Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

Petersen RC: Clinical practice. Mild cognitive impairment. N Engl J Med 2011; 364: 2227–2234.
Muir SW, Gopaul K, Montero Odasso MM: The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 2012; 41: 299–308.
Delbaere K, et al: Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry 2012; 20: 845–853.
Liu-Ambrose TY, et al: Increased risk of falling in older community-dwelling women with mild cognitive impairment. Phys Ther 2008; 88: 1482–1491.
Montero-Odasso M, Muir SW, Speechley M: Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil 2012; 93: 293–299.
Montero-Odasso M, et al: The motor signature of mild cognitive impairment: results from the gait and brain study. J Gerontol A Biol Sci Med Sci 2014; 69: 1415–1421.
Robinovitch SN, et al: Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet 2013; 381: 47–54.
Tangen GG, et al: Relationships between balance and cognition in patients with subjective cognitive impairment, mild cognitive impairment, and Alzheimer disease. Phys Ther 2014; 94: 1123–1134.
Patla AE, et al: Visual control of step length during overground locomotion – task-specific modulation of the locomotor synergy. J Exp Psychol Hum Perception Perform 1989; 15: 603–617.
Patla AE, Greig M: Any way you look at it, successful obstacle negotiation needs visually guided on-line foot placement regulation during the approach phase. Neurosci Lett 2006; 397: 110–114.
Pieruccini-Faria F, Jones JA, Almeida QJ: Insight into dopamine-dependent planning deficits in Parkinson’s disease: a sharing of cognitive & sensory resources. Neuroscience 2016; 318: 219–229.
Lythgo N, Begg R, Best R: Stepping responses made by elderly and young female adults to approach and accommodate known surface height changes. Gait Posture 2007; 26: 82–89.
Pieruccini-Faria F, Jones JA, Almeida QJ: Motor planning in Parkinson’s disease patients experiencing freezing of gait: the influence of cognitive load when approaching obstacles. Brain Cogn 2014; 87: 76–85.
Brown LA, McKenzie NC, Doan JB: Age-dependent differences in the attentional demands of obstacle negotiation. J Gerontol A Biol Sci Med Sci 2005; 60: 924–927.
Yogev-Seligmann G, Hausdorff JM, Giladi N: Do we always prioritize balance when walking? Towards an integrated model of task prioritization. Mov Disord 2012; 27: 765–770.
Montero-Odasso M, Speechley M: Falls in cognitively impaired older adults: implications for risk assessment and prevention. J Am Geriatr Soc 2018; 66: 367–375.
Bloem BR, et al: The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci 2006; 248: 196–204.
Holtzer R, Wang C, Verghese J: Performance variance on walking while talking tasks: theory, findings, and clinical implications. Age (Dordr) 2014; 36: 373–381.
van Iersel MB, et al: Frail elderly patients with dementia go too fast. J Neurol Neurosurg Psychiatry 2006; 77: 874–876.
Pieruccini-Faria F, et al: Interactions between cognitive and sensory load while planning and controlling complex gait adaptations in Parkinson’s disease. BMC Neurol 2014; 14: 250.
Montero-Odasso MM, et al: Disentangling cognitive-frailty: results from the gait and brain study. J Gerontol A Biol Sci Med Sci 2016; 71: 1476–1482.
Morris JC, et al: Clinical dementia rating training and reliability in multicenter studies: the Alzheimer’s Disease Cooperative Study experience. Neurology 1997; 48: 1508–1510.
Spitzer RL, et al: DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, text rev. American Psychiatric Publishing, Inc., 2002.
Nasreddine ZS, et al: The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–699.
Reitan RM: The relation of the trail making test to organic brain damage. J Consult Psychol 1955; 19: 393–394.
Dubois B, et al: The FAB: a frontal assessment battery at bedside. Neurology 2000; 55: 1621–1626.
Mungas D: Differential clinical sensitivity of specific parameters of the Rey Auditory-Verbal Learning Test. J Consult Clin Psychol 1983; 51: 848–855.
Washburn RA, et al: The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 1993; 46: 153–162.
Yesavage JA: Geriatric depression scale. Psychopharmacol Bull 1988; 24: 709–711.
Tinetti ME, Richman D, Powell L: Falls efficacy as a measure of fear of falling. J Gerontol 1990; 45:P239–P243.
Tinetti ME, Powell L: Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol 1993; 48: 35–38.
Tinetti ME, et al: Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol 1994; 49:M140–M147.
Beurskens R, Bock O: Age-related deficits of dual-task walking: a review. Neural Plast 2012; 2012: 131608.
Freire RC, Pieruccini-Faria F, Montero-Odasso M: Are human development index dimensions associated with gait performance in older adults? A systematic review. Exp Gerontol 2018; 102: 59–68.
O’Brien RM: A caution regarding rules of thumb for variance inflation factors. Quality Quantity 2007; 41: 673–690.
Guralnik JM, et al: Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000; 55:M221–M231.
Bowler RM, Lezak MD: Neuropsychologic evaluation and exposure to neurotoxicants. Handb Clin Neurol 2015; 131: 23–45.
Montero-Odasso MM, et al: Association of dual-task gait with incident dementia in mild cognitive impairment: results from the gait and brain study. JAMA Neurol 2017; 74: 857–865.
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