Association between Statin Use and Balance in Older Adults.

Background: Several medications have been associated with an increased risk of balance deficits and greater likelihood to sustain a fall, representing a large health and economic issue. Statins are regularly prescribed to prevent strokes and heart attacks, but their impact on balance is unknown. The aim of this paper was to determine whether statin use is associated with poorer balance performances in older adults. Methods: All participants, one group taking statins (n = 34), and the other group not taking statins (n = 31), completed a balance assessment with their eyes closed and their eyes opened on a MatScan Pressure Sensing Mat. Center of Pressure (CoP) velocity, peak-to-peak distance, and standard deviation were collected in both anteroposterior (AP) and mediolateral (ML) directions. Multiple linear regression analyses were performed for each balance outcome, testing the statin use status as a predictor and controlling for appropriate factors including participants characteristics, lipid profile, and cardiovascular disease. Results: After controlling for confounding factors, statin use significantly predicted both CoP ML-Amplitude (ß = 0.638, p = 0.004) and ML-Velocity (ß = 0.653, p = 0.002) in the eyes-opened condition. Conclusions: The present study detected a negative association between statin use and balance control in the ML direction, suggesting that caution should be taken when prescribing statins in older adults, as this could decrease ML stability and ultimately increase fall and fracture risks.

An Overview of the Cardiorespiratory Hypothesis and Its Potential Contribution to the Care of Neurodegenerative Disease in Africa.

One hypothesis that could explain the beneficial effects of physical exercise on cognitive function is the cardiorespiratory hypothesis. This hypothesis proposes that improved cognitive functioning may be in part a result of the physiological processes that occur after physical exercise such as: Increased cerebral perfusion and regional cerebral blood flow. These processes ensure increased oxygenation and glucose transportation to the brain, which together can improve cognitive function. The objective of this narrative review is to examine the contribution of this hypothesis in the care of African older adults with neurodegenerative conditions (i.e., dementia (Alzheimer's disease)) or with mild cognitive impairments. Although studies in developed countries have examined people of African descent (i.e., with African Americans), only the limited findings presented in this review reflect how these conditions are also important for the African continent. This review revealed that no studies have examined the effects of cardiorespiratory fitness on neurodegenerative disease in Africa. African nations, like many other developing countries, have an aging population that is growing and will face an increased risk of neurodegenerative declines. It is therefore imperative that new research projects be developed to explore the role of the cardiorespiratory fitness in neurodegenerative disease prevention in African nations.

Exploring Professionals' Experiences in the Rehabilitation of Older Clients with Dual-Sensory Impairment.

En vue de mieux comprendre et d'améliorer le processus de réadaptation des personnes âgées présentant à la fois une déficience auditive et visuelle, soit une double déficience sensorielle (DDS), cette étude s'est penchée sur les perspectives des professionnels de la santé qui œuvrent chez cette population. Treize professionnels aux parcours variés ont été interviewés en lien avec leur expérience de travail auprès de personnes âgées avec DDS. Les entrevues ont été transcrites et codées, et une analyse de contenu a été effectuée. Les participants des diverses professions ont perçu qu'ils devaient assumer les rôles additionnels suivants : (1) conseiller, (2) guide, (3) formateur ou rééducateur. Ces rôles consistaient à aider les personnes avec DDS et leurs familles présentant une dépression, des problèmes d'acceptation, des consultations répétées et des parcours complexes dans le système de santé. Selon les professionnels interviewés, ces rôles supplémentaires accroissent leur charge de travail et les confrontent à des problématiques pour lesquelles ils n'ont pas reçu de formation. Ils suggèrent l'implantation d'une formation sur les DDS pour les professionnels et les membres de la famille concernés, ainsi qu'une approche de réadaptation en équipe multidisciplinaire.To better understand and improve the rehabilitation process of older adults with sensory losses in both hearing and vision or dual sensory impairment (DSI), this study explored the perspectives of health care professionals who work with this population. Thirteen individuals, with varied professional backgrounds, were interviewed about their experiences in working with older adults with DSI. We transcribed and coded the interviews, then conducted content analysis. Regardless of their professional backgrounds, the participants reported additional roles that they perceived they fulfilled: (a) counsellor, (b) navigator, and (c) trainer and re-trainer. These roles involved helping individuals with DSI, and their family, with depression, acceptance, repeat consultations, and way-finding through the health system. From the professionals' perspective, these additional roles increase workload and place them in situations they were not trained for. They suggest education for all professionals and for family members working with people with DSI; moreover, they suggest a multidisciplinary team rehabilitation approach.

