Aging effects on prefrontal cortex oxygenation in a posture-cognition dual-task: an fNIRS pilot study

The effect of distraction and feedback on prefrontal cortex activity and balance in middle-aged adults: A functional near-infrared spectroscopy pilot study

Maintaining balance while simultaneously performing other tasks is common during everyday activities. However, this dual-tasking (DT) divides attention and increases cognitive demand, which can be detrimental to stability in older adults. It is unknown if the focus of attention influences how a dual-task affects balance and whether this is detectable in middle-aged adults. This study investigates the effect of dual-task and attentional focus on prefrontal cortex (PFC) activity in young (YA) and middle-aged (MA) adults using functional-near infrared spectroscopy. Blood oxygen level of the PFC was measured during a quiet standing cognitive-motor dual-task where MA (n = 15, mean age 57.2 ± 4.8 years, 5 female) and YA (n = 20, mean age 24.9 ± 4.7 years, 9 female) stood on a forceplate while either fixating their gaze on a target ('fixed') or viewing their real-time postural oscillations in the anteroposterior direction ('sway') with and without serial 7 subtractions. It was expected that the MA group would show higher PFC activity, larger COP excursions, and poorer performance during DT than the YA group. PFC activity was larger during DT and during the fixed condition but did not differ between groups. COP excursion was also greater when attention was 'fixed' and was consistently larger in MA. MA drove a positive correlation between PFC activity and COP excursion during DT indicative of a higher attentional demand during distraction. Taken together, this study suggests that PFC processing and posture control are different in middle aged adults compared to young adults.

Dual-Task Effect on Center of Pressure Oscillations and Prefrontal Cortex Activation Between Young and Older Adults

Purpose: This study aimed to investigate the dual-task effect on conventional center of pressure (CoP) outcomes, CoP oscillations, and prefrontal cortex (PFC) activation between young and older adults. Methods: Fourteen healthy older adults (age: 66.25 ± 3.43 years) and another fourteen gender-matched young adults (age: 19.80 ± 0.75 years) participated in this study. Participants completed single-task and dual-task standing trials in a fixed order. The displacement of CoP and PFC activation were recorded using a Force plate and a functional near-infrared spectroscopy system, respectively. Two-way MANOVAs were used to examine the group and task effects. Additionally, the Pearson correlation analyses were used to investigate the relationship between CoP oscillations and PFC activation. Results: Our results showed a worse balance performance, greater CoP oscillations of 0-0.1 (11.03 ± 8.24 vs. 23.20 ± 12.54 cm2) and 0.1-0.5 (13.62 ± 9.30 vs. 30.00 ± 23.12 cm2) Hz in the medial-lateral direction and higher right (dorsomedial: -0.0003 ± 0.021 vs. 0.021 ± 0.021 & ventrolateral: 0.0087 ± 0.047 vs. 0.025 ± 0.045 mol/ml) and left (dorsomedial: 0.0033 ± 0.024 vs. 0.020 ± 0.025 & ventrolateral: 0.0060 ± 0.037 vs. 0.034 ± 0.037 mol/ml) PFC activation in response to a secondary cognitive task in older adults (p < .05). Older adults also showed significant positive correlations between CoP oscillations in the anterior-posterior direction and PFC activation under the single-task standing. Conclusion: These results suggest that older adults presented a loss of postural automaticity contributing to cognitive dysfunction. Moreover, heightened CoP oscillations at 0-0.5 Hz in response to a secondary cognitive task could provide evidence of a loss of automaticity, which might be associated with a greater reliance on the sensory inputs.

Regional cerebral oxygen saturation during initial mobilization of critically ill patients is associated with clinical outcomes: a prospective observational study

BACKGROUND

Vital signs help determine the safety of early mobilization in critically ill patients in intensive care units. However, none of these variables directly assess cerebral circulation. Therefore, we aimed to investigate the relationship of regional cerebral oxygen saturation (rSO2) and vital signs with in-hospital death in critically ill patients.

METHODS

This prospective study included critically ill patients admitted to the Uonuma Kikan Hospital Emergency Center who received physical therapy between June 2020 and December 2022. We continuously measured rSO2 during the initial mobilization using a wearable brain near-infrared spectroscopy device. With in-hospital death as the primary endpoint, the association between rSO2 and in-hospital death was assessed in Analysis 1 to determine the rSO2 cut-off value that predicts in-hospital death. In Analysis 2, patients were categorised into survival and non-survival groups to examine the temporal changes in vital signs and rSO2 associated with postural changes during mobilization.

RESULTS

Of the 132 eligible patients, 98 were included in Analysis 1, and 70 were included in Analysis 2. Analysis 1 demonstrated that lower premobilization rSO2 was independently associated with in-hospital death (odds ratio 0.835, 95% confidence interval 0.724-0.961, p = 0.012). Receiver operating characteristic curve analysis identified an optimal rSO2 cut-off value of 57% for predicting in-hospital death (area under the curve 0.818, sensitivity 73%, specificity 83%). Analysis 2 showed that rSO2 changes during mobilization were unrelated to changes in vital signs, suggesting rSO2 as an independent prognostic marker.

CONCLUSIONS

The results suggest that rSO2 measured during initial mobilization is associated with in-hospital death in critically ill patients.

Resting-state functional near-infrared spectroscopy in neurodegenerative diseases - A systematic review

OBJECTIVE

To systematically review and summarize alterations found in resting-state activity as measured via functional near-infrared spectroscopy (fNIRS) in neurodegenerative diseases.

BACKGROUND

fNIRS is a novel and emerging neuroimaging method suitable for a variety of study designs. Resting-state is the measure of brain activity in the absence of a task, which has been investigated for yielding information about neurodegenerative diseases, mainly using magnetic resonance imaging. We aimed to systematically review the usage of resting-state fNIRS (rsfNIRS) in neurodegenerative diseases.

INCLUSION CRITERIA

Studies investigating people diagnosed with a neurodegenerative disease and resting-state activity obtained with fNIRS using at least two channels.

METHODS

We searched three databases for publications. After the screening, 16 studies were included in the systematic review. The quality of the studies was assessed, and data were extracted. Data were qualitatively synthesized and in the case of at least 10 similar studies, a meta-analysis was planned.

