Citation

Verghese J, Wang C, Ayers E, Izzetoglu M, Holtzer R. Neurology 2016; 88(2): 191-197.

Affiliation

From the Departments of Neurology (J.V., E.A., R.H.), Medicine (J.V.), and Epidemiology (C.W.), Albert Einstein College of Medicine; Ferkauf Graduate School of Psychology (R.H.), Yeshiva University, Bronx, NY; and Drexel University School of Biomedical Engineering (M.I.), Philadelphia, PA.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0000000000003421

PMID

27927937

Abstract

OBJECTIVE: To determine whether brain activity over the prefrontal cortex measured in real time during walking predicts falls in high-functioning older adults.

METHOD: We examined166 older persons (mean age 75 years, 51% women) enrolled in a prospective aging study. High-functioning status defined as the absence of dementia or disability with normal gait diagnosed by study clinicians. The magnitude of task-related changes in oxygenated hemoglobin levels over the prefrontal cortex was measured with functional near-infrared spectroscopy during motor (walking at normal pace) and cognitive (reciting alternate letters of the alphabet) single tasks and a dual-task condition (walking while reciting alternate letters of the alphabet). Incident falls were prospectively assessed over a 50-month study period.

RESULTS: Over a mean follow-up of 33.9 ± 11.9 months, 116 falls occurred. Higher levels of prefrontal cortical activation during the dual-task walking condition predicted falls (hazard ratio adjusted for age, sex, education, medical illnesses and general mental status 1.32, 95% confidence interval 1.03-1.70). Neither behavioral outcomes (velocity or letter rate) on the dual task nor brain activation patterns on the single tasks (normal walk or talk alone) predicted falls in this high-functioning sample. The results remained robust after accounting for multiple confounders and for cognitive status, slow gait, previous falls, and frailty.

CONCLUSIONS: Prefrontal brain activity levels while performing a cognitively demanding walking condition predicted falls in high-functioning seniors. These findings implicate neurobiological processes early in the pathogenesis of falls.

© 2016 American Academy of Neurology.

Language: en