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To Walk or To Talk… That is the Question.

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Try this with someone you know who has dementia and may or may not use a cane or walker.

You’re walking down the hall together, side by side, and you ask, “How are you?”.

The person you are walking with suddenly stops, looks over at you, and answers the question.

You respond something genial like, “Oh that’s good,” and now that the conversation is over, the person resumes walking again.

This is the walk and talk test (not a real test) and this person just failed it.

Basically what it tells you is that the brain cannot split its focus to walk and talk at the same time.  It can only walk OR talk, not both.  There is a limited capacity for divided attention- the ability to actively pay attention to more than one task at a time.

So if someone with Alzheimer’s or some other progressive neurodegenerative disease demonstrates decreased divided attention, what should you do?  Compensate for the deficit or challenge the brain to improve?

Ah, the therapeutic decision-making process…

Here is some interesting research related to cognitive processing and motor control to help us decide which approach to take- and this is really the bread and butter of fall prevention.

According to Fay B. Horak’s Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?, there are many cognitive resources required just to maintain upright posture.  And the more difficult the postural task, the more cognitive processing is required.  This means that someone who puts their pants on standing up uses much more cognitive energy than someone who sits to do it.  It also means that someone who is unsteady when he walks, and really needs to use all of his cognitive resources just to maintain postural control, is at risk for falls if asked to complete a secondary task (talk).  Combine that with other cognitive issues including decreased insight into deficits and decreased ability to divide attention, and there’s just not enough cognitive power to go around.

Translation…  Do not walk and talk.

The body gets much more benefit from walking- it improves strength and balance and bone health- than the brain gets from over taxing it’s cognitive resources.  It is far more therapeutic, and less risky, to walk quietly next to somebody with dementia and talk to them when they are seated.

 

Age and Ageing 2006; 35-S2: ii7–ii11 © The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. doi:10.1093/ageing/afl077  All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org ii7  MECHANISTIC AND PHYSIOLOGICAL ASPECT  Neurological Sciences Institute of Oregon Health & Science University, Portland, OR, USA

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251721/

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