RESULTS

Most studies investigated Mild cognitive impairment (50%), followed by Alzheimer's disease (25%). Other neurodegenerative diseases encompassed Parkinson's disease, Multiple sclerosis, and Amyotrophic lateral sclerosis. All studies reported oxygenated hemoglobin. Still, studies were heterogeneous in terms of study design, measurement duration, fNIRS device, montage, pre-processing, and analyses. A meta-analysis was not considered possible due to this heterogeneity.

CONCLUSION

rsfNIRS shows promise in neurodegenerative disease, as most studies have observed resting-state alterations when compared to healthy controls. However, inconsistencies across studies limit data comparison and meta-analysis. Hence, we strongly advocate the application of fNIRS reporting guidelines and the establishment of rsfNIRS-specific guidelines. This will ensure reliable and comparable results in future research.

The effect of sensory manipulation on the static balance control and prefrontal cortex activation in older adults with mild cognitive impairment: a functional near-infrared spectroscopy (fNIRS) study

BACKGROUND

This study aimed to investigate the modulatory role of prefrontal cortex (PFC) activity in older adults with mild cognitive impairment (MCI) when sensory cues were removed or presented inaccurately (i.e., increased sensory complexity) during sensory manipulation of a balance task. The research sheds light on the neural regulatory mechanisms of the brain related to balance control in individuals with MCI.

METHODS

21 older adults with MCI (male/female: 9/12, age: 71.19 ± 3.36 years) were recruited as the experimental group and 19 healthy older adults (male/female: 10/9, age: 70.16 ± 4.54 years) as the control group. Participants were required to perform balance tests under four standing conditions: standing on a solid surface with eyes open, standing on a foam surface with eyes open, standing on a solid surface with eyes closed, and standing on a foam surface with eyes closed. Functional Near-Infrared Spectroscopy (fNIRS) and force measuring platform are used to collect hemodynamic signals of the PFC and center of pressure (COP) data during the balance task, respectively.

RESULTS

Under the eyes open condition, significant Group*Surface interaction effects were found in the mean velocity of the COP (MVELO), the mean velocity in the medial-lateral (ML) direction (MVELOml) and the 95% confidence ellipse area of the COP (95%AREA-CE). Additionally, significant Group*Surface interaction effect was found in the left orbitofrontal cortex (L-OFC). The significant group effects were detected for three ROI regions, namely the left ventrolateral prefrontal cortex (L-VLPFC), the left dorsolateral prefrontal cortex (L-DLPFC), the right dorsolateral prefrontal cortex (R-DLPFC). Under the eyes closed condition, the significant Group*Surface interaction effects were found in root mean square (RMS), the RMS in the ML direction (RMSml) and the 95%AREA-CE. Additionally, significant group effects were detected for five ROI regions, namely R-VLPFC, the left frontopolar cortex (L-FPC), L-DLPFC, R-DLPFC and R-OFC.

CONCLUSION

Our study emphasizes the role of the PFC in maintaining standing balance control among older adults with MCI, particularly during complex sensory conditions, and provides direct evidence for the role of the PFC during balance control of a clinically relevant measure of balance.

TRIAL REGISTRATION

ChiCTR2100044221, 12/03/2021.

Cortical activity in body balance tasks as a function of motor and cognitive demands: A systematic review

Technological tools, like electroencephalography and functional near-infrared spectroscopy, have deepened our understanding of cortical regions involved in balance control. In this systematic literature review, we aimed to identify the prevalent cortical areas activated during balance tasks with specific motor or cognitive demands. Our search strategy encompassed terms related to balance control and cortical activity, yielding 2250 results across five databases. After screening, 67 relevant articles were included in the review. Results indicated that manipulations of visual and/or somatosensory information led to prevalent activity in the parietal, frontal and temporal regions; manipulations of the support base led to prevalent activity of the parietal and frontal regions; both balance-cognitive dual-tasking and reactive responses to extrinsic perturbations led to prevalent activity in the frontal and central regions. These findings deepen our comprehension of the cortical regions activated to manage the complex demands of maintaining body balance in the performance of tasks posing specific requirements. By understanding these cortical activation patterns, researchers and clinicians can develop targeted interventions for balance-related disorders.

(Interfering) Cortical mechanisms of standing balance and cognition in old-age depression: A functional near-infrared spectroscopy (fNIRS) study

Major depressive disorder in old age can cause changes in the cerebral cortex that might lead to postural imbalance and thus increase fall risk. We aim to examine cortical activation during standing balance in depressed older patients compared to healthy controls and to determine how an additional cognitive task affects this activation. Eleven older patients (age ≥65 years) diagnosed with major depressive disorder and sixteen age-matched healthy controls participated in the study. Functional near-infrared spectroscopy (fNIRS) was used to assess cortical activation of the prefrontal (PFC) and motor (MC) cortex during standing balance with eyes closed under single and dual task (counting backwards). The present study generally revealed tendencies in the MC - and partly the PFC too - for more activation whilst balancing compared to baseline. Also, in the MC, patients tended to show more cortical activation compared to controls and dual task tended to elicit more activation. The results suggest that depressed older patients, to compensate for their illness, may require increased cortical activation to perform motor and cognitive tasks than healthy controls. The absence of PFC activation in the main analyses may be related to the small participant number and possibly to too simple task conditions.

Analysis of electroencephalography characteristics during walking in stroke patients under different conditions: a cross-sectional study

Aims/Background Backward walking is gaining traction in rehabilitation therapy, showing promise as an intervention for stroke patients with walking difficulties. However, the brain activity patterns (neurophysiological mechanisms) underlying backward walking in these patients remain unclear. This study investigated the neurophysiological mechanism in stroke patients within 1 year of their stroke. Methods Twenty-four subjects walked forward and backward for 5 min on an 8-m track while their electroencephalographic signals were collected. The power values of each frequency band were compared during forward and backward walking, and the delta to alpha power ratio (DAR) was calculated. Results The results showed a significant increase in α-band activity within the frontal cortex during backward walking (p < 0.05). This increase correlated positively with scores on the Fugl-Meyer lower extremity motor function assessment scale. Similarly, α-band activity showed significant enhancement within the right parietal cortex during backward walking (p < 0.05). There were no significant differences between forward and backward walking states in δ, θ, and β wavebands across the entire brain region (p > 0.05). Additionally, the DAR was significantly lower during backward walking than during forward walking (p < 0.05). Conclusion This study suggests that backward walking may more effectively activate neural activity in the prefrontal and right posterior parietal cortices. This finding supports the potential of backward walking to enhance motor execution and walking function in stroke patients, thereby supporting its application as a rehabilitation method.

Individualized Structural Perturbations on Normative Brain Connectome Restrict Deep Brain Stimulation Outcomes in Parkinson's Disease

BACKGROUND

Patients with Parkinson's disease (PD) respond to deep brain stimulation (DBS) variably. However, how brain substrates restrict DBS outcomes remains unclear.

OBJECTIVE

In this article, we aim to identify prognostic brain signatures for explaining the response variability.

METHODS

We retrospectively investigated a cohort of patients with PD (n = 141) between 2017 and 2022, and defined DBS outcomes as the improvement ratio of clinical motor scores. We used a deviation index to quantify individual perturbations on a reference structural covariance network acquired with preoperative T1-weighted magnetic resonance imaging. The neurobiological perturbations of patients were represented as z scored indices based on the chronological perturbations measured on a group of normal aging adults.

RESULTS

After applying stringent statistical tests (z > 2.5) and correcting for false discoveries (P < 0.01), we found that accelerated deviations mainly affected the prefrontal cortex, motor strip, limbic system, and cerebellum in PD. Particularly, a negative network within the accelerated deviations, expressed as "more preoperative deviations, less postoperative improvements," could predict DBS outcomes (mean absolute error = 0.09, R2 = 0.15). Moreover, a fusion of personal brain predictors and medical responses significantly improved traditional evaluations of DBS outcomes. Notably, the most important brain predictor, a pathway connecting the cognitive unit (prefrontal cortex) and motor control unit (cerebellum and motor strip), partially mediates DBS outcomes with the age at surgery.

CONCLUSIONS

Our findings suggest that individual structural perturbations on the cognitive motor control circuit are critical for modulating DBS outcomes. Interventions toward the circuit have the potential for additional clinical improvements. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Effects of 12 weeks of head-down strong abdominal breathing on motor and cognitive performance during dual-tasking in patients with chronic obstructive pulmonary disease: Study protocol for a randomised controlled trial

Objective

Head-down training can affect behavioural and neurocognitive control while performing dual tasks (DT). Breathing training improves motor and cognitive performance in patients with chronic obstructive pulmonary disease (COPD). As a neurorehabilitation tool, functional near-infrared spectroscopy (fNIRS) has been demonstrated to be an effective method for detecting changes in brain activation during motor recovery, as well as monitoring patients' long-term progress during DT in motor and cognitive performance. However, no studies have examined the combined effect of head-down position and breathing exercises on motor and cognitive performance during DT. This study will employ a novel intervention involving head-down strong abdominal breathing training to investigate its effects on motor and cognitive performance during DT in patients with COPD aiming to inform future training modalities in the community and at home.

Methods

We will recruit participants from Anqing, China, through community announcements, bulletin board postings, WeChat, and offline visits and screen 72 patients with stable COPD, classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) I-II, by pulmonologists at the university hospital. All participants will be randomly assigned to the head-down strong abdominal breathing (tilt angle 0-30° on the inversion apparatus, respiratory rate 20-30 breaths/min), head-down training, and strong abdominal breathing training groups in a 1:1:1 ratio. The intervention will last 12 weeks, with sessions performed thrice weekly for 1 h.

Results

The primary outcomes will be motor-cognitive DT time, dual-task effects, correct responses to cognitive tasks, and gait characteristics assessed at baseline, 6 and 12 weeks of intervention. The patient's dorsolateral prefrontal cortex (PFC) will also be stimulated with fNIRS at wavelengths of 730 and 850 nm, with a sampling rate of 11 Hz, to record oxy-haemoglobin (oxy-Hb), deoxy-haemoglobin (deoxy-Hb), and total oxyhaemoglobin (total-Hb). Secondary outcomes will include pre- and post-intervention scales for dyspnoea, overall cognitive function, balance, and anxiety and depression.

Conclusion

Alterations in the PFC involved in attentional control, planning, and decision-making may partially explain cognitive and motor deficits (such as impaired balance and slower walking speed) in patients with COPD. This study may help to understand the effects of head-down strong abdominal breathing training on cognitive and motor performance under DT in patients with COPD and compare it with head-down training and breathing training alone. It may also help to determine whether it is a simple and effective form of exercise at home and in the community.

Effectiveness of a Dual-Task Intervention Involving Exercise and Vocalized Cognitive Tasks

Background/Objectives: Population aging is rapidly increasing, and the importance of preventive medicine has been stressed. Health checkups, diet, and exercise are of paramount importance. This study aimed to evaluate the effectiveness of a personalized dual-task intervention that combined exercise with cognitive tasks in improving physical and cognitive functions among independently living older individuals. Methods: Participants aged >65 years who were mostly independent in their activities of daily living were divided into two groups. The group receiving the 20 min robot-assisted session was compared with the group receiving traditional functional restoration training. This randomized trial assessed the impact of this intervention on the 30 s chair stand test score and Montreal Cognitive Assessment-Japanese version score of the participants. Results: Both scores significantly improved in the intervention group, indicating enhanced lower-limb function and cognitive capabilities. Conclusions: These findings suggest that integrating cognitive tasks with physical exercise can stand as an effective strategy to improve overall well-being in older people, offering valuable insights for designing comprehensive preventive health programs tailored to this demographic.

Brain activation during standing balance control in dual-task paradigm and its correlation among older adults with mild cognitive impairment: a fNIRS study

BACKGROUND

This study aimed to compare the balance ability and functional brain oxygenation in the prefrontal cortex (PFC) among older adults with mild cognitive impairment (MCI) under single and dual tasks, and also investigate their relationship. Neural regulatory mechanisms of the brain in the MCI were shed light on in balance control conditions.

METHODS

21 older adults with MCI (female = 12, age: 71.19 ± 3.36 years) were recruited as the experimental group and 19 healthy older adults (female = 9, age: 70.16 ± 4.54 years) as the control group. Participants completed balance control of single task and dual task respectively. Functional near-infrared spectroscopy (fNIRS) and force measuring platform are used to collect hemodynamic signals of the PFC and center of pressure (COP) data during the balance task, respectively.

RESULTS

The significant Group*Task interaction effect was found in maximal displacement of the COP in the medial-lateral (ML) direction (D-ml), 95% confidence ellipse area (95%AREA), root mean square (RMS), the RMS in the ML direction (RMS-ml), the RMS in the anterior-posterior (AP) direction (RMS-ap), sway path (SP), the sway path in the ML direction (SP-ml), and the sway path in the AP direction (SP-ap). The significant group effect was detected for five regions of interest (ROI), namely the left Brodmann area (BA) 45 (L45), the right BA45 (R45), the right BA10 (R10), the left BA46 (L46), and the right BA11 (R11). Under single task, maximal displacement of the COP in the AP direction (D-ap), RMS, and RMS-ap were significantly negatively correlated with R45, L45, and R11 respectively. Under dual task, both RMS and 95%AREA were correlated positively with L45, and both L10 and R10 were positively correlated with RMS-ap.

CONCLUSION

The MCI demonstrated worse balance control ability as compared to healthy older adults. The greater activation of PFC under dual tasks in MCI may be considered a compensatory strategy for maintaining the standing balance. The brain activation was negatively correlated with balance ability under single task, and positively under dual task.

TRIAL REGISTRATION

ChiCTR2100044221 , 12/03/2021.

Exercise interventions, postural control, and prefrontal cortex activation in older adults

Improving postural control in older adults is necessary for reducing fall risk, and prefrontal cortex activation may also play a role. We sought to examine the impact of exercise interventions on postural control and prefrontal cortex activation during standing balance tasks. We hypothesized that balance would improve and prefrontal control would be reduced. We assessed a subset of participants enrolled in a randomized trial of two exercise interventions. Both groups completed strength and endurance training and the experimental treatment arm included training on timing and coordination of stepping. Postural control and prefrontal cortex activation were measured during dual-task standing balance tasks before and after the intervention. Eighteen participants in the standard strengthening and mobility training arm and 16 in the timing and coordination training arm were included. We examined pre- to post-intervention changes within each study arm, and compared them between interventions. Results did not show any pre- to post-intervention changes on standing postural control nor prefrontal cortex activation in either arm. In addition, there were no differences between the two intervention arms in either balance or prefrontal activation. While exercise interventions can improve mobility, we do not demonstrate evidence of improved standing balance or prefrontal control in standing.

The prefrontal cortex hemodynamic responses to dual-task paradigms in older adults: A systematic review and meta-analysis

Background

Functional near-infrared spectroscopy (fNIRS) is a method to measure cerebral hemodynamics. Determining the changes in prefrontal cortex (PFC) hemodynamics during dual-task paradigms is essential in explaining alterations in physical activities, especially in older adults.

Aims

To systematically review and meta-analyze the effects of dual-task paradigms on PFC hemodynamics in older adults.

Methods

The search was conducted in PubMed, Scopus, and Web of Science from inception until March 2023 to identify studies on the effects of dual-task paradigms on PFC hemodynamics. The meta-analysis included variables of cerebral hemodynamics, such as oxygenated hemoglobin (HbO₂) and deoxygenated hemoglobin (HbR). The heterogeneity of the included studies was determined using the I² statistic. Additionally, subgroup analysis was conducted to compare the effects of different types of cognitive tasks.

Results

A total of 37 studies were included in the systematic review, 25 studies comprising 2224 older adults were included in the meta-analysis. Our findings showed that inhibitory control and working memory tasks significantly increased HbO₂ in the PFC by 0.53 (p < 0.01, 95% CI = 0.37 to 0.70) and 0.13 (p < 0.01, 95% CI = 0.08 to 0.18) μmol/L, respectively. Overall, HbO₂ was significantly increased during dual-task paradigms by 0.36 μmol/L (P < 0.01, 95% CI = 0.27 to 0.45). Moreover, dual-task paradigms also decreased HbR in the PFC by 0.04 (P < 0.01, 95% CI = -0.07 to -0.01). Specifically, HbR decreased by 0.08 during inhibitory control tasks (p < 0.01, 95% CI = -0.13 to -0.02), but did not change during working memory tasks.

Conclusion

Cognitive tasks related to inhibitory control required greater cognitive demands, indicating higher pfc activation during dual-task paradigms in older adults. for clinical implications, the increase in pfc oxygenated hemoglobin and decrease in pfc deoxygenated hemoglobin may help explain why older adults are more likely to fall during daily activities.

Identifying the changes in the cortical activity of various brain regions for different balance tasks: A review

BACKGROUND

Balance support is critical to a person's overall function and health. Previous neuroimaging studies have shown that cortical structures play an essential role in postural control.

OBJECTIVE

This review aims to identify differences in the pattern of neural activity induced by balance tasks with different balance control requirements.

METHODS

Seventy-four articles were selected from the field of balance training and were examined based on four brain function detection technologies.

RESULTS

In general, most studies focused on the activity changes of various cortical areas during training at different difficulty levels, but more and more attention has also begun to focus on the functional changes of other cortical and deep subcortical structures. Our analysis also revealed the neglect of certain task types.

CONCLUSION

Based on these results, we identify and discuss future research directions that may contribute to a clear understanding of neural functional plasticity under different tasks.

Using functional near-infrared spectroscopy to measure prefrontal cortex activity during dual-task walking and navigated walking: A feasibility study

INTRODUCTION

While functional near-infrared spectroscopy (fNIRS) can provide insight into motor-cognitive deficits during ecologically valid gait conditions, the feasibility of using fNIRS during complex walking remains unknown. We tested the process and scientific feasibility of using an fNIRS device to measure cortical activity during complex walking tasks consisting of straight walking and navigated walking under single and dual-task (DT) conditions.

METHODS

Nineteen healthy people from 18 to 64 years (mean age: 45.7 years) participated in this study which consisted of three complex walking protocols: (i) straight walking, DT walking (walking while performing an auditory Stroop task) and single-task auditory Stroop, (ii) straight and navigated walking, and (iii) navigated walking and navigated DT walking. A rest condition (standing still) was also included in each protocol. Process feasibility outcomes included evaluation of the test procedures and participant experience during and after each protocol. Scientific feasibility outcomes included signal quality measures, and the ability to measure changes in concentration of deoxygenated and oxygenated hemoglobin in the prefrontal cortex.

