Changes in executive functions and self-efficacy are independently associated with improved usual gait speed in older women

Teresa Liu-Ambrose, Jennifer C Davis, Lindsay S Nagamatsu, Chun Liang Hsu, Lindsay A Katarynych, Karim M Khan, Teresa Liu-Ambrose, Jennifer C Davis, Lindsay S Nagamatsu, Chun Liang Hsu, Lindsay A Katarynych, Karim M Khan

Abstract

Background: Improved usual gait speed predicts substantial reduction in mortality. A better understanding of the modifiable factors that are independently associated with improved gait speed would ensure that intervention strategies are developed based on a valid theoretical framework. Thus, we examined the independent association of change in executive functions and change in falls-related self-efficacy with improved gait speed among community-dwelling senior women.

Methods: A secondary analysis of the 135 senior women aged 65 to 75 years old who completed a 12-month randomized controlled trial of resistance training. Usual gait speed was assessed using a 4-meter walk. Three executive processes were assessed by standard neuropsychological tests: 1) set shifting; 2) working memory; and 3) selective attention and response inhibition. A linear regression model was constructed to determine the independent association of change in executive functions and falls-related self-efficacy with change in gait speed.

Results: Improved selective attention and conflict resolution, and falls-related self-efficacy, were independently associated with improved gait speed after accounting for age, global cognition, baseline gait speed, and change in quadriceps strength. The total variance explained was 24%.

Conclusions: Interventions that target executive functions and falls-related self-efficacy, in addition to physical functions, to improve gait speed may be more efficacious than those that do not.

Trial registration: ClinicalTrials.gov Identifier: NCT00426881.

