The role of executive function and attention in gait

Abstract

Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk.

Figure 1

Association between gait speed and performance on the TMT in the InCHIANTI study. Subjects with poor and intermediate performance in the TMT (i.e., large increase when going from TMT-A to TMT-B) had decreased gait speed, especially on the obstacle course. From Ble et al..

Figure 2

Common and distinct effects of secondary, dual tasks on the gait of patients with Parkinson’s disease and age-matched healthy controls. Above: Swing time variability and Below: Average gait speed. While all both groups slowed down during dual tasking, gait variability increased only in the patient group. From Yogev et al..