A comparison of the impact of physical exercise, cognitive training and combined intervention on spontaneous walking speed in older adults.

BACKGROUND: Spontaneous walking speed (SWS) is one of the most important indicators of health in older adults. Studies have shown benefits of physical trainings on SWS in older adults but the impact of cognitive training and multidomain interventions remains understudied. AIMS: This original study aimed at comparing the impact of aerobic/resistance exercise, computerized cognitive training and the combination of both interventions compared with active control conditions on SWS in healthy older adults. METHODS: Ninety community-dwelling older adults were randomly assigned to four different combinations composed of two active interventions: physical aerobic/resistance and cognitive dual-task trainings, and two active control conditions: stretching exercises and computer lessons. The four combinations were the following: (1) aerobic/resistance and cognitive dual task (n = 28), (2) aerobic/resistance and computer lessons (n = 21), (3) stretching exercises and cognitive dual task and (n = 23), (4) stretching exercises and computer lessons (n = 18). Training sessions were held three times/week for three months. SWS for 30 s was assessed before and after the intervention. RESULTS: Repeated-measures ANOVA showed a main effect of time and a significant three-way interaction suggesting differential improvement in SWS according to training combinations. A clinical meaningful improvement in SWS was observed in groups 1-3 (0.08-0.14 m/s; effect sizes: small to moderate) but not in the active control group 4. DISCUSSION: Results of this study suggest that aerobic/resistance exercise and computerized dual-task training are two non-pharmacological interventions by which SWS, a functional vital sign, can be clinically improved in older adults. CONCLUSION: This original study pointed out different tools to prevent functional decline in older people.

Comparable Cerebral Oxygenation Patterns in Younger and Older Adults during Dual-Task Walking with Increasing Load.

The neuroimaging literature on dual-task gait clearly demonstrates increased prefrontal cortex (PFC) involvement when performing a cognitive task while walking. However, findings from direct comparisons of the cerebral oxygenation patterns of younger (YA) and older (OA) adults during dual-task walking are mixed and it is unclear how YA and OA respond to increasing cognitive load (difficulty) while walking. This functional near infra-red (fNIRS) study examined cerebral oxygenation of YA and OA during self-paced dual-task treadmill walking at two different levels of cognitive load (auditory n-back). Changes in accuracy (%) as well as oxygenated (HbO) and deoxygenated (HbR) hemoglobin were examined. For the HbO and HbR measures, eight regions of interest (ROIs) were assessed: the anterior and posterior dorsolateral and ventrolateral PFC (aDLPFC, pDLPFC, aVLPFC, pVLPFC) in each hemisphere. Nineteen YA (M = 21.83 years) and 14 OA (M = 66.85 years) walked at a self-selected pace while performing auditory 1-back and 2-back tasks. Walking alone (single motor: SM) and performing the cognitive tasks alone (single cognitive: SC) were compared to dual-task walking (DT = SM + SC). In the behavioural data, participants were more accurate in the lowest level of load (1-back) compared to the highest (2-back; p < 0.001). YA were more accurate than OA overall (p = 0.009), and particularly in the 2-back task (p = 0.048). In the fNIRS data, both younger and older adults had task effects (SM < DT) in specific ROIs for ΔHbO (three YA, one OA) and ΔHbR (seven YA, eight OA). After controlling for walk speed differences, direct comparisons between YA and OA did not reveal significant age differences, but did reveal a difficulty effect in HbO in the left aDLPFC (p = 0.028) and significant task effects (SM < DT) in HbR for six of the eight ROIs. Findings suggest that YA and OA respond similarly to manipulations of cognitive load when walking on a treadmill at a self-selected pace.

Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults.

PURPOSE: Physical exercise and cognitive training have been shown to enhance cognition among older adults. However, few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study. Prior trials on combined training have led to interesting yet equivocal results. The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults. METHODS: Seventy-six participants were randomly assigned to one of four training combinations using a 2×2 factorial design. The physical intervention was a mixed aerobic and resistance training program, and the cognitive intervention was a dual-task (DT) training program. Stretching and toning exercises and computer lessons were used as active control conditions. Physical and cognitive measures were collected pre- and postintervention. RESULTS: All groups showed equivalent improvements in measures of functional mobility. The aerobic-strength condition led to larger effect size in lower body strength, independently of cognitive training. All groups showed improved speed of processing and inhibition abilities, but only participants who took part in the DT training, independently of physical training, showed increased task-switching abilities. The level of functional mobility after intervention was significantly associated with task-switching abilities. CONCLUSION: Combined training did not yield synergetic effects. However, DT training did lead to transfer effects on executive performance in neuropsychological tests. Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults.

Does Combined Physical and Cognitive Training Improve Dual-Task Balance and Gait Outcomes in Sedentary Older Adults?

Everyday activities like walking and talking can put an older adult at risk for a fall if they have difficulty dividing their attention between motor and cognitive tasks. Training studies have demonstrated that both cognitive and physical training regimens can improve motor and cognitive task performance. Few studies have examined the benefits of combined training (cognitive and physical) and whether or not this type of combined training would transfer to walking or balancing dual-tasks. This study examines the dual-task benefits of combined training in a sample of sedentary older adults. Seventy-two older adults (≥60 years) were randomly assigned to one of four training groups: Aerobic + Cognitive training (CT), Aerobic + Computer lessons (CL), Stretch + CT and Stretch + CL. It was expected that the Aerobic + CT group would demonstrate the largest benefits and that the active placebo control (Stretch + CL) would show the least benefits after training. Walking and standing balance were paired with an auditory n-back with two levels of difficulty (0- and 1-back). Dual-task walking and balance were assessed with: walk speed (m/s), cognitive accuracy (% correct) and several mediolateral sway measures for pre- to post-test improvements. All groups demonstrated improvements in walk speed from pre- (M = 1.33 m/s) to post-test (M = 1.42 m/s, p < 0.001) and in accuracy from pre- (M = 97.57%) to post-test (M = 98.57%, p = 0.005).They also increased their walk speed in the more difficult 1-back (M = 1.38 m/s) in comparison to the 0-back (M = 1.36 m/s, p < 0.001) but reduced their accuracy in the 1-back (M = 96.39%) in comparison to the 0-back (M = 99.92%, p < 0.001). Three out of the five mediolateral sway variables (Peak, SD, RMS) demonstrated significant reductions in sway from pre to post test (p-values < 0.05). With the exception of a group difference between Aerobic + CT and Stretch + CT in accuracy, there were no significant group differences after training. Results suggest that there can be dual-task benefits from training but that in this sedentary sample Aerobic + CT training was not more beneficial than other types of combined training.

Shedding light on the effect of priority instructions during dual-task performance in younger and older adults: A fNIRS study.

Age-related differences in the ability to perform two tasks simultaneously (or dual-task) have become a major concern in aging neurosciences and have often been assessed with two distinct paradigms; the Psychological Refractory Period (PRP) and the Dual-Task (DT) paradigms. PRP studies assess participants when they give Priority to one task over the other (complete A then B), whereas in DT studies participants give Equal priority to both tasks (complete A and B). The Equal condition could be viewed as adding an executive control component to the task since the participants must spontaneously monitor attention between tasks. In the current study, we assessed the effect of priority instructions (Priority vs. Equal) on the dual-task performance and brain activity of younger (n = 16) and older adults (n = 19) with functional near infra-red spectroscopy (fNIRS). In younger adults, the Priority condition showed right-sided activation in the prefrontal cortex during DT execution. Older adults showed bilateral frontal activation, yet restrained to specific areas. They showed increased activation in DT vs. single task condition in the left dorsolateral prefrontal cortex (DLPFC) and the bilateral ventrolateral prefrontal cortex (VLPFC). In the Equal condition, the DT condition showed isolated left DLPFC and VLPFC activation in younger adults and widespread bilateral DLPFC activation in older adults. These results suggest that for both older and younger adults, priority effects are associated with distinct patterns of prefrontal activation. Age-related differences also exist in these patterns such that prefrontal activation seems to be more spread out at different sites in older adults when they are instructed to give Equal priority to both tasks.

