This Article Full Text Full Text (PDF) Services Download to citation manager Citing Articles Citing Articles via HighWire PubMed PubMed Citation

Executive Function and Gait in Older Adults With Cognitive Impairment

¹ Department of Psychiatry, ³ Department of Mechanical Engineering,⁴ Institute of Gerontology, and ⁵ Division of Geriatric Medicine Department of Internal Medicine, The University of Michigan, Ann Arbor.
² Department of Psychology, University of North Carolina at Chapel Hill.
⁶ Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Michigan.

Address correspondence to Carol Persad, PhD, Neuropsychology, Department of Psychiatry, University of Michigan, 2101 Commonwealth, Suite C, Ann Arbor, MI 48105. E-mail: cpersad{at}umich.edu

Background. Cognitive impairment has been shown to predict falls risk in older adults. The ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. However, it is unclear how well persons with cognitive impairment can step accurately to avoid such hazards and what specific aspects of cognition predict stepping ability in different patient populations.

Methods. Healthy older adults (NC), patients with Mild Cognitive Impairment with only memory impairment (MCI–EF) or memory and executive function impairments (MCI+EF) and early Alzheimer's patients (AD) were timed as they performed a stepping accuracy test with increasing cognitive demand (Walking Trail-Making Test; W-TMT), which required stepping on instrumented targets with either increasing sequential numbers (W-TMT A) or alternating sequential numbers and letters (W-TMT B).

Results. After accounting for age and baseline walking speed, the AD and MCI+EF groups were significantly slower than the NC and MCI–EF groups on the task with the highest cognitive demand, W-TMT B (interaction effect F = 6.781, p <.0001). No group differences were noted on the W-TMT A task that was less cognitively demanding. Neuropsychological measures of executive functioning were associated with slower W-TMT B performance, whereas memory, visual attention and visual spatial skills were not (adjusted R² = 0.42).

Conclusions. Executive function is important for stepping performance, particularly under more complex environmental conditions.

Key Words: Gait • Cognition • Dementia • Executive functioning

This article has been cited by other articles:

				N. B. Alexander and J. M. Hausdorff Guest Editorial: Linking Thinking, Walking, and Falling J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2008; 63(12): 1325 - 1328. [Full Text] [PDF]