BJMB
Brazilian Journal of Motor Behavior
Special issue:
Effects of aging on locomotor patterns
!
Costa et al.
2022
VOL.16
N.5
352 of 361
Dual-task performance in seniors with mild cognitive impairment and Alzheimer’s disease:
a longitudinal study
DANIELLE C. P. S. COSTA
1
| JULIANA H. ANSAI
2
| LAURA M. MELO
1
| ANA CAROLINA V. FERREIRA
1
| PAULO G.
ROSSI
1
| FRANCISCO A. C. VALE
3
| LARISSA P. ANDRADE
1
1
Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
2
Department of Gerontology, Federal University of São Carlos, São Carlos, SP, Brazil.
3
Department of Medicine, Federal University of São Carlos, São Carlos, SP, Brazil.
Correspondence to:!Larissa Pires de Andrade, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luiz, km 235, Zipcode 13565-905,
+55 16 3351-8704
email: larissa.andrade@ufscar.br
https://doi.org/10.20338/bjmb.v16i5.309
HIGHLIGTHS
• Alzheimer's disease has an impact on the
ability of carrying out a dual task.
• Dual task performance worsens over time in
older adults with Alzheimer’s disease.
• Time, steps and cadence worsened with time
in older adults with Alzheimer’s disease.
• We suggest that walking and using the phone
is an effective dual task assessment.
ABBREVIATIONS
AD Alzheimer`s disease
CDR Clinical Dementia Rating
CMT cognitive-motor test
DSM-IV-TR Diagnostic and Statistical Manual
of Mental Disorders
DT Dual task
MCI Mild cognitive impairment
MMSE Mini Mental State Exam
PrC Preserved cognition
T1 Initial moment
T2 After 32 months
TUGT Timed up and go test
UFSCar Universidade Federal de São
Carlos
PUBLICATION DATA
Received 07 06 2022
Accepted 02 12 2022
Published 15 12 2022
BACKGROUND: Motor performance in older adults with cognitive impairment is worse under dual task
conditions, increasing the risk of falls. However, there is a lack of studies that analyze this performance over
time in people with different cognitive profiles.
AIM: This study aimed to compare the performance of an isolated task and a dual task in people with preserved
cognition (PrC), with mild cognitive impairment (MCI) and Alzheimer`s disease (AD).
METHOD: Data were collected on two occasions (T1 and T2), thirty-two months apart. Participants (n=51) were
separated between groups: PrC (n=22), MCI (n=19) and AD (n=10). They were analyzed in three situations: 1)
isolated motor task - Timed up and go test (TUGT); 2) cognitive-motor test (CMT)– dialing on a phone; 3) dual
task (DT). To compare the performance of the dual task between the groups, delta was calculated and the
ANCOVA test was applied.
RESULTS: Although the cost of the dual task was not significantly different over time in any group, we found
increases in the time required to complete the TUGT (p<0.01) and TUGT-DT (p>0.01) after 32 months in the AD
group and a reduction in time in the PrC and MCI groups. A greater number of steps in the TUGT-DT (p<0.01)
and an increase in cadence in the TUGT (p = 0.01) and TUGT-DT (p<0.01) were also found in the AD group.
CONCLUSION: We suggest that a more functional task, such as walking while typing on the phone, may be
considered a more sensitive way of assessing older adults with AD.
KEYWORDS: Alzheimer’s disease | Dual task | Cognitive Impairment | Older adults | Timed Up and Go test
INTRODUCTION
Due to the increase in life expectancy, pathologies inherent to aging, including the
possibility of neurodegenerative diseases, such as some types of public health, have
become an important public health problem. This is because dementia is considered one
of the main causes of disability in adult life, triggering high costs of assistance to the
burden of family members and relatives. However, it presents a challenge for research to
understand the trajectory of this disease over time,and thus be able to guide health actions
through the most effective approaches and interventions
1
. Alzheimer’s disease (AD) is a
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
353 of 361
Special issue:
Effects of aging on locomotor patterns
progressive, irreversible condition that exerts a negative impact on cognitive functions and
the performance of activities of daily living
2
. Mild cognitive impairment (MCI) is another
condition that has been investigated in the aging process and constitutes a transition
phase between physiological neuronal loss in the natural aging process and dementia
3
.
