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Relationship of Executive Function and Educational Status With Functional Balance in Older Adults

Voos, Mariana Callil PT, PhD1; Custódio, Elaine Bazilio PT2; Malaquias, Joel Jr. PT2

Journal of Geriatric Physical Therapy: January/March 2011 - Volume 34 - Issue 1 - p 11–18
doi: 10.1097/JPT.0b013e3181ff2452
Research Report

Background: The Berg Balance Scale (BBS) is frequently used to assess functional balance in older adults. The relationship of executive function and level of education with the BBS performance has not been described. The aim of this study was to determine whether (1) the performance on a task requiring executive function (part B of the Trail Making Test, TMT-B) influences results of motor and cognitive tests and (2) the number of years of formal education could be related to performance on BBS in older adults. We also explored whether there would be differences, based on performance on TMT-B (high vs low) in motor function (BBS, the timed up and go [TUG]) or cognitive function (TMT-A and TMTDELTA), the Mini Mental State Examination (MMSE), as well as years of education.

Methods: Participants included 101 older adults (age range, 60-80 years) residing in São Paulo, Brazil. Functional balance was assessed using BBS and TUG. Executive function was assessed using the TMT and MMSE. Educational status was determined by self-report of participant's total number of years of formal education.

Results: The BBS scores were inversely related to TMT-A time (r = −0.63, r 2 = 0.40, P < .001) and TMT-B time (r = −0.56, r 2 = 0.31, P < .001). There was a similar relationship with TMTDELTA (r = −0.47, r 2 = 0.22, P < .001). The BBS scores were positively correlated to years of formal education (r = 0.48, r 2 = 0.23, P < .001). There was a ceiling effect on the TMT-B, with many individuals reaching maximum score of 300 seconds. Participants with high levels of executive function had higher BBS and MMSE scores, more education, and lower TMT-A, TMTDELTA and TUG scores (P < .001) than the lower functioning group.

Conclusions: Individuals with higher capacity on tasks requiring visuospatial abilities, psychomotor speed, and executive function, such as the TMT, had better performance on BBS. Individuals with a high executive function, measured by TMT-B, also performed better on other motor and cognitive tests.

1Physical Therapy, Occupational Therapy and Speech Therapy Department, Faculty of Medicine. University of São Paulo, São Paulo, Brazil.

2Neurological Physical Therapy Specialization Course, Universidade Gama Filho, São Paulo, Brazil.

Address correspondence to: Mariana Callil Voos, PT, PhD, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo. Rua Cipotânea, 51, 2º. Andar. 05360-160. São Paulo. Brasil (

Copyright © 2011 the Section on Geriatrics of the American Physical Therapy Association
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