Spatial Memory Deficits in Patients with Chronic Bilateral Vestibular Failure

Vestibular insights into cognition and psychiatry

The vestibular system has traditionally been thought of as a balance apparatus; however, accumulating research suggests an association between vestibular function and psychiatric and cognitive symptoms, even when balance is measurably unaffected. There are several brain regions that are implicated in both vestibular pathways and psychiatric disorders. The present review examines the anatomical associations between the vestibular system and various psychiatric disorders. Despite the lack of direct evidence for vestibular pathology in the key psychiatric disorders selected for this review, there is a substantial body of literature implicating the vestibular system in each of the selected psychiatric disorders. The second part of this review provides complimentary evidence showing the link between vestibular dysfunction and vestibular stimulation upon cognitive and psychiatric symptoms. In summary, emerging research suggests the vestibular system can be considered a potential window for exploring brain function beyond that of maintenance of balance, and into areas of cognitive, affective and psychiatric symptomology. Given the paucity of biological and diagnostic markers in psychiatry, novel avenues to explore brain function in psychiatric disorders are of particular interest and warrant further exploration.

Dyscalculia and vestibular function

BACKGROUND

A few studies in humans suggest that changes in stimulation of the balance organs of the inner ear (the 'vestibular system') can disrupt numerical cognition, resulting in 'dyscalculia', the inability to manipulate numbers. Many studies have also demonstrated that patients with vestibular dysfunction exhibit deficits in spatial memory.

OBJECTIVES

It is suggested that there may be a connection between spatial memory deficits resulting from vestibular dysfunction and the occurrence of dyscalculia, given the evidence that numerosity is coupled to the processing of spatial information (e.g., the 'spatial numerical association of response codes ('SNARC') effect').

RESULTS AND CONCLUSION

The evidence supporting this hypothesis is summarised and potential experiments to test it are proposed.

Performance in anxiety and spatial memory tests following bilateral vestibular loss in the rat and effects of anxiolytic and anxiogenic drugs

Vestibular dysfunction in humans is associated with anxiety and cognitive disorders. However, various animal studies of the effects of vestibular loss have yielded conflicting results, from reduced anxiety to increased anxiety, depending on the particular model of vestibular dysfunction and the anxiety test used. In this study we revisited the question of whether rats with surgical bilateral vestibular deafferentation (BVD) exhibit changes in anxiety-related behaviour by testing them in the open field maze (OFM), elevated plus maze (EPM) and elevated T maze (ETM) in the presence of a non-sedating anxiolytic drug, buspirone, or an anxiogenic drug, FG-7142. We also tested the animals in a spatial T maze (STM) in order to evaluate their cognitive function under the same set of conditions. We found that BVD animals exhibited increased locomotor activity (P≤0.003), reduced supported and unsupported rearing (P≤0.02 and P≤0.000, respectively) and reduced thigmotaxis (P≤0.000) in the OFM, which for the most part the drugs did not modify. By contrast, there were no significant differences between BVD and sham control animals in the EPM and the BVD animals exhibited a marginally longer escape latency in the ETM (P≤0.03), with no change in avoidance latency. In the STM, the BVD animals demonstrated a large and significant decrease in accuracy compared to the sham control animals (P≤0.000), which was not affected by drug treatment. These results have replicated previous findings regarding increased locomotor activity, reduced rearing and thigmotaxis in the OFM, and impaired performance in the STM. However, they failed to replicate some previous results obtained using the EPM and ETM. Overall, they do not support the hypothesis that BVD animals exhibit increased anxiety-like behaviour and suggest that the cognitive deficits may be independent of the emotional effects of vestibular loss.

Compensation following bilateral vestibular damage

Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH) produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that non-labyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.