RESULTS

All participants were able to complete the three protocols with most agreeing that the equipment was comfortable (57.9%) and that the testing duration was adequate (73.7%). Most participants did not feel tired (94.7%) with some experiencing pain (42.1%) during the protocols. The signal qualities were high for each protocol. Compared to the rest condition, there was an increase in oxygenated hemoglobin in the prefrontal cortex when performing dual-task walking and navigation.

CONCLUSION

We showed that our experimental setup was feasible for assessing activity in the prefrontal cortex with fNIRS during complex walking. The experimental setup was deemed acceptable and practicable. Signal quality was good during complex walking conditions and findings suggest that the different tasks elicit a differential brain activity, supporting scientific feasibility.

Does Standing Up Enhance Performance on the Stroop Task in Healthy Young Adults? A Systematic Review and Meta-Analysis

Understanding the changes in cognitive processing that accompany changes in posture can expand our understanding of embodied cognition and open new avenues for applications in (neuro)ergonomics. Recent studies have challenged the question of whether standing up alters cognitive performance. An electronic database search for randomized controlled trials was performed using Academic Search Complete, CINAHL Ultimate, MEDLINE, PubMed, and Web of Science following PRISMA guidelines, PICOS framework, and standard quality assessment criteria (SQAC). We pooled data from a total of 603 healthy young adults for incongruent and 578 for congruent stimuli and Stroop effect (mean age = 24 years). Using random-effects results, no difference was found between sitting and standing for the Stroop effect (Hedges' g = 0.13, 95% CI = -0.04 to 0.29, p = 0.134), even when comparing congruent (Hedges' g = 0.10; 95% CI: -0.132 to 0.339; Z = 0.86; p = 0.389) and incongruent (Hedges' g = 0.18; 95% CI: -0.072 to 0.422; Z = 1.39; p = 0.164) stimuli separately. Importantly, these results imply that changing from a seated to a standing posture in healthy young adults is unlikely to have detrimental effects on selective attention and cognitive control. To gain a full understanding of this phenomenon, further research should examine this effect in a population of healthy older adults, as well as in a population with pathology.

Neurometabolic correlates of posturography in normal aging and older adults with mild cognitive impairment: Evidence from a 1H-MRS study

Proton magnetic resonance spectroscopy (¹H-MRS) holds promise for revealing and understanding neurodegenerative processes associated with cognitive and functional impairments in aging. In the present study, we examined the neurometabolic correlates of balance performance in 42 cognitively intact older adults (healthy controls - HC) and 26 older individuals that were diagnosed with mild cognitive impairment (MCI). Neurometabolite ratios of total N-acetyl aspartate (tNAA), glutamate-glutamine complex (Glx), total choline (tCho) and myo-inositol (mIns) relative to total creatine (tCr) were assessed using single voxel ¹H-MRS in four different brain regions. Regions of interest were the left hippocampus (HPC), dorsal posterior cingulate cortex (dPCC), left sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (dlPFC). Center-of-pressure velocity (Vcop) and dual task effect (DTE) were used as measures of balance performance. Results indicated no significant group differences in neurometabolite ratios and balance performance measures. However, our observations revealed that higher tCho/tCr and mIns/tCr in hippocampus and dPCC were generic predictors of worse balance performance, suggesting that neuroinflammatory processes in these regions might be a driving factor for impaired balance performance in aging. Further, we found that higher tNAA/tCr and mIns/tCr and lower Glx/tCr in left SM1 were predictors of better balance performance in MCI but not in HC. The latter observation hints at the possibility that individuals with MCI may upregulate balance control through recruitment of sensorimotor pathways.

Cerebellum-Cerebrum paired target magnetic stimulation on balance function and brain network of patients with stroke: A functional near-infrared spectroscopy pilot study

Transcranial magnetic stimulation (TMS) modulation over the cerebellum, primary motor cortex, and supplementary motor cortex individually can improve the balance function of patients with stroke. However, whether their combination could have a better balance modulation effect is uncertain. Therefore, we hypothesized that performing TMS over a combination of these targets can regulate the balance function of patients with stroke. We compared the effects of one-session TMS on eye-open and eye-closed balance conditions in patients with stroke, using different target pairs of unilateral cerebellar (CB-single), cerebellar-primary motor cortex (CB-M1), and cerebellar-supplementary motor area (CB-SMA) targets. A total of 31 patients with stroke were enrolled and randomly divided into three groups to receive single sessions of intermittent theta burst stimulation each. Functional near-infrared spectrum data on resting and standing task states (eye-open and eye-closed) and center of pressure parameters (eye-open and eye-closed) were collected before and after the intervention. Compared with the results in the CB-single group, five intergroup differences in the changes in the center of pressure parameters in the CB-M1 group and two significant differences in the CB-SMA group were observed after one session of intermittent theta burst stimulation. In the CB-SMA group, 12 out of the 14 parameters improved significantly in the EC condition after the intervention. Meanwhile, the functional near-infrared spectrum results showed that the CB-SMA group exhibited a significant inhibitory pattern in the resting-state functional connectivity, which was not observed in the other two groups. In conclusion, we believe that paired targeting of the CB-SMA can reshape the brain network and improve the balance function of patients with stroke.

Influence of Cognitive Task Difficulty in Postural Control and Hemodynamic Response in the Prefrontal Cortex during Static Postural Standing

In daily life, we perform several tasks simultaneously, and it is essential to have adequate postural control to succeed. Furthermore, when performing two or more tasks concurrently, changes in postural oscillation are expected due to the competition for the attentional resources. The aim of this study was to evaluate and compare the center of pressure (CoP) behavior and the hemodynamic response of the prefrontal cortex during static postural standing while performing cognitive tasks of increasing levels of difficulty on a smartphone in young adults. Participants were 35 healthy young adults (mean age ± SD = 22.91 ± 3.84 years). Postural control was assessed by the CoP analysis (total excursion of the CoP (TOTEX CoP), displacements of the CoP in medial–lateral (CoP-ML) and anterior–posterior (CoP-AP) directions, mean total velocity displacement of CoP (MVELO CoP), mean displacement velocity of CoP in medial–lateral (MVELO CoP-ML) and anterior–posterior (MVELO CoP-AP) directions, and 95% confidence ellipse sway area (CEA)), the hemodynamic response by the oxyhemoglobin ([oxy-Hb]), deoxyhemoglobin ([deoxy-Hb]), and total hemoglobin ([total-Hb]) concentrations using a force plate and functional near-infrared spectroscopy (fNIR), respectively. The results showed that the difficult cognitive task while performing static postural standing caused an increase in all CoP variables in analysis (p < 0.05) and of [oxy-Hb] (p < 0.05), [deoxy-Hb] (p < 0.05) and [total-Hb] (p < 0.05) compared to the postural task. In conclusion, the increase in the cognitive demands negatively affected the performance of the postural task when performing them concurrently, compared to the postural task alone. The difficult cognitive task while performing the postural task presented a greater influence on postural sway and activation of the prefrontal cortex than the postural task and the easy cognitive task.

