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van Dooren TS, Lucieer FMP, Janssen AML, Kingma H, van de Berg R. The Video Head Impulse Test and the Influence of Daily Use of Spectacles to Correct a Refractive Error. Front Neurol 2018; 9:125. [PMID: 29599742 PMCID: PMC5863505 DOI: 10.3389/fneur.2018.00125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/20/2018] [Indexed: 01/23/2023] Open
Abstract
Objective To determine the influence of daily use of spectacles to correct a refractive error, on the vestibulo-ocular reflex (VOR) gain measured with the video head impulse test (vHIT). Study design This prospective study enrolled subjects between 18 and 80 years old with and without a refractive error. Subjects were classified into three groups: (1) contact lenses, (2) spectacles, and (3) control group without visual impairment. Exclusion criteria comprised ophthalmic pathology, history of vestibular disorders, and alternated use of spectacles and contact lenses in daily life. Corrective spectacles were removed seconds before testing. One examiner performed all vHIT’s under standardized circumstances using the EyeSeeCam system. This system calculated the horizontal VOR gain for rightward and leftward head rotations separately. Results No statistically significant difference was found in VOR gain between the control group (n = 16), spectacles group (n = 48), and contact lenses group (n = 15) (p = 0.111). Both the spectacles group and contact lenses group showed no statistically significant correlation between VOR gain and amount of refractive error, for rightwards (p = 0.071) and leftwards (p = 0.716) head rotations. There was no statistical significant difference in VOR gain between testing monocularly or binocularly (p = 0.132) and between testing with or without wearing contact lenses (p = 0.800). Conclusion In this study, VOR gain was not influenced by wearing corrective spectacles or contact lenses on a daily basis. Based on this study, no corrective measures are necessary when performing the vHIT on subjects with a refractive error, regardless of the way of correction.
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Affiliation(s)
- T S van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - F M P Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A M L Janssen
- Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - H Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
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Wettstein VG, Weber KP, Bockisch CJ, Hegemann SC. Compensatory saccades in head impulse testing influence the dynamic visual acuity of patients with unilateral peripheral vestibulopathy1. J Vestib Res 2018; 26:395-402. [PMID: 27814315 DOI: 10.3233/ves-160591] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Both the dynamic visual acuity (DVA) test and the video head-impulse test (vHIT) are fast and simple ways to assess peripheral vestibulopathy. After losing peripheral vestibular function, some patients show better DVA performance than others, suggesting good compensatory mechanisms. It seems possible that compensatory covert saccades could be responsible for improved DVA. OBJECTIVE To investigate VOR gain and compensatory saccades with vHIT and compare them to the DVA of patients with unilateral peripheral vestibulopathy. METHODS VOR gain deficit and compensatory saccades were measured with vHIT. VOR gain was calculated for each trial as mean eye velocity divided by mean head velocity during 4 samples between 24 ms - 40 ms after peak head acceleration. DVA was then assessed. VHIT was analyzed for percentage of covert saccades and for cumulative overt saccade amplitude. Twenty-four patients with unilateral vestibular deficit were included. A control group of 113 healthy subjects provided normal data. RESULTS On the affected side, pathologic values for DVA (mean 0.83 logMAR±0.25 SD) and VOR gain (mean 0.16±0.13) were obtained, whereas the healthy side showed normal values (0.53 logMAR±0.15 for DVA and 0.89±0.18 for VOR gain). Yet, DVA performance on the affected side was significantly better in patients with higher covert saccade percentage (p = 0.012) and lower cumulative overt saccade amplitude (p < 0.001). CONCLUSION Compensatory covert saccades seen in vHIT correlate with improved performance of DVA-testing in patients with unilateral peripheral vestibular loss. Hence, in addition to testing peripheral vestibulopathy, our results indicate a way for assessing rehabilitatory compensation in such patients by DVA in addition to vHIT.
