Original research| Volume 96, ISSUE 4, P690-696, April 2015

Download started.


Effects of Emotionally Charged Auditory Stimulation on Gait Performance in the Elderly: A Preliminary Study

Published:December 23, 2014DOI:



      To evaluate the effect of a novel divided attention task—walking under auditory constraints—on gait performance in older adults and to determine whether this effect was moderated by cognitive status.


      Validation cohort.


      General community.


      Ambulatory older adults without dementia (N=104).


      Not applicable.

      Main Outcome Measures

      In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds.


      The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5–10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences.


      Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.


      List of abbreviations:

      ADL (activities of daily living)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention (CDC)
        Vital signs: walking among adults—United States, 2005 and 2010.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 595-601
        • Yang Y.
        • Diez-Roux A.V.
        Walking distance by trip purpose and population subgroups.
        Am J Prev Med. 2012; 43: 11-19
        • Owen N.
        • Humpel N.
        • Leslie E.
        • Bauman A.
        • Sallis J.F.
        Understanding environmental influences on walking: review and research agenda.
        Am J Prev Med. 2004; 27: 67-76
        • Simpson M.E.
        • Serdula M.
        • Galuska D.A.
        • Gillespie C.
        • Donehoo R.
        • Macera C.
        • Mack K.
        Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000.
        Am J Prev Med. 2003; 25: 95-100
        • Rafferty A.P.
        • Reeves M.J.
        • McGee H.B.
        • Pivarnik J.M.
        Physical activity patterns among walkers and compliance with public health recommendations.
        Med Sci Sports Exerc. 2002; 34: 1255-1261
        • Hausdorff J.M.
        • Yogev G.
        • Springer S.
        • Simon E.S.
        • Giladi N.
        Walking is more like catching than tapping: gait in the elderly as a complex cognitive task.
        Exp Brain Res. 2005; 164: 541-548
        • Beauchet O.
        • Dubost V.
        • Allali G.
        • Gonthier R.
        • Hermann F.R.
        • Kressig R.W.
        ‘Faster counting while walking’ as a predictor of falls in older adults.
        Age Ageing. 2007; 36: 418-423
        • Szturm T.
        • Maharjan P.
        • Marotta J.J.
        • Shay B.
        • Shrestha S.
        • Sakhalkar V.
        The interacting effect of cognitive and motor task demands on performance of gait, balance and cognition in young adults.
        Gait Posture. 2013; 38: 596-602
        • Verghese J.
        • Buschke H.
        • Viola L.
        • et al.
        Validity of divided attention tasks in predicting falls in older individuals: a preliminary study.
        J Am Geriatr Soc. 2002; 50: 1572-1576
        • Camicioli R.
        • Howieson D.
        • Lehman S.
        • Kaye J.
        Talking while walking: the effect of a dual task in aging and Alzheimer’s disease.
        Neurology. 1997; 48: 955-958
        • Lundin-Olsson L.
        • Nyberg L.
        • Gustafson Y.
        “Stops walking when talking” as a predictor of falls in elderly people.
        Lancet. 1997; 349 ([letter]): 617
        • de Hoon E.W.
        • Allum J.H.
        • Carpenter M.G.
        • et al.
        Quantitative assessment of the stops walking while talking test in the elderly.
        Arch Phys Med Rehabil. 2003; 84: 838-842
        • Hauer K.
        • Pfisterer M.
        • Weber C.
        • Wezler N.
        • Kliegel M.
        • Oster P.
        Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls.
        J Am Geriatr Soc. 2003; 51: 1638-1644
        • Sheridan P.L.
        • Solomont J.
        • Kowall N.
        • Hausdorff J.M.
        Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer’s disease.
        J Am Geriatr Soc. 2003; 51: 1633-1637
        • Beauchet O.
        • Dubost V.
        • Aminian K.
        • Gonthier R.
        • Kressig R.W.
        Dual-task-related gait changes in the elderly: does the type of cognitive task matter?.
        J Mot Behav. 2005; 37: 259-264
        • Beauchet O.
        • Annweiler C.
        • Dubost V.
        • et al.
        Stops walking when talking: a predictor of falls in older adults?.
