Dual-tasking and aging—About multiple perspectives and possible implementations in interventions for the elderly

Locomotor-cognitive dual-tasking is reduced in older adults relative to younger: A systematic review with meta-analysis

BACKGROUND

The capacity to dual-task is critically important over the lifespan, enabling an individual to respond to demands in their environment, both safely and efficiently.

RESEARCH QUESTION

Does recent evidence suggest that relative to younger adults, older adults are most disadvantaged when performing locomotor-cognitive dual-tasks under conditions that are more representative of the real-world?

METHOD

A literature search of major electronic databases was conducted to find relevant peer-reviewed papers published since 2011. Thirty-nine studies that compared proportional dual-task costs (pDTC) between older and younger adults on a locomotor-cognitive dual-task were included. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies.

RESULTS

pDTC were calculated for a total of 504 motor and 53 cognitive outcomes. Weighted means showed that older adults experienced larger pDTCs than younger adults for motor (mean difference = -6.97) and cognitive (mean difference = -8.15) outcomes. Velocity variability measures produced the largest group difference on motor pDTC (mean difference = -32.83), as did cognitive tasks that targeted arithmetic (mean difference = -18.57) and texting skills (mean difference = -17.43). Cognitive tasks that were 'most representative' resulted in the largest age differences on motor pDTC (mean difference = -16.89).

SIGNIFICANCE

This meta-analysis showed that dual-tasking challenged the ability of older adults to maintain consistency in the sequential timing of their gait. As well, older adults demonstrated greater pDTCs on motor outcomes, especially when the cognitive tasks were more representative of day-to-day activities. Taken together, this suggests that clinical assessments should focus on measures of variability rather than absolute measures of temporal and spatial gait. It is recommended that future research use more representative paradigms that are sensitive to dual-task interference and predictive of real-world behaviour.

Dual- and Single-Task Training in Older Adults With Age-Related Hearing Loss: A Randomized Controlled Study

We aimed to investigate the effects of dual- and single-task training in older adults with age-related hearing loss. Intervention groups included single-, dual-task training, and control groups. The dual- and single-task trainings were held 2 days a week for 40 min for a total of 10 sessions for 5 weeks. We evaluated physical, cognitive, and auditory functions, quality-of-life, balance, concerns about falling, independence in activities of daily living, and dual-task performance. A total of 42 patients fully participated in this study. Statistically significant differences were observed in chair stand, chair sit-and-reach, global cognitive function, and delayed recall between the intervention groups and control group (p < .05). There was no statistically significant difference in quality-of-life, balance, falling concerns, independence in activities of daily living, and dual-task performance between all groups (p > .05). In conclusion, single- and dual-task training had a positive effect on physical and cognitive functioning in older adults with age-related hearing loss.

The Effects of 12-Week Dual-Task Physical-Cognitive Training on Gait, Balance, Lower Extremity Muscle Strength, and Cognition in Older Adult Women: A Randomized Study

This study aims to investigate the effects of dual-task physical-cognitive the training on body balance (BB), gait performance (GP), lower limb muscle strength (LEMS), and cognitive performance (CP) in a group of cognitively normal older adult women (n = 44; 66.20 ± 4.05 years). Of these, 22 were randomly allocated to the dual-task training (DT) group, and 22 participated in the control group (CG). Assessments were performed at baseline, after 12 weeks of intervention, and at the end of 12 weeks of follow-up, using the following instruments: Timed Up & Go (TUG), Timed Up & Go manual (TUGm), Timed Up & Go cognitive (TUGc), Balance Test (TEC), sit-to-stand test (STS), and verbal fluency test (VF). After 12 weeks of DT training, participants showed a significant time × group interaction in all motor assessments (BB, GP, LEMS), as well as in three cognitive tests (VF-grouping, VF-exchange, VF-total). No time-group interaction effect was indicated for the VF-category test. At all evaluation times, CG members maintained constant physical and cognitive performance. We conclude that 12 weeks of physical-cognitive DT training was effective in promoting BB, GP, and LEMS, as well as CP in cognitively normal older adult women, with lasting effects up to 12 weeks after the intervention.

Response-code conflict in dual-task interference and its modulation by age

Difficulties in performing two tasks at once can arise from several sources and usually increase in advanced age. Tasks with concurrent bimodal (e.g., manual and oculomotor) responding to single stimuli consistently revealed crosstalk between conflicting response codes as a relevant source. However, how this finding translates to unimodal (i.e., manual only) response settings and how it is affected by age remains open. To address this issue, we had young and older adults respond to high- or low-pitched tones with one (single task) or both hands concurrently (dual task). Responses were either compatible or incompatible with the pitch. When responses with the same level of compatibility were combined in dual-task conditions, their response codes were congruent to each other, whereas combining a compatible and an incompatible response created mutually incongruent (i.e., conflicting) response codes, potentially inducing detrimental crosstalk. Across age groups, dual-task costs indeed were overall highest with response-code incongruency. In these trials, compatible responses exhibited higher costs than incompatible ones, even after removing trials with strongly synchronized responses. This underadditive cost asymmetry argues against mutual crosstalk as the sole source of interference and corroborates notions of strategic prioritization of limited processing capacity based on mapping-selection difficulty. As expected, the effects of incongruent response codes were found to be especially deleterious in older adults, supporting assumptions of age-related deficits in multiple-action control at the level of task-shielding. Overall, our results suggest that aging is linked to higher response confusability and less efficient flexibility for capacity sharing in dual-task settings.

