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Reduced motor cortex inhibition and a 'cognitive-first' prioritisation strategy for older adults during dual-tasking.

ABSTRACT: It is well established that older adults are less able to perform attentionally demanding motor tasks, placing them at greater risk of accident-related injury. The primary purpose of this study was to investigate whether the interplay between prefrontal and motor cortex activity could predict such age-related performance deficits. Using a dual-task (DT) paradigm, 15 younger and 15 older adults participated in experiment 1, where brain activity was simultaneously measured using functional near infrared spectroscopy (fNIRS) and transcranial magnetic stimulation (TMS). Experiment 1 demonstrated poorer performance for the older group across a range of DTs combining visuomotor arm tracking with a secondary cognitive or motor task. Interestingly however, older adults' DT performance error was isolated to the motor component of DTs. TMS data revealed reduced motor cortex (M1) inhibition during DTs for older adults, and a trend for this correlating with poorer performance. In contrast, poorer performing younger adults showed significantly higher M1 inhibition. Experiment 2 was conducted given a high amount of movement artifact in experiment 1 fNIRS data. Using fNIRS to measure prefrontal, premotor, and motor cortex activity in an additional 15 older adults, we found no evidence of an interplay between these regions predicting DT performance. Nevertheless, performance data replicated experiment 1 in showing that DT error was isolated to motor tasks in older adults, with no significant cognitive task error. Overall, this study shows that older adults seemed to adopt a 'cognitive-first' prioritisation strategy during the DTs involved in our study, and that deficits in DT performance may be related to the modulation of M1 inhibitory mechanisms. We propose that clinicians advise older adults to allocate greater attention to motor tasks during activities where they may be at risk of accident-related injury.

SUBMITTER: Corp DT

PROVIDER: S-EPMC6263161 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Reduced motor cortex inhibition and a 'cognitive-first' prioritisation strategy for older adults during dual-tasking.

Corp Daniel T DT Youssef George J GJ Clark Ross A RA Gomes-Osman Joyce J Yücel Meryem A MA Oldham Stuart J SJ Aldraiwiesh Shatha S Rice Jordyn J Pascual-Leone Alvaro A Rogers Mark A MA

Experimental gerontology 20180924

It is well established that older adults are less able to perform attentionally demanding motor tasks, placing them at greater risk of accident-related injury. The primary purpose of this study was to investigate whether the interplay between prefrontal and motor cortex activity could predict such age-related performance deficits. Using a dual-task (DT) paradigm, 15 younger and 15 older adults participated in experiment 1, where brain activity was simultaneously measured using functional near in ...[more]

PMID: 30261247

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Project description:IntroductionThe use of dual-task model such as dual-task gait has been extensively studied to assess cognitive-motor performance among older adults. However, space restriction and safety factor limit its applications in remote assessment. To address the gap, we propose a video processing-based approach to remotely quantify cognitive-motor performance using a 20-s repetitive elbow flexion-extension test with dual-task condition, called video-based motoric-cognitive meter (MCM).MethodsEighteen older participants (age: 78.6 ± 6.5 years) who were clinically diagnosed as having either mild cognitive impairment or dementia were included in this study. Participants were asked to perform 20-s repetitive elbow flexion-extension exercise with a memory exercise by counting backward from a two-digit number. During the test, all movements of the forearm were recorded by a video camera. As a comparator, a validated wrist-worn sensor was used, which allowed quantifying upper extremity kinematics.ResultsThe results showed a good agreement (r ≥ 0.530 and ICC2,1 ≥ 0.681) between the derived dual-task upper extremity motor performance from the proposed video-based MCM and a clinically validated sensor-based MCM. We also observed moderate correlations (r ≥ 0.496) between some measures of video-based MCM (flexion time, extension time, and flexion-extension time) and clinical cognitive scale (Mini-Mental State Examination [MMSE]). Additionally, some measures of dual-task upper extremity motor performance (speed, flexion time, extension time, and flexion-extension time) were associated with dual-task gait speed (r ≥ 0.557), which has been found to be correlated with cognitive impairment. Lastly, the selected dual-task motor performance metric (flexion time) was sensitive to predict MMSE scores in linear regression analyses with statistical significance (adjusted R2 = 0.306, p = 0.025).ConclusionThis study proposes a video processing-based approach to analyze dual-task upper extremity motor performance from a simple and convenient upper extremity function test. The results indicate concurrent validity of the proposed video-based MCM compared with the sensor-based MCM, and associations between dual-task upper extremity motor performance and clinically validated cognitive markers (MMSE scores and dual-task gait). Future studies are warranted to explore sensitivity of this solution to promote remote assessment of cognitive-motor performance among older adults in telehealth applications.

Project description:Standing upright on stable and unstable surfaces requires postural control. Postural control declines as humans age, presenting greater risk of fall-related injury and other negative health outcomes. Secondary cognitive tasks can further impact balance, which highlights the importance of coordination between cognitive and motor processes. Past research indicates that this coordination relies on executive function (EF; the ability to control, maintain, and flexibly direct attention to achieve goals), which coincidentally declines as humans age. This suggests that secondary cognitive tasks requiring EF may exert a greater influence on balance compared to non-EF secondary tasks, and this interaction could be exaggerated among older adults. In the current study, we had younger and older adults complete two Surface Stability conditions (standing upright on stable vs. unstable surfaces) under varying Cognitive Load; participants completed EF (Shifting, Inhibiting, Updating) and non-EF (Processing Speed) secondary cognitive tasks on tablets, as well as a single task control scenario with no secondary cognitive task. Our primary balance measure of interest was sway area, which was measured with an array of wearable inertial measurement unit sensors. Replicating prior work, we found a main effect of Surface Stability with less sway on stable surfaces compared to unstable surfaces, and we found an interaction between Age and Surface Stability with older adults exhibiting significantly greater sway selectively on unstable surfaces compared to younger adults. New findings revealed a main effect of Cognitive Load on sway, with the single task condition having significantly less sway than two of the EF conditions (Updating and Shifting) and the non-EF condition (Processing Speed). We also found an interaction of Cognitive Load and Surface Stability on postural control, where Surface Stability impacted sway the most for the single task and two of the executive function conditions (Inhibition and Shifting). Interestingly, Age did not interact with Cognitive Load, suggesting that both age groups were equally impacted by secondary cognitive tasks, regardless the presence or type of secondary cognitive task. Taken together, these patterns suggest that cognitive demands vary in their impact on posture control across stable vs. unstable surfaces, and that EF involvement may not be the driving mechanism explaining cognitive-motor dual-task interference on balance.

Dataset Information

Reduced motor cortex inhibition and a 'cognitive-first' prioritisation strategy for older adults during dual-tasking.

Publications

Reduced motor cortex inhibition and a 'cognitive-first' prioritisation strategy for older adults during dual-tasking.

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