Spatial separation of visual and vestibular processing in the human hippocampal formation

The hippocampal formation, that is, the hippocampus proper and the parahippocampal region, is essential for various aspects of memory and plays an important role in human navigation. Navigational cues can be provided by both the visual system (e.g., landmarks, optic flow) and the vestibular system (e.g., estimation of direction during path integration). This study reviews anatomical, electrophysiological, and imaging data that support the view that vestibular input is primarily processed in the anterior part of the hippocampal formation, whereas visual cues are primarily integrated in the posterior part. In cases of reduced vestibular or visual input or excessive sensory stimulation, this hippocampal navigational network is reorganized. The separation of vestibular and visual information in the hippocampal formation has a twofold functional consequence: missing input from either system may be partially substituted for, and the task-dependent sensorial weight can be shifted to, the more reliable modality for navigation.

Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications

The comorbidity among balance disorders, anxiety disorders and migraine has been studied extensively from clinical and basic research perspectives. From a neurological perspective, the comorbid symptoms are viewed as the product of sensorimotor, interoceptive and cognitive adaptations that are produced by afferent interoceptive information processing, a vestibulo-parabrachial nucleus network, a cerebral cortical network (including the insula, orbitofrontal cortex, prefrontal cortex and anterior cingulate cortex), a raphe nuclear-vestibular network, a coeruleo-vestibular network and a raphe-locus coeruleus loop. As these pathways overlap extensively with pathways implicated in the generation, perception and regulation of emotions and affective states, the comorbid disorders and effective treatment modalities can be viewed within the contexts of neurological and psychopharmacological sites of action of current therapies.

Mental transformation abilities in patients with unilateral and bilateral vestibular loss

Vestibular information helps to establish a reliable gravitational frame of reference and contributes to the adequate perception of the location of one's own body in space. This information is likely to be required in spatial cognitive tasks. Indeed, previous studies suggest that the processing of vestibular information is involved in mental transformation tasks in healthy participants. In this study, we investigate whether patients with bilateral or unilateral vestibular loss show impaired ability to mentally transform images of bodies and body parts compared to a healthy, age-matched control group. An egocentric and an object-based mental transformation task were used. Moreover, spatial perception was assessed using a computerized version of the subjective visual vertical and the rod and frame test. Participants with bilateral vestibular loss showed impaired performance in mental transformation, especially in egocentric mental transformation, compared to participants with unilateral vestibular lesions and the control group. Performance of participants with unilateral vestibular lesions and the control group are comparable, and no differences were found between right- and left-sided labyrinthectomized patients. A control task showed no differences between the three groups. The findings from this study substantiate that central vestibular processes are involved in imagined spatial body transformations; but interestingly, only participants with bilateral vestibular loss are affected, whereas unilateral vestibular loss does not lead to a decline in spatial imagery.

Mammillothalamic tract lesions disrupt dead reckoning in the rat

Debate surrounds the role of the limbic system structures' contribution to spatial orientation. The results from previous studies have supported a role for the mammillary bodies and their projections to the anterior thalamus in rapid encoding of relationships among environmental cues; however, this work is based on behavioral tasks in which environmental and self-movement cues could not be dissociated. The present study examines the effects of mammillothalamic tract lesions on spatial orientation in the food hoarding paradigm and the water maze. Although the food hoarding paradigm dissociates the use of environmental and self-movement cues, both sources of information are available to guide performance in the water maze. Mammillothalamic tract lesions selectively impaired performance on both tasks. These impairments are interpreted as providing further evidence for the role of limbic system structures in processing self-movement cues.

Modulation of memory by vestibular lesions and galvanic vestibular stimulation

For decades it has been speculated that there is a close association between the vestibular system and spatial memories constructed by areas of the brain such as the hippocampus. While many animal studies have been conducted which support this relationship, only in the last 10 years have detailed quantitative studies been carried out in patients with vestibular disorders. The majority of these studies suggest that complete bilateral vestibular loss results in spatial memory deficits that are not simply due to vestibular reflex dysfunction, while the effects of unilateral vestibular damage are more complex and subtle. Very recently, reports have emerged that sub-threshold, noisy galvanic vestibular stimulation can enhance memory in humans, although this has not been investigated for spatial memory as yet. These studies add to the increasing evidence that suggests a connection between vestibular sensory information and memory in humans.

