The Effect of Postural Control on Attentional Resource Allocation in Alzheimer’s Disease: An Event-Related Potential Study

Abstract

Objective

To examine how the postural demand of quiet standing, compared to sitting, affects the allocation of attentional resources during a concurrent cognitive task in healthy older adults and individuals with Alzheimer’s disease (AD).

Methods

87 healthy older adults (age 71.7 ± 4.2 years; MoCA 28.9 ± 1.1) and 16 individuals with AD (age 74.3 ± 5.1 years; MoCA 19.6 ± 6.3) completed a two-minute auditory novelty oddball task (50 stimuli: 80% frequent, 10% rare, 10% novelty) in both standing and sitting positions. Neural activity was recorded using electroencephalography (EEG). We used linear mixed models to compare P3 event-related potentials (ERPs) across groups and conditions, focusing on the P3b component (conscious stimulus evaluation) and the P3a component (automatic novelty detection). Behavioral outcomes were accuracy and reaction times on the oddball task, and sway velocity collected from a head-mounted accelerometer.

Results

A significant condition × group interaction was found for P3b latency in response to frequent stimuli (p = 0.003). While sitting, the AD group showed shorter P3b latencies than healthy older adults (p = 0.036). However, this pattern reversed under postural load: individuals with AD had significantly longer P3b latencies when standing compared to sitting (p = 0.01), whereas healthy older adults showed the opposite pattern, with significantly decreased latencies (p = 0.04). No significant effects were found for P3b amplitude or for the P3a component. Postural condition did not significantly impact behavioral outcomes in either group.

Conclusions

Quiet standing may impose a selective neural cost on individuals with AD, reflected in slower conscious cognitive processing, while appearing to act as an arousing factor that facilitates faster processing in healthy older adults. Maintaining posture might require a reallocation of limited attentional resources that disrupts higher-order processing in AD.

Keywords

postural control Alzheimer’s disease EEG ERP cognitive workload auditory oddball

Get full access to this article

View all access options for this article.

References

Abou Khalil

Doré-Mazars

Senot

Wang

D. P.

Legrand

(2020). Is it better to sit down, stand up or walk when performing memory and arithmetic activities? Experimental Brain Research, 238(11), 2487–2496. https://doi.org/10.1007/s00221-020-05858-z

Akimoto

Kanno

Kambara

Nozawa

Sugiura

Okumura

Kawashima

(2013). Spatiotemporal dynamics of high-gamma activities during a 3-Stimulus visual oddball task. PLoS One, 8(3), Article e59969. https://doi.org/10.1371/journal.pone.0059969

Allan

L. M.

Ballard

C. G.

Rowan

E. N.

Kenny

R. A.

(2009). Incidence and prediction of falls in dementia: A prospective study in older people. PLoS One, 4(5), Article e5521. https://doi.org/10.1371/journal.pone.0005521

Alperin

B. R.

Mott

K. K.

Rentz

D. M.

Holcomb

P. J.

Daffner

K. R.

(2014). Investigating the age-related “anterior shift” in the scalp distribution of the P3b component using principal component analysis. Psychophysiology, 51(7), 620–633. https://doi.org/10.1111/psyp.12206

Al-Yahya

Dawes

Smith

Dennis

Howells

Cockburn

(2011). Cognitive motor interference while walking: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 35(3), 715–728. https://doi.org/10.1016/j.neubiorev.2010.08.008

Andersson

Hagman

Talianzadeh

Svedberg

Larsen

H. C.

(2002). Effect of cognitive load on postural control. Brain Research Bulletin, 58(1), 135–139. https://doi.org/10.1016/s0361-9230(02)00770-0

Andrade

Rinaldi

Coelho

Tanaka

Stella

Gobbi

(2014). Dual task and postural control in Alzheimer’s and Parkinson’s disease. Motriz. Revista de Educacao Fisica, 20(1), 78–84. https://doi.org/10.1590/S1980-65742014000100012

Bayot

Dujardin

Tard

Defebvre

Bonnet

C. T.

Allart

Delval

(2018). The interaction between cognition and motor control: A theoretical framework for dual-task interference effects on posture, gait initiation, gait and turning. Neurophysiologie Clinique, 48(6), 361–375. https://doi.org/10.1016/j.neucli.2018.10.003

Beauchet

Dubost

Herrmann

Kressig

(2005). Stride-to-stride variability while backward counting among healthy young adults. Journal of NeuroEngineering and Rehabilitation, 2(1), 26. https://doi.org/10.1186/1743-0003-2-26

10.