Higher levels of cardiovascular fitness are associated with better executive function and prefrontal oxygenation in younger and older women.

AIM: Many studies have suggested that physical exercise training improves cognition and more selectively executive functions. There is a growing interest to clarify the neurophysiological mechanisms that underlie this effect. The aim of the current study was to evaluate the neurophysiological changes in cerebral oxygenation associated with physical fitness level and executive functions. METHOD: In this study, 22 younger and 36 older women underwent a maximal graded continuous test (i.e., [Formula: see text]O2max ) in order to classify them into a fitness group (higher vs. lower fit). All participants completed neuropsychological paper and pencil testing and a computerized Stroop task (which contained executive and non-executive conditions) in which the change in prefrontal cortex oxygenation was evaluated with near infrared spectroscopy (NIRS). RESULTS: Our findings revealed a Fitness × Condition interaction (p < 0.05) such that higher fit women scored better on measures of executive functions than lower fit women. In comparison to lower fit women, higher fit women had faster reaction times in the Executive condition of the computerized Stroop task. No significant effect was observed in the non-executive condition of the test and no interactions were found with age. In measures of cerebral oxygenation (ΔHbT and ΔHbO2), we found a main effect of fitness on cerebral oxygenation during the Stroop task such that only high fit women demonstrated a significant increase in the right inferior frontal gyrus. DISCUSSION/CONCLUSION: Higher fit individuals who demonstrate better cardiorespiratory functions (as measured by [Formula: see text]O2max ) show faster reaction times and greater cerebral oxygenation in the right inferior frontal gyrus than women with lower fitness levels. The lack of interaction with age, suggests that good cardiorespiratory functions can have a positive impact on cognition, regardless of age.

Critical success factors in awareness of and choice towards low vision rehabilitation.

PURPOSE: The goal of the current study was to examine the critical factors indicative of an individual's choice to access low vision rehabilitation services. METHODS: Seven hundred and forty-nine visually impaired individuals, from the Montreal Barriers Study, completed a structured interview and questionnaires (on visual function, coping, depression, satisfaction with life). Seventy-five factors from the interview and questionnaires were entered into a data-driven Classification and Regression Tree Analysis in order to determine the best predictors of awareness group: positive personal choice (I knew and I went), negative personal choice (I knew and did not go), and lack of information (Nobody told me, and I did not know). RESULTS: Having a response of moderate to no difficulty on item 6 (reading signs) of the Visual Function Index 14 (VF-14) indicated that the person had made a positive personal choice to seek rehabilitation, whereas reporting a great deal of difficulty on this item was associated with a lack of information on low vision rehabilitation. In addition to this factor, symptom duration of under nine years, moderate difficulty or less on item 5 (seeing steps or curbs) of the VF-14, and an indication of little difficulty or less on item 3 (reading large print) of the VF-14 further identified those who were more likely to have made a positive personal choice. Individuals in the lack of information group also reported greater difficulty on items 3 and 5 of the VF-14 and were more likely to be male. CONCLUSIONS: The duration-of-symptoms factor suggests that, even in the positive choice group, it may be best to offer rehabilitation services early. Being male and responding moderate difficulty or greater to the VF-14 questions about far, medium-distance and near situations involving vision was associated with individuals that lack information. Consequently, these individuals may need additional education about the benefits of low vision services in order to make a positive personal choice.

The Effects of Combining Videogame Dancing and Pelvic Floor Training to Improve Dual-Task Gait and Cognition in Women with Mixed-Urinary Incontinence.