Older adults with cognitive impairment have a poorer performance in dual tasks
compared to those with preserved cognition (PrC)
4
. Cross-sectional studies comparing
older adults with PrC to those with some type of cognitive impairment have reported a
negative impact on gait during a dual task in the latter group
5,6,7,8
. These changes may be
explained by a central interference caused by the increase in brain activity during the
simultaneous performance of two tasks and the limitation of attentional resources
9
, which
may decrease performance in one or both tasks and considerably increase the risk of falls
10
.
Although the studies cited have contributed knowledge on dual task performance,
as well as motor performance among older adults with MCI and AD, there is a need for
longitudinal studies to investigate the dual task performance of older adults in different
cognitive status conditions.
Therefore, the aim of the present longitudinal study was to compare the
performance on an isolated task and dual task in older adults with PrC, MCI and mild AD.
We tested the hypothesis that, over time, older adults with PrC, with MCI and AD would
present significant differences when performing the dual task, with worse performance in
older adults who had greater cognitive impairment.
METHODS
Participants
The present study is a sub-study of the longitudinal project called the“Brazilian
longitudinal study about motor alterations in older people with cognitive disorders
(BLSMotorCD)”. This study received approval from the human research ethics committee
(certificate number: 72774317.7.0000.5504) and all the participants or their caregivers
signed a statement of informed consent. At the initial moment (T1), 118 older adults were
recruited, who were evaluated and allocated into three groups: PrC, MCI and AD.
AD and MCI were diagnosed according to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR)
11
, including assessments of the Clinical Dementia Rating
(CDR)
12
and Mini Mental State Examination (MMSE)
13
. The confirmation of the diagnosis
was performed at the Department of Medicine at the Universidade Federal de São Carlos
(UFSCar) by a trained team coordinated by Dr. FACV at the Behavioral Cognitive
Neurology Clinic.
After 32 months (T2)
10
, one hundred and eighteen older adults were contacted
again by the evaluators. Of these, fifty-one individuals participated in T2 (10 with AD, 19
with MCI and 22 with PrC). Reasons for discontinuation during the study period were
withdrawal (n = 23), loss of contact (n = 12), death (n = 11) and exclusion
(bedridden/restricted to a wheelchair: n = 18; severe behavioral disorder: n = 3).
Procedures
The two evaluators at T1
5
and T2 were blinded to the allocation of volunteers in
the different groups and underwent a reliability analysis. The inter-examiner reliability test
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
354 of 361
Special issue:
Effects of aging on locomotor patterns
was performed on the same day for both evaluators and the intra-examiner was applied
with an interval of seven days from the first test. Nineteen randomly selected types of
footage of TUGT evaluations were used. Only the time variable was computed for the
reliability test. All footage used was from cognitively preserved individuals or diagnosed
with MCI. Each examiner evaluated the same videos in the two periods described
(intraclass correlation coefficient = 1).
After analyzing the patient history, sociodemographic variables, the Geriatric
Depression Scale was applied to determine symptoms of depression
14
and the Minnesota
Questionnaire was administered to measure the level of physical activity
15
. Then, the
participants performed the following tasks twice, one considered as familiarization and the
second for the test:
Timed Up and Go test (TUGT)
The version of the TUGT adapted for older adults with cognitive impairment was
used
16
. The following standard commands were given: “Get ready, go. Stand up, walk, go
around the cone and sit down”
16
. The timer was started when the individual left the chair
and stopped when the subject leaned back again. Cadence was calculated by the number
of steps divided by the running time (Figure 1). The course performed in less than 12.47
seconds has less risk of falling, while if the time is longer than 12.47 seconds, it represents
a greater risk of falls
17
.
Figure 1.!Illustration of commands while applying the TUGT. Source: the author.
Cognitive-motor task (CMT)
For the Cognitive-motor task, the participant was instructed to type a sequence of
eight numbers on a cell phone, a common task nowadays that requires preserved
cognition functions (such as attention and visuospatial notion, for example), as well as the
motor function for typing. A randomly selected card was attached to the screen of the
telephone and the participant received the following instructions: “Get ready, go. Pick up
the telephone, type the eight numbers on the card and put the phone back on the table”
5
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
355 of 361
Special issue:
Effects of aging on locomotor patterns
(Figure 2).The objective of this task was to observe the performance of older adults when
performing the task of dialing on the telephone, without walking
18
.
Figure 2.!Illustration of commands while applying the CMT. Source: the author.
Timed Up and Go Test with cognitive task (TUGT-DT)
For the dual task, a second randomly selected card was used. The participant
received the following instructions: “Get ready, go. Stand up, pick up the telephone, walk
while typing the eight numbers on the card, walk around the cone, put the telephone back
on the table and sit down”
5
(Figure 3).
Figure 3.!Illustration of commands while applying the TUGT-DT. Source: the author.
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
356 of 361
Special issue:
Effects of aging on locomotor patterns
Statistical Analysis
Descriptive statistics were first performed. The Shapiro-Wilk test was used to
determine the normality of the data. Non-normal data were transformed into Z-scores.
Differences between T1 and T2 were calculated to analyze the time, errors and cost of the
CMT (ratio of the difference in the ratio of numbers typed per second times the percentile
of the correct answers of the cognitive task and the TUGT-DT over the same ratio of the
cognitive task) (Figure 4), time, steps and cadence of the TUGT and time, steps, cadence,
errors and cost of the dual task (ratio of the difference between the TUGT-DT and the
TUGT time over the TUGT time) (Figure 5) in the groups
5
. As a difference among the
groups was found for age, which could affect the results, ANCOVA was performed
considering age as a confounding variable. The chi-square test was used to compare the
categorical variables. The level of significance was set to 5% (p < 0.05).
Figure 4.! Calculation of the cost of the Cognitive-Motor task. t=time, CT=task cost, DT=Dual task,
TUG=Timed up and go test.
Figure 5.! Calculation of the cost of the dual task. CT= task cost, RRC=ratio of correct answer (ratio of
answer by second x correct percentile), DT=dual task, TC=isolated cognitive-motor task.
RESULTS
Table 1 shows the sociodemographic variables of the sample at T1. Significant
differences among the groups were found for age, sex, number or medications, level of
physical activity and cognition.
Table 1. Sociodemographic and clinical characteristics of sample (n = 51).
Variable (mean ± SD)
PrC
n = 22
MCI
n = 19
AD
n = 10
p
Age
72±6.34
72±4.95
78±4.39
0.021*#
Female sex, n (%)
12 (54.5)
18 (94.7)
4 (40.0)
0.002*@
Schooling (years)
7±4.2
6.26±4.04
6.10±3.66
0.590
Multi/bifocal glasses, n (%)
16 (72.72)
13 (68.42)
5 (50.0)
Gait-assistance device, n (%)
1 (4.54)
2 (10.53)
1 (10.0)
0.873
Medications (n)
2.68±2.35
5.11±3.33
5.20±2.49
0.043*α
Comorbidities (n)
2.09±1.51
2.74±1.56
3.50±1.35
0.380
BMI (kg/m²)
28.68±5.53
29.80±4.64
28.42±4.24
0.640
Minnesota (points)
2876.42±3609.18
1424.57±1300.59
846.55±1255.85
0.012*β
GDS (points)
2.00±1.74
3.53±2.39
3.10±1.85
0.057
PrC: preserved cognition; MCI: mild cognitive impairment; AD: Alzheimer's disease; n: number of individuals; SD: standard deviation; kg:
kilograms; m: meters; BMI: body mass index; GDS: Geriatric Depression Scale; *p <0.05; .#: AD ≠MCI and PrC; @: MCI ≠PrC and AD; α:
PrC ≠ AD; β: PrC ≠MCI and AD.
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
357 of 361
Special issue:
Effects of aging on locomotor patterns
Table 2 shows the data on the performance of the three groups over time.
Significant differences were found among the groups (PrC, MCI and AD) for two variables
on the TUGT (time and cadence) and three variables on the dual task (time, number of
steps and cadence). Significant increases in the time required to complete the TUGT and
TUGT-DT were found after 32 months in the AD group (p < 0.01 and p = 0.02,
respectively), whereas a reduction in time was found in the PrC and MCI groups. A greater
number of steps on the TUGT-DT (p < 0.01) and an increase in cadence on the TUGT and
TUGT-DT (p = 0.01 and p < 0.01, respectively) were also found in the AD group.
Table 2. Performance on isolated and dual tasks of older adults in PrC, MCI and AD groups over time.