Berg

K. O.

Kairy

(2002). Balance interventions to prevent falls. Generations: Journal of the American Society on Aging, 26(4), 75–78.

11.

Boisgontier

M. P.

Beets

I. A.

Duysens

Nieuwboer

Krampe

R. T.

Swinnen

S. P.

(2013). Age-related differences in attentional cost associated with postural dual tasks: Increased recruitment of generic cognitive resources in older adults. Neuroscience & Biobehavioral Reviews, 37(8), 1824–1837. https://doi.org/10.1016/j.neubiorev.2013.07.014

12.

Brown

L. A.

Shumway-Cook

Woollacott

M. H.

(1999). Attentional demands and postural recovery: The effects of aging. The Journals of Gerontology: Series A, 54(4), M165–M171. https://doi.org/10.1093/gerona/54.4.m165

13.

Cohen

J. A.

Verghese

Zwerling

J. L.

(2016). Cognition and gait in older people. Maturitas, 93, 73–77. https://doi.org/10.1016/j.maturitas.2016.05.005

14.

Daffner

K. R.

Chong

Sun

Tarbi

E. C.

Riis

J. L.

McGinnis

S. M.

Holcomb

P. J.

(2011). Investigating the age-related “anterior shift” in the scalp distribution of the P3b component using principal component analysis. Psychophysiology, 48(7), 945–954. https://doi.org/10.1111/j.1469-8986.2010.01160.x

15.

Debener

Kranczioch

Herrmann

C. S.

Engel

A. K.

(2002). Auditory novelty oddball allows reliable distinction of top–down and bottom–up processes of attention. International Journal of Psychophysiology, 46(1), 77–84. https://doi.org/10.1016/s0167-8760(02)00072-7

16.

Delorme

Makeig

(2004). EEGLAB: An open source toolbox for analysis of single-trial EEG dynamics including independent component analysis. Journal of Neuroscience Methods, 134(1), 9–21. https://doi.org/10.1016/j.jneumeth.2003.10.009

17.

Demirayak

Kıyı

İ.

İşbitiren

Y. Ö.

Yener

(2023). Cognitive load associates prolonged P300 latency during target stimulus processing in individuals with mild cognitive impairment. Scientific Reports, 13(1), Article 15956. https://doi.org/10.1038/s41598-023-43132-8

18.

Devos

Gustafson

Liao

Ahmadnezhad

Kuhlmann

Estes

B. J.

Martin

L. E.

Mahnken

J. D.

Brooks

W. M.

Burns

J. M.

(2023). Effect of cognitive reserve on physiological measures of cognitive workload in older adults with cognitive impairments. Journal of Alzheimer’s Disease, 92(1), 141–151. https://doi.org/10.3233/jad-220890

19.

Dijkstra

B. W.

Bekkers

E. M. J.

Gilat

de Rond

Hardwick

R. M.

Nieuwboer

(2020). Functional neuroimaging of human postural control: A systematic review with meta-analysis. Neuroscience & Biobehavioral Reviews, 115, 351–362. https://doi.org/10.1016/j.neubiorev.2020.04.028

20.

Escera

Alho

Winkler

Näätänen

(1998). Neural mechanisms of involuntary attention to acoustic novelty and change. Journal of Cognitive Neuroscience, 10(5), 590–604. https://doi.org/10.1162/089892998562997

21.

Fakorede

Alkhameys

Liao

Martin

Devos

(2025). Neural evidence for attentional resource allocation to postural control using brain-body imaging. Behavioural Brain Research, 494, Article 115716. https://doi.org/10.1016/j.bbr.2025.115716

22.