        Eur J Neurol. 2009; 16: 786-795
        • Ayers E.I.
        • Tow A.C.
        • Holtzer R.
        • Verghese J.
        Walking while talking and falls in aging.
        Gerontology. 2014; 60: 108-113
        • Verghese J.
        • Holtzer R.
        • Lipton R.B.
        • Wang C.
        Mobility stress test approach to predicting frailty, disability, and mortality in high-functioning older adults.
        J Am Geriatr Soc. 2012; 60: 1901-1905
        • Whitney S.L.
        • Marchetti G.F.
        • Schade A.
        • Wrisley D.M.
        The sensitivity and specificity of the Timed “Up & Go” and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders.
        J Vestib Res. 2004; 14: 397-409
        • Jenkins M.E.
        • Johnson A.M.
        • Holmes J.D.
        • Stephenson F.F.
        • Spaulding S.J.
        Predictive validity of the UPDRS postural stability score and the Functional Reach Test, when compared with ecologically valid reaching tasks.
        Parkinsonism Relat Disord. 2010; 16: 409-411
        • Sterke C.S.
        • Huisman S.L.
        • van Beeck E.F.
        • Looman C.W.
        • van der Cammen T.J.
        Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?.
        Int Psychogeriatr. 2010; 22: 254-263
        • Wrisley D.M.
        • Kumar N.A.
        Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults.
        Phys Ther. 2010; 90: 761-773
        • Foreman K.B.
        • Addison O.
        • Kim H.S.
        • Dibble L.E.
        Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing.
        Parkinsonism Relat Disord. 2011; 17: 166-171
        • Duncan R.P.
        • Earhart G.M.
        Four square step test performance in people with Parkinson disease.
        J Neurol Phys Ther. 2013; 37: 2-8
        • Smith P.A.
        Aging, Auditory Distraction and Grammaticality Judgment.
        Aphasiology. 2010; 24: 1342-1353
        • Parmentier F.B.
        • Andres P.
        The involuntary capture of attention by sound: novelty and postnovelty distraction in young and older adults.
        Exp Psychol. 2010; 57: 68-76
        • Harris K.C.
        • Eckert M.A.
        • Ahlstrom J.B.
        • Dubno J.R.
        Age-related differences in gap detection: effects of task difficulty and cognitive ability.
        Hear Res. 2010; 264: 21-29
        • Kwak E.E.
        Effect of rhythmic auditory stimulation on gait performance in children with spastic cerebral palsy.
        J Music Ther. 2007; 44: 198-216
        • Wittwer J.E.
        • Webster K.E.
        • Hill K.
        Rhythmic auditory cueing to improve walking in patients with neurological conditions other than Parkinson’s disease—what is the evidence?.
        Disabil Rehabil. 2013; 35: 164-176
        • Sejdić E.
        • Jeffery R.
        • Vanden Kroonenberg A.
        • Chau T.
        An investigation of stride interval stationarity while listening to music or viewing television.
        Hum Mov Sci. 2012; 31: 695-706
        • Kim S.J.
        • Kwak E.E.
        • Park E.S.
        • Cho S.R.
        Differential effects of rhythmic auditory stimulation and neurodevelopmental treatment/Bobath on gait patterns in adults with cerebral palsy: a randomized controlled trial.
        Clin Rehabil. 2012; 26: 904-914
        • Arias P.
        • Cudeiro J.
        Effect of rhythmic auditory stimulation on gait in Parkinsonian patients with and without freezing of gait.
        PLoS One. 2010; 5: e9675
        • Thaut M.H.
        • Leins A.K.
        • Rice R.R.
        • et al.
        Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial.
        Neurorehabil Neural Repair. 2007; 21: 455-459
        • Styns F.
        • van Noorden L.
        • Moelants D.
        • Leman M.
        Walking on music.
        Hum Mov Sci. 2007; 26: 769-785
        • Sander K.
        • Scheich H.
        Auditory perception of laughing and crying activates human amygdala regardless of attentional state.
        Brain Res Cogn Brain Res. 2001; 12: 181-198
        • Sander K.
        • Brechmann A.
        • Scheich H.
        Audition of laughing and crying leads to right amygdala activation in a low-noise fMRI setting.
        Brain Res Brain Res Protoc. 2003; 11: 81-91
        • Sander K.
        • Scheich H.
        Left auditory cortex and amygdala, but right insula dominance for human laughing and crying.
        J Cogn Neurosci. 2005; 17: 1519-1531
        • Sander K.