References

    1. Cesari M, Kritchevsky SB, Penninx BW, Nicklas BJ, Simonsick EM, Newman AB, Tylavsky FA, Brach JS, Satterfield S, Bauer DC. Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2005;53(10):1675–1680. doi: 10.1111/j.1532-5415.2005.53501.x.
    1. Lord S, Ward J, Williams P, Anstey K. Physiological factors associated with falls in older community-dwelling women. Journal of American Geriatrics Society. 1994;42:1110–1117.
    1. Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott A, Hausherr E, Meunier P, Breart G, Group E. Fall-related factors and risk of hip fracture: The EPIDOS prospective study. Lancet. 1996;348:145–149. doi: 10.1016/S0140-6736(96)01440-7.
    1. Rosano C, Kuller LH, Chung H, Arnold AM, Longstreth WT Jr, Newman AB. Subclinical brain magnetic resonance imaging abnormalities predict physical functional decline in high-functioning older adults. J Am Geriatr Soc. 2005;53(4):649–654. doi: 10.1111/j.1532-5415.2005.53214.x.
    1. Rosano C, Simonsick EM, Harris TB, Kritchevsky SB, Brach J, Visser M, Yaffe K, Newman AB. Association between physical and cognitive function in healthy elderly: the health, aging and body composition study. Neuroepidemiology. 2005;24(1-2):8–14. doi: 10.1159/000081043.
    1. Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski SA. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007;55(11):1727–1734. doi: 10.1111/j.1532-5415.2007.01413.x.
    1. Atkinson HH, Rosano C, Simonsick EM, Williamson JD, Davis C, Ambrosius WT, Rapp SR, Cesari M, Newman AB, Harris TB. Cognitive function, gait speed decline, and comorbidities: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2007;62(8):844–850.
    1. Inzitari M, Newman AB, Yaffe K, Boudreau R, de Rekeneire N, Shorr R, Harris TB, Rosano C. Gait speed predicts decline in attention and psychomotor speed in older adults: the health aging and body composition study. Neuroepidemiology. 2007;29(3-4):156–162. doi: 10.1159/000111577.
    1. Stuss DT, Alexander MP. Executive functions and the frontal lobes: a conceptual view. Psychol Res. 2000;63(3-4):289–298. doi: 10.1007/s004269900007.
    1. West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bull. 1996;120(2):272–292. doi: 10.1037/0033-2909.120.2.272.
    1. Kuo H-K, Lipsitz LA. Cerebral White Matter Changes and Geriatric Syndromes: Is There a Link? J Gerontol A Biol Sci Med Sci. 2004;59(8):M818–826.
    1. Cummings JL. Frontal-subcortical circuits and human behavior. Archives of neurology. 1993;50(8):873–880.
    1. Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ. Exercise training and nutritional supplementation for physical frailty in very elderly people. The New England journal of medicine. 1994;330(25):1769–1775. doi: 10.1056/NEJM199406233302501.
    1. Boone KB, Miller BL, Lesser IM, Hill E, D'Elia L. Performance on frontal lobe tests in healthy older individuals. Dev Neuropsychol. 1990;6:215–223. doi: 10.1080/87565649009540462.
    1. Royall DR. Prevalence of executive control function (ECF) impairment among healthy non-institutionalized retirees: the Freedom House Study. Gerontologist. 1998;38S:314–315.
    1. Thal DR, Del Tredici K, Braak H. Neurodegeneration in normal brain aging and disease. Sci Aging Knowledge Environ. 2004;2004(23):pe26. doi: 10.1126/sageke.2004.23.pe26.
    1. Briley DP, Wasay M, Sergent S, Thomas S. Cerebral white matter changes (leukoaraiosis), stroke, and gait disturbance. J Am Geriatr Soc. 1997;45(12):1434–1438.
    1. Soumare A, Elbaz A, Zhu Y, Maillard P, Crivello F, Tavernier B, Dufouil C, Mazoyer B, Tzourio C. White matter lesions volume and motor performances in the elderly. Annals of neurology. 2009;65(6):706–715. doi: 10.1002/ana.21674.
    1. Masdeu JC, Wolfson L, Lantos G, Tobin JN, Grober E, Whipple R, Amerman P. Brain white-matter changes in the elderly prone to falling. Archives of neurology. 1989;46(12):1292–1296.
    1. Baloh RW, Ying SH, Jacobson KM. A longitudinal study of gait and balance dysfunction in normal older people. Archives of neurology. 2003;60(6):835–839. doi: 10.1001/archneur.60.6.835.
    1. Liu-Ambrose T, Khan KM, Donaldson MG, Eng JJ, Lord SR, McKay HA. Falls-related self-efficacy is independently associated with balance and mobility in older women with low bone mass. J Gerontol A Biol Sci Med Sci. 2006;61(8):832–838.
    1. Myers A, Powell L, Maki B, Holliday P, Brawley L, Sherk W. Psychological indicators of balance confidence: Relationship to actual and perceived abilities. Journal of gerontology. 1996;51A:M37–M43.
    1. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Liu-Ambrose T, Khan KM, Eng JJ, Lord SR, McKay HA. Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities. Gerontology. 2004;50(6):373–382. doi: 10.1159/000080175.
    1. Liu-Ambrose T, Ahamed Y, Graf P, Feldman F, Robinovitch SN. Older fallers with poor working memory overestimate their postural limits. Archives of physical medicine and rehabilitation. 2008;89(7):1335–1340. doi: 10.1016/j.apmr.2007.11.052.
    1. Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance training and executive functions: a 12-month randomized controlled trial. Archives of internal medicine. 2010;170(2):170–178. doi: 10.1001/archinternmed.2009.494.
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24(4):709–711.
    1. Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. Journal of clinical epidemiology. 2005;58(6):595–602. doi: 10.1016/j.jclinepi.2004.10.018.
    1. Lord S, Sherrington C, Menz H. Falls in older people Risk factors and strategies for prevention. Cambridge: Cambridge University Press; 2001. A physiological profile approach for falls prevention; pp. 221–238.
    1. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cognit Psychol. 2000;41(1):49–100. doi: 10.1006/cogp.1999.0734.
    1. Spreen O, Strauss E. A compendium of neurological tests. 2. New York: Oxford University Press, Inc.; 1998.
    1. Graf P, Uttl B, Tuokko H. Color- and picture-word Stroop tests: performance changes in old age. J Clin Exp Neuropsychol. 1995;17(3):390–415. doi: 10.1080/01688639508405132.
    1. Powell L, Myers A. The Activities-specific Confidence (ABC) scale. Journal of gerontology. 1995;50A:M28–M34.
    1. Soumare A, Tavernier B, Alperovitch A, Tzourio C, Elbaz A. A Cross-Sectional and Longitudinal Study of the Relationship Between Walking Speed and Cognitive Function in Community-Dwelling Elderly People. J Gerontol A Biol Sci Med Sci. 2009.
    1. Iersel MBv, Kessels RPC, Bloem BR, Verbeek ALM, Olde Rikkert MGM. Executive Functions Are Associated With Gait and Balance in Community-Living Elderly People. J Gerontol A Biol Sci Med Sci. 2008;63(12):1344–1349.
    1. Williamson JD, Espeland M, Kritchevsky SB, Newman AB, King AC, Pahor M, Guralnik JM, Pruitt LA, Miller ME, for the LSi. Changes in Cognitive Function in a Randomized Trial of Physical Activity: Results of the Lifestyle Interventions and Independence for Elders Pilot Study. J Gerontol A Biol Sci Med Sci. 2009. p. glp014.
    1. Rapport LJ, Hanks RA, Millis SR, Deshpande SA. Executive functioning and predictors of falls in the rehabilitation setting. Archives of physical medicine and rehabilitation. 1998;79(6):629–633. doi: 10.1016/S0003-9993(98)90035-1.
    1. Liu-Ambrose T, Donaldson MG, Ahamed Y, Graf P, Cook WL, Close J, Lord SR, Khan KM. Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Am Geriatr Soc. 2008;56(10):1821–1830. doi: 10.1111/j.1532-5415.2008.01931.x.
    1. Liu-Ambrose TY, Nagamatsu LS, Handy TC, Leghari A. Does impaired cerebellar function contribute to risk of falls in seniors? A pilot study using functional magnetic resonance imaging. J Am Geriatr Soc. 2008;56(11):2153–2155. doi: 10.1111/j.1532-5415.2008.01984.x.
    1. Baillieux H, Smet HJ, Paquier PF, De Deyn PP, Marien P. Cerebellar neurocognition: Insights into the bottom of the brain. Clin Neurol Neurosurg. 2008.
    1. Talley KM, Wyman JF, Gross CR. Psychometric properties of the activities-specific balance confidence scale and the survey of activities and fear of falling in older women. J Am Geriatr Soc. 2008;56(2):328–333. doi: 10.1111/j.1532-5415.2007.01550.x.
    1. Kwon S, Perera S, Pahor M, Katula JA, King AC, Groessl EJ, Studenski SA. What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study) The journal of nutrition, health & aging. 2009;13(6):538–544.
    1. Buchner DM, Cress ME, Esselman PC, Margherita AJ, de Lateur BJ, Campbell AJ, Wagner EH. Factors associated with changes in gait speed in older adults. J Gerontol A Biol Sci Med Sci. 1996;51(6):M297–302.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する