Variables: T2-T1=∆
(mand ± SD)
PrC
n = 22
MCI
n = 19
AD
n = 10
P
Effect
size
Power
Isolated task
Time - CMT (s)
-0.20±0.39
-0.06±0.83
0.55±1.84
0.42
0.03
0.19
Errors –CMT
0.24±1.41
-0.24±0.19
-0.65±0.75
0.32
0.05
0.24
Cost - CMT (%)
-17.0±140.0
-2.0±43.0
43.0±60.0
0.45
0.03
0.18
Time - TUGT (s)
-0.27±0.45
-0.30±0.60
1.16±1.60
0.00*#
0.26
0.95
Steps - TUGT
-0.19±0.84
-0.19±1.11
0.78±0.75
0.06
0.11
0.56
Cadence - TUGT
(steps/min)
-0.34±1.02
-0.51±0.77
0.84±0.95
0.01*#
0.17
0.79
Dual task
Time (s)
-0.33±0.26
-0.11±1.07
0.94±1.35
0.02*#
0.15
0.72
Steps
-0.31±0.48
-0.21±0.81
1.09±1.42
0.00*#
0.22
0.89
Cadence (steps/min)
-0.51±0.81
0.15±1.00
0.84±0.76
0.00*#
0.25
0.94
Errors
-0.10±0.19
-0.22±0.82
0.64±1.88
0.13
0.08
0.41
Cost (%)
-16.0±57.0
18.0±127.0
-00.0±120.0
0.53
0.02
0.15
T1: baseline; T2: follow-up; SD: standard deviation; PrC: preserved cognition; MCI: mild cognitive impairment; AD: Alzheimer's disease; n:
number of individuals; CMT: cognitive-motor task; TUGT: Timed Up and Go Test; s: seconds; min: minutes; *p <0.05.#: AD ≠ MCI and PrC
DISCUSSION
The main finding of this study was that older adults with AD, over time, had a
significant impact on their performance in all variables in both conditions (simple task and
DT). A worse performance was found in relation to cadence and time required to complete
the isolated task (TUGT) in the AD group, while the older adults in the MCI and PrC groups
had similar performances over time. These findings indicate that two years and eight
months is enough time to have a significant impact on the motor aspects of individuals with
AD, even in the early stages of the disease, while this same period of time does not seem
to affect isolated motor tasks in older adults with PrC or mild cognitive impairment.
According to Ansai
5
, dual task measures are more associated with cognitive
domains when compared to single-task measures. Therefore, we expected to find greater
differences in the cost of dual tasking over time.
However, the cost of the DT did not change significantly in any of the groups
analyzed, and significant differences were found in relation to the time required to perform
the tasks, number of steps and cadence for both the isolated tasks and the pairs in the AD
group. Similar findings are described by Cedervall
10
who analyzed gait performance in
older adults with mild AD over a period of two years and found no significant difference in
the cost of DT, while gait speed and step length were decreased.
Nevertheless, we can interpret that, during the period of this study, the motor
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
358 of 361
Special issue:
Effects of aging on locomotor patterns
impairment in the older adults with AD declined considerably to the point that even when
evaluated separately, there was a difference in this group. In our case, older adults with
AD, at T1, performed the test in 14.3s and, in T2, in 19.63s. We can see a significant
decline in this time, but it is worth noting that in both moments, the values are above the
predictive value for risk of falls in Brazilian older adults - 12.47 seconds
17
.
However, studies suggest that the dual task assessment can identify MCI and AD
6,19
and can predict an increased risk of falls in older adults with some degree of cognitive
impairment
20
. By strengthening these hypotheses, we suggest that a functional task such
as walking and typing on the common telephone today and which requires preserved
cognitive functions (such as attention and visuospatial notion, for example), as well as the
motor function for typing, can become more challenging and should be considered in the
evaluation of older adults with cognitive impairment.
Changes in the dual task performance can be explained by central interference
caused by increased brain activity and limited attentional resources when performing two
tasks simultaneously
9
. Gait requires processing by the motor cortex, basal ganglia, and
cerebellum, as well as the interaction of attention, executive functions, and visuospatial
skills. In other words, it requires brain activation and preserved cognition domains. This
occurs more markedly in older adults with cognitive deficits
6
.
In fact, studies report a strong association between cognitive functions (especially
frontal cognitive functions) and motor aspects in older adults with cognitive impairment
4
.
The task of walking and typing a number on the phone requires frontal cognitive skills of
attention and executive functions, as well as the preservation of motor skills to ensure
good performance
5
. Thus, the reduction in cognitive capacity that occurs in older adults
can explain the changes in gait, which, in turn, can affect postural stability and increase the
risk of falls
10,20,21
.
The hypothesis of this study was confirmed, as older adults diagnosed with
Alzheimer's Disease, even in the early stages, showed worse performance in the dual task
over time. There appears to be no difference in dual task performance between individuals
with mild cognitive impairment over time compared with older adults with PrC. This
suggests that the brain regions altered by the physiological process of aging and in cases
of MCI do not seem to suffer significant interference to trigger a deficit in the performance
of the dual task in this period of time, unlike the condition of older adults with AD. These
findings are similar to studies that evaluated older adults with and without cognitive
impairment in a longitudinal perspective
9,10,22
.
