Journal Mobile Options
Table of Contents
Vol. 23, No. 2-3, 2007
Issue release date: February 2007
Cerebrovasc Dis 2007;23:203–210

Executive Function Is Independently Associated with Performances of Balance and Mobility in Community-Dwelling Older Adults after Mild Stroke: Implications for Falls Prevention

Liu-Ambrose T. · Pang M.Y.C. · Eng J.J.
aUBC Bone Health Research Group: Center for Hip Health, BC Women’s Hospital and Health Center Osteoporosis Program, Faculty of Medicine, bDepartment of Psychology and cSchool of Rehabilitation Sciences, Department of Physical Therapy, University of British Columbia, and dRehabilitation Research Laboratory, GF Strong Rehabilitation Center, Vancouver, and eSchool of Kinesiology, Simon Fraser University, Burnaby, Canada; fDepartment of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, SAR, China

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Stroke survivors have a high incidence of falls. Impaired executive-controlled processes are frequent in stroke survivors and are associated with falls in this population. Better understanding of the independent association between executive-controlled processes and physiological fall risk (i.e. performances of balance and mobility) could enhance future interventions that aim to prevent falls and to promote an independent lifestyle among stroke survivors. Methods: Cross-sectional analysis of 63 adults who suffered a mild stroke >1 year prior to the study, aged ≧50 years. Results: Cognitive flexibility was independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke, after accounting for age, quadriceps strength of the paretic side and current physical activity level. Conclusions: Clinicians may need to consider cognitive function when assessing and treating impaired balance and mobility in community-dwelling older adults after mild stroke.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Feigin VL, Lawes CM, Bennett DA, Anderson CS: Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;2:43–53.
  2. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Stroke: neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am 1999;10:887–906.
  3. Jorgensen L, Engstad T, Jacobsen BK: Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke 2002;33:542–547.
  4. Forster A, Young J: Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ 1995;311:83–86.
  5. Campbell AJ, Borrie MJ, Spears GF: Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989;44:M112–M117.
  6. Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–1707.
  7. Barba R, Martinez-Espinosa S, Rodriguez-Garcia E, Pondal M, Vivancos J, Del Ser T: Poststroke dementia: clinical features and risk factors. Stroke 2000;31:1494–1501.
  8. Desmond DW, Moroney JT, Paik MC, Sano M, Mohr JP, Aboumatar S, Tseng CL, Chan S, Williams JB, Remien RH, Hauser WA, Stern Y: Frequency and clinical determinants of dementia after ischemic stroke. Neurology 2000;54:1124–1131.
  9. Kokmen E, Whisnant JP, O’Fallon WM, Chu CP, Beard CM: Dementia after ischemic stroke: a population-based study in Rochester, Minnesota (1960–1984). Neurology 1996;46:154–159.
  10. Stuss DT, Alexander MP: Executive functions and the frontal lobes: a conceptual view. Psychol Res 2000;63:289–298.
  11. Spreen O, Strauss E: A Compendium of Neurological Tests, ed 2. New York, Oxford University Press, 1998.
  12. Rapport LJ, Hanks RA, Millis SR, Deshpande SA: Executive functioning and predictors of falls in the rehabilitation setting. Arch Phys Med Rehabil 1998;79:629–633.
  13. Goldman-Rackic P: Specifications of higher cortical functions. J Head Trauma Rehabil 1993;8:13–23.

    External Resources

  14. Ballard C, Stephens S, Kenny R, Kalaria R, Tovee M, O’Brien J: Profile of neuropsychological deficits in older stroke survivors without dementia. Dement Geriatr Cogn Disord 2003;16:52–56.
  15. Rapport LJ, Webster JS, Flemming KL, Lindberg JW, Godlewski MC, Brees JE, Abadee PS: Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting. Arch Phys Med Rehabil 1993;74:621–626.
  16. Fong KN, Chan CC, Au DK: Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Inj 2001;15:443–453.
  17. Heruti RJ, Lusky A, Dankner R, Ring H, Dolgopiat M, Barell V, Levenkrohn S, Adunsky A: Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome. Arch Phys Med Rehabil 2002;83:742–749.
  18. Hajek VE, Gagnon S, Ruderman JE: Cognitive and functional assessments of stroke patients: an analysis of their relation. Arch Phys Med Rehabil 1997;78:1331–1337.
  19. Pang MY, Eng JJ, Dawson AS, McKay HA, Harris JE: A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. J Am Geriatr Soc 2005;53:1667–1674.
  20. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  21. Tombaugh TN, McIntyre NJ: The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992;40:922–935.
  22. Yesavage JA: Geriatric Depression Scale. Psychopharmacol Bull 1988;24:709–711.
  23. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982;17:37–49.
  24. Kelly-Hayes M, Robertson JT, Broderick JP, Duncan PW, Hershey LA, Roth EJ, Thies WH, Trombly CA: The American Heart Association Stroke Outcome Classification: executive summary. Circulation 1998;97:2474–2478.
  25. Berg K, Wood-Dauphinee S, Gayton D: Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989;41:304–310.

    External Resources

  26. Bogle Thorbahn LD, Newton RA: Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 1996;76:576–583, discussion 584–585.
  27. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B: Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992;83(suppl 2):S7–S11.
  28. Richards C, Malouin F, Dumas F, Tardif D: Gait velocity as an outcome measure of locomotive recovery after stroke; in Craik R, Oatis C (eds): Gait Analysis. Theory and Applications. St Louis, Mosby Inc, 1995, pp 335– 364.
  29. Berg K, Wood-Dauphinee S, Williams JB: The balance scale: reliability assessment with elderly residents and patients with acute stroke. Scand J Rehabil Med 1995;27:27–36.
  30. Podsiadlo D, Richardson S: The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–148.
  31. Whitney JC, Lord SR, Close JC: Streamlining assessment and intervention in a falls clinic using the Timed Up and Go Test and Physiological Profile Assessments. Age Ageing 2005;34:567–571.
  32. Eng JJ, Chu KS, Dawson AS, Kim CM, Hepburn KE: Functional walk tests in individuals with stroke: relation to perceived exertion and myocardial exertion. Stroke 2002;33:756–761.
  33. Brown M, Sinacore DR, Host HH: The relationship of strength to function in the older adult. J Gerontol A Biol Sci Med Sci 1995;50(spec No):55–59.
  34. Kozakai R, Tsuzuku S, Yabe K, Ando F, Niino N, Shimokata H: Age-related changes in gait velocity and leg extension power in middle-aged and elderly people. J Epidemiol 2000;10:S77–S81.
  35. Brooke-Wavell K, Athersmith LE, Jones PR, Masud T: Brisk walking and postural stability: a cross-sectional study in postmenopausal women. Gerontology 1998;44:288–292.
  36. Prioli AC, Freitas Junior PB, Barela JA: Physical activity and postural control in the elderly: coupling between visual information and body sway. Gerontology 2005;51:145–148.
  37. Stroop J: Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643–662.

    External Resources

  38. Wechsler D: Wechsler Adult Intelligence Scale – Revised Manual. San Antonio, Psychological Corporation, 1980.
  39. Golden C, Freshwater S: The Stroop Color and Word Test. A Manual for Clinical and Experimental Uses. Wood Dale, Stoelting Company, 1998.
  40. Gregoire J, Van der Linden M: Effect of age on forward and backward digit spans. Aging Neuropsychol Cogn 1997;4:140–149.

    External Resources

  41. Tiedemann A, Sherrington C, Lord SR: Physiological and psychological predictors of walking speed in older community-dwelling people. Gerontology 2005;51:390–395.
  42. Bohannon R: The relationship of knee muscle performance and gait in stroke patients. Disabil Rehabil 1996;18:638.
  43. Washburn RA, Zhu W, McAuley E, Frogley M, Figoni SF: The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil 2002;83:193–200.
  44. Tabachnick B, Fidell L: Using Multivariate Statistics, ed 4. Boston, Allyn & Bacon, 2001.
  45. Tabbarah M, Crimmins EM, Seeman TE: The relationship between cognitive and physical performance: MacArthur Studies of Successful Aging. J Gerontol A Biol Sci Med Sci 2002;57:M228–M235.
  46. Grillner S, Parker D, el Manira A: Vertebrate locomotion – a lamprey perspective. Ann NY Acad Sci 1998;860:1–18.
  47. Dault MC, Geurts AC, Mulder TW, Duysens J: Postural control and cognitive task performance in healthy participants while balancing on different support-surface configurations. Gait Posture 2001;14:248–255.
  48. Maki BE, Zecevic A, Bateni H, Kirshenbaum N, McIlroy WE: Cognitive demands of executing postural reactions: does aging impede attention switching? Neuroreport 2001;12:3583–3587.
  49. Kuo HK, Lipsitz LA: Cerebral White matter changes and geriatric syndromes: is there a link? J Gerontol A Biol Sci Med Sci 2004;59:M818–M826.
  50. Holtzer R, Verghese J, Xue X, Lipton RB: Cognitive processes related to gait velocity: results from the Einstein Aging Study. Neuropsychology 2006;20:215–223.
  51. Ble A, Volpato S, Zuliani G, Guralnik JM, Bandinelli S, Lauretani F, Bartali B, Maraldi C, Fellin R, Ferrucci L: Executive function correlates with walking speed in older persons: the InCHIANTI study. J Am Geriatr Soc 2005;53:410–415.
  52. Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM: Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 2006;21:950–957.
  53. Persad CC, Giordani B, Chen HC, Ashton-Miller JA, Alexander NB, Wilson CS, Berent S, Guire K, Schultz AB: Neuropsychological predictors of complex obstacle avoidance in healthy older adults. J Gerontol B Psychol Sci Soc Sci 1995;50:P272–P277.
  54. Di Fabio RP, Kurszewski WM, Jorgenson EE, Kunz RC: Footlift asymmetry during obstacle avoidance in high-risk elderly. J Am Geriatr Soc 2004;52:2088–2093.
  55. Brauer SG, Woollacott M, Shumway-Cook A: The interacting effects of cognitive demand and recovery of postural stability in balance-impaired elderly persons. J Gerontol A Biol Sci Med Sci 2001;56:M489–M496.
  56. Colcombe S, Kramer AF: Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci 2003;14:125–130.
  57. Lezak MD: Neuropsychological Assessment, ed 3. New York, Oxford University Press, 1995.
  58. Burgess PW, Alderman N, Evans J, Emslie H, Wilson BA: The ecological validity of tests of executive function. J Int Neuropsychol Soc 1998;4:547–558.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50