Global Cognition, Gender, and Level of Education Predict Dual-Task Gait Speed Variability Metrics in Older Adults.

INTRODUCTION: The purpose of this study was to determine if demographic variables and measures of cognitive function, functional mobility, self-reported balance self-efficacy, and self-reported physical activity can predict gait speed variability during single-task walking (STGSCV), during cognitive-motor dual-tasking (DTGSCV), and dual-task effect on gait speed variability (DTEGSCV) in older adults. METHODS: In 62 older adults, demographics were recorded and cognitive function (including the Montreal Cognitive Assessment, MoCA), functional mobility, balance self-efficacy (Activities-specific Balance Confidence Scale, ABC), and self-reported physical activity (Physical Activity Scale for the Elderly, PASE) were assessed. Three linear regression models were used to determine whether the functional mobility tests, PASE score, ABC score, and tests of cognitive function predicted gait speed variability outcomes (STGSCV, DTGSCV, DTEGSCV), with demographics included as covariates. RESULTS: MoCA score (p = 0.003), gender (p = 0.040), and years of education (p = 0.010) significantly predicted DTGSCV (R2 = 0.297, p = 0.002). MoCA score (p = 0.008) and years of education (p < 0.001) also significantly predicted DTEGSCV. Despite a significant regression model (R2 = 0.316, p = 0.001), there were no significant individual predictors of STGSCV. CONCLUSION: Older adults with lower cognitive function scores, according to the MoCA, and higher levels of education demonstrate larger gait speed variability during dual-tasking and may be at increased risk of real-world mobility issues or falling.

Including cognitive assessments with functional testing predicts capabilities relevant to everyday walking in older adults.

BACKGROUND: Dual-task (DT) testing reflects real-world walking demands in older adults but is not always feasible to perform in clinic. Whether clinical measures that predict single-task (ST) performance also predict DT performance or dual-task effects (DTEs) has not been fully explored. RESEARCH QUESTION: What are the relationships between cognitive performance, functional mobility, and self-reported physical activity and balance confidence and ST and DT Gait Speed and Cognitive Reaction Time, as well as DTEs on Gait Speed (DTEGS) and Cognitive Reaction Time (DTERT), in older adults? METHODS: Sixty-two older adults (71.5 ± 7.1 years, 17 males) completed cognitive performance, functional mobility, and self-report physical activity and balance confidence assessments. Three 1-min trials were performed: 1) ST Cognition (clock task), 2) ST Gait and 3) DT Cognition + Gait, with Cognitive Reaction Time (recorded during clock task performance via DirectRT) and Gait Speed (measured during walking trial via APDM system) recorded, and DTEGS and DTERT calculated, as the cognitive and gait outcomes. Six multivariate regressions were conducted to test whether cognitive performance, functional mobility, and self-report assessments predicted Gait Speed and Cognitive Reaction Time in ST and DT conditions and DTEs. RESULTS: The Comprehensive Trail Making Test (CTMT) predicted Reaction Time in ST cognitive (ß = - 0.525, p = .003) and DT (ß = - 0.510, p = .006) trials. The Physical Activity Scale for the Elderly (PASE) predicted DTERT (ß = - 0.397, p = .008). The 10-Meter Walk Test (10MWT) predicted Gait Speed in ST gait (ß = 0.692, p < .001) and DT (ß = 0.715, p < .001) trials. The Four Square Step Test (FSST) predicted ST Gait Speed (ß = - 0.233, p = .034). The Montreal Cognitive Assessment (MoCA) (ß = 0.293, p = .027), 10MWT (ß = 0.322, p = .046), and the FSST (ß = 0.378, p = .019) predicted DTEGS. SIGNIFICANCE: The 10MWT, CTMT, and MoCA can be easily implemented in the clinic and may be good choices to assess cognitive and functional abilities necessary for ambulation in older adults.

Dual-tasking impacts gait, cognitive performance, and gaze behavior during walking in a real-world environment in older adult fallers and non-fallers.