Hypnotizability-related effects of vestibular impairment on posture and locomotion

Body sway and locomotion are differentially modulated in high (highs) and low (lows) hypnotizable subjects undergoing alteration of visual and neck/leg proprioceptive inputs. The study's aim was to investigate whether partial impairment of vestibular information due to backward head extension affects postural (Study 1) and locomotor behavior (Study 2) differentially in highs and lows. Results showed that, at variance with the visual and proprioceptive modalities, vestibular inactivation did not induce major differences between the 2 groups, with the exception of improvement in walking straight across consecutive trials, which was observed only in highs. The article presents an overview of the structures and mechanisms possibly involved in the observed hypnotizability-related differences in motor control and suggests that hypnotic susceptibility might be a relevant factor in neuro-rehabilitative treatments because it accounts for part of the variability in the sensorimotor self.

Structural and functional plasticity of the hippocampal formation in professional dancers and slackliners

The acquisition of special skills can induce plastic changes in the human hippocampus, a finding demonstrated in expert navigators (Maguire et al. (2000) Proc Natl Acad Sci USA 97:4,398-403). Conversely, patients with acquired chronic bilateral vestibular loss develop atrophy of the hippocampus, which is associated with impaired spatial memory (Brandt et al. (2005) Brain 128:2,732-741). This suggests that spatial memory relies on vestibular input. In this study 21 professional dancers and slackliners were examined to assess whether balance training with extensive vestibulo-visual stimulation is associated with altered hippocampal formation volumes or spatial memory. Gray matter voxel-based morphometry showed smaller volumes in the anterior hippocampal formation and in parts of the parieto-insular vestibular cortex of the trained subjects but larger volumes in the posterior hippocampal formation and the lingual and fusiform gyri bilaterally. The local volumes in the right anterior hippocampal formation correlated negatively and those in the right posterior hippocampal formation positively with the amount of time spent training ballet/ice dancing or slacklining at the time of the study. There were no differences in general memory or in spatial memory as assessed by the virtual Morris water task. Trained subjects performed significantly better on a hippocampal formation-dependent task of nonspatial memory (transverse patterning). The smaller anterior hippocampal formation volumes of the trained subjects may be the result of a long-term suppression of destabilizing vestibular input. This is supported by the associated volume loss in the parieto-insular vestibular cortex. The larger volumes in the posterior hippocampal formation of the trained subjects might result from their increased utilization of visual cues for balance. This is supported by the concomitant larger volumes in visual areas like the lingual and fusiform gyri. Our findings indicate that there is a spatial separation of vestibular and visual processes in the human hippocampus.

Perceptual and motor inhibition in individuals with vestibular disorders

BACKGROUND AND PURPOSE

Vestibular dysfunction has been shown to be associated with altered cognitive function. The purpose of this study was to examine changes in cognitive function in participants with vestibular disease during the course of vestibular physical therapy.

METHODS

Twenty-two participants (mean age = 52, standard deviation = 11) with previously diagnosed vestibular disorders were tested at the beginning and end of rehabilitation. The Motor and Perceptual Inhibition Test (MAPIT) was used to assess manual reaction times when responding to various stimuli presented on a computer screen. Additional physical performance measures and questionnaires related to dizziness, fear of falling, and activities of daily living were used to quantify change during the 6-week intervention period. The repeatable battery for the assessment of neuropsychological status (a measure of memory and executive function) was used to ensure that participants did not have memory or executive function deficits.

RESULTS

Overall, there were no significant differences in MAPIT score before versus after physical therapy intervention, however there were some participants who demonstrated improvements in motor inhibition (MI) and perceptual inhibition (PI) scores. Interstingly, 8 of the 9 participants with abnormal caloric test findings had improvements on 2 of the PI scores. Overall 50% to 64% of the participants demonstrated improvement in the 4 different MAPIT scores. There were improvements in physical performance and self-report measures at the end of the 6-week physical therapy intervention program.

DISCUSSION/CONCLUSION

Individuals with vestibular disorders may show improvement in MI and PI after a 6-week physical therapy intervention program; those with abnormalities on caloric and rotational chair tests appear especially likely to experience improvement in PI. Additional study is needed to determine whether individuals with vestibular disorders have remediable deficits in MI and PI.

