# Personalized brain activity modulation to improve balance and cognition in elderly fallers

> **NIH NIH R01** · HEBREW REHABILITATION CENTER FOR AGED · 2020 · $614,334

## Abstract

Standing and walking are almost always completed in unison with other mental tasks such as talking, reading
or problem solving. The ability to safely perform this important type of “dual tasking” is dependent upon one's
capacity to effectively activate the appropriate brain networks involved in both motor and cognitive function. In
older adults who have suffered recent, otherwise unexplained falls, such dual tasking significantly interferes
with the control of standing or walking. We thus contend that strategies designed to facilitate brain activation
within cognitive-motor brain networks hold great potential to reduce dual task costs, enhance numerous other
aspects of physical and cognitive function, and ultimately, reduced falls in older adults. Transcranial direct
current stimulation (tDCS) is a safe, noninvasive technology that can selectively enhance brain excitability (i.e.,
the likelihood of activation) by passing low-level currents between electrodes placed upon the scalp. We have
demonstrated in a series of ground-breaking studies that tDCS targeting the left dorsolateral prefrontal cortex
(dlPFC)—a primary brain region involved in cognitive “executive” function—incudes lasting improvements in
dual task performance and mobility in older adults. Still, the optimal brain region(s) to target with tDCS, and
the duration of benefits induced by multi-session tDCS interventions, are unknown. Moreover, to date, tDCS
delivery has attempted to optimize current flow based on modeling of a “typical” brain and has thus not been
personalized to individual differences in the anatomy of the aging brain.
We will conduct a randomized, sham-controlled, double-blinded trial with a 6-month follow-up period to
compare the effects of 4 different personalized, multisession tDCS interventions on the dual task costs
to standing and walking (Aim 1), as well as other physical (Aim 2) and cognitive (Aim 3) factors on the
causal pathway to falls that are important to everyday function, in older adults with previous falls. We
will recruit 120 men and women (30 per intervention arm) aged 65-85 years with two or more falls within the
past year, who are fearful of falling again, yet have no major neural or musculoskeletal disorders. tDCS
interventions will entail 20 sessions over a four-week period targeting 1) the left dlPFC only; 2) the bilateral
primary motor cortex (M1, leg regions) only; 3) both of these regions simultaneously; or 4) neither of these
regions (i.e., sham). We will utilize current flow modeling of baseline structural MRIs to customize tDCS
electrode placement and stimulation parameters to optimize current flow to the desired target(s) within each
participant's brain. We hypothesize that multi-focal tDCS designed to simultaneously increase functional
activation of motor and cognitive networks will have the greatest benefits on dual tasking and other important
physical and cognitive outcomes on the causal pathway to falls in this vulnerable population o...

## Key facts

- **NIH application ID:** 9965710
- **Project number:** 5R01AG059089-03
- **Recipient organization:** HEBREW REHABILITATION CENTER FOR AGED
- **Principal Investigator:** Bradley D. Manor
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $614,334
- **Award type:** 5
- **Project period:** 2018-09-30 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9965710

## Citation

> US National Institutes of Health, RePORTER application 9965710, Personalized brain activity modulation to improve balance and cognition in elderly fallers (5R01AG059089-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9965710. Licensed CC0.

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