Brain Activation During Active Balancing and Its Behavioral Relevance in Younger and Older Adults: A Functional Near-Infrared Spectroscopy (fNIRS) Study

Age-related deterioration of balance control is widely regarded as an important phenomenon influencing quality of life and longevity, such that a more comprehensive understanding of the neural mechanisms underlying this process is warranted. Specifically, previous studies have reported that older adults typically show higher neural activity during balancing as compared to younger counterparts, but the implications of this finding on balance performance remain largely unclear. Using functional near-infrared spectroscopy (fNIRS), differences in the cortical control of balance between healthy younger (n = 27) and older (n = 35) adults were explored. More specifically, the association between cortical functional activity and balance performance across and within age groups was investigated. To this end, we measured hemodynamic responses (i.e., changes in oxygenated and deoxygenated hemoglobin) while participants balanced on an unstable device. As criterion variables for brain-behavior-correlations, we also assessed postural sway while standing on a free-swinging platform and while balancing on wobble boards with different levels of difficulty. We found that older compared to younger participants had higher activity in prefrontal and lower activity in postcentral regions. Subsequent robust regression analyses revealed that lower prefrontal brain activity was related to improved balance performance across age groups, indicating that higher activity of the prefrontal cortex during balancing reflects neural inefficiency. We also present evidence supporting that age serves as a moderator in the relationship between brain activity and balance, i.e., cortical hemodynamics generally appears to be a more important predictor of balance performance in the older than in the younger. Strikingly, we found that age differences in balance performance are mediated by balancing-induced activation of the superior frontal gyrus, thus suggesting that differential activation of this region reflects a mechanism involved in the aging process of the neural control of balance. Our study suggests that differences in functional brain activity between age groups are not a mere by-product of aging, but instead of direct behavioral relevance for balance performance. Potential implications of these findings in terms of early detection of fall-prone individuals and intervention strategies targeting balance and healthy aging are discussed.

Activation of the Prefrontal Cortex and Improvement of Cognitive Performance with Standing on One Leg

The prefrontal cortex (PFC) is involved in attention, motor planning, and executive functions. In addition, it is known that postural control and cognitive performance are affected during dual-task paradigms, suggesting that postural control and cognition use common areas of the brain. Although postural control and cognition have been used as interfering dual tasks, the neuronal mechanisms underlying interference are not fully understood. We simultaneously performed postural and cognitive tasks in healthy young adults and evaluated activity in the PFC using near-infrared spectrometry. The displacement of the center of pressure (COP) is reduced by cognitive tasks. Difficult postural tasks increased the relative proportion and amplitude of postural sway in the high-frequency bandwidth, related to the adjustment of postural sway. Although the cognitive tasks did not affect the relative proportion of each frequency bandwidth, the amplitudes were selectively reduced. The postural task-dependent change in PFC activity was correlated with the relative proportion and amplitude of postural sway in the high-frequency bandwidth of the COP movement. Cognitive task-dependent changes in PFC activity were not correlated with postural sway. Cognitive performance was better in unipedal standing than bipedal standing. These findings suggest that postural tasks affect cognitive performance via the activation of the PFC, but cognitive tasks affect postural control through a different mechanism.

Compromised Brain Activity With Age During a Game-Like Dynamic Balance Task: Single- vs. Dual-Task Performance

Background: Postural control and cognition are affected by aging. We investigated whether cognitive distraction influenced neural activity differently in young and older adults during a game-like mediolateral weight-shifting task with a personalized task load.

Methods: Seventeen healthy young and 17 older adults performed a balance game, involving hitting virtual wasps, serial subtractions and a combination of both (dual-task). A motion analysis system estimated each subject's center of mass position. Cortical activity in five regions was assessed by measuring oxygenated hemoglobin (HbO₂) with a functional Near-Infrared Spectroscopy system.

Results: When adding cognitive load to the game, weight-shifting speed decreased irrespective of age, but older adults reduced the wasp-hits more than young adults. Accompanying these changes, older adults decreased HbO₂ in the left pre-frontal cortex (PFC) and frontal eye fields (FEF) compared to single-tasking, a finding not seen in young adults. Additionally, lower HbO₂ levels were found during dual-tasking compared to the summed activation of the two single tasks in all regions except for the right PFC. These relative reductions were specific for the older age group in the left premotor cortex (PMC), the right supplementary motor area (SMA), and the left FEF.

Conclusion: Older adults showed more compromised neural activity than young adults when adding a distraction to a challenging balance game. We interpret these changes as competitive downgrading of neural activity underpinning the age-related deterioration of game performance during dual-tasking. Future work needs to ascertain if older adults can train their neural flexibility to withstand balance challenges during daily life activities.

Hemodynamic and behavioral changes in older adults during cognitively demanding dual tasks

INTRODUCTION

Executive functions play a fundamental role in walking by integrating information from cognitive-motor pathways. Subtle changes in brain and behavior may help identify older adults who are more susceptible to executive function deficits with advancing age due to prefrontal cortex deterioration. This study aims to examine how older adults mitigate executive demands while walking during cognitively demanding tasks.

METHODS

Twenty healthy older adults (M = 71.8 years, SD = 6.4) performed simple reaction time (SRT), go/no-go (GNG), n-back (NBK), and double number sequence (DNS) cognitive tasks of increasing difficulty while walking (i.e., dual task). Functional near infra-red spectroscopy (fNIRS) was used to measure the hemodynamic response (i.e., oxy- [HbO2] and deoxyhemoglobin [HbR]) changes in the prefrontal cortex (PFC) during dual and single tasks (i.e., walking alone). In addition, performance was measured using gait speed (m/s), response time (s), and accuracy (% correct).

