Age-related cortical mechanisms underlying postural control: a systematic review

Introduction Despite growing interest in age-related cortical mechanisms of postural control, heterogeneity across studies has limited the synthesis of existing evidence. This systematic review aimed to (1) characterize age-related alterations in cortical activity during standing balance tasks with sensory, cognitive, and mechanical challenges; (2) examine the association between cortical activity and postural sway; and (3) characterize the current methodology of assessing cortical activity during standing balance tasks in older adults (OA). Methods Relevant research articles were identified through systematic searches of MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to October 8, 2025. Eligible studies measured cortical activity during standing balance under sensory, cognitive, and mechanical challenges using electroencephalography (EEG) or functional near-infrared spectroscopy (fNIRS). We used the Standard Quality Assessment Criteria for quantitative studies for quality assessment. Results Thirty-seven studies with a total of 1,302 participants, including 788 OA (60.5%), were included. Most studies ( n = 29, 78.4%) demonstrated strong methodological quality. Evidence suggested diminished task-dependent cortical modulation and weaker associations between cortical activity and postural sway as task demands increased in OA compared to younger adults (YA). OA tended to show prolonged latencies and reduced amplitudes following mechanical perturbation. Nevertheless, some studies also suggested that OA may still recruit additional cortical resources under specific task conditions, which may reflect compensatory processes. Discussion This systematic review indicates that aging may be associated with diminished task-dependent cortical modulation, weaker associations between cortical activity and postural sway, and delayed sensorimotor processing during challenging balance tasks. These findings provide a foundation for future studies aimed at clarifying age-related cortical mechanisms of postural control during standing balance. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251159695.