The Effects of Tau, Amyloid, and White Matter Lesions on Mobility, Dual Tasking, and Balance in Older People

J Gerontol A Biol Sci Med Sci. 2021 Mar 31;76(4):683-691. doi: 10.1093/gerona/glaa143.


Background: This study aimed to investigate whether white matter lesions (WML), β-amyloid-, and tau pathologies are independently associated with mobility, dual tasking, and dynamic balance performance in older nondemented individuals.

Methods: We included 299 older people (mean, SD, age: 71.8, 5.6 years) from the Swedish BioFINDER study, whereof 175 were cognitively unimpaired and 124 had mild cognitive impairment (MCI). In multivariable regression analyses, dependent variables included mobility (Timed Up & Go [TUG]), dual tasking (TUG with a simultaneous subtraction task, that is, TUG-Cog, as well as dual task cost), and balance (Figure-of-eight). The analyses were controlled for age, sex, education, diagnosis (ie, MCI), and comorbidity (stroke, diabetes, and ischemic heart disease). Independent variables included WML volume, and measures of β-amyloid (abnormal cerebrospinal fluid [CSF] Aβ42/40 ratio) and tau pathology (CSF phosphorylated tau [p-tau]).

Results: Multivariable regression analyses showed that an increased WML volume was independently associated with decreased mobility, that is, TUG (standardized β = 0.247; p < .001). Tau pathology was independently associated with dual tasking both when using the raw data of TUG-Cog (β = 0.224; p = .003) and the dual-task cost (β= -0.246; p = .001). Amyloid pathology was associated with decreased balance, that is, Figure-of-eight (β = 0.172; p = .028). The independent effects of WML and tau pathology were mainly observed in those with MCI, which was not the case for the effects of amyloid pathology on balance.

Conclusions: Common brain pathologies have different effects where WML are independently associated with mobility, tau pathology has the strongest effect on dual tasking, and amyloid pathology seems to be independently associated with balance. Although these novel findings need to be confirmed in longitudinal studies, they suggest that different brain pathologies have different effects on mobility, balance, and dual-tasking in older nondemented individuals.

Keywords: Biomarkers; Dementia; Difficulty walking; Magnetic resonance imaging; Postural balance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amyloid beta-Peptides / cerebrospinal fluid*
  • Cognition
  • Cognitive Dysfunction* / cerebrospinal fluid
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / physiopathology
  • Cognitive Dysfunction* / psychology
  • Comorbidity
  • Correlation of Data
  • Female
  • Geriatric Assessment / methods
  • Humans
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging / statistics & numerical data
  • Male
  • Mobility Limitation*
  • Physical Functional Performance
  • Postural Balance*
  • Sweden / epidemiology
  • Task Performance and Analysis*
  • White Matter* / diagnostic imaging
  • White Matter* / pathology
  • tau Proteins / cerebrospinal fluid*


  • Amyloid beta-Peptides
  • tau Proteins