Uneven surface and cognitive dual-task independently affect gait quality in older adults.

This was an observational cross-sectional analysis, not an intervention study, so it cannot show that changing a patient's walking environment or cognitive load causes clinical decline. The sample was highly educated and high-functioning: 104 older adults, mean age 75, 78 (75%) had more than high school education, and executive test scores were at or above the 80th percentile, so results may not apply to frailer or more cognitively impaired patients. Participants had to walk without assistance and were excluded for stroke, dementia or mild cognitive impairment symptoms, major motor or neurological disease; 13 participants were excluded because of accelerometry technical errors. The walking tasks were limited to 15 m straightaways with wood prisms under carpet and a simple alternate-letter task; the authors state these may not represent everyday obstacles, slopes or curved paths. Cognitive assessment was limited to MMSE and Trail Making Tests A and B, so other domains such as recall, working memory or verbal fluency were not examined. Some accelerometry data were sampled at 30 Hz and upsampled, and the study did not record perceived task difficulty or ask participants to prioritize walking or alphabeting.

The authors declared no conflict of interest. The article metadata indicates NIH extramural research support.

Do not conclude that uneven ground plus a cognitive task is worse for gait than either challenge alone. The study found no interaction effect between surface and cognition.