Wollesen B, Wanstrath M, van Schooten K S, Delbaere K
1Human Movement Science, University of Hamburg, Mollerstr, 10, 20148 Hamburg, Germany.
Department for Occupational Medicine, Hazardous Substances and Public Health, German Social Accident Insurance for the Health and Welfare Services, Hamburg, Germany.
Eur Rev Aging Phys Act. 2019 Jul 27;16:12. doi: 10.1186/s11556-019-0218-1. eCollection 2019.
Walking in natural environments can be considered a dual-task (DT) scenario that requires increasing cognitive resources with advancing age. Previous reviews concluded that gait speed under DT conditions is equivalent to gait speed as a single task (ST) in the prediction of future falls in older people. However, without a clear taxonomy, these conclusions might be premature. The aim of this review is to use a taxonomy for classifying cognitive tasks of cognitive-motor interference (CMI) paradigms while walking to identify which task domains lead to more pronounced cognitive-motor decrements due to fall risk and concern about falling (CoF) in older people.
A systematic literature research following PRISMA guidelines was conducted using MEDLINE, Psych-Info and EMBASE. Inclusion criteria were: older people ≥60 years with a previous fall or CoF, use of a DT paradigm to discriminate fallers and non-fallers, straight overground walking, reported gait measurements during ST and DT conditions. A meta-analysis estimated the effect of DT costs for the cognitive task domain and spatiotemporal gait parameters.
= 3737 studies were found within the databases. Nineteen studies were included ( = 14 for meta-analysis). Fallers and people with CoF showed reduced walking speed for ST and DT conditions. Effects of DT were examined for mental tracking tasks. The combined odds ratio (OR [95% confidence interval]) for fallers vs. non-fallers for ST was 3.13 [0.47, 5.80] with moderate heterogeneity ( = 48%). For DT, the OR was 5.17 [2.42, 7.93] with low heterogeneity ( = 37%). Comparing participants with and without CoF, the OR for ST was 12.41 [9.97, 14.84] with high heterogeneity ( = 85%) and OR for mental tracking DT was 10.49 [7.58, 13.40] with moderate heterogeneity ( = 51%).
CMI was not significantly different between fallers and non-fallers or people with and without CoF; however, our taxonomy revealed a large variety of cognitive conditions and a higher number of studies using mental tracking tasks, which make it impossible to draw firm conclusions. Future studies should use a more standardised and ecologically valid approach when evaluating the validity of DT gait performance in the prediction of falls, CoF or other age-related conditions.
This review was registered at Prospero with the ID: CRD42017068912.
在自然环境中行走可被视为一种双重任务（DT）情景，随着年龄增长，这需要更多的认知资源。以往的综述得出结论，在预测老年人未来跌倒方面，双重任务条件下的步态速度与单一任务（ST）时的步态速度相当。然而，由于缺乏明确的分类法，这些结论可能为时过早。本综述的目的是使用一种分类法对行走时认知 - 运动干扰（CMI）范式的认知任务进行分类，以确定哪些任务领域会因老年人跌倒风险和跌倒恐惧（CoF）而导致更明显的认知 - 运动能力下降。
按照PRISMA指南，使用MEDLINE、Psych - Info和EMBASE进行系统的文献研究。纳入标准为：年龄≥60岁且有过跌倒或跌倒恐惧的老年人；使用双重任务范式区分跌倒者和非跌倒者；在平坦地面上直线行走；报告单一任务和双重任务条件下的步态测量结果。荟萃分析估计了双重任务成本对认知任务领域和时空步态参数的影响。
在数据库中发现了3737项研究。纳入了19项研究（14项用于荟萃分析）。跌倒者和有跌倒恐惧的人在单一任务和双重任务条件下的步行速度均降低。对心理追踪任务进行了双重任务效应的研究。跌倒者与非跌倒者在单一任务时的合并优势比（OR [95%置信区间]）为3.13 [0.47, 5.80]，异质性中等（I² = 48%）。对于双重任务，OR为5.17 [2.42, 7.93]，异质性较低（I² = 37%）。比较有和没有跌倒恐惧的参与者，单一任务的OR为12.41 [9.97, 14.84]，异质性高（I² = 85%），心理追踪双重任务的OR为10.49 [7.58, 13.40]，异质性中等（I² = 51%）。
跌倒者与非跌倒者或有和没有跌倒恐惧的人之间的认知 - 运动干扰没有显著差异；然而，我们的分类法揭示了多种认知状况以及大量使用心理追踪任务的研究，这使得无法得出确凿结论。未来研究在评估双重任务步态表现对跌倒、跌倒恐惧或其他与年龄相关状况的预测有效性时，应采用更标准化且生态有效的方法。
本综述已在Prospero注册，注册号：CRD420170689