However, more research is needed to investigate these situations in the MCI, as
previous studies have reported that older adults with cognitive deficits have a higher risk of
falls than those with preserved cognition
20
.
This study has limitations that should be considered, such as the small sample
size (n = 51) and the different numbers of participants in each group (PrC = 22, MCI = 19
and AD = 10). The strengths of this study were the confirmation of the diagnosis by a
specialized medical team, the use of a clinical measure of mobility widely used by health
professionals (Timed Up and Go Test), the reliability of the evaluators (ICC = 1) and using
a more functional dual task that can be reproduced by other health professionals.
Future studies should analyze the changes over time in different cognitive
domains in dual tasks among older adults with MCI, AD and PrC. Such studies could help
explain the association between cognitive changes and motor aspects in these three
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
359 of 361
Special issue:
Effects of aging on locomotor patterns
groups. Moreover, measures of dual task performance should be included in the
evaluation of older adults with cognitive impairment, which could help establish prevention
measures and rehabilitation processes for older adults with cognitive impairment,
especially those with Alzheimer's disease.
CONCLUSION
Alzheimer's Disease, even in the mild phase, has a significant impact on the motor
performance of older adults over time. While the cost of the dual task did not undergo
significant changes in any of the three groups analyzed, the individuals with AD had a
poorer performance on dual tasks in terms of the time required to complete the tasks,
number of steps and cadence compared to the older adults with MCI and preserved
cognition. These changes in older adults with AD during the performance of a more
functional dual task, such as walking and talking on the telephone, can be considered an
effective way to evaluate this population.
REFERENCES
1. World Health Organization (WHO). Dementia: a public health priority. Genebra, 2012. 112
p.
2. Alzheimer’s Disease International. World Alzheimer Report 2019: Attitudes for dementia.
London: Alzheimer’s Disease International. 2019. 160 p.
3. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med.
2004;256:183–194. DOI: 10.1111/j.1365-2796.2004.01388.x.
4. Sheridan PL, Hausdorff JM. The role of higher - level cognitive function in gait: Executive
dysfunction contributes to fall risk in Alzheimer’s disease. Dement Geriatr Cogn Disord.
2007;24:125-137. DOI: 10.1159/000105126.
5. Ansai JH, Andrade LP, Rossi PG, Almeida ML, Vale FAC, Rebelatto JR. Association
Between Gait and Dual Task with Cognitive Domains in Older People With Cognitive
Impairment. J Motor Behav. 2018;50(4):409–415. DOI: 10.1080/00222895.2017.1363702.
6. Tseng BY, Cullum CM, Zhang R. Older Adults with Amnestic Mild Cognitive Impairment
Exhibit Exacerbated Gait Slowing under Dual task Challenges. Curr Alzheimer Res. 2014;
11(5):494–500. DOI: 10.2174/1567205011666140505110828.
7. Borges SM, Radanovic M, Forlenza OV. Functional mobility in a divided attention task in
older adults with cognitive impairment. J Motor Behav. 2015;47(5):378-385. DOI:
10.1080/00222895.2014.998331.
8. Muir SW, Speechley M, Wells J, Borrie M, Gopaul K, Montero-Odasso M. Gait assessment
in mild cognitive impairment and Alzheimer’s disease: The effect of dual task challenges
across the cognitive spectrum. Gait Posture. 2012;35:96-100. DOI:
10.1016/j.gaitpost.2011.08.014.
9. Papegaaij S, Hortobagyi T, Godde B, Kaan WA, Erhard P, Volcker-Rehage C. Neural
correlates of motor-cognitive dual tasking in young and old adults. Plos One. 2017;12(12).
DOI: 10.1371/journal.pone.0189025.
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
360 of 361
Special issue:
Effects of aging on locomotor patterns
10. Cedervall Y, Halvorsen K, Berg ACA. A longitudinal study of gait function and
characteristics of gait disturbance in individuals with Alzheimer’s disease. Gait Posture.
2014;39:1022-1027. DOI: 10.1016/j.gaitpost.2013.12.026.
11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders:
4th edition. Washington, 1994.
