Skip to main content

Advertisement

Log in

Performance variance on walking while talking tasks: theory, findings, and clinical implications

  • Published:
AGE Aims and scope Submit manuscript

Abstract

Dual tasks that involve walking and cognitive interference tests are commonly used in mobility assessments and interventions. However, factors that explain variance in dual-task performance costs are poorly understood. We, therefore, examined the moderating effects of two putative constructs, postural reserve and hazard estimate, on performance on a walking while talking paradigm. Participants were 285 non-demented older adults (mean age = 76.9 years; %female = 54.4). Postural reserve was operationalized as the presence or absence of clinical gait abnormalities. An empirical factor, based on measures of executive functions, served as a marker for hazard estimate. The moderation effects of postural reserve and hazard estimate on dual-task costs were examined via two-way interactions in a joint linear mixed effect model. Significant dual-task costs were observed for gait speed (95% CI = 30.814 to 39.121) and cognitive accuracy (95% CI = 6.568 to 13.607). High hazard estimate had a protective effect against decline in gait speed (95% CI = −8.372 to −0.151) and cognitive accuracy (95% CI = −8.372 to −0.680). Poor postural reserve was associated with reduced decline in gait speed (95% CI = −9.611 to −0.702) but did not moderate the decline in cognitive accuracy (95% CI = −3.016 to 4.559). Assessing postural reserve and hazard estimate can help improve mobility risk assessment procedures and interventions for individuals with cognitive and movement disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders 4th Ed, Text Revision. American Psychiatric Association, Washington, DC

    Google Scholar 

  • Baker PS, Bodner EV, Allman RM (2003) Measuring life-space mobility in community-dwelling older adults. J Am Geriatr Soc 51(11):1610–1614

    Article  PubMed  Google Scholar 

  • Benedict RH, Holtzer R, Motl RW, Foley FW, Kaur S, Hojnacki D, Weinstock-Guttman B (2011) Upper and lower extremity motor function and cognitive impairment in multiple sclerosis. J Int Neuropsychol Soc 1–11

  • Benton AHK (1976) Multilingual aphasia examination. University of Iowa, Iowa City

    Google Scholar 

  • Bloem BR, Valkenburg VV, Slabbekoorn M, van Dijk JG (2001) The multiple tasks test strategies in Parkinson's disease. Exp Brain Res 137(3–4):478–486

    Article  CAS  PubMed  Google Scholar 

  • Brach JS, Perera S, Studenski S, Newman AB (2008) The reliability and validity of measures of gait variability in community-dwelling older adults. Arch Phys Med Rehabil 89(12):2293–2296

    Article  PubMed Central  PubMed  Google Scholar 

  • Camicioli R, Howieson D, Lehman S, Kaye J (1997) Talking while walking: the effect of a dual task in aging and Alzheimer's disease. Neurology 48(4):955–958

    Article  CAS  PubMed  Google Scholar 

  • Diggle PJ, Heagerty P, Liang KY, Zeger SL (2002) Analysis of longitudinal data, 2nd edn. Oxford University Press, Oxford

    Google Scholar 

  • D'Orio VL, Foley FW, Armentano F, Picone MA, Kim S, Holtzer R (2012) Cognitive and motor functioning in patients with multiple sclerosis: neuropsychological predictors of walking speed and falls. J Neurol Sci 316(1–2):42–46

    Article  PubMed  Google Scholar 

  • Galvin JE, Roe CM, Powlishta KK, Coats MA, Muich SJ, Grant E, Morris JC (2005) The AD8: a brief informant interview to detect dementia. Neurology 65(4):559–564

    Article  CAS  PubMed  Google Scholar 

  • Gerin-Lajoie M, Richards CL, McFadyen BJ (2005) The negotiation of stationary and moving obstructions during walking: anticipatory locomotor adaptations and preservation of personal space. Mot Control 9(3):242–269

    Google Scholar 

  • Glass JM, Schumacher EH, Lauber EJ, Zurbriggen EL, Gmeindl L, Kieras DE, Meyer DE (2000) Aging and the psychological refractory period: task-coordination strategies in young and old adults. Psychol Aging 15(4):571–595

    Article  CAS  PubMed  Google Scholar 

  • Goodglass HKE (1983) The assessment of aphasia and related disorders, 2nd edn. Lea & Febiger, Philadelphia

    Google Scholar 

  • Hartley AA (2001) Age differences in dual-task interference are localized to response-generation processes. Psychol Aging 16(1):47–54

    Article  CAS  PubMed  Google Scholar 

  • Hartley AA, Little DM (1999) Age-related differences and similarities in dual-task interference. J Exp Psychol Gen 128(4):416–449

    Article  CAS  PubMed  Google Scholar 

  • Hausdorff JM, Schweiger A, Herman T, Yogev-Seligmann G, Giladi N (2008) Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci 63(12):1335–1343

