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Can you walk and talk at the same time? Dual Tasking and Mild Cognitive Impairment

Do you ever notice you or your loved one are more likely to lose balance while walking and talking at the same time? Imagine that you are walking on a cobblestone path with a friend, calculating the time it may take to get to your destination.

Walking and talking is a type of dual tasking which requires a lot of mental resources to be able to do safely. A complex cascade of cognitive processes occurs as an individual assesses the hazard associated with continuing to walk and focusing on balance vs. continuing their conversation. Typically, someone who is dual tasking can choose “safety first”, where they prioritize their balance over their other task (in our example, mental math). This is not always possible, however, in people with Mild Cognitive Impairment (MCI).


As of 2017, the American Academy of Neurology estimated that 16.62% of adults over 65 have Mild Cognitive Impairment, (1) a noticeable decline in cognitive abilities that does not interfere with one’s ability to perform daily activities. (2) MCI is an impairment in cognition that is greater than the effects of normal aging, though less than the threshold for diagnosis of dementia. MCI can be a secondary effect of other diseases for some people, whereas others with MCI may go on to develop dementia or Alzheimer disease. (1)


While MCI is typically first described with cognitive decline, walking and mobility problems have been identified in people with MCI as well, including a slow gait speed. People with MCI are also at a higher risk of falling compared to other adults. Studies have shown that the ability to assess and respond to risky situations while walking is impaired in individuals with MCI. This is especially true while dual tasking, such as in our earlier example. (3)


The majority--40%--of falls in people with MCI occur when negotiating an obstacle (3) , such as stepping over an object. When someone approaches an obstacle, they need to change how they are walking in order to navigate it safely. This referred to as an anticipatory gait adjustment. A recent study examined obstacle negotiation while walking in individuals with MCI. Researchers found that people with MCI made fewer anticipatory gait adjustments while dual tasking as compared to their peers without cognitive impairments.



What can be done about this?


If someone has known difficulty with dual tasking, it is important to ensure safety and try to avoid doing two things at once. This is crucial when navigating a risky setting such as stepping over an obstacle. In addition, it is important to address any balance problems as soon as they are noticed!


Exercise is a pivotal part of managing MCI, especially if balance is a concern. In fact, there are few other known treatments to reverse the processes associated with cognitive decline. Exercise has even been shown to help improve performance on cognitive measures in people with MCI. (1) Dual Task Training is a specific type of exercise where someone is purposefully trying to do two things at once. This is often performed with a balance task combined with either a mental task (cognitive dual task training) or a physical task (manual dual task training). A physical therapist can help select exercises that help to improve balance specific to each individual’s needs, as well as ensure safety while carrying them out.


If you are seeking guidance related to any of the content in this article, consider checking in with our clinic, the Maine Strong Balance Center; we are available as a resource for your physical therapy needs! If you think you may have MCI, it is important to talk to your doctor. More information about MCI can be found at the following link: https://w ww.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578




References:

1. American Academy of Neurology.Practice Guideline for Clinicians. Practice guideline update: mild cognitive impairment. Summary slides. 2018.

2. Gillis C, Miraei F, Potashman M, Arfan Ikram M, Maserjian N. The incidence of mild cognitive impairment: a systematic review and data synthesis. Alzheimers Dement (Amst). 2019; 11: 248-256.

3. Pieruccine-Faria F, Sarquis-Adamson Y, Montero-Odasso. Gerontology. 2019; 65:164-173. Mild Cognitive Impairments Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”