Prefrontal cortical asymmetry and motor slowing in older women: evidence that fear of falling modulates emotional valence and reaction time

Abstract

Aim: To investigate the relationship between cortical activation and motor performance in older women with different levels of fear of falling (FoF) and fall history. Methods: Fifty-five participants were evaluated, including 40 older adults divided into four groups (NotFall-LFoF, NotFall-HFoF, Fall-LFoF, Fall-HFoF) and 15 younger controls. Motor reaction time was assessed using adapted TRT_S2012 software, while cortical activity was recorded via EEG (EMOTIV EPOC+). Cortical arousal was indexed by the β/α ratio, and valence by (αF4/βF4) − (αF3/βF3) asymmetry. Statistical analyses included ANOVA and Pearson's correlation (α ≤ 0.05). Results: Groups were homogeneous in demographic and cognitive characteristics. Significant differences were observed in cortical arousal (p = 0.014) and valence (p = 0.004). Higher FoF levels were associated with reduced prefrontal symmetry and slower reaction times. Strong negative correlations were found between valence and reaction times (r > −0.9). FES-I scores showed positive correlations with motor latency (r = 0.8–0.9) and negative correlations with cortical indices (r = −0.7 to −0.9). Conclusions: Fear of falling modulates prefrontal cortical activation, shifting motor control from automatic to more conscious processing, which impairs motor efficiency. FoF emerges as a potential cortical biomarker of motor vulnerability, reinforcing the importance of neurorehabilitation strategies integrating emotional and cortical regulation to improve mobility and reduce fall risk in aging populations.