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Cognition and gait: How the brain thinks about balance

May 19, 2015
by Pamela Tabar, Editor-in-Chief
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Exercising the brain can improve balance and help reduce falls by sharpening the regions of the brain responsible for concentration and multi-tasking, especially in residents who have a history of falls, according to a study published in the Journals of Gerontology B.

Researchers at Chicago’s Northwestern University and the University of Illinois Chicago campus recruited 45 black seniors (average age: 72) to take part in one-hour “brain exercise” classes twice a week for 10 weeks. During the classes, participants played three different computer activities designed to stimulate the executive function (EF) regions of the brain—the regions responsible for attention. The games (Jewel Diver, Road Tour and Sweep Seeker), developed by Posit Science, asked participants to concentrate on tracking multiple falling jewels, remembering route information on a map, matching items and making decisions based on visual processing.

The Berg Balance Scale

The Berg Balance Scale (BBS) is designed to measure the balance abilities of older adults. Determining a resident’s BBS score involves testing his or her ability to perform 14 balance tasks, including rising from a chair, standing with eyes closed, turning around, picking up an object from the floor and other position changes, some of which are timed. Each task is given a score of 0 to 4, depending on the resident’s ability to perform it fully or in the time allotted.

A score of 41 to 56 indicates a low fall risk, whereas a score of 20 or less indicates a high fall risk. A change of eight points or more in scores over time is a red flag for a notable change in function status.

Participants were tested for gait and balance abilities before classes started  and were re-tested immediately after the classes. Even after only 10 weeks, the participants saw “statistically significant” improvements in scores based on the Berg Balance Scale (see box, right) and in increased gait speed. Researchers attribute this finding to the relationship between the central nervous system and mobility—including the role of the brain’s executive functions to keep the body from falling and to recover from a near-fall.

“Although the exact mechanisms underlying the association between cognition and mobility are still being explored, studies show that gait variability in older adults is associated with atrophy in brain regions that are related to attention, and that global cognitive function, verbal memory, and EF predict longitudinal gait speed decline,” noted the study’s authors.

The other issue explored in the study is the role of race in the relationship between cognition and gait. The study, which the researchers say is the first to focus on the impact of cognitive training on mobility in black older adults, noted that although prior research indicates that black older adults do not fall statistically more often than white older adults, black seniors do show a higher incidence of both inactivity and health disparity than their white counterparts. The study also opens doors for new research needed on the best ways to deliver cognitive training to different ethnic populations, as well as “the feasibility of a cognitive training intervention for older adults in urban senior centers,” the authors said. “[To] our knowledge, no cognitive training interventions for balance/gait have targeted ethnic/racial minorities to date.”

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