        • Frome Y.
        • Scheich H.
        FMRI activations of amygdala, cingulate cortex, and auditory cortex by infant laughing and crying.
        Hum Brain Mapp. 2007; 28: 1007-1022
        • Tschacher W.
        • Schildt M.
        • Sander K.
        Brain connectivity in listening to affective stimuli: a functional magnetic resonance imaging (fMRI) study and implications for psychotherapy.
        Psychother Res. 2010; 20: 576-588
        • Sloman L.
        • Pierrynowski M.
        • Berridge M.
        • Tupling S.
        • Flowers J.
        Mood, depressive illness and gait patterns.
        Can J Psychiatry. 1987; 32: 190-193
        • Naugle K.M.
        • Joyner J.
        • Hass C.J.
        • Janelle C.M.
        Emotional influences on locomotor behavior.
        J Biomech. 2010; 43: 3099-3103
        • Naugle K.M.
        • Hass C.J.
        • Joyner J.
        • Coombes S.A.
        • Janelle C.M.
        Emotional state affects the initiation of forward gait.
        Emotion. 2011; 11: 267-277
        • Naugle K.M.
        • Hass C.J.
        • Bowers D.
        • Janelle C.M.
        Emotional state affects gait initiation in individuals with Parkinson’s disease.
        Cogn Affect Behav Neurosci. 2012; 12: 207-219
        • Gage W.H.
        • Sleik R.J.
        • Polych M.A.
        • McKenzie N.C.
        • Brown L.A.
        The allocation of attention during locomotion is altered by anxiety.
        Exp Brain Res. 2003; 150: 385-394
        • Lipton R.B.
        • Katz M.J.
        • Kuslansky G.
        • et al.
        Screening for dementia by telephone using the memory impairment screen.
        J Am Geriatr Soc. 2003; 51: 1382-1390
        • Verghese J.
        • Katz M.J.
        • Derby C.A.
        • Kuslansky G.
        • Hall C.B.
        • Lipton R.B.
        Reliability and validity of a telephone-based mobility assessment questionnaire [letter].
        Age Ageing. 2004; 33: 628-632
        • Blessed G.
        • Tomlinson B.E.
        • Roth M.
        The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects.
        Br J Psychiatry. 1968; 114: 797-811
        • Buschke H.
        Selective reminding for analysis of memory and learning.
        J Verbal Learn Verbal Behav. 1973; 12: 543-550
        • Wechsler D.
        Wechsler Adult Intelligence Scale—Revised (WAIS-R).
        Psychological Corporation, New York1981
        • Monsch A.U.
        • Bondi M.W.
        • Butters N.
        • Salmon D.P.
        • Katzman R.
        • Thal L.J.
        Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer type.
        Arch Neurol. 1992; 49: 1253-1258
        • Yesavage J.A.
        • Brink T.L.
        • Rose T.L.
        • et al.
        Development and validation of a geriatric depression screening scale: a preliminary report.
        J Psychiatr Res. 1982; 17: 37-49
        • Holtzer R.
        • Verghese J.
        • Xue X.
        • Lipton R.B.
        Cognitive processes related to gait velocity: results from the Einstein Aging Study.
        Neuropsychology. 2006; 20: 215-223
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        Fourth Edition. American Psychiatric Association, Arlington, VA1994
        • Strozyk D.
        • Dickson D.W.
        • Lipton R.B.
        • et al.
        Contribution of vascular pathology to the clinical expression of dementia.
        Neurobiol Aging. 2010; 31: 1710-1720
        • Verghese J.
        • Wang C.
        • Lipton R.B.
        • Holtzer R.
        • Xue X.
        Quantitative gait dysfunction and risk of cognitive decline and dementia.
        J Neurol Neurosurg Psychiatry. 2007; 78: 929-935
        • Mathuranath P.S.
        • George A.
        • Ranjith N.
        • et al.
        Incidence of Alzheimer’s disease in India: a 10 years follow-up study.
        Neurol India. 2012; 60: 625-630
        • Mayeux R.
        • Reitz C.
        • Brickman A.M.
        • et al.
        Operationalizing diagnostic criteria for Alzheimer’s disease and other age-related cognitive impairment, part 1.
        Alzheimers Dement. 2011; 7: 15-34
        • Seshadri S.
        • Beiser A.
        • Au R.
        • et al.
        Operationalizing diagnostic criteria for Alzheimer’s disease and other age-related cognitive impairment, part 2.
        Alzheimers Dement. 2011; 7: 35-52
        • Gill T.M.
        • Kurland B.
        The burden and patterns of disability in activities of daily living among community-living older persons.