    Article  PubMed Central  PubMed  Google Scholar 

  • Holtzer R, Stern Y, Rakitin BC (2004) Age-related differences in executive control of working memory. Mem Cognit 32(8):1333–1345

    Article  PubMed  Google Scholar 

  • Holtzer R, Stern Y, Rakitin BC (2005) Predicting age-related dual-task effects with individual differences on neuropsychological tests. Neuropsychology 19(1):18–27

    Article  PubMed  Google Scholar 

  • Holtzer R, Verghese J, Xue X, Lipton RB (2006) Cognitive processes related to gait velocity: results from the Einstein Aging Study. Neuropsychology 20(2):215–223

    Article  PubMed  Google Scholar 

  • Holtzer R, Friedman R, Lipton RB, Katz M, Xue X, Verghese J (2007) The relationship between specific cognitive functions and falls in aging. Neuropsychology 21(5):540–548

    Article  PubMed Central  PubMed  Google Scholar 

  • Holtzer R, Goldin Y, Zimmerman M, Katz M, Buschke H, Lipton RB (2008a) Robust norms for selected neuropsychological tests in older adults. Arch Clin Neuropsychol 23(5):531–541

    Article  Google Scholar 

  • Holtzer R, Verghese J, Wang C, Hall CB, Lipton RB (2008b) Within-person across-neuropsychological test variability and incident dementia. JAMA 300(7):823–830

    Article  CAS  Google Scholar 

  • Holtzer R, Mahoney JR, Izzetoglu M, Izzetoglu K, Onaral B, Verghese J (2011) fNIRS Study of walking and walking while talking in young and old individuals. J Gerontol A Biol Sci Med Sci 66(8):879–887

    Article  PubMed  Google Scholar 

  • Holtzer R, Wang C, Lipton R, Verghese J (2012a) The protective effects of executive functions and episodic memory on gait speed decline in aging defined in the context of cognitive reserve. J Am Geriatr Soc 60(11):2093–2098

    Google Scholar 

  • Holtzer R, Wang C, Verghese J (2012b) The relationship between attention and gait in aging: facts and fallacies. Mot Control 16(1):64–80

    Google Scholar 

  • Li KZH, Lindenberger U, Freund AM, Baltes PB (2001) Walking while memorizing: age-related differences in compensatory behavior. Psychol Sci 12(3):230–237

    Article  CAS  PubMed  Google Scholar 

  • Liang KY, Zeger SL (1986) Longitudinal data-analysis using generalized linear-models. Biometrika 73(1):13–22

    Article  Google Scholar 

  • Lindenberger U, Marsiske M, Baltes PB (2000) Memorizing while walking: increase in dual-task costs from young adulthood to old age. Psychology and Aging 15(3):417–436

    Article  CAS  PubMed  Google Scholar 

  • Lipton RB, Katz MJ, Kuslansky G, Sliwinski MJ, Stewart WF, Verghese J, Buschke H (2003) Screening for dementia by telephone using the memory impairment screen. J Am Geriatr Soc 51(10):1382–1390

    Article  PubMed  Google Scholar 

  • Meyer DE, Glass JM, Mueller ST, Seymour TL, Kieras DE (2001) Executive-process interactive control: a unified computational theory for answering 20 questions (and more) about cognitive ageing. Eur J Cogn Psychol 13(1–2):123–164

    Google Scholar 

  • Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD (2000) The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis. Cognit Psychol 41(1):49–100

    Article  CAS  PubMed  Google Scholar 

  • Montero-Odasso M, Schapira M, Soriano ER, Varela M, Kaplan R, Camera LA, Mayorga LM (2005) Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 60(10):1304–1309

    Article  PubMed  Google Scholar 

  • Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, Harris TB (2006) Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 295(17):2018–2026

    Article  CAS  PubMed  Google Scholar 

  • Randolph C, Tierney MC, Mohr E, Chase TN (1998) The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol 20(3):310–319

    Article  CAS  PubMed  Google Scholar 

  • Reitan RM (1958) Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Ski 8:271–276

    Google Scholar 

  • Salthouse TA (1996) The processing-speed theory of adult age differences in cognition. Psychol Rev 103(3):403–428

    Article  CAS  PubMed  Google Scholar 

  • Schrodt LA, Mercer VS, Giuliani CA, Hartman M (2004) Characteristics of stepping over an obstacle in community dwelling older adults under dual-task conditions. Gait & Posture 19(3):279–287

    Article  Google Scholar 

  • Schwenk M, Zieschang T, Oster P, Hauer K (2010) Dual-task performances can be improved in patients with dementia: a randomized controlled trial. Neurology 74(24):1961–1968

    Article  PubMed  Google Scholar 

  • Somberg BL, Salthouse TA (1982) Divided attention abilities in young and old adults. J Exp Psychol Hum Percept Perform 8(5):651–663

    Article  CAS  PubMed  Google Scholar 

  • Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Guralnik J (2011) Gait speed and survival in older adults. JAMA 305(1):50–58

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Verbeke GDM (2009) Joint models for longitudinal data: introduction and overview. In: Fitzmaurice DMG, Verbeke G, Molenberghs G (eds) Longitudinal data analysis. Chapman & Hall, Boca Raton, pp 319–326

    Google Scholar 

  • Verghese J, Holtzer R (2010) Walking the walk while talking: cognitive therapy for mobility in dementia? Neurology 74(24):1938–1939

    Article  PubMed  Google Scholar 

  • Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H (2002) Abnormality of gait as a predictor of non-Alzheimer's dementia. N Engl J Med 347(22):1761–1768

    Article  PubMed  Google Scholar 

  • Verghese J, Kuslansky G, Holtzer R, Katz M, Xue X, Buschke H, Pahor M (2007a) Walking while talking: effect of task prioritization in the elderly. Arch Phys Med Rehabil 88(1):50–53

    Article  Google Scholar 

  • Verghese J, Wang C, Lipton RB, Holtzer R, Xue X (2007b) Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 78(9):929–935

    Article  Google Scholar 

  • Verghese J, Robbins M, Holtzer R, Zimmerman M, Wang C, Xue X, Lipton RB (2008) Gait dysfunction in mild cognitive impairment syndromes. J Am Geriatr Soc 56(7):1244–1251

    Article  PubMed Central  PubMed  Google Scholar 

  • Verghese J, Ambrose AF, Lipton RB, Wang CL (2010a) Neurological gait abnormalities and risk of falls in older adults. J Neurol 257(3):392–398

    Article  Google Scholar 

  • Verghese J, Mahoney J, Ambrose AF, Wang C, Holtzer R (2010b) Effect of cognitive remediation on gait in sedentary seniors. J Gerontol A Biol Sci Med Sci 65(12):1338–1343

    Article  Google Scholar 

  • Verghese J, Wang C, Holtzer R (2011) Relationship of clinic-based gait speed measurement to limitations in community-based activities in older adults. Arch Phys Med Rehabil 92(5):844–846

    Article  PubMed Central  PubMed  Google Scholar 

  • Verghese J, Holtzer R, Lipton RB, Wang C (2012) Mobility stress test approach to predicting frailty, disability, and mortality in high-functioning older adults. J Am Geriatr Soc 60(10):1901–1905

    Article  PubMed Central  PubMed  Google Scholar 

  • Verghese J, Wang C, Lipton RB, Holtzer R (2013) Motoric cognitive risk syndrome and the risk of dementia. J Gerontol A Biol Sci Med Sci 68(4):412–418. doi:10.1093/gerona/gls191

    Article  PubMed  Google Scholar 

  • Wechsler D (1997) Wechsler Adult Intelligence Scale, 3rd edn. The Psychological Corporation, New York

    Google Scholar 

  • Yogev G, Giladi N, Peretz C, Springer S, Simon ES, Hausdorff JM (2005) Dual tasking, gait rhythmicity, and Parkinson's disease: which aspects of gait are attention demanding? Eur J Neurosci 22(5):1248–1256

    Article  PubMed  Google Scholar 

  • Yogev-Seligmann G, Rotem-Galili Y, Mirelman A, Dickstein R, Giladi N, Hausdorff JM (2010) How does explicit prioritization alter walking during dual-task performance? Effects of age and sex on gait speed and variability. Phys Ther 90(2):177–186

    Article  PubMed  Google Scholar 

  • Yogev-Seligmann G, Giladi N, Brozgol M, Hausdorff JM (2012a) A training program to improve gait while dual tasking in patients with Parkinson's disease: a pilot study. Arch Phys Med Rehabil 93(1):176–181

    Article  Google Scholar 

  • Yogev-Seligmann G, Hausdorff JM, Giladi N (2012b) Do we always prioritize balance when walking? Towards an integrated model of task prioritization. Mov Disord 27(6):765–770

    Article  Google Scholar 

  • Yogev-Seligmann G, Rotem-Galili Y, Dickstein R, Giladi N, Hausdorff JM (2012c) Effects of explicit prioritization on dual task walking in patients with Parkinson's disease. Gait & Posture 35(4):641–646

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by the National Institutes on Aging R01AG036921 (PI: R. Holtzer).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roee Holtzer.

About this article

Cite this article

Holtzer, R., Wang, C. & Verghese, J. Performance variance on walking while talking tasks: theory, findings, and clinical implications. AGE 36, 373–381 (2014). https://doi.org/10.1007/s11357-013-9570-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11357-013-9570-7

Keywords

Navigation