Older Adults. Appl. Sci. 2024, 14, 7957. https://doi.org/10.3390/app14177957
Georgantas A, Stefani P, Lyros E, Chytas D, Christakou A. Examining Performance between Different Cognitive-Motor Dual-Task Tests in Community-Dwelling Older Adults. Applied Sciences. 2024; 14(17):7957. https://doi.org/10.3390/app14177957
Chicago/Turabian StyleGeorgantas, Anastasios, Panagiota Stefani, Epameinondas Lyros, Dimitrios Chytas, and Anna Christakou. 2024. "Examining Performance between Different Cognitive-Motor Dual-Task Tests in Community-Dwelling Older Adults" Applied Sciences 14, no. 17: 7957. https://doi.org/10.3390/app14177957