Brain activity during dual-task standing in older adults

Melike Kahya*, Natalia A. Gouskova, On Yee Lo, Junhong Zhou, Davide Cappon, Emma Finnerty, Alvaro Pascual-Leone, Lewis A. Lipsitz, Jeffrey M. Hausdorff, Brad Manor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: In older adults, the extent to which performing a cognitive task when standing diminishes postural control is predictive of future falls and cognitive decline. The neurophysiology of such “dual-tasking” and its effect on postural control (i.e., dual-task cost) in older adults are poorly understood. The purpose of this study was to use electroencephalography (EEG) to examine the effects of dual-tasking when standing on brain activity in older adults. We hypothesized that compared to single-task “quiet” standing, dual-task standing would decrease alpha power, which has been linked to decreased motor inhibition, as well as increase the ratio of theta to beta power, which has been linked to increased attentional control. Methods: Thirty older adults without overt disease completed four separate visits. Postural sway together with EEG (32-channels) were recorded during trials of standing with and without a concurrent verbalized serial subtraction dual-task. Postural control was measured by average sway area, velocity, and path length. EEG metrics included absolute alpha-, theta-, and beta-band powers as well as theta/beta power ratio, within six demarcated regions-of-interest: the left and right anterior, central, and posterior regions of the brain. Results: Most EEG metrics demonstrated moderate-to-high between-day test–retest reliability (intra-class correlation coefficients > 0.70). Compared with quiet standing, dual-tasking decreased alpha-band power particularly in the central regions bilaterally (p = 0.002) and increased theta/beta power ratio in the anterior regions bilaterally (p < 0.001). A greater increase in theta/beta ratio from quiet standing to dual-tasking in numerous demarcated brain regions correlated with greater dual-task cost (i.e., absolute increase, indicative of worse performance) to postural sway metrics (r = 0.45–0.56, p < 0.01). Lastly, participants who exhibited greater alpha power during dual-tasking in the anterior-right (r = 0.52, p < 0.01) and central-right (r = 0.48, p < 0.01) regions had greater postural sway velocity during dual-tasking. Conclusion: In healthy older adults, alpha power and theta/beta power ratio change with dual-task standing. The change in theta/beta power ratio in particular may be related to the ability to regulate standing postural control when simultaneously performing unrelated, attention-demanding cognitive tasks. Modulation of brain oscillatory activity might therefore be a novel target to minimize dual-task cost in older adults.

Original languageEnglish
Article number123
JournalJournal of NeuroEngineering and Rehabilitation
Issue number1
StatePublished - Dec 2022


FundersFunder number
Boston Claude D. Pepper Older Americans Independence CenterP30-AG013679
Neuroelectrics Corp.
National Institutes of HealthR24AG06142, P01 AG031720
National Institute on AgingR01AG059089, R03AG072233, R21 AG064575, T32AG023480
BrightFocus Foundation
“la Caixa” Foundation
United States-Israel Binational Science Foundation2015271


    • Brain activity
    • Dual-tasking
    • Electroencephalography
    • Older adults
    • Posture


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