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Affiliation(s)
- V G Wettstein
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K P Weber
- Departments of Neurology and Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C J Bockisch
- Departments of Neurology, Ophthamology, and Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S C Hegemann
- Department of Otorhinolaryngology and Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Switzerland
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Abstract
OBJECTIVE Recent studies suggest an association between vestibular and cognitive function. The goal of the study was to investigate whether vestibular function was impaired in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) compared with cognitively normal individuals. STUDY DESIGN Cross-sectional study. SETTING Outpatient memory clinic and longitudinal observational study unit. PATIENTS Older individuals ≥55 years with MCI or AD. Age, sex, and education-matched normal controls were drawn from the Baltimore Longitudinal Study of Aging (BLSA). INTERVENTION Saccular and utricular function was assessed with cervical and ocular vestibular-evoked myogenic potentials (c- and oVEMPs) respectively, and horizontal semicircular canal function was assessed with video head impulse testing. MAIN OUTCOME MEASURES Presence or absence of VEMP responses, VEMP amplitude, and vestibular ocular reflex (VOR) gain were measured. RESULTS Forty-seven individuals with cognitive impairment (MCI N = 15 and AD N = 32) underwent testing and were matched with 94 controls. In adjusted analyses, bilaterally absent cVEMPs were associated with an over three-fold odds of AD (OR 3.42, 95% CI 1.33-8.91, p = 0.011). One microvolt increases in both cVEMP and oVEMP amplitudes were associated with decreased odds of AD (OR 0.28, 95% CI 0.09-0.93, p = 0.038 and OR 0.92, 95% CI 0.85-0.99, p = 0.036, respectively). There was no significant difference in VOR gain between the groups. CONCLUSIONS These findings confirm and extend emerging evidence of an association between vestibular dysfunction and cognitive impairment. Further investigation is needed to determine the causal direction for the link between peripheral vestibular loss and cognitive impairment.
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Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology. Otol Neurotol 2017; 38:870-875. [DOI: 10.1097/mao.0000000000001429] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anson E, Bigelow RT, Swenor B, Deshpande N, Studenski S, Jeka JJ, Agrawal Y. Loss of Peripheral Sensory Function Explains Much of the Increase in Postural Sway in Healthy Older Adults. Front Aging Neurosci 2017; 9:202. [PMID: 28676758 PMCID: PMC5476729 DOI: 10.3389/fnagi.2017.00202] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/06/2017] [Indexed: 11/25/2022] Open
Abstract
Postural sway increases with age and peripheral sensory disease. Whether, peripheral sensory function is related to postural sway independent of age in healthy adults is unclear. Here, we investigated the relationship between tests of visual function (VISFIELD), vestibular function (CANAL or OTOLITH), proprioceptive function (PROP), and age, with center of mass sway area (COM) measured with eyes open then closed on firm and then a foam surface. A cross-sectional sample of 366 community dwelling healthy adults from the Baltimore Longitudinal Study of Aging was tested. Multiple linear regressions examined the association between COM and VISFIELD, PROP, CANAL, and OTOLITH separately and in multi-sensory models controlling for age and gender. PROP dominated sensory prediction of sway across most balance conditions (β's = 0.09–0.19, p's < 0.001), except on foam eyes closed where CANAL function loss was the only significant sensory predictor of sway (β = 2.12, p < 0.016). Age was not a consistent predictor of sway. This suggests loss of peripheral sensory function explains much of the age-associated increase in sway.
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Affiliation(s)
- Eric Anson
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of MedicineBaltimore, MD, United States
| | - Robin T Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of MedicineBaltimore, MD, United States
| | - Bonnielin Swenor
- Lions Vision Center, Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimore, MD, United States
| | - Nandini Deshpande
- School of Rehabilitation Therapy, Queens UniversityKingston, ON, Canada
| | - Stephanie Studenski
- Longitudinal Studies Section, National Institute on AgingBaltimore, MD, United States
| | - John J Jeka
- Department of Kinesiology, Temple UniversityPhiladelphia, PA, United States
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of MedicineBaltimore, MD, United States
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Xie Y, Anson ER, Simonsick EM, Studenski SA, Agrawal Y. Compensatory Saccades Are Associated With Physical Performance in Older Adults: Data From the Baltimore Longitudinal Study of Aging. Otol Neurotol 2017; 38:373-378. [PMID: 28192379 PMCID: PMC5308452 DOI: 10.1097/mao.0000000000001301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether compensatory saccade metrics observed in the video head impulse test, specifically saccade amplitude and latency, predict physical performance. STUDY DESIGN Cross-sectional analysis of the Baltimore Longitudinal Study of Aging, a prospective cohort study. SETTING National Institute on Aging Intramural Research Program Clinical Research Unit in Baltimore, Maryland. PATIENTS Community-dwelling older adults. INTERVENTION(S) Video head impulse testing was performed, and compensatory saccades and horizontal vestibulo-ocular reflex (VOR) gain were measured. Physical performance was assessed using the Short Physical Performance Battery (SPPB), which included the feet side-by-side, semitandem, tandem, and single-leg stance; repeated chair stands; and usual gait speed measurements. MAIN OUTCOME MEASURE(S) Compensatory saccade amplitude and latency, VOR gain, and SPPB performance. RESULTS In 183 participants who underwent vestibular and SPPB testing (mean age 71.8 yr; 53% females), both higher mean saccade amplitude (odds ratio [OR] =1.62, p = 0.010) and shorter mean saccade latency (OR = 0.88, p = 0.004) were associated with a higher odds of failing the tandem stand task. In contrast, VOR gain was not associated with any physical performance measure. CONCLUSION We observed in a cohort of healthy older adults that compensatory saccade amplitude and latency were associated with tandem stance performance. Compensatory saccade metrics may provide insights into capturing the impact of vestibular loss on physical function in older adults.
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Affiliation(s)
- Yanjun Xie
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6 Floor, Baltimore, Maryland 21287 United States
| | - Eric R. Anson
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6 Floor, Baltimore, Maryland 21287 United States
| | - Eleanor M. Simonsick
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institute of Health, 251 Bayview Boulevard Suite 100, Baltimore, Maryland 21224 United States
| | - Stephanie A. Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institute of Health, 251 Bayview Boulevard Suite 100, Baltimore, Maryland 21224 United States
| | - Yuri Agrawal
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6 Floor, Baltimore, Maryland 21287 United States
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Khan SI, Hübner PP, Brichta AM, Smith DW, Migliaccio AA. Aging reduces the high-frequency and short-term adaptation of the vestibulo-ocular reflex in mice. Neurobiol Aging 2017; 51:122-131. [PMID: 28063365 DOI: 10.1016/j.neurobiolaging.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Serajul I Khan
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick P Hübner
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Alan M Brichta
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Doug W Smith
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Americo A Migliaccio
- Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.
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Chiarovano E, Wang W, Rogers SJ, MacDougall HG, Curthoys IS, de Waele C. Balance in Virtual Reality: Effect of Age and Bilateral Vestibular Loss. Front Neurol 2017; 8:5. [PMID: 28163693 PMCID: PMC5247457 DOI: 10.3389/fneur.2017.00005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background Quantitative balance measurement is used in clinical practice to prevent falls. The conditions of the test were limited to eyes open, eyes closed, and sway-referenced vision. We developed a new visual perturbation to challenge balance using virtual reality (VR), measuring postural stability by a Wii Balance Board (WBB). Methods In this study, we recorded balance performance of 116 healthy subjects and of 10 bilateral vestibular loss patients using VR to assess the effect of age and the effect of total loss of vestibular function. We used several conditions: eyes open (normal visual inputs), eyes closed (no visual inputs), stable visual world (vision referenced), and perturbed visual world (visual perturbation) at different amplitudes of perturbation. Balance under these visual conditions was assessed on the WBB (stable support surface) and on the WBB plus foam rubber (unstable support surface). Results In healthy subjects, we found that the percentage of falls increased with age and with the amplitude of perturbation for both conditions: WBB or WBB + foam. Moreover, we can define a threshold for falls in each age group as the amplitude of perturbation which induced falls. For bilateral vestibular loss patients, on the WBB + foam, all of them failed with eyes closed and with perturbed visual world even at the minimal amplitude of perturbation. Finally, we observed that stable visual world induced fewer falls than eyes closed whatever the subject’s group (healthy or bilateral vestibular loss) and whatever the age decade. Conclusion VR allowed us to develop a useful new tool with a wide range of visual perturbations. Rather than only two levels of visual condition (eyes open and eyes closed), the VR stimulus can be continuously adjusted to produce a visual perturbation powerful enough to induce falls even in young healthy subjects and which has allowed us to determine a threshold for falls.
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Affiliation(s)
- Elodie Chiarovano
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Cognition and Action Group, CNRS UMR8257, University of Paris Descartes, Paris, France
| | - Wei Wang
- Cognition and Action Group, CNRS UMR8257, University of Paris Descartes, Paris, France; University of Hangzhou Dianzi, Hangzhou, China
| | - Stephen J Rogers
- School of Psychology, University of Sydney , Sydney, NSW , Australia
| | | | - Ian S Curthoys
- School of Psychology, University of Sydney , Sydney, NSW , Australia
| | - Catherine de Waele
- Cognition and Action Group, CNRS UMR8257, University of Paris Descartes, Paris, France; Pitie Salpetriere Hospital, ENT Department, Paris, France
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Arshad Q, Seemungal BM. Age-Related Vestibular Loss: Current Understanding and Future Research Directions. Front Neurol 2016; 7:231. [PMID: 28066316 PMCID: PMC5165261 DOI: 10.3389/fneur.2016.00231] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/02/2016] [Indexed: 01/23/2023] Open
Abstract
The vestibular system sub-serves a number of reflex and perceptual functions, comprising the peripheral apparatus, the vestibular nerve, the brainstem and cerebellar processing circuits, the thalamic relays, and the vestibular cerebral cortical network. This system provides signals of self-motion, important for gaze and postural control, and signals of traveled distance, for spatial orientation, especially in the dark. Current evidence suggests that certain aspects of this multi-faceted system may deteriorate with age and sometimes with severe consequences, such as falls. Often the deterioration in vestibular functioning relates to how the signal is processed by brain circuits rather than an impairment in the sensory transduction process. We review current data concerning age-related changes in the vestibular system, and how this may be important for clinicians dealing with balance disorders.
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Affiliation(s)
- Qadeer Arshad
- Division of Brain Sciences, Imperial College London , London , UK
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EVALUACIÓN VESTIBULAR EN 2016. PUESTA AL DÍA. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Thomas NM, Bampouras TM, Donovan T, Dewhurst S. Eye Movements Affect Postural Control in Young and Older Females. Front Aging Neurosci 2016; 8:216. [PMID: 27695412 PMCID: PMC5025428 DOI: 10.3389/fnagi.2016.00216] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 09/01/2016] [Indexed: 11/13/2022] Open
Abstract
Visual information is used for postural stabilization in humans. However, little is known about how eye movements prevalent in everyday life interact with the postural control system in older individuals. Therefore, the present study assessed the effects of stationary gaze fixations, smooth pursuits, and saccadic eye movements, with combinations of absent, fixed and oscillating large-field visual backgrounds to generate different forms of retinal flow, on postural control in healthy young and older females. Participants were presented with computer generated visual stimuli, whilst postural sway and gaze fixations were simultaneously assessed with a force platform and eye tracking equipment, respectively. The results showed that fixed backgrounds and stationary gaze fixations attenuated postural sway. In contrast, oscillating backgrounds and smooth pursuits increased postural sway. There were no differences regarding saccades. There were also no differences in postural sway or gaze errors between age groups in any visual condition. The stabilizing effect of the fixed visual stimuli show how retinal flow and extraocular factors guide postural adjustments. The destabilizing effect of oscillating visual backgrounds and smooth pursuits may be related to more challenging conditions for determining body shifts from retinal flow, and more complex extraocular signals, respectively. Because the older participants matched the young group's performance in all conditions, decreases of posture and gaze control during stance may not be a direct consequence of healthy aging. Further research examining extraocular and retinal mechanisms of balance control and the effects of eye movements, during locomotion, is needed to better inform fall prevention interventions.
