Imagined Timed Up & Go test: A new tool to assess higher-level gait and balance disorders in older adults? Olivier Beauchet a, ⁎, Cédric Annweiler a , Frédéric Assal b , Stephanie Bridenbaugh c , François R. Herrmann d , Reto W Kressig c , Gilles Allali b a Department of Internal Medicine and Geriatrics, Angers University Hospital; UPRES EA 2646, University of Angers, UNAM, France b Department of Neurology & Faculty of Medicine, Geneva University Hospitals, Switzerland c Department of Geriatrics, University of Basel & Basel University Hospital, Switzerland d Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland abstract article info Article history: Received 29 October 2009 Received in revised form 15 January 2010 Accepted 23 March 2010 Available online 4 May 2010 Keywords: Timed Up & Go test Motor imagery Mobility Assessment Older adult Background: Few studies have explored motor imagery (MI) as a way of accessing the higher-level of control of complex body movements involved in gait or balance. The objective of this study was 1) to measure and compare the time needed to complete the Timed Up & Go test (TUG), the time needed to imagine performing the same test (iTUG) and to calculate the time difference between both of these conditions (delta time) in a sample of young and older adults, and 2) to examine whether there was an association between the Timed Up & Go test results (TUG, iTUG, delta time), age and cognitive decline. Methods: A total of 162 subjects (38 healthy young adults, mean age 25.7 ± 2.3 years, 73.7% women and 124 older inpatients, mean age 85.3 ± 6.5 years, 76.6% women) were included in this cross-sectional study. The mean ± SD of TUG, iTUG and delta time, age and the Mini Mental State Examination (MMSE) score were used as main outcomes. Results: Age was associated with an increase in time of TUG (P b 0.001) and of delta time (P = 0.015), and with a decrease in time of iTUG (P b 0.001), whereas cognitive decline was only associated with increase in delta time (P = 0.030). There was an increase in time of TUG (P b 0.001) and in delta time (P b 0.001) for subjects who used a walking aid. The increase in delta time depended on the MMSE score when the subjects did not use a walking aid (P for trend = 0.001). Conclusions: iTUG is clinically feasible among frail older adults and may quickly inform any clinician about higher-level changes in control of gait and balance in older adults. © 2010 Elsevier B.V. All rights reserved. 1. Introduction Motor imagery (MI) is defined as mentally simulating a given action without actual execution and is widely used to study higher-level control of action [1,2]. MI is usually used in clinical practice to improve motor skill performance in athletes and patients with neurological diseases such as stroke or Parkinson's disease [3–8]. Few studies have explored MI as a way of accessing the higher-level of control of complex body movements involved in dynamic movements such as gait or balance. Based on a mental chronometry approach which is a tool in neuroscience used to measure the time course of mental operations, it has been shown that there was a close temporal correspondence between executing and imaging gait in healthy young subjects [9,10]. To the best of our knowledge, MI has not yet been used for the assessment of gait and balance in older adults with cognitive decline. Age and cognitive decline have been both associated with change in higher-level gait and balance control [11–13]. Recent research based on dual-task paradigms highlighted that walking requires more attention in older adults compared with young adults [11]. It has also been shown that dementia-related changes in gait are not only associated with classic motor disorders in the basal ganglia, cerebellum and primary motor areas, but also with a central misprocessing of information mainly related to executive dysfunction [12,13]. The combined effects of age and cognitive decline on the MI of gait and balance remain unknown. The Timed Up & Go test (TUG) is a basic evaluation of functional mobility and measures the time needed to rise from a chair, walk 3 m, turn around and return to a seated position [14]. The TUG test has been used extensively in geriatric medicine in order to evaluate gait and balance performance [15–19]. An evaluation of gait and balance based on an imagined version of TUG (iTUG) has never been explored. Because of the well-known age and cognitive-related changes in higher-level gait and balance control, we hypothesized that a greater time difference Journal of the Neurological Sciences 294 (2010) 102–106 ⁎ Corresponding author. Department of Internal Medicine and Geriatrics, Angers University Hospital, 49933 Angers Cedex 9, France. Tel.: + 33 2 41 35 45 50; fax: + 33 2 41 35 48 94. E-mail address: olbeauchet@chu-angers.fr (O. Beauchet). 0022-510X/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jns.2010.03.021 Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns