Different cognitive functions discriminate gait performance in younger and older women: A pilot study

Highlights

• Different cognitive functions discriminated gait speed in younger and older women.

• Fast-pace gait speed was slower in younger women with lower visuoperceptual abilities.

• Dual-task gait speed was slower in younger women with lower visuoperceptual abilities.

• Dual-task gait speed was slower in older women with lower memory and executive function.

Abstract

Aim

Cognitive dysfunction is associated with slower gait speed in older women, but whether cognitive function affects gait performance earlier in life has yet to be investigated. Thus, the objective of this study was to test the hypothesis that cognitive function will discriminate gait performance in healthy younger women.

Methods

Fast-pace and dual-task gait speed were measured in 30 young to middle-aged (30–45 y) and 26 older (61–80 y) women without mild cognitive impairment. Visuoperceptual ability, working memory, executive function, and learning ability were assessed using neuropsychological tests. Within each age group, women were divided by the median into lower and higher cognitive function groups to compare gait performance.

Results

Younger women with higher visuoperceptual ability had faster fast-pace (2.25 ± 0.30 vs. 1.98 ± 0.18 m/s, p ≤ 0.01) and dual-task gait speed (2.02 ± 0.27 vs. 1.69 ± 0.25 m/s, p ≤ 0.01) than women with lower visuoperceptual ability. The difference in dual-task gait speed remained significant (p = 0.02) after adjusting for age, years of education, and other covariates. Dividing younger women based on other cognitive domains showed no difference in gait performance. In contrast, working memory and executive function discriminated dual-task gait speed (p < 0.05) in older women after adjusting for age and education.

Conclusion

To our knowledge, this is the first study to show that poorer cognitive function even at a relatively young age can negatively impact mobility. Different cognitive functions discriminated gait performance based on age, highlighting a possible influence of aging in the relationship between cognitive function and mobility in women.

Introduction

Older women walk slower and have a higher prevalence of gait abnormalities than older men [1], [2]. This is a significant health concern as walking is important for many activities of daily living, thus gait abnormalities can substantially reduce quality of life and contribute to loss of independence [3]. Investigation into contributing factors for mobility loss in women is therefore necessary to reduce disability. However, markers of gait impairment may depend on age thus investigation of healthy younger and older women are warranted to expose novel, possibly age-specific indicators that can increase options for interventions to reduce gait deterioration with aging.

Evidence is accumulating that cognitive function as assessed using neuropsychological tests is a strong predictor of mobility. Older adults that have lower cognitive ability to perform complex, goal-oriented behavior (i.e., executive function) are reported to have slower gait speed [4], [5], [6], as well as poor performance during dual-task gait activities such as talking while walking [4], [7] as compared to adults with higher cognitive ability. This has also been shown for older adults with poorer memory [5], [6], [8] and/or slow information processing speed [6], [9] with impairment of multiple cognitive functions associated with a greater decline in gait speed over time [10]. Of important note, the strong association between cognitive function and gait performance is also found in older adults without dementia, history of stroke, or other brain disorders [8]. This indicates that neuropathology is not a requisite for a relationship to exist between cognition and gait. This is due to the shared brain regions that regulate gait and cognitive functions, thus impairment in shared neural substrate may manifest as gait abnormalities, cognitive deficits, or both. Indeed, gait speed has been shown to predict incident cognitive decline suggesting that gait abnormalities may be an indicator of cognitive dysfunction in otherwise healthy adults [11]. While it is appreciated that an association exist between cognitive function and gait performance in older adults, it is unknown if a similar link is present in younger adults before the progression of potentially confounding factors that often accompany advancing age.

The present pilot study was designed to explore whether the aforementioned relationship between cognitive function and gait performance in older individuals is also present earlier in life, particularly in women. In doing so, this pilot study will provide preliminary new insight into the influence of age on the relationship between cognition and gait, along with results that could be used as evidence of feasibility for larger studies on this topic. We hypothesized that cognitive function will relate to gait performance during fast-pace gait and dual-tasking in younger women as well as older women. Fast-pace was examined since it may be more sensitive to cognitive dysfunction than usual-pace [12], [13], and dual-tasking was used to increase cognitive demand during walking to assist in determining if younger women with lower cognitive capacity have altered gait performance.