RESULTS

Using repeated measures ANOVAs, neural findings demonstrated a main effect of task such that ∆HbO2 (p = .047) and ∆HbR (p = .040) decreased between single and dual tasks. An interaction between task and cognitive difficulty (p = .014) revealed that gait speed decreased in the DNS between single and dual tasks. A main effect of task in response time indicated that the SRT response time was faster than all other difficulty levels (p < .001). Accuracy performance declined between single and dual tasks (p = .028) and across difficulty levels (p < .001) but was not significantly different between the NBK and DNS.

CONCLUSION

Findings suggest that a healthy older adult sample might mitigate executive demands using an automatic locomotor control strategy such that shifting conscious attention away from walking during the dual tasks resulted in decreased ∆HbO2 and ∆HbR. However, decreased prefrontal activation was inefficient at maintaining response time and accuracy performance and may be differently affected by increasing cognitive demands.

The beneficial effects of acute strength training on sway activity and sway regularity in healthy older men: Evidence from a posturography study

The effects of acute strength training on balance control were studied in healthy older human men (age-range 60-77y). Participants performed the Tandem Romberg Stance while completing an attention demanding cognitive task (Mathematical Counting) before and after a single acute strength training session applied to the lower limb musculature (experimental group; n = 19) or no intervention (control group; n = 18). Balance stability and the automaticity of balance control were estimated through the calculation of the center-of-pressure (CoP) velocity (Vcop) and the statistical regularity (wavelet entropy) of the CoP trajectory (WEcop), respectively. Training included 3 sets of 3 repetitions of barbell squats using Smith Machine, ranging from 90 % of one repetition maximum (1RM) to 100 % 1RM with 3 min rest between repetitions and 5 min rest between sets. Vcop and WEcop decreased after training (all time main effects, p ≤ 0.028) but group time interactions were not significant (all, p ≥ 0.056). Exploratory analyses revealed that participants in the experimental group showed a significant decrease of Vcop and WEcop in the mediolateral (ML) directions from pre to post [ML Vcop: 15.4 %; Bonferroni-corrected p = 0.048); ML WEcop: 10.5 %; Bonferroni-corrected p = 0.016]. A trend towards a decrease in Vcop and WEcop was also observed in controls, with more prominent gains in the anteroposterior than in the ML direction (Bonferroni-corrected p > 0.2). Overall, findings suggest that acute strength training may improve attentional control of balance along the narrow dimension of the support. Further studies are warranted to examine the specific mechanisms underlying these findings.

The Benefits of Physical Activity in Individuals with Cardiovascular Risk Factors: A Longitudinal Investigation Using fNIRS and Dual-Task Walking

Cardiovascular fitness is linked to better executive functions, preserved gait speed, and efficient cortical activity. Older adults with cardiovascular risk factors (CVRFs) typically show poor cognitive performance, low physical fitness, and altered brain functioning compared with healthy individuals. In the current study, the impact of regular physical activity on cognition, locomotion, and brain functions was explored in a cohort of older adults with low or high CVRFs. Cortical activation of the frontal areas was investigated using functional Near-Infrared Spectroscopy (fNIRS) at baseline, at 6 months and at 12 months. Evoked cortical response and behavioral performance were assessed using the dual-task walking paradigm, consisting of three conditions: single cognitive task (2-back task), single walking task (walking), and dual-task (2-back whilst walking). Results show greater task-related cortical response at baseline in individuals with high CVRFs compared to those with low CVRFs. Moreover, participants with high CVRFs benefitted the most from participating in regular physical activity, as their cortical response decreased at the 12-month follow-up and became comparable to that of participants with low CVRFs. These changes were observed in conjunction with improved cognitive performance and stable gait speed throughout the 12-month period in both groups. Our findings provide evidence that participation in regular physical activity may be especially beneficial in individuals with CVRFs by promoting brain and cognitive health, thus potentially contributing to prevention of cognitive decline. Future research may explore whether such effects are maintained in the long-term in order to design ad-hoc interventions in this specific population.

Prefrontal Cortex Involvement during Dual-Task Stair Climbing in Healthy Older Adults: An fNIRS Study

Executive function and motor control deficits adversely affect gait performance with age, but the neural correlates underlying this interaction during stair climbing remains unclear. Twenty older adults (72.7 ± 6.9 years) completed single tasks: standing and responding to a response time task (SC), ascending or descending stairs (SM_up, SM_down); and a dual-task: responding while ascending or descending stairs (DT_up, DT_down). Prefrontal hemodynamic response changes (∆HbO2, ∆HbR) were examined using functional near-infrared spectroscopy (fNIRS), gait speed was measured using in-shoe smart insoles, and vocal response time and accuracy were recorded. Findings revealed increased ∆HbO2 (p = 0.020) and slower response times (p < 0.001) during dual- versus single tasks. ∆HbR (p = 0.549), accuracy (p = 0.135) and gait speed (p = 0.475) were not significantly different between tasks or stair climbing conditions. ∆HbO2 and response time findings suggest that executive processes are less efficient during dual-tasks. These findings, in addition to gait speed and accuracy maintenance, may provide insights into the neural changes that precede performance declines. To capture the subtle differences between stair ascent and descent and extend our understanding of the neural correlates of stair climbing in older adults, future studies should examine more difficult cognitive tasks.

A Systematic Review of the Application of Functional Near-Infrared Spectroscopy to the Study of Cerebral Hemodynamics in Healthy Aging

Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies have shown that healthy aging is associated with functional brain deterioration that preferentially affects the prefrontal cortex. This article reviews the application of an alternative method, functional near-infrared spectroscopy (fNIRS), to the study of age-related changes in cerebral hemodynamics and factors that influence cerebral hemodynamics in the elderly population. We conducted literature searches in PudMed and PsycINFO, and selected only English original research articles that used fNIRS to study healthy individuals with a mean age of ≥ 55 years. All articles were published in peer-reviewed journals between 1977 and May 2019. We synthesized 114 fNIRS studies examining hemodynamic changes that occurred in the resting state and during the tasks of sensation and perception, motor control, semantic processing, word retrieval, attentional shifting, inhibitory control, memory, and emotion and motivation in healthy older adults. This review, which was not registered in a registry, reveals an age-related reduction in resting-state cerebral oxygenation and connectivity in the prefrontal cortex. It also shows that aging is associated with a reduction in functional hemispheric asymmetry and increased compensatory activity in the frontal lobe across multiple task domains. In addition, this article describes the beneficial effects of healthy lifestyles and the detrimental effects of cardiovascular disease risk factors on brain functioning among nondemented older adults. Limitations of this review include exclusion of gray and non-English literature and lack of meta-analysis. Altogether, the fNIRS literature provides some support for various neurocognitive aging theories derived from task-based PET and fMRI studies. Because fNIRS is relatively motion-tolerant and environmentally unconstrained, it is a promising tool for fostering the development of aging biomarkers and antiaging interventions.

