Dual-Tasking: Spotlighting the Impacts on Individuals with Dementia

Ryan Langston

Credit: Geriatric Assessment, Intervention, & Technologies Laboratory (GAIT Lab)

Dual-tasking among adults living with dementia is more sensitive to the detection of impairments in these individuals’ gait, posture, and functional mobility compared to single-task assessments, according to recent findings in “Dual-tasks and dementia severity impact postural stability and gait among people living with dementia in residential care facilities: A cross sectional pilot study.”¹

This research was presented by Ryan Langston from the Medical College of Georgia at Augusta University, at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, Massachusetts. Langston and colleagues additionally noted in their findings presented at ACP that dual-tasking performance interference may be affected by individuals’ dementia severity.

Prior to their description of their new data, the research team suggested that individuals who live with dementia are known to have mobility and cognition which is relatively worse than individuals who do not live with dementia. They also added that dementia tends to increase such individuals’ fall risk, basing their information on the study “The Lived Experience of Healthcare Workers in Preventing Falls in Community Dwelling Individuals with Dementia.”²

In the study cited, it had been noted that “combining physical and cognitive strategies was not widely practiced as part of a falls prevention strategy,” and that this “approach has potential benefits but was highlighted as being complex and needs to be person-centered.”² Such findings highlight the importance of fall risk awareness and its connection to dementia.

In another cited study, Langston and colleagues noted that the research had indicated that dual-tasking had the potential to be utilized for screening fall risk, though they highlighted that additional evidence may be necessary.³ This study had highlighted gait changes during dual-task testing and their link with future risk of falling, adding that the association was shown to be stronger than the same link for conditions which were single-task conditions.

The investigators set out to assess and compare the impacts of single-task and dual-task conditions on subjects’ functional mobility, gait, and posture, specifically looking at participants who had been living with all-cause dementia and living in residential care facilities. Additionally, the study aimed to assess how the severity of dementia might influence performance and interference in dual-task scenarios.

The research team had used Montreal Cognitive Assessment (MoCA) score assessments for dementia. A score on the MoCA assessment of 26 or below is considered to be an indicator of the presence of cognitive impairment.⁴

As stated previously, among adults with dementia, dual-tasking was shown by the team to be more sensitive to the impairment detection as far as subjects’ gait, functional mobility, and posture compared to single-task.¹ They also noted that several responses during dual-tasks had been higher among subjects with moderate-to-severe dementia compared to mild dementia, including the following:

• Lesser double limb support;
• Increases in postural jerk;
• Higher midswing elevation;
• Faster gait speed.

The investigators also concluded in their research that dual-tasking may be necessary for consideration in evaluations routinely made on individuals living with dementia, the purpose being to monitor any declines in cognitive abilities. Additionally, dual-tasking could help to identify adults with impairment increases in their gait, functional mobility, and posture.

References

1. ^{Langston R, Sams R, Young L, et al. Dual-tasks and dementia severity impact postural stability and gait among people living with dementia in residential care facilities: A cross sectional pilot study. American College of Physicians Internal Medicine Meeting 2024. Boston, MA. April 18-20, 2024.}
2. ^{Felton N, Deave T. The Lived Experience of Healthcare Workers in Preventing Falls in Community Dwelling Individuals with Dementia. Geriatrics. 2022; 7(5):113. https://doi.org/10.3390/geriatrics7050113.}
3. ^{Muir-Hunter SW, Wittwer JE. Dual-task testing to predict falls in community-dwelling older adults: a systematic review. Physiotherapy. 2016 Mar;102(1):29-40. doi: 10.1016/j.physio.2015.04.011. Epub 2015 Jul 7. PMID: 26390824.}
4. ^{Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991. PMID: 15817019.}