Move it or lose it--is stimulation of the vestibular system necessary for normal spatial memory?

Studies in both experimental animals and human patients have demonstrated that peripheral vestibular lesions, especially bilateral lesions, are associated with spatial memory impairment that is long-lasting and may even be permanent. Electrophysiological evidence from animals indicates that bilateral vestibular loss causes place cells and theta activity to become dysfunctional; the most recent human evidence suggests that the hippocampus may cause atrophy in patients with bilateral vestibular lesions. Taken together, these studies suggest that self-motion information provided by the vestibular system is important for the development of spatial memory by areas of the brain such as the hippocampus, and when it is lost, spatial memory is impaired. This naturally suggests the converse possibility that activation of the vestibular system may enhance memory. Surprisingly, there is some human evidence that this may be the case. This review considers the relationship between the vestibular system and memory and suggests that the evolutionary age of this primitive sensory system as well as how it detects self-motion (i.e., detection of acceleration vs. velocity) may be the reasons for its unique contribution to spatial memory.

Improvement of a figure copying deficit during subsensory galvanic vestibular stimulation

We describe the effects of galvanic vestibular stimulation (GVS) on an individual who, following right hemisphere stroke, is unable to copy figures accurately. His copies contain most of the constituent elements, but are poorly integrated and drawn in a seemingly haphazard manner. To test whether GVS could help overcome these difficulties, we administered the Rey-Osterrieth complex figure copy task while manipulating both the presence and laterality of the galvanic signal. The signal was applied at a level that was too low to elicit sensation which ensured that the individual was unaware of either when or on what side he was being stimulated. Relative to a sham condition, two consecutive blocks of GVS increased both the accuracy with which the main configural elements of the figure were reconstructed, and there was some, albeit less consistent evidence, that these were drawn in a more wholistic as opposed to piecemeal manner. Improvement was not reliant on the polarity of the stimulating electrodes. These results suggest that GVS can help overcome difficulties in the perception and/or reconstruction of hierarchical visual form, and thereby uncover a new link between vestibular information processing and visual task performance.

Long-term deficits on a foraging task after bilateral vestibular deafferentation in rats

Animal studies have shown that bilateral vestibular deafferentation (BVD) causes deficits in spatial memory that may be related to electrophysiological and neurochemical changes in the hippocampus. Recently, human studies have also indicated that human patients can exhibit spatial memory impairment and hippocampal atrophy even 8-10 yr following BVD. Our previous studies have shown that rats with unilateral vestibular deafferentation (UVD) showed an impairment at 3 months after the surgery on a food foraging task that relies on hippocampal integration of egocentric cues, such as vestibular information; however, by 6 months postop, they showed a recovery of function. By contrast, the long-term effects of BVD on spatial navigation have never been well studied. In this study, we tested BVD or sham rats on a food foraging task at 5 months postop. Under light conditions, BVD rats were able to use visual cues to guide themselves home, but did so with a significantly longer homing time. However, in darkness, BVD rats were severely impaired in the foraging task, as indicated by a significantly longer homing distance and homing time, with more errors and larger heading angles when compared with sham rats. These results suggest that, unlike UVD, BVD causes long-term deficits in spatial navigation that are unlikely to recover, even with repeated T-maze training.

Head direction cell activity in mice: robust directional signal depends on intact otolith organs

The head direction (HD) cell signal is a representation of an animal's perceived directional heading with respect to its environment. This signal appears to originate in the vestibular system, which includes the semicircular canals and otolith organs. Preliminary studies indicate the semicircular canals provide a necessary component of the HD signal, but involvement of otolithic information in the HD signal has not been tested. The present study was designed to determine the otolithic contribution to the HD signal, as well as to compare HD cell activity of mice with that of rats. HD cell activity in the anterodorsal thalamus was assessed in wild-type C57BL/6J and otoconia-deficient tilted mice during locomotion within a cylinder containing a prominent visual landmark. HD cell firing properties in C57BL/6J mice were generally similar to those in rats. However, in C57BL/6J mice, landmark rotation failed to demonstrate dominant control of the HD signal in 36% of the sessions. In darkness, directional firing became unstable during 42% of the sessions, but landmark control was not associated with HD signal stability in darkness. HD cells were identified in tilted mice, but directional firing properties were not as robust as those of C57BL/6J mice. Most HD cells in tilted mice were controlled by landmark rotation but showed substantial signal degradation across trials. These results support current models that suggest otolithic information is involved in the perception of directional heading. Furthermore, compared with rats, the HD signal in mice appears to be less reliably anchored to prominent environmental cues.