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Affiliation(s)
- Neil M Thomas
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
| | - Theodoros M Bampouras
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
| | - Tim Donovan
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
| | - Susan Dewhurst
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
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Anson ER, Bigelow RT, Carey JP, Xue QL, Studenski S, Schubert MC, Weber KP, Agrawal Y. Aging Increases Compensatory Saccade Amplitude in the Video Head Impulse Test. Front Neurol 2016; 7:113. [PMID: 27486430 PMCID: PMC4947583 DOI: 10.3389/fneur.2016.00113] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022] Open
Abstract
Objective Rotational vestibular function declines with age resulting in saccades as a compensatory mechanism to improve impaired gaze stability. Small reductions in rotational vestibulo-ocular reflex (VOR) gain that would be considered clinically normal have been associated with compensatory saccades. We evaluated whether compensatory saccade characteristics varied as a function of age, independent of semicircular canal function as quantified by VOR gain. Methods Horizontal VOR gain was measured in 243 participants age 27–93 from the Baltimore Longitudinal Study of Aging using video head impulse testing. Latency and amplitude of the first saccade (either covert – occurring during head impulse, or overt – occurring following head impulse) were measured for head impulses with compensatory saccades (n = 2230 head impulses). The relationship between age and saccade latency, as well as the relationship between age and saccade amplitude, were evaluated using regression analyses adjusting for VOR gain, gender, and race. Results Older adults (mean age 75.9) made significantly larger compensatory saccades relative to younger adults (mean age 45.0). In analyses adjusted for VOR gain, there was a significant association between age and amplitude of the first compensatory covert saccade (β = 0.015, p = 0.008). In analyses adjusted for VOR gain, there was a significant association between age and amplitude of the first compensatory overt saccade (β = 0.02, p < 0.001). Compensatory saccade latencies did not vary significantly by age. Conclusion We observed that aging increases the compensatory catch-up saccade amplitude in healthy adults after controlling for VOR gain. Size of compensatory saccades may be useful in addition to VOR gain for characterizing vestibular function in aging adults.
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Affiliation(s)
- Eric R Anson
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Robin T Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Quan-Li Xue
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Stephanie Studenski
- Longitudinal Studies Section, National Institute on Aging , Baltimore, MD , USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Konrad P Weber
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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Anson ER, Bigelow RT, Carey JP, Xue QL, Studenski S, Schubert MC, Agrawal Y. VOR Gain Is Related to Compensatory Saccades in Healthy Older Adults. Front Aging Neurosci 2016; 8:150. [PMID: 27445793 PMCID: PMC4919329 DOI: 10.3389/fnagi.2016.00150] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
Objective: Vestibulo-ocular reflex (VOR) gain is well-suited for identifying rotational vestibular dysfunction, but may miss partial progressive decline in age-related vestibular function. Since compensatory saccades might provide an alternative method for identifying subtle vestibular decline, we describe the relationship between VOR gain and compensatory saccades in healthy older adults. Methods: Horizontal VOR gain was measured in 243 subjects age 60 and older from the Baltimore Longitudinal Study of Aging using video head impulse testing (HIT). Saccades in each HIT were identified as either “compensatory” or “compensatory back-up,” i.e., same or opposite direction as the VOR response respectively. Saccades were also classified as “covert” (occurring during head movement) and “overt” (occurring after head movement). The relationship between VOR gain and percentage of HITs with saccades, as well as the relationship between VOR gain and saccade latency and amplitude, were evaluated using regression analyses adjusting for age, gender, and race. Results: In adjusted analyses, the percentage of HITs with compensatory saccades increased 4.5% for every 0.1 decrease in VOR gain (p < 0.0001). Overt compensatory saccade amplitude decreased 0.6° (p < 0.005) and latency increased 90 ms (p < 0.001) for every 0.1 increase in VOR gain. Covert back-up compensatory saccade amplitude increased 0.4° for every 0.1 increase in VOR gain. Conclusion: We observed significant relationships between VOR gain and compensatory saccades in healthy older adults. Lower VOR gain was associated with larger amplitude, shorter latency compensatory saccades. Compensatory saccades reflect underlying rotational vestibular hypofunction, and may be particularly useful at identifying partial vestibular deficits as occur in aging adults.
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Affiliation(s)
- Eric R Anson
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Robin T Bigelow
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - John P Carey
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Qian-Li Xue
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore, MD, USA; Center on Aging and Health, Johns Hopkins Medical InstitutionsBaltimore, MD, USA
| | - Stephanie Studenski
- Longitudinal Studies Section, National Institute on Aging Baltimore, MD, USA
| | - Michael C Schubert
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Yuri Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine Baltimore, MD, USA
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Hafström A, Malmström EM, Terdèn J, Fransson PA, Magnusson M. Improved Balance Confidence and Stability for Elderly After 6 Weeks of a Multimodal Self-Administered Balance-Enhancing Exercise Program: A Randomized Single Arm Crossover Study. Gerontol Geriatr Med 2016; 2:2333721416644149. [PMID: 28138495 PMCID: PMC5119910 DOI: 10.1177/2333721416644149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/25/2016] [Accepted: 02/29/2016] [Indexed: 01/06/2023] Open
Abstract
Objective: To develop and assess the efficacy of a multimodal balance-enhancing exercise program (BEEP) designed to be regularly self-administered by community-dwelling elderly. The program aims to promote sensory reweighting, facilitate motor control, improve gaze stabilization, and stimulate continuous improvement by being constantly challenging. Method: Forty participants aged 60 to 80 years performed 6 weeks of BEEP training, on average for 16 min four times weekly, in a randomized one-arm crossover design. Results: One-leg standing time improved 32% with eyes open (EO), 206% with eyes closed (EC) on solid surface, and 54% EO on compliant surface (p < .001). Posturography confirmed balance improvements when perturbed on solid and compliant surfaces with EO and EC (p ≤ .033). Walking, step stool, and Timed Up and Go speeds increased (p ≤ .001), as did scores in Berg Balance and balance confidence scales (p ≤ .018). Discussion: Multimodal balance exercises offer an efficient, cost-effective way to improve balance control and confidence in elderly.
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Anson E, Jeka J. Perspectives on Aging Vestibular Function. Front Neurol 2016; 6:269. [PMID: 26779116 PMCID: PMC4701938 DOI: 10.3389/fneur.2015.00269] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/14/2015] [Indexed: 01/10/2023] Open
Abstract
Much is known about age-related anatomical changes in the vestibular system. Knowledge regarding how vestibular anatomical changes impact behavior for older adults continues to grow, in line with advancements in diagnostic testing. However, despite advancements in clinical diagnostics, much remains unknown about the functional impact that an aging vestibular system has on daily life activities such as standing and walking. Modern diagnostic tests are very good at characterizing neural activity of the isolated vestibular system, but the tests themselves are artificial and do not reflect the multisensory aspects of natural human behavior. Also, the majority of clinical diagnostic tests are passively applied because active behavior can enhance performance. In this perspective paper, we review anatomical and behavioral changes associated with an aging vestibular system and highlight several areas where a more functionally relevant perspective can be taken. For postural control, a multisensory perturbation approach could be used to bring balance rehabilitation into the arena of precision medicine. For walking and complex gaze stability, this may result in less physiologically specific impairments, but the trade-off would be a greater understanding of how the aging vestibular system truly impacts the daily life of older adults.
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Affiliation(s)
- Eric Anson
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Medical Institutes , Baltimore, MD , USA
| | - John Jeka
- Department of Kinesiology, Temple University, Philadelphia, PA, USA; Department of Bioengineering, Temple University, Philadelphia, PA, USA
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Hile ES. Imbalance and Falls in Older Cancer Survivors. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Aging affects every sensory system in the body, including the vestibular system. Although its impact is often difficult to quantify, the deleterious impact of aging on the vestibular system is serious both medically and economically. The deterioration of the vestibular sensory end organs has been known since the 1970s; however, the measurable impact from these anatomical changes remains elusive. Tests of vestibular function either fall short in their ability to quantify such anatomical deterioration, or they are insensitive to the associated physiologic decline and/or central compensatory mechanisms that accompany the vestibular aging process. When compared with healthy younger individuals, a paucity of subtle differences in test results has been reported in the healthy older population, and those differences are often observed only in response to nontraditional and/or more robust stimuli. In addition, the reported differences are often clinically insignificant insomuch that the recorded physiologic responses from the elderly often fall within the wide normative response ranges identified for normal healthy adults. The damaging economic impact of such vestibular sensory decline manifests itself in an exponential increase in geriatric dizziness and a subsequent higher prevalence of injurious falls. An estimated $10 to $20 billion dollar annual cost has been reported to be associated with falls-related injuries and is the sixth leading cause of death in the elderly population, with a 20% mortality rate. With an estimated 115% increase in the geriatric population over 65 years of age by the year 2050, the number of balanced-disordered patients with a declining vestibular system is certain to reach near epidemic proportions. An understanding of the effects of age on the vestibular system is imperative if clinicians are to better manage elderly patients with balance disorders, dizziness, and vestibular disease.