Fonken

Y. M.

Kam

J. W. Y.

Knight

R. T.

(2020). A differential role for human hippocampus in novelty and contextual processing: Implications for P300. Psychophysiology, 57(7), Article e13400. https://doi.org/10.1111/psyp.13400

23.

Friedman

Kazmerski

Fabiani

(1997). An overview of age-related changes in the scalp distribution of P3b. Electroencephalography and Clinical Neurophysiology, 104(6), 498–513. https://doi.org/10.1016/s0168-5597(97)00036-1

24.

Gago

M. F.

Yelshyna

Bicho

Silva

H. D.

Rocha

Lurdes Rodrigues

Sousa

(2016). Compensatory postural adjustments in an oculus virtual reality environment and the risk of falling in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders Extra, 6(2), 252–267. https://doi.org/10.1159/000447124

25.

Goodin

D. S.

Squires

K. C.

Henderson

B. H.

Starr

(1978). An early event-related cortical potential. Psychophysiology, 15, 360–365. https://doi.org/10.1111/j.1469-8986.1978.tb01392.x

26.

Sohrabpour

Brown

Liu

(2018). Electrophysiological source imaging: A noninvasive window to brain dynamics. Annual Review of Biomedical Engineering, 20(1), 171–196. https://doi.org/10.1146/annurev-bioeng-062117-120853

27.

Helfrich

R. F.

Knight

R. T.

(2019). Cognitive neurophysiology: Event-related potentials. Handbook of Clinical Neurology, 160, 543–558. https://doi.org/10.1016/b978-0-444-64032-1.00036-9

28.

Horak

F. B.

(1996). Adaptation of automatic postural responses. In The acquisition of motor behavior in vertebrates (pp. 57–85). Cambridge, MA: Books / MIT Press.

29.

Huxhold

S.-C.

Schmiedek

Lindenberger

(2006). Dual-tasking postural control: Aging and the effects of cognitive demand in conjunction with focus of attention. Brain Research Bulletin, 69(3), 294–305. https://doi.org/10.1016/j.brainresbull.2006.01.002

30.

Inagaki

Shimizu

Sakairi

(2018). Effects of posture regulation on mood states, heart rate and test performance in children. Educational Psychology, 38(9), 1129–1146. https://doi.org/10.1080/01443410.2018.1504003

31.

Karatekin

Couperus

J. W.

Marcus

D. J.

(2004). Attention allocation in the dual-task paradigm as measured through behavioral and psychophysiological responses. Psychophysiology, 41(2), 175–185. https://doi.org/10.1111/j.1469-8986.2004.00147.x

32.

Kerr

Condon

S. M.

McDonald

L. A.

(1985). Cognitive spatial processing and the regulation of posture. Journal of Experimental Psychology: Human Perception and Performance, 11(5), 617–622. https://doi.org/10.1037//0096-1523.11.5.617

33.

LabStreamingLayer . (2024). Lab streaming layer. https://labstreaminglayer.org/#/

34.

Ladouce

Donaldson

D. I.

Dudchenko

P. A.

Ietswaart

(2019). Mobile EEG identifies the re-allocation of attention during real-world activity. Scientific Reports, 9(1), Article 15851. https://doi.org/10.1038/s41598-019-51996-y

35.

Lajoie

Teasdale

Bard

Fleury

(1993). Attentional demands for static and dynamic equilibrium. Experimental Brain Research, 97(1), 139–144. https://doi.org/10.1007/bf00228824

36.

Lopez-Calderon

Luck

S. J.

(2014). ERPLAB: An open-source toolbox for the analysis of event-related potentials. Frontiers in Human Neuroscience, 8, 213. https://doi.org/10.3389/fnhum.2014.00213

37.

Luck

S. J.

Kappenman

E. S.

Fuller

R. L.

Robinson

Summerfelt

Gold

J. M.

(2009). Impaired response selection in schizophrenia: Evidence from the P3 wave and the lateralized readiness potential. Psychophysiology, 46(4), 776–786. https://doi.org/10.1111/j.1469-8986.2009.00817.x

38.

Luck

S. J.

Stewart

A. X.

Simmons

A. M.

Rhemtulla

(2021). Standardized measurement error: A universal metric of data quality for averaged event-related potentials. Psychophysiology, 58(6), Article e13793. https://doi.org/10.1111/psyp.13793

39.

Maidan

Fahoum

Shustak

Gazit

Patashov

Tchertov

Giladi

Hausdorff

J. M.

Mirelman

(2019). Changes in event-related potentials during dual task walking in aging and Parkinson’s disease. Clinical Neurophysiology, 130(2), 224–230. https://doi.org/10.1016/j.clinph.2018.11.019

40.

Manckoundia

Pfitzenmeyer

d’Athis

Dubost

Mourey

(2006). Impact of cognitive task on the posture of elderly subjects with Alzheimer’s disease compared to healthy elderly subjects. Movement Disorders, 21(2), 236–241. https://doi.org/10.1002/mds.20649

41.

Marshall

S. P.

(2007). Identifying cognitive state from eye metrics. Aviation, Space and Environmental Medicine, 78(5S), B165–B175.

42.

Martelli

Barban

Zoccolotti

Silveri

M. C.

(2012). Slowing of information processing in Alzheimer disease: Motor as well as cognitive factors. Cognitive and Behavioral Neurology, 25(4), 175–185. https://doi.org/10.1097/WNN.0b013e318274fc44

43.

MathWorks . (2024). R2023b release highlights - MATLAB and simulink. https://www.mathworks.com/products/new_products/release2023b.html

44.

Mendes

A. J.

Pacheco-Barrios

Lema

Gonçalves Ó

Fregni

Leite

Carvalho

(2022). Modulation of the cognitive event-related potential P3 by transcranial direct current stimulation: Systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 132, 894–907. https://doi.org/10.1016/j.neubiorev.2021.11.002

45.

Mento

(2017). The role of the P3 and CNV components in voluntary and automatic temporal orienting: A high spatial-resolution ERP study. Neuropsychologia, 107, 31–40. https://doi.org/10.1016/j.neuropsychologia.2017.10.037

46.

Moon

Huang

C. K.

Sadeghi

Akinwuntan

A. E.

Devos

(2021). Proof-of-Concept of the virtual reality comprehensive balance assessment and training for sensory organization of dynamic postural control. Frontiers in Bioengineering and Biotechnology, 9, Article 678006. https://doi.org/10.3389/fbioe.2021.678006

47.

Morasso

P. G.

Schieppati

(1999). Can muscle stiffness alone stabilize upright standing? Journal of Neurophysiology, 82(3), 1622–1626. https://doi.org/10.1152/jn.1999.82.3.1622

48.

Nasreddine

Z. S.

Phillips

N. A.

Bedirian

Charbonneau

Whitehead

Collin

Cummings

J. L.

Chertkow

(2005). The Montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

49.

Pinheiro

J. C.

Bates

D. M.

(2000). Mixed-effects models in S and S-PLUS. Springer-Verlag.

50.

Polich

(2007). Updating P300: An integrative theory of P3a and P3b. Clinical Neurophysiology, 118(10), 2128–2148. https://doi.org/10.1016/j.clinph.2007.04.019

51.

Prieto

T. E.

Myklebust

J. B.

Hoffmann

R. G.

Lovett

E. G.

Myklebust

B. M.

(1996). Measures of postural steadiness: Differences between healthy young and elderly adults. IEEE Transactions on Biomedical Engineering, 43(9), 956–966. https://doi.org/10.1109/10.532130

52.

Protzak

Wiczorek

Gramann

(2021). Peripheral visual perception during natural overground dual-task walking in older and younger adults. Neurobiology of Aging, 98, 146–159. https://doi.org/10.1016/j.neurobiolaging.2020.10.009

53.

Raymakers

J. A.

Samson

M. M.

Verhaar

H. J.

(2005). The assessment of body sway and the choice of the stability parameter(s). Gait & Posture, 21(1), 48–58. https://doi.org/10.1016/j.gaitpost.2003.11.006

54.