        J Gerontol A Biol Sci Med Sci. 2003; 58: 70-75
      1. The prevention of falls in later life: a report of the Kellogg International Work Group on the Prevention of Falls by the Elderly.
        Dan Med Bull. 1987; 34: 1-24
        • Bilney B.
        • Morris M.
        • Webster K.
        Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait.
        Gait Posture. 2003; 17: 68-74
        • Locascio J.J.
        • Growdon J.H.
        • Corkin S.
        Cognitive test performance in detecting, staging, and tracking Alzheimer’s disease.
        Arch Neurol. 1995; 52: 1087-1099
        • Schauer M.
        • Mauritz K.H.
        Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement.
        Clin Rehabil. 2003; 17: 713-722
        • Horvath J.
        • Czigler I.
        • Birkas E.
        • Winkler I.
        • Gervai J.
        Age-related differences in distraction and reorientation in an auditory task.
        Neurobiol Aging. 2009; 30: 1157-1172
        • Dennis N.A.
        • Cabeza R.
        Neuroimaging of healthy cognitive imaging.
        in: Craik F.I.M. Salthouse T.A. The handbook of aging and cognition. Psychology Pr, New York2008: 1-54
        • Getzmann S.
        • Gajewski P.D.
        • Falkenstein M.
        Does age increase auditory distraction? Electrophysiological correlates of high and low performance in seniors.
        Neurobiol Aging. 2013; 34: 1952-1962
        • Getzmann S.
        • Falkenstein M.
        Understanding of spoken language under challenging listening conditions in younger and older listeners: a combined behavioral and electrophysiological study.
        Brain Res. 2011; 1415: 8-22
        • Cabeza R.
        • Anderson N.D.
        • Locantore J.K.
        • McIntosh A.R.
        Aging gracefully: compensatory brain activity in high-performing older adults.
        Neuroimage. 2002; 17: 1394-1402
        • Wingfield A.
        • Tun P.A.
        • McCoy S.L.
        Hearing loss in older adulthood—what it is and how it interacts with cognitive performance.
        Curr Dir Psychol Sci. 2005; 14: 144-148
        • Zhang X.Q.
        • Min B.Q.
        • Ma Y.C.
        • Yang P.J.
        • Li D.P.
        [Relationship between three neuropsychological tests and cerebral glucose metabolism in Alzheimer’s disease].
        Zhonghua Yi Xue Za Zhi. 2003; 83 ([Chinese]): 100-102
        • Wittwer J.E.
        • Webster K.E.
        • Hill K.
        Effect of rhythmic auditory cueing on gait in people with Alzheimer disease.
        Arch Phys Med Rehabil. 2013; 94: 718-724
        • Al-Yahya E.
        • Dawes H.
        • Smith L.
        • Dennis A.
        • Howells K.
        • Cockburn J.
        Cognitive motor interference while walking: a systematic review and meta-analysis.
        Neurosci Biobehav Rev. 2011; 35: 715-728
        • Dreher J.C.
        • Grafman J.
        Dissociating the roles of the rostral anterior cingulate and the lateral prefrontal cortices in performing two tasks simultaneously or successively.
        Cereb Cortex. 2003; 13: 329-339
        • Nebel K.
        • Wiese H.
        • Stude P.
        • de Greiff A.
        • Diener H.C.
        • Keidel M.
        On the neural basis of focused and divided attention.
        Brain Res Cogn Brain Res. 2005; 25: 760-776
        • Rosano C.
        • Studenski S.A.
        • Aizenstein H.J.
        • Boudreau R.M.
        • Longstreth Jr., W.T.
        • Newman A.B.
        Slower gait, slower information processing and smaller prefrontal area in older adults.
        Age Ageing. 2012; 41: 58-64
        • Herholz K.
        Cerebral glucose metabolism in preclinical and prodromal Alzheimer’s disease [review].
        Expert Rev Neurother. 2010; 10: 1667-1673
        • Huijbers M.J.
        • Bergmann H.C.
        • Olde Rikkert M.G.M.
        • Kessels R.P.
        Memory for emotional pictures in patients with Alzheimer’s dementia: comparing picture-location binding and subsequent recognition.
        J Aging Res. 2011; 2011: 409364
        • Klein-Koerkamp Y.
        • Beaudoin M.
        • Baciu M.
        • Hot P.
        Emotional decoding abilities in Alzheimer’s disease: a meta-analysis.
        J Alzheimers Dis. 2012; 32: 109-125
        • McCade D.
        • Savage G.
        • Naismith S.L.
        Review of emotion recognition in mild cognitive impairment.
        Dement Geriatr Cogn Disord. 2011; 32: 257-266