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Affiliation(s)
- Christopher K. Zalewski
- Otolaryngology Branch, Audiology Unit, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, Maryland
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Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 2015; 44:29. [PMID: 26141721 PMCID: PMC4506627 DOI: 10.1186/s40463-015-0081-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The head impulse test (HIT) is a recognised clinical sign of the high frequency vestibulo-ocular reflex (VOR), which can be quantified with video-oculography. This measures the VOR gain as the ratio of angular eye velocity to angular head velocity. Although normative data is available for VOR gain with video-oculography, most normal studies in general include small numbers of subjects and do not include analysis of variation of VOR gain with age. The purpose of our study was to establish normative data across 60 control subjects aged 20 to 80 years to represent a population distribution. METHODS Sixty control subjects without any current or previous form of brain disorder or vertigo participated in this study and form the basis for future comparison to patients with vestibular lesions. The relationship between the horizontal vestibulo-ocular reflex (HVOR) velocity gain and age was analysed using a mixed regression model with a random effect for subjects. Differences in testing technique were assessed to ensure reliability in results. RESULTS The mean HVOR velocity gain of 60 normal subjects was 0.97 (SD = 0.09) at 80 ms and 0.94 (SD = 0.10) at 60 ms. The 2 SD lower limit of normal HVOR velocity gain was 0.79 at 80 ms and 0.75 at 60 ms. No HVOR velocity gain fell below 0.76 and 0.65 at 80 ms and 60 ms respectively. The HVOR velocity gain declined by 0.012 and 0.017 per decade as age increased at 80 ms and 60 ms respectively. A non-physiologically high horizontal HVOR velocity gain was found to occur in tests where passive HITs were predictable in direction and time and where target distance was below 0.70 m. CONCLUSIONS Normative data with respect to HVOR velocity gain decreases slightly with age, but with careful attention to methodology the 2 SD lower limit of normal is relatively robust across a wide age range and into the eighth decade, without requirement for adjustment with age.
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Affiliation(s)
- Benjamin Mossman
- Department of Neurology, Wellington Hospital, Riddiford Street, Private Bag 7902, Wellington South, Wellington, New Zealand
| | - Stuart Mossman
- Department of Neurology, Wellington Hospital, Riddiford Street, Private Bag 7902, Wellington South, Wellington, New Zealand.
| | - Gordon Purdie
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus, Senftenberg, Germany
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Fernández L, Breinbauer HA, Delano PH. Vertigo and Dizziness in the Elderly. Front Neurol 2015; 6:144. [PMID: 26167157 PMCID: PMC4481149 DOI: 10.3389/fneur.2015.00144] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/12/2015] [Indexed: 11/13/2022] Open
Abstract
The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years. Balance disorders in the elderly constitute a major public health problem, and require an adequate diagnosis and management by trained physicians. In the elderly, common causes of vertigo may manifest differently, as patients tend to report less rotatory vertigo and more non-specific dizziness and instability than younger patients, making diagnosis more complex. In this mini review, age-related degenerative processes that affect balance are presented. Diagnostic and therapeutic approaches oriented to the specific impaired system, including visual, proprioceptive, and vestibular pathways, are proposed. In addition, presbystasis – the loss of vestibular and balance functions associated with aging – benign paroxysmal positional vertigo, and stroke (in acute syndromes) should always be considered.
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Affiliation(s)
- Lara Fernández
- Otolaryngology Department, Clinical Hospital of the University of Chile , Santiago , Chile
| | - Hayo A Breinbauer
- Otolaryngology Department, San Juan de Dios Hospital, University of Chile , Santiago , Chile ; Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo , Santiago , Chile
| | - Paul Hinckley Delano
- Otolaryngology Department, Clinical Hospital of the University of Chile , Santiago , Chile ; Physiology and Biophysics Program, Institute of Biomedical Sciences (ICBM), Medicine Faculty, University of Chile , Santiago , Chile
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