A Dual-Task Paradigm Using the Oral Trail Making Test While Walking to Study Cognitive-Motor Interactions in Older Adults

Langeard, Antoine; Torre, Marta Maria; Temprado, Jean-Jacques · 2021 · Crossref

DOI: 10.3389/fnagi.2021.712463

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Summary

This study investigates cognitive-motor interactions in older adults by testing a dual-task (DT) paradigm that combines walking with the Oral Trail Making Test (OTMT). The research addresses the need for valid clinical tools to detect age-related declines in executive function and gait, specifically focusing on switching abilities. As aging progresses, gait becomes increasingly dependent on executive functions, and interference between these domains is a marker for fall risk and cognitive decline. The authors hypothesized that a DT paradigm loading switching abilities would effectively distinguish younger-old adults (YO, <70 years) from older-old adults (OO, ≥70 years). The study included 65 healthy older participants (29 YO and 36 OO) who underwent five conditions: single-task (ST) walking, ST OTMT part A (processing speed), ST OTMT part B (switching), and two DT conditions combining walking with OTMT-A or OTMT-B. Gait parameters (velocity, step length, step time, and variability) were measured using a GaitRite system, while cognitive performance was assessed via completion time and error counts. Statistical analyses included repeated-measures ANOVAs to assess DT interference and logistic regression with receiver operating characteristic (ROC) curves to evaluate the paradigm’s ability to distinguish age groups. Results indicated that DT conditions significantly impaired both cognitive and gait performance compared to ST conditions. The OTMT-B task, which requires switching, produced greater interference than OTMT-A. Specifically, participants exhibited slower gait velocity, shorter step lengths, and increased step time during DT-OTMT-B compared to DT-OTMT-A and ST walking. Cognitively, completion times were longer and error rates were higher in DT conditions, particularly for OTMT-B. Crucially, the number of errors made during the DT-OTMT-B task significantly predicted age group status. Older-old adults committed significantly more errors than younger-old adults during this specific task. Logistic regression confirmed that error count was a significant predictor of being in the OO group, with an odds ratio of 1.683. The ROC analysis demonstrated moderate accuracy (AUC = 0.725) in distinguishing the two age groups based on these errors. The study concludes that the DT paradigm using the Oral Trail Making Test while walking is a sensitive tool for detecting cognitive-motor interference in older adults. It confirms that switching tasks impose high interference on gait and that this interference increases with age. The findings suggest that this easily implemented paradigm could be useful in clinical settings to detect early cognitive or motor declines, particularly in distinguishing older-old adults who may be at higher risk for functional impairment.

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• dual task performance