Control of rodent and human spatial navigation by room and apparatus cues

A growing body of literature indicates that rats prefer to navigate in the direction of a goal in the environment (directional responding) rather than to the precise location of the goal (place navigation). This paper provides a brief review of this literature with an emphasis on recent findings in the Morris water task. Four experiments designed to extend this work to humans in a computerized, virtual Morris water task are also described. Special emphasis is devoted to how directional responding and place navigation are influenced by room and apparatus cues, and how these cues control distinct components of navigation to a goal. Experiments 1 and 2 demonstrate that humans, like rats, perform directional responses when cues from the apparatus are present, while Experiment 3 demonstrates that place navigation predominates when apparatus cues are eliminated. In Experiment 4, an eyetracking system measured gaze location in the virtual environment dynamically as participants navigated from a start point to the goal. Participants primarily looked at room cues during the early segment of each trial, but primarily focused on the apparatus as the trial progressed, suggesting distinct, sequential stimulus functions. Implications for computational modeling of navigation in the Morris water task and related tasks are discussed.

Anxiety and otovestibular disorders: linking behavioral phenotypes in men and mice

Human anxiety and vestibular disorders have long been known to co-occur. Paralleling human clinical and non-clinical data, mounting genetic, pharmacological and behavioral evidence confirms that animal anxiety interplays and co-exists with vestibular/balance deficits. However, relatively few animal models have addressed the nature of this relationship. This paper examines side-by-side human psychiatric and otovestibular phenotypes with animal experimentation data, and outlines future directions of translational research in this field. Discussed here are recently developed specific animal models targeting this interplay, other traditional animal tests sensitive to altered anxiety and vestibular domains, and the existing problems with translation of animal data into human phenotypes. The role of hearing deficits and their contribution to anxiety and vestibular phenotypes are also outlined. Overall, the overlap between anxiety and balance disorders emerges as an important phenomenon in both animal and clinical studies, and may contribute markedly to the complexity of behavioral and physiological phenotypes. Animal experimental models that focus on the interplay between anxiety and vestibular disorders are needed to improve our understanding of this important biomedical problem.

Spatial memory and hippocampal volume in humans with unilateral vestibular deafferentation

Patients with acquired chronic bilateral vestibular loss were recently found to have a significant impairment in spatial memory and navigation when tested with a virtual Morris water task. These deficits were associated with selective and bilateral atrophy of the hippocampus, which suggests that spatial memory and navigation also rely on vestibular input. In the present study 16 patients with unilateral vestibular deafferentation due to acoustic neurinoma were examined 5- to 13-yrs post-surgery. Volumetry of the hippocampus was performed in patients and age- and sex-matched healthy controls by manually tracing the structure and by an evaluator-independent voxel-based morphometry. Spatial memory and navigation were assessed with a virtual Morris water task. No significant deficits in spatial memory and navigation could be demonstrated in the patients with left vestibular failure, whereas patients with right vestibular loss showed a tendency to perform worse on the respective tests. Impairment was significant only for one computed measure (heading error). The subtle deficiencies with right vestibular loss are compatible with the recently described dominance of the right labyrinth and the vestibular cortex in the right hemisphere. Volumetry did not reveal any atrophy of the hippocampus in either patient group.