OBJECTIVE: Many women over 65 years of age suffer from mixed urinary incontinence (MUI) and executive function (EF) deficits. Both incontinence and EF declines increase fall risk. The current study assessed EF and dual-task gait after a multicomponent intervention that combined pelvic floor muscle (PFM) training and videogame dancing (VGD). MATERIALS AND METHODS: Baseline (Pre1), pretraining (Pre2), and post-training (Post) neuropsychological and dual-task gait assessments were completed by 23 women (mean age, 70.4 years) with MUI. During the dual-task, participants walked and performed an auditory n-back task. From Pre2 to Post, all women completed 12 weeks of combined PFM and VGD training. RESULTS: After training (Pre2 to Post), the number of errors in the Inhibition/Switch Stroop condition decreased significantly, the Trail Making Test difference score improved marginally, and the number of n-back errors during dual-task gait significantly decreased. A subgroup analysis based on continence improvements (pad test) revealed that only those subjects who improved in the pad test had significantly reduced numbers of n-back errors during dual-task gait. CONCLUSIONS: The results of this study suggest that a multicomponent intervention can improve EFs and the dual-task gait of older women with MUI. Future research is needed to determine if the training-induced improvements in these factors reduce fall risk.

The effect of three months of aerobic training on stroop performance in older adults.

Growing evidence supports the use of physical training interventions to improve both physical and cognitive performances in healthy older adults. Few studies have examined the impact of aerobic exercise on Stroop task performance, a measure of executive functions. In the current 3-month aerobic training study, 50 older adults (mean age = 67.96 ± 6.25 years) were randomly assigned to either a three-month physical training group or to a control group (waiting list). Training sessions were 3 times per week for 60 minutes. All participants completed pre- and post-test measures of cognitive performance using the modified Stroop task and physical performance (Rockport one-mile test). Compared to controls, the training group showed significant improvements in physical capacity (P < 0.001) and enhanced Stroop performance, but only in the inhibition/switching condition (P < 0.03). Furthermore, the increase in aerobic capacity induced by the training regimen correlated negatively with reaction time in the inhibition/switching condition of the Stroop task at posttest (r = -0.538; P = 0.007). Importantly, the reported gains in cognitive performance were observed after only three months of physical training. Taken together, the results suggest that even short-term physical interventions can enhance older adults' executive functions.

Successful adaptation of gait in healthy older adults during dual-task treadmill walking.

Dual-task methods have been used to demonstrate increased prioritization of walking performance over cognition in healthy aging. This is expressed as greater dual-task costs in cognitive performance than in walking. However, other research shows that older adults can prioritize cognitive performance over walking when instructed to do so. We asked whether age-related cognitive prioritization would emerge by experimentally manipulating cognitive difficulty. Young and older adults performed mental arithmetic at two levels of difficulty, alone or while walking. Electromyography and footswitches were used to measure muscle activity and stride parameters. Under high cognitive load, older adults increased their stride time, stride length, and hamstring activity, while maintaining their cognitive performance. Young adults showed negligible dual-task costs in each domain. The older adults appeared to successfully adapt their stride in response to high cognitive demands. The results have implications for neural models of gait regulation, and age differences in task emphasis.

Dual-task performance reveals increased involvement of executive control in fine motor sequencing in healthy aging.

The purpose of the current study was to examine the role of executive control in fine motor sequencing using a motor-cognitive dual-task paradigm. Younger and older adults performed a sequential tapping task separately and concurrently with a semantic judgment task (Experiment 1) and a mental arithmetic task (Experiment 2). Experiment 1 established that under low cognitive load, older adults were slower and less accurate in sequential tapping than younger adults. Load was manipulated in Experiment 2, and across mental arithmetic difficulty levels, older adults were less accurate in sequential tapping when performing mental arithmetic than younger adults. At the highest difficulty level, both groups suffered performance costs. In line with gross motor research, these findings suggest a role for executive functions in fine motor performance in old age.

A comparison of motor skill learning and retention in younger and older adults.