Richardson

D. P.

Foxe

J. J.

Freedman

E. G.

(2024). Reduced proactive and reactive cognitive flexibility in older adults underlies performance costs during dual-task walking: A Mobile brain/body imaging (MoBI) study. bioRxiv. https://doi.org/10.1101/2024.01.27.577090

55.

Sadeghi

Bristow

Fakorede

Liao

Palmer

J. A.

Lyons

K. E.

Pahwa

Huang

C.-K.

Akinwuntan

Devos

(2024). The effect of sensory reweighting on postural control and cortical activity in Parkinson's disease: A pilot study. Archives of Rehabilitation Research and Clinical Translation, 6(4), Article 100368. https://doi.org/10.1016/j.arrct.2024.100368

56.

Salisbury

D. F.

Rutherford

Shenton

M. E.

McCarley

R. W.

(2001). Button-pressing affects P300 amplitude and scalp topography. Clinical Neurophysiology, 112(9), 1676–1684. https://doi.org/10.1016/S1388-2457(01)00607-1

57.

Schaefer

Lövdén

Wieckhorst

Lindenberger

(2010). Cognitive performance is improved while walking: Differences in cognitive-sensorimotor couplings between children and young adults. European Journal of Developmental Psychology, 7(3), 371–381. https://doi.org/10.1080/17405620802535666

58.

Serra

Mancini

Cercignani

Di Domenico

Spanò

Giulietti

Koch

Marra

Bozzali

(2017). Network-based substrate of cognitive reserve in Alzheimer’s disease. Journal of Alzheimer’s Disease, 55(1), 421–430. https://doi.org/10.3233/jad-160735

59.

Serra-Añó

Pedrero-Sánchez

J. F.

Hurtado-Abellán

Inglés

Espí-López

G. V.

López-Pascual

(2019). Mobility assessment in people with Alzheimer disease using smartphone sensors. Journal of NeuroEngineering and Rehabilitation, 16(1), 103. https://doi.org/10.1186/s12984-019-0576-y

60.

Smith

K. C.

Davoli

C. C.

Knapp

W. H.

Abrams

R. A.

(2019). Standing enhances cognitive control and alters visual search. Attention, Perception, & Psychophysics, 81(7), 2320–2329. https://doi.org/10.3758/s13414-019-01723-6

61.

Teasdale

Simoneau

(2001). Attentional demands for postural control: The effects of aging and sensory reintegration. Gait & Posture, 14(3), 203–210. https://doi.org/10.1016/s0966-6362(01)00134-5

62.

Toda

Tachibana

Sugita

Konishi

(1993). P300 and reaction time in Parkinson’s disease. Journal of Geriatric Psychiatry and Neurology, 6(3), 131–136. https://doi.org/10.1177/089198879300600301

63.

Vila-Chã

Vaz

Oliveira

A. S.

(2021). Electrocortical activity in older adults is more influenced by cognitive task complexity than concurrent walking. Frontiers in Aging Neuroscience, 13, Article 718648. https://doi.org/10.3389/fnagi.2021.718648

64.

Vuillerme

Nougier

Teasdale

(2000). Effects of a reaction time task on postural control in humans. Neuroscience Letters, 291(2), 77–80. https://doi.org/10.1016/s0304-3940(00)01374-4

65.

Wallmann

H. W.

(2009). The basics of balance and falls. Home Health Care Management & Practice, 21(6), 436–439. https://doi.org/10.1177/1084822309337189

66.

Woollacott

Shumway-Cook

(2002). Attention and the control of posture and gait: A review of an emerging area of research. Gait & Posture, 16(1), 1–14. https://doi.org/10.1016/S0966-6362(01)00156-4

67.

Zhou

Seeley

W. W.

(2014). Network dysfunction in Alzheimer’s disease and frontotemporal dementia: Implications for psychiatry. Biological Psychiatry, 75(7), 565–573. https://doi.org/10.1016/j.biopsych.2014.01.020

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.38 MB