Impairment on the hippocampal-dependent virtual Morris water task in schizophrenia

Traditional neuropsychological tests of visual and verbal memory have been used to evaluate memory deficits in schizophrenia. However, these tests cannot be used in non-human animal research, which is important for the discovery of treatments that will improve cognition and for study of the etiology of schizophrenia. To help bridge the gap between human and non-human animal research on hippocampal function in schizophrenia, this study sought to characterize the behavioral performance exhibited by patients using the Morris water task (MWT). The MWT has been shown in human and non-human animal studies to be hippocampus-dependent. In the virtual MWT, human subjects navigate a computer-generated on-screen environment to escape from the "water" by locating a platform. Patients with schizophrenia and controls performed two versions of the virtual MWT: a hippocampal-dependent hidden-platform version, relying on allocentric navigational abilities, and a non-hippocampal-dependent visible-platform version, relying on cued-navigational abilities. Patients traveled further and took longer to find the hidden platform over training blocks and spent less time in the correct quadrant during a probe trial. There was no deficit in the visible-platform condition. These findings identify a behavioral impairment on a hippocampal-dependent task in schizophrenia and support using the MWT in testing animal models of schizophrenia.

Lesions of the vestibular system disrupt hippocampal theta rhythm in the rat

The hippocampus has a major role in memory for spatial location. Theta is a rhythmic hippocampal EEG oscillation that occurs at approximately 8 Hz during voluntary movement and that may have some role in encoding spatial information. We investigated whether, as part of this process, theta might be influenced by self-movement signals provided by the vestibular system. The effects of bilateral peripheral vestibular lesions, made > or = 60 days prior to recording, were assessed in freely moving rats. Power spectral analysis revealed that theta in the lesioned animals had a lower power and frequency compared with that recorded in the control animals. When the electroencephalography (EEG) was compared in epochs matched for speed of movement and acceleration, theta was less rhythmic in the lesioned group, indicating that the effect was not a result of between-group differences in this behavior. Blood measurements of corticosterone were also similar in the two groups indicating that the results could not be attributed to changes in stress levels. Despite the changes in theta EEG, individual neurons in the CA1 region of lesioned animals continued to fire with a periodicity of approximately 8 Hz. The positive correlation between cell firing rate and movement velocity that is observed in CA1 neurons of normal animals was also maintained in cells recorded from lesion group animals. These findings indicate that although vestibular signals may contribute to theta rhythm generation, velocity-related firing in hippocampal neurons is dependent on nonvestibular signals such as sensory flow, proprioception, or motor efference copy.

Impairment and recovery on a food foraging task following unilateral vestibular deafferentation in rats

It has been suggested that the vestibular system may contribute to the development of higher cognitive function, especially spatial learning and memory that uses idiothetic cues (e.g., dead reckoning). However, few studies have been done using behavioral tasks that could potentially separate the animals' ability for dead reckoning from piloting. The food foraging task requires the animal to continuously monitor and integrate self-movement cues and generate an accurate return path. It has been shown that bilateral vestibular-lesioned rats were impaired on this task. The present study used the same task to further examine the contribution of vestibular information to spatial navigation by comparing unilateral and bilateral lesions and by testing the animals at different time points following the lesion. The results demonstrated that animals with unilateral vestibular deafferentation were impaired in performing the task in the dark at 3 months after the lesion, and this impairment disappeared at 6 months after the lesion. This supports the notion that vestibular information contributes to dead reckoning and suggests possible recovery of function over time after the lesion. Animals with bilateral vestibular deafferentation were not able to be tested on the foraging task because they exhibited behavior distinct from the unilateral-lesioned animals, with significant hesitation in leaving their home cage for as long as 6 months after the lesion.

Place-related neural responses in the monkey hippocampal formation in a virtual space

Place cells in the rodent hippocampal formation (HF) are suggested to be the neural substrate for a spatial cognitive map. This specific spatial property of the place cells are regulated by both allothetic cues (i.e., intramaze local and distal cues) as well as idiothetic sensory inputs; the context signaled by the distal cues allows local and idiothetic cues to be employed for spatial tuning within the maze. To investigate the effects of distal cues on place-related activity of primate HF neurons, 228 neurons were recorded from the monkey HF during virtual navigation in a similar situation to a rodent water maze, in which distal cues were important to locate the animal's position. A subset of 72 neurons displayed place-related activity in one or more virtual spaces. Most place-related responses disappeared or changed their spatial tuning (i.e., remapping) when the arrangements of the distal cues were altered/moved in the virtual spaces. These specific features of the monkey HF might underlie neurophysiological bases of human episodic memory.

