Prefrontal Cortical Asymmetry and Motor Slowing in Older Women: EEG Evidence That Fear of Falling Modulates Emotional Valence and Reaction Time

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.