Dual-Task Conditions on Static Postural Control in Older Adults: A Systematic Review and Meta-Analysis

Dual-task (DT) consists of the performance of two tasks simultaneously. An index of DT difficulty has been linked to decreased postural control. Because a wide range of DT is employed, this study aimed to evaluate its effects in static balance in older adults. PubMed, Web of Science, and Scopus were screened, and the secondary tasks were grouped as manual, reaction time, discrimination and decision making, mental tracking, verbal fluency, working memory, or "other" tasks. A total of 66 studies have been included. The meta-analysis was conducted on 28 effects and showed a significant mean effect size of d = 0.24 (p = .02, SE = 0.10; confidence interval [0.04, 0.44]), indicating a worsening in stability during DT. In conclusion, postural control was worsened by the Stroop test and the arithmetic tasks improved it. The results do not underpin any conclusive statement on the impact of DT, and a standard operating procedure was created.

Contribution of the dorsolateral prefrontal cortex activation, ankle muscle activities, and coactivation during dual-tasks to postural steadiness: a pilot study

[Purpose] To examine the influence of dorsolateral prefrontal cortex (DLPFC) activation, ankle muscle activities, and coactivation on postural steadiness during dual-tasks. [Participants and Methods] A total of 14 participants (8 males, 6 females) were included. The participants stood straight on the force plate, and performed 3 different tasks: 1) a quiet standing (single-task), 2) a repetition of a number (dual-task 1: DT1), and 3) a serial subtraction (dual-task 2: DT2). We divided the participants into 2 groups (S and L group) according to whether their center of pressure paths in the dual-tasks were shorter or longer than those in the single-task. The EMG activity of the gastrocnemius lateralis and tibialis anterior were measured; the oxygenated hemoglobin (oxy-Hb) level in the DLPFC were measured using fNIRS. [Results] The results revealed that oxy-Hb in the left DLPFC increased significantly in all participants during DT2 compared to a single-task. Further, we found that the S group exhibited a higher rate of tibialis anterior activity and ankle muscle coactivation than the L group during DT2. [Conclusion] We concluded that the increase of the DLPFC activation varied with the dual-tasks; moreover, younger individuals modulate their standing posture using different strategies for posture steadiness during posture-calculating task.

Age-related prefrontal cortex activation in associative memory: An fNIRS pilot study

Older adults typically perform more poorly than younger adults in free recall memory tests. This age-related deficit has been linked to decline of brain activation and brain prefrontal lateralization, which may be the result of compensatory mechanisms. In the present pilot study, we investigated the effect of age on prefrontal cortex (PFC) activation during performance of a task that requires memory associations (temporal vs. spatial clustering), using functional Near-Infrared Spectroscopy (fNIRS). Ten younger adults, ten cognitively high-performing older individuals, and ten low-performing older individuals completed a free recall task, where either a temporal or spatial strategy (but not both simultaneously) could be employed to retrieve groups of same-category stimuli, whilst changes in PFC hemodynamics were recorded by means of a 12-channel fNIRS system. The results suggest PFC activation, and right lateralization specific to younger adults. Moreover, age did not affect use of memory organization, given that temporal clustering was preferred over spatial clustering in all groups. These findings are in line with previous literature on the aging brain and on temporal organization of memory. Our results also suggest that the PFC may be specifically involved in memory for temporal associations. Future research may consider whether age-related deficits in temporal organization may be an early sign of PFC pathology and possible neurodegeneration.

Functional neuroimaging of human postural control: A systematic review with meta-analysis

Postural instability is a strong risk factor for falls that becomes more prominent with aging. To facilitate treatment and prevention of falls in an aging society, a thorough understanding of the neural networks underlying postural control is warranted. Here, we present a systematic review of the functional neuroimaging literature of studies measuring posture-related neural activity in healthy subjects. Study methods were overall heterogeneous. Eleven out of the 14 studies relied on postural simulation in a supine position (e.g. motor imagery). The key nodes of human postural control involved the brainstem, cerebellum, basal ganglia, thalamus and several cortical regions. An activation likelihood estimation meta-analysis revealed that the anterior cerebellum was consistently activated across the wide range of postural tasks. The cerebellum is known to modulate the brainstem nuclei involved in the control of posture. Hence, this systematic review with meta-analysis provides insight into the neural correlates which underpin human postural control and which may serve as a reference for future neural network and region of interest analyses.

Brain activity during dual task gait and balance in aging and age-related neurodegenerative conditions: A systematic review

The aims of this systematic review were to investigate (1) real-time brain activity during DT gait and balance, (2) whether changes in brain activity correlate with changes in behavioral outcomes in older adults and people with age-related neurodegenerative conditions. PubMed, PsycINFO, and Web of Science were searched from 2009 to 2019 using the keywords dual task, brain activity, gait, balance, aging, neurodegeneration, and other related search terms. A total of 15 articles were included in this review. Functional near-infrared spectroscopy and electroencephalogram measures demonstrated that older adults had higher brain activity, particularly in the prefrontal cortex (PFC), compared to young adults during dual task gait and balance. Similar neurophysiological results were observed in people with age-related neurodegenerative conditions. Few studies demonstrated a relationship between increased brain activity and better behavioral outcomes. This systematic review supports the notion that aging and age-related neurodegenerative conditions are associated with neuronal network changes, resulting in increased brain activity specifically in the PFC. Further studies are warranted to assess the relationship between increased PFC activation during dual task gait and balance and behavioral outcomes to better optimize the rehabilitation interventions.