The effects of vestibular lesions on hippocampal function in rats

Interest in interaction between the vestibular system and the hippocampus was stimulated by evidence that peripheral vestibular lesions could impair performance in learning and memory tasks requiring spatial information processing. By the 1990s, electrophysiological data were emerging that the brainstem vestibular nucleus complex (VNC) and the hippocampus were connected polysynaptically and that hippocampal place cells could respond to vestibular stimulation. The aim of this review is to summarise and critically evaluate research published in the last 5 years that has seen major progress in understanding the effects of vestibular damage on the hippocampus. In addition to new behavioural studies demonstrating that animals with vestibular lesions exhibit impairments in spatial memory tasks, electrophysiological studies have confirmed long-latency, polysynaptic pathways between the VNC and the hippocampus. Peripheral vestibular lesions have been shown to cause long-term changes in place cell function, hippocampal EEG activity and even CA1 field potentials in brain slices maintained in vitro. During the same period, neurochemical investigations have shown that some hippocampal subregions exhibit long-term changes in the expression of neuronal nitric oxide synthase, arginase I and II, and the NR1 and NR2A N-methyl-D-aspartate (NMDA) receptor subunits following peripheral vestibular damage. Despite the progress, a number of important issues remain to be resolved, such as the possible contribution of auditory damage associated with vestibular lesions, to the hippocampal effects observed. Furthermore, although these studies demonstrate that damage to the vestibular system does have a long-term impact on the electrophysiological and neurochemical function of the hippocampus, they do not indicate precisely how vestibular information might be used in hippocampal functions such as developing spatial representations of the environment. Understanding this will require detailed electrical stimulation and lesion studies to elucidate the way in which different kinds of vestibular information are transmitted to various hippocampal subregions.

Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans

The human hippocampal formation plays a crucial role in various aspects of memory processing. Most literature on the human hippocampus stresses its non-spatial memory functions, but older work in rodents and some other species emphasized the role of the hippocampus in spatial learning and memory as well. A few human studies also point to a direct relation between hippocampal size, navigation and spatial memory. Conversely, the importance of the vestibular system for navigation and spatial memory was until now convincingly demonstrated only in animals. Using magnetic resonance imaging volumetry, we found that patients (n = 10) with acquired chronic bilateral vestibular loss (BVL) develop a significant selective atrophy of the hippocampus (16.9% decrease relative to controls). When tested with a virtual variant (on a PC) of the Morris water task these patients exhibited significant spatial memory and navigation deficits that closely matched the pattern of hippocampal atrophy. These spatial memory deficits were not associated with general memory deficits. The current data on BVL patients and bilateral hippocampal atrophy revive the idea that a major--and probably phylogenetically ancient--function of the archicortical hippocampal tissue is still evident in spatial aspects of memory processing for navigation. Furthermore, these data demonstrate for the first time in humans that spatial navigation critically depends on preserved vestibular function, even when the subjects are stationary, e.g. without any actual vestibular or somatosensory stimulation.

Immunosuppressive treatment in bilateral vestibulopathy with inner ear antibodies

CONCLUSIONS

Although vestibular recovery was observed after steroid treatment, it remains uncertain whether this improvement was spontaneous or due to medication. These data do not allow us to generally recommend corticosteroid treatment in patients with BVF and inner ear antibodies.

OBJECTIVE

A retrospective study was performed based on the observation of two patients with suspected autoimmune bilateral vestibular failure (BVF) with normal hearing and antilabyrinthine or nervous tissue-specific serum antibodies who showed vestibular recovery after corticosteroid treatment.