Associations of Gait Speed, Cadence, Gait Stability Ratio, and Body Balance with Falls in Older Adults

To investigate the association between gait speed (GS), cadence (CAD), gait stability ratio (GSR), and body balance (BB) with falls in a large sample of older adults. The analysis included 619 individuals-305 men and 314 women (69.50 ± 5.62 years)-residing in the Autonomous Region of Madeira, Portugal. Mobility in GS, CAD, and GSR was assessed using the 50-foot walk test and BB by the Fullerton Advanced Balance scale. The frequency of falls was obtained by self-report. Linear regression analysis showed that higher performance in GS and BB was able to reduce the risk of falling by up to 0.34 and 0.44 times, respectively. An increase in the GSR value enhanced the risk of falling by up to 0.10 times. Multinomial analysis indicated that, in relation to the highest tertile (reference), older adults classified with GS and BB performance in the lowest tertile (lowest) had an increased chance (OR) of falling by up to 149.3% and 48.8%, respectively. Moreover, in relation to the highest tertile, the performance of the GSR classified in the lowest and medium tercile showed an increase in the chance of falling by up to 57.4% and 56.4%, respectively.

Comparison of Dual Task Training Versus Aerobics Training in Improving Cognition in Healthy Elderly Population

Background Cognitive impairments, particularly in old age, are pervasive and occur because of both normal and pathological senescence. Engaging in some routine bodily activities combined with activities that stimulate cognitive skills appears beneficial in increasing cognitive resistance to degenerative processes of the brain. Dual-task training (DTT) by combining motor and cognitive activities causes improvement, particularly in executive function, working memory and divided attention, whereas aerobic exercise training (AET) plays an important role in improving executive function, attention, and memory. In this study, we attempted to compare the efficiency of DTT versus AT in improving cognitive function in healthy older individuals. Methods Forty healthy older adults between 60 and 70 years of age who met the inclusion criteria participated in this study. They were randomly split into two groups A and B. Group A (64.05±3.17 years) received DTT three times a week, whereas group B (65.50±3.44 years) received AT five times a week. Both training programs were conducted for six weeks. Cognitive function was assessed using Trail Making Test (TMT)-A, TMT-B, and Montreal Cognitive Assessment (MoCA). The assessment was done at baseline (first day of intervention), on completion of the third week, and again at the end of the training session i.e., the sixth week. The Chi-square test and the student's paired and unpaired t-tests were used for statistical analysis with a level of significance P<0.05. Discussion and result Betterment in cognitive functions was evident after six weeks of DTT and AET. Post-intervention improvements were noted in TMT-A, TMT-B, and MoCA scores in both groups A and B (P>0.0001). However, the difference between the pre and post-intervention scores was greater for group A compared to group B indicative of remarkable improvements in cognitive function in group A. Conclusion The current study demonstrated that both DTT and AET are notably efficient in improving cognitive function in a healthy elderly population. However, in comparison, DTT was significantly more effective than AET (P<0.05). This shows that six weeks of DTT is effective in improving cognitive function and slowing age-associated cognitive decline in older adults.

Mix-and-Match or Mismatch? Exploring the Perspectives of Older Adults About Zumba Dance and Its Potential Utilization for Dual-Task Training

Despite the popularity of Zumba dancing, research is scarce about its impact on older adults. Meanwhile, the integration of cognitive tasks with physical exercises, also known as dual tasking, is an evolving strategy to facilitate activities for older adults. This study investigated the perceptions of persons aged ≥55 years on Zumba and its potential to be incorporated into a dual-task program. We conducted a descriptive-qualitative study involving 44 Filipino older adults. Using content analysis, four themes were identified: moving toward match or mismatch, balancing benefits with burdens, dual tasking as innovative yet potentially challenging, and overcoming barriers with enablers. Although Zumba was perceived as an inclusive and beneficial activity, individual and contextual limitations could hinder its suitability. Moreover, dual tasking in Zumba was considered an innovative approach, although challenges should be addressed to promote its feasibility. Several strategies could enable the design and implementation of age-appropriate Zumba and dual-tasking programs for older adults.

