Posture and cognition in the elderly: interaction and contribution to the rehabilitation strategies

In this paper we review the effects of aging on sensory systems and their impact on posture, balance and gait. We also address cognitive aging and attempt to specify which altered cognitive functions negatively impact balance and walking. The role of cognition in postural control is tested with dual-task experiments. This situation results in deleterious effects due to an attentional overload. Given the human cognitive system has limited capacities, we propose that simultaneously performing two tasks depends on the capacity of each individual to perform these tasks on a continuum between automatic execution to highly controlled performance. A level of maximum control exceeds the subject's attentional capacity, which makes it impossible to perform both tasks simultaneously. The subject therefore prioritizes one of the tasks. We use representative dual-task studies from the literature to illustrate the relationship between the different cognitive components and their impact on the control of posture and gait in elderly subjects with altered cognitive capacities and with elderly subjects who are fallers or who have altered sensory-motor capacities. Recently this postural-cognitive relationship was addressed with a new approach. We report how cognitive training can improve dual-task management and we attempt to define the cognitive mechanisms that may be responsible for better postural balance.