MATERIAL AND METHODS

Twelve patients with BVF and serum inner ear antibodies who had received imuunosuppressive treatment with corticosteroids were evaluated in terms of medical history, repetitive caloric irrigation and repetitive determination of inner ear antibodies. BVF was complete in four patients and incomplete in eight.

RESULTS

After immunosuppressive therapy, four of the 12 patients showed a moderate recovery of the peak slow-phase velocity of horizontal nystagmus induced by bithermal caloric stimulation, which was only transient in two of them.

General vestibular testing

A dysfunction of the vestibular system is commonly characterized by a combination of phenomena involving perceptual, ocular motor, postural, and autonomic manifestations: vertigo/dizziness, nystagmus, ataxia, and nausea. These 4 manifestations correlate with different aspects of vestibular function and emanate from different sites within the central nervous system. The diagnosis of vestibular syndromes always requires interdisciplinary thinking. A detailed history allows early differentiation into 9 categories that serve as a practical guide for differential diagnosis: (1) dizziness and lightheadedness; (2) single or recurrent attacks of vertigo; (3) sustained vertigo; (4) positional/positioning vertigo; (5) oscillopsia; (6) vertigo associated with auditory dysfunction; (7) vertigo associated with brainstem or cerebellar symptoms; (8) vertigo associated with headache; and (9) dizziness or to-and-fro vertigo with postural imbalance. A careful and systematic neuro-ophthalmological and neuro-otological examination is also mandatory, especially to differentiate between central and peripheral vestibular disorders. Important signs are nystagmus, ocular tilt reaction, other central or peripheral ocular motor dysfunctions, or a unilateral or bilateral peripheral vestibular deficit. This deficit can be easily detected by the head-impulse test, the most relevant bedside test for the vestibulo-ocular reflex. Laboratory examinations are used to measure eye movements, to test semicircular canal, otolith, and spatial perceptional function and to determine postural control. It must, however, be kept in mind that all signs and ocular motor and vestibular findings have to be interpreted within the context of the patient's history and a complete neurological examination.

Cytosolic glucocorticoid receptor expression in the rat vestibular nucleus and hippocampus following unilateral vestibular deafferentation

It has been suggested that vestibular compensation, the process of behavioural recovery that occurs following peripheral vestibular damage, might be partially dependent on the release of glucocorticoids (GC) during the early stages of recovery from the lesion. One possibility is that glucocorticoid receptors (GRs) in the vestibular nucleus complex (VNC) might change following the lesion, altering their response to GCs. We sought to test this hypothesis by quantifying the expression of cytosolic GRs in the bilateral VNCs at 10 h, 58 h and 2 weeks following unilateral vestibular deafferentation (UVD) in rat, using western blotting. We also examined GR expression in the CA1, CA2/3 and dentate gyrus (DG) subregions of the hippocampus and measured serum corticosterone levels. Compared with sham surgery and anaesthetic controls, we found no significant changes in GR expression in the ipsilateral or contralateral VNCs at any time post-UVD. However, we did find a significant decrease in GR expression in the ipsilateral CA1 at 2 weeks post-UVD. Serum corticosterone levels were significantly lower in all groups at 58 h post-op. compared to 10 h and 2 weeks; however, there were no significant differences between the UVD and control groups at any time point. These results suggest that changes in GR expression in the VNC are unlikely to contribute to the development of vestibular compensation. However, long-term changes in GR expression in CA1 might be related to chronic deficits in hippocampal function and spatial cognition following vestibular damage.

Bilateral labyrinthectomy causes long-term deficit in object recognition in rat

It has been reported that patients with vestibular disorders experience a wide range of cognitive disorders, including memory loss. However, to our knowledge, no study has investigated the contribution of vestibular information to episodic memory in experimental animals using vestibular deafferentation. In the present study, the effects of a complete unilateral or bilateral surgical lesion of the vestibular labyrinths in a spontaneous object recognition task were evaluated in Wistar rats 3 and 6 months following the surgery. We found that rats with bilateral vestibular deafferentation, but not those with unilateral vestibular deafferentation were impaired on the task at both time points. These results suggest for the first time that vestibular information may contribute to non-spatial memory to some extent.