Benefits of adding food education sessions to an exercise programme on cardiovascular risk factors in patients with type 2 diabetes

To evaluate the impact of adding food education sessions to an exercise programme on cardiovascular risk factors in middle-aged and older patients with type 2 diabetes (T2D), a randomised parallel-group study was performed. Glycated haemoglobin, body mass index (BMI), waist circumference, fat mass (FM) and blood pressure were assessed at baseline and after 9 months. The recruitment was made in three primary healthcare centres from Vila Real, Portugal. Thirty-three patients (65⋅4 ± 5⋅9 years old) were engaged in a 9-month community-based lifestyle intervention programme: a supervised exercise programme (EX; n = 15; combined aerobic, resistance, agility/balance and flexibility exercise; three sessions per week; 75 min per session); or the same exercise programme plus concomitant food education sessions (EXFE; n = 18; 15-min lectures and dual-task strategies during exercise (answer nutrition questions while walking); 16 weeks). Significant differences between groups were identified in the evolution of BMI (P < 0.001, ) and FM (P < 0.001, ), with best improvements observed in the EXFE group. The addition of a simple food education dietary intervention to an exercise programme improved body weight and composition, but not glycaemic control and blood pressure in middle-aged and older patients with T2D.

Optimization of postural control in precise gaze shifts and laser pointing

Young adults are known to reduce their postural sway to perform precise visual search and laser pointing tasks. We tested if young adults could reduce even more postural and/or center of pressure sway to succeed in both tasks simultaneously. The methodology is novel because published pointing tasks usually require continuously looking at the pointed target and not exploring an image while pointing elsewhere at the same time. Twenty-five healthy young adults (23.2 ± 2.5 years) performed six visual tasks. In the free-viewing task, participants randomly explored images with no goal. In two visual search tasks, participants searched to locate objects (easy search task) or graphical details (hard search task). Participants additionally pointed a laser beam into a central circle (2°) or pointed the laser turned off. Postural sway and center of pressure sway were reduced complementarily - in various variables - to perform the visual search and pointing tasks. Unexpectedly, the pointing task influenced more strongly postural sway and center of pressure sway than the search tasks. Overall, the participants adopted a functional strategy in stabilizing their posture to succeed in the pointing task and also to fully explore images. Therefore, it is possible to inverse the strength of effects found in the literature (usually stronger for the search task) in modulating the experimental methodology. In search tasks more than in free-viewing tasks, participants mostly rotated their eyes and head, and not their full body, to stabilize their posture. These results could have implications for shooting activities, video console games and rehabilitation most particularly.

The Impact of a Community-Based Food Education Program on Nutrition-Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial

The purpose of this study was to evaluate the impact of a community-based food education program on nutrition-related knowledge in middle-aged and older patients with type 2 diabetes (T2D). Participants (n = 36; 65.9 ± 6.0 years old) were recruited in primary health care to a 9-month community-based lifestyle intervention program for patients with T2D and randomly assigned to an exercise program (control group; n = 16) or an exercise program plus a food education program (experimental group; n = 20). Nutrition-related knowledge was assessed through a modified version of the General Nutrition Knowledge Questionnaire. The increase in total nutrition-related knowledge score and sources of nutrients area score was significantly higher in the experimental group compared to the control group. No significant changes in nutrition-related knowledge were found between groups in dietary recommendations and diet-disease relationship areas, although improvements were observed. This community-based food education program, with the use of easy to implement strategies (short-duration lectures and dual-task problem solving activities during exercise), had a positive and encouraging impact on nutrition-related knowledge in middle-aged and older patients with T2D.

Cognitive performance under motor demands - On the influence of task difficulty and postural control

We often walk around when we have to think about something, but suddenly stop when we are confronted with a demanding cognitive task, such as calculating 1540*24. While previous neurophysiological research investigated cognitive and motor performance separately, findings that combine both are rare. To get a deeper understanding of the influence of motor demands as well as the difficulty of a simultaneously performed cognitive task, we investigated 20 healthy individuals. Participants performed two cognitive tasks with different levels of difficulty while sitting or standing on one leg. In addition to behavioral data, we recorded the electroencephalogram from 26Ag/AgCI scalp electrodes. The critical time-windows, predefined by visual inspection, yielded an early (200-300 ms, P2) and a subsequent positivity (350-500 ms, P3). Statistical analysis of the early time window registered a motor × cognition interaction. Resolution of this interaction revealed an effect of the cognitive task in the one-legged stance motor condition, with a more pronounced positivity for the difficult task. No significant differences between cognitive tasks emerged for the simple motor condition. The time-window between 350 and 500 ms registered main effects of the motor task and a trend for the cognitive task. While the influence of cognitive task difficulty (in the P3) is in accordance with previous studies, the motor task effect is specific to one-legged stance (cf. no effects for running in previous research). The motor-cognition interaction found in the P2 indicates that the more difficult motor task (one-legged stance) facilitates cognitive task performance.