12. Montaño MB, Ramos LR. Validade da versão em português da Clinical Dementia Rating
(CDR). Rev Saúde Públ. 2005;39(6). DOI: 10.1590/S0034-89102005000600007.
13. Folstein MF. Mini Mental State. A practical method for grading the cognitive state of
patients for the clinicians. J Psychiatr Res. 1975;12:189-198. DOI: 10.1016/0022-
3956(75)90026-6.
14. Castelo MS, Coelho-Filho JM, Carvalho AF, Lima JW, Noleto JC, Ribeiro KG, et al. Validity
of the Brazilian version of the geriatric depression scale (GDS) among primary care
patients. Int Psychogeriatr. 2010;22(1):109-113. DOI: 10.1017/S1041610209991219.
15. Lustosa LP, Pereira DS, Dias RC, Britto RR, Parentoni AN, Pereira LSM. Translation and
cultural adaptation of the Minnesota Leisure Time Activities Questionnaire in community-
dwelling older people. Geriatr Gerontol Aging. 2011;5:57-65. ID:
BR_16663bf9f13f70c8eed632c3603f4777.
16. Melo LM, Ansai JH, Rossi PG, Vale FAC, Takahashi ACM, Andrade LP. Performance of
an Adapted Version of the Timed Up-and-Go Test in People with Cognitive Impairments. J
Mot Behav. 2019;18:1-8. DOI: 10.1080/00222895.2018.1552917.
17. Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of Timed Up and Go Test for
screening risk of falls among community-dwelling elderly. Braz J Phys Ther.
2012;16(5):381-388. DOI: 10.1590/S1413-35552012005000041.
18. Ansai JH, Andrade LP, Rossi PG, Takahashi ACM, Vale FAC, Rebelatto JR. (2017b). Gait,
dual task and history of falls in elderly with preserved cognition, mild cognitive impairment,
and mild Alzheimer’s disease. Braz J Phys Ther. 2017;21(2):144-151. DOI:
10.1016/j.bjpt.2017.03.010
19. Montero-Odasso M, Oteng-Amoako A, Speechley M, Gopaul K, Beauchet O, Annweiler C,
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(11):1415–1421. DOI:
10.1093/gerona/glu155.
20. Taylor ME, Ketels MM, Delbaere K, Lord SR, Mikolaizak AS, Close JC. Gait impairment
and fall in cognitively impaired older adults: an explanatory model of sensoriomotor and
neuropsychological mediators. Age Ageing. 2012;41:665-669. DOI:
10.1093/ageing/afs057.
21. Hernandez SSS, Coelho FGM, Gobbi S, Stella F. Effects of a physical activity program on
cognitive functions, balance and risk of falls in older adults people with Alzheimer's
dementia. Braz J Phys Ther. 2010;14(1):68-74. DOI: 10.1590/S1413-
35552010000100011.
BJMB! ! ! ! ! ! ! !
Brazilian(Journal(of(Motor(Behavior(
(
Costa et al.
2022
VOL.16
N.5
361 of 361
Special issue:
Effects of aging on locomotor patterns
22. Donoghue O, Feeney J, O’Leary N, Kenny RA. Baseline Mobility is Not Associated with
Decline in Cognitive Function in Healthy Community-Dwelling Older Adults: Findings from
The Irish Longitudinal Study on Ageing (TILDA). Am J Geriatr Psychiatry. 2018;26(4):438-
448. DOI: 10.1016/j.jagp.2017.11.006.
Citation: Costa DCPS, Ansai JH, Melo LM, Ferreira ACV, Rossi PG, Vale FAC, Andrade LP. (2022).!Dual-task
performance in seniors with mild cognitive impairment and Alzheimer’s disease: a longitudinal study. Brazilian Journal
of Motor Behavior, 16(5):353-362.
Editor-in-chief: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil. !
Associate editors: Dr José Angelo Barela - São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia
Madalena Rinaldi - Federal University of Espírito Santo (UFES), Vitória, ES, Brazil; Dr Renato de Moraes – University
of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Guest editors: Dr Paulo Cezar Rocha dos Santos - Weizmann Institute of Science, Rehovot, Israel; Dr Diego Orcioli
Silva - São Paulo State University (UNESP), Rio Claro, SP, Brazil.
Copyright:© 2022 Costa, Ansai, Melo, Ferreira, Rossi, Vale and Andrade and BJMB. This is an open-access article
distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International
License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-
profit sectors.
Competing interests: The authors have declared that no competing interests exist.
DOI:!https://doi.org/10.20338/bjmb.v16i5.309