INTRODUCTION: Everyday walking often involves simultaneous performance of a cognitive task in environments with competing auditory and visual stimuli. Previous research has not evaluated task performance in these situations, where older adults are known to fall, limiting our understanding of how older adults adjust their gait, visual scanning (gaze), and cognitive processing to avoid falls (or not). The purpose of this study was to examine the effect of dual-task walking in a high-distraction real-world environment on cognitive performance, gait performance, and gaze behavior in older adult fallers relative to non-fallers. METHODS: Fourteen community-dwelling, older adult fallers (76.6 ± 9.1 years, 11 females) and 15 community-dwelling, older adult non-fallers (77.4 ± 7.6 years, 11 females) participated. Participants performed single-task walking, single-task cognitive (seated category naming), and dual-task walking (category naming + walking) trials for 1 min each in a real-world environment (busy hospital lobby). Gait speed, stride length variability, stride duration variability, gaze fixation duration on 6 areas of interest (AOIs), and percentage of time fixating on 6 AOIs were recorded during single- and dual-task walking trials. Number of correct responses, time to first response, and mean subsequent response time (measure of rate of decline of response retrieval throughout trial) were determined for single-task cognitive and dual-task walking trials. Two-way MANCOVAs and MANOVAs were used to compare the effects of fall status and task condition on gait and cognitive variables. Hierarchical linear regression models were used to assess predictors of gaze behavior variables. RESULTS: Compared to single-task, during dual-task trials, participants walked 0.21 m/s slower, had 1.5 fewer verbal responses, and a 2823 ms shorter mean subsequent response time, indicating a faster declining rate of retrieval during the cognitive task. Additionally, during dual-task walking, participants fixated their gaze on Far People (AOI) for a significantly smaller percentage of time and on the Near Walking Path (AOI) for a significantly greater percentage of time than during single-task walking. During all trials, being a non-faller predicted a longer average fixation duration on the Far Environment (AOI) than for fallers. Environmental busyness, baseline gait speed, and baseline executive function impacted gaze behavior. CONCLUSION: All participants exhibited dual-task decrements in gait and cognitive performance and changes in gaze behavior from single- to dual-task walking. Perhaps of more importance, non-fallers appear to have had more freedom to divert their gaze to less relevant environmental stimuli while walking, and two measures of fall risk impacted patterns of gaze behavior differently. Thus, overt visual attention during walking in real-world environments should be further explored in relation to fall risk.

Students' ratings of teacher support and academic and social-emotional well-being.

Data on students' perceptions of teacher social support, academic functioning, and social-emotional functioning were collected from a sample of 796 7th and 8th grade middle school students using the Child and Adolescent Social Support Scale (CASSS; Malecki, Demaray, & Elliott, 2000), Iowa Tests of Basic Skills (ITBS) and school records, and the Behavior Assessment Scale for Children, Second Edition, Adolescent Version, (BASC-2 SRP-A; Reynolds & Kamphaus, 2004). The purpose of the current study was to examine possible gender differences in perceptions of the frequency and importance of different types of teacher support and the related academic and social-emotional outcomes. Girls rated Emotional and Appraisal Support as more important than did boys. Teacher Emotional Support was significantly and positively related to grade point average (GPA) for boys and girls. For girls only, Emotional and Informational Support were significantly related to ITBS Reading scores, and Emotional, Informational, and Instrumental Support were significantly related to ITBS Math scores. Regarding social-emotional variables, Emotional Support was significantly and negatively related to School Problems, Internalizing Problems, Inattention/Hyperactivity, and overall Emotional Symptoms and positively related to Personal Adjustment for both boys and girls. Furthermore, Emotional Support from teachers was more strongly related to Inattention/Hyperactivity for girls than boys. These results emphasize the importance of providing teacher social support, especially emotional support, to students in early adolescence and recognizing gender differences in the function of specific types of teacher support.