The goal of the current study was to explore learning and short-term retention using a modified serial reaction time task. The multi-finger sequence task was designed to present repeated and random sequences in a completely interleaved fashion, giving participants within block, variable practice, on the two types of sequences. Eighteen younger adults (M(age) = 24 years) and 15 older adults (M(age) = 65 years) participated in the experiment. Participants were asked to respond on a piano keyboard to a visual stimulus that appeared in one of four squares on the computer screen. They were not informed that one of the sequences presented would repeat. Sequence-specific learning, within-day and across-days, was inferred from differences in accuracy and reaction time between repeated and random sequences. Age equivalence was observed in sequence-specific learning and retention across days, and suggests that older adults may benefit from variable practice.

Sub-micron and nanoscale feature depth modulates alignment of stromal fibroblasts and corneal epithelial cells in serum-rich and serum-free media.

Topographic features are generally accepted as being capable of modulating cell alignment. Of particular interest is the potential that topographic feature geometry induces cell alignment indirectly through impacting adsorbed proteins from the cell culture medium on the surface of the substrate. However, it has also been reported that micron-scale feature depth significantly impacts the level of alignment of cellular populations on topography, despite being orders of magnitude larger than the average adsorbed protein layer (nm). In order to better determine the impact of biomimetic length scale topography and adsorbed protein interaction on cellular morphology we have systematically investigated the effect of combinations of sub-micron to nanoscale feature depth and lateral pitch on corneal epithelial cell alignment. In addition we have used the unique properties of a serum-free media alternative in direct comparison to serum-rich medium to investigate the role of culture medium protein composition on cellular alignment to topographically patterned surfaces. Our observation that increasing groove depth elicited larger populations of corneal epithelial cells to align regardless of culture medium composition and of cell orientation with respect to the topography, suggests that these cells can sense changes in topographic feature depths independent of adsorbed proteins localized along ridge edges and tops. However, our data also suggests a strong combinatory effect of topography with culture medium composition, and also a cell type dependency in determining the level of cell elongation and alignment to nanoscale topographic features.

Effects of balance status and age on muscle activation while walking under divided attention.

We examined the role of attention during different phases of the gait cycle by using a dual-task paradigm. Younger and older adults performed a self-paced treadmill walking task, a semantic judgment task, and both tasks simultaneously. We recorded vocal reaction time for the judgment task, and we recorded muscle activity by the use of electromyography. We derived dual-task costs from difference scores (single vs dual task). Our analysis of the judgment task showed that both groups responded more quickly during dual-task conditions than during single-task conditions. In five of eight muscle groups, stance-phase muscle activity decreased significantly from dual to single task. For older adults, individuals with poor balance increased their muscle activity during dual-task performance. These results suggest that, during moderately demanding walking and cognitive performance, poor balancers can compensate successfully for their motoric vulnerability.

Localization of type VI collagen in tissue-engineered cartilage on polymer scaffolds.

Together, the chondrocyte and its pericellular matrix have been collectively termed the chondron. Current opinion is that the pericellular matrix has both protective and signalling functions between chondrocyte and extracellular matrix. Formation of a native chondrocyte pericellular matrix or chondron structure might therefore be advantageous when tissue engineering a functional hyaline cartilage construct. The presence of chondrons has not been previously described in cartilage engineered on a scaffold. In this paper, we describe a modified immunochemical method to detect collagen VI, a key molecular marker for the pericellular matrix, and an investigation of type VI collagen distribution in engineered hyaline cartilage constructs. Cartilage constructs were engineered from adult human or bovine hyaline chondrocytes cultured on sponge or nonwoven fiber based HYAFF 11 scaffolds. Type VI collagen was detected in all constructs, but a distinctive, high-density, chondron-like distribution of collagen VI was present only in constructs exhibiting additional features of hyaline cartilage engineered using nonwoven HYAFF 11. Chondron structures were localized in areas of the extracellular matrix displaying strong collagen II and GAG staining of constructs where type II collagen composed a high percentage (over 65%) of the total collagen.