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Dobbels B, Mertens G, Gilles A, Claes A, Moyaert J, van de Berg R, Van de Heyning P, Vanderveken O, Van Rompaey V. Cognitive Function in Acquired Bilateral Vestibulopathy: A Cross-Sectional Study on Cognition, Hearing, and Vestibular Loss. Front Neurosci 2019; 13:340. [PMID: 31105513 PMCID: PMC6492511 DOI: 10.3389/fnins.2019.00340] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/25/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Several studies have demonstrated cognitive deficits in patients with bilateral vestibulopathy (BVP). So far, little attention has been paid to the hearing status of vestibular patients when evaluating their cognition. Given the well-established link between sensorineural hearing loss (SNHL) and cognitive decline and the high prevalence of SNHL in BVP patients, it is therefore uncertain if the cognitive deficits in BVP patients are solely due to their vestibular loss or might be, partially, explained by a concomitant SNHL. OBJECTIVE To evaluate the link between cognition, hearing, and vestibular loss in BVP patients. DESIGN Prospective cross-sectional analysis of cognitive performance in patients with BVP and control participants without vestibular loss. Both groups included subjects with a variety of hearing (dys)function. Cognition was assessed by means of the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing Impaired Individuals (RBANS-H). RESULTS Sixty-four BVP patients were evaluated and compared with 83 control participants. For each subscale and the totale RBANS-H scale a multiple linear regression model was fitted with the following variables: vestibular loss, hearing loss, age, gender, and education. Hearing loss seemed to be associated with worse outcome on the total RBANS-H scale and subscales immediate memory and language. Vestibular loss, on the other hand, was linked to worse performance on the attention subscale of the RBANS-H. Furthermore, we did not observe a correlation between saccular function and cognition. CONCLUSION This study has found general cognitive deficits in a large sample size of BVP patients. Multiple linear regression models revealed that both vestibular and hearing dysfunction were associated with different subscales of the cognitive test battery, the RBANS-H. Whereas hearing loss was associated with worse performance on total RBANS-H score, immediate memory and language, vestibular loss was observed to negatively affect attention performance.
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Affiliation(s)
- Bieke Dobbels
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Griet Mertens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annes Claes
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Julie Moyaert
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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Rogge AK, Hötting K, Nagel V, Zech A, Hölig C, Röder B. Improved balance performance accompanied by structural plasticity in blind adults after training. Neuropsychologia 2019; 129:318-330. [PMID: 31004689 DOI: 10.1016/j.neuropsychologia.2019.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/18/2019] [Accepted: 04/13/2019] [Indexed: 12/25/2022]
Abstract
Postural control requires the sensory integration of visual, vestibular, and proprioceptive signals. In the absence of vision, either by blindfolding or in blind individuals, balance performance is typically poorer than with sight. Previous research has suggested that despite showing compensatory vestibular and proprioceptive processing during upright standing, balance performance in blind individuals is overall lower than in sighted controls with eyes open. The present study tested whether balance training, which places demands on vestibular and proprioceptive self-motion perception, improves balance performance in blind adults, and whether we find similar structural correlates in cortical and subcortical brain areas as have been reported in sighted individuals. Fourteen congenitally or late blind adults were randomly assigned to either a balance or a relaxation group and exercised twice a week for 12 weeks. Assessments prior to and after training included balance tests and the acquisition of T1-weighted MRI images. The blind balance group significantly improved in dynamic, static, and functional balance performance compared to the blind relaxation group. The balance performance improvement did not differ from that of age- and gender matched sighted adults after balance training. Cortical thickness increased in the left parahippocampus and decreased in the inferior insula bilaterally in the blind balance group compared to the blind relaxation group. Thickness decreases in the insula were related to improved static and functional balance. Gray matter volume was reduced in the left hippocampus proper and increased in the right subiculum in the blind balance group. The present data suggest that impaired balance performance in blind adults can be significantly improved by a training inducing plasticity in brain regions associated with vestibular and proprioceptive self-motion processing.
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Affiliation(s)
- Ann-Kathrin Rogge
- Universität Hamburg, Biological Psychology and Neuropsychology, Von-Melle-Park 11, 20146, Hamburg, Germany.
| | - Kirsten Hötting
- Universität Hamburg, Biological Psychology and Neuropsychology, Von-Melle-Park 11, 20146, Hamburg, Germany.
| | - Volker Nagel
- Universität Hamburg, Sports Medicine, Turmweg 2, 20146, Hamburg, Germany.
| | - Astrid Zech
- Friedrich Schiller University, Human Movement Science, Seidelstraße 20, 07749, Jena, Germany.
| | - Cordula Hölig
- Friedrich Schiller University, Human Movement Science, Seidelstraße 20, 07749, Jena, Germany.
| | - Brigitte Röder
- Universität Hamburg, Biological Psychology and Neuropsychology, Von-Melle-Park 11, 20146, Hamburg, Germany.
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van Dooren TS, Lucieer FMP, Duijn S, Janssen AML, Guinand N, Pérez Fornos A, Van Rompaey V, Kingma H, Ramat S, van de Berg R. The Functional Head Impulse Test to Assess Oscillopsia in Bilateral Vestibulopathy. Front Neurol 2019; 10:365. [PMID: 31105632 PMCID: PMC6499172 DOI: 10.3389/fneur.2019.00365] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Bilateral vestibulopathy (BV) is a chronic condition in which vestibular function is severely impaired or absent on both ears. Oscillopsia is one of the main symptoms of BV. Oscillopsia can be quantified objectively by functional vestibular tests, and subjectively by questionnaires. Recently, a new technique for testing functionally effective gaze stabilization was developed: the functional Head Impulse Test (fHIT). This study compared the fHIT with the Dynamic Visual Acuity assessed on a treadmill (DVAtreadmill) and Oscillopsia Severity Questionnaire (OSQ) in the context of objectifying the experience of oscillopsia in patients with BV. Methods: Inclusion criteria comprised: (1) summated slow phase velocity of nystagmus of <20°/s during bithermal caloric tests, (2) torsion swing tests gain of <30% and/or phase <168°, and (3) complaints of oscillopsia and/or imbalance. During the fHIT (Beon Solutions srl, Italy) patients were seated in front of a computer screen. During a passive horizontal head impulse a Landolt C optotype was shortly displayed. Patients reported the seen optotype by pressing the corresponding button on a keyboard. The percentage correct answers was registered for leftwards and rightwards head impulses separately. During DVAtreadmill patients were positioned on a treadmill in front of a computer screen that showed Sloan optotypes. Patients were tested in static condition and in dynamic conditions (while walking on the treadmill at 2, 4, and 6 km/h). The decline in LogMAR between static and dynamic conditions was registered for each speed. Every patient completed the Oscillopsia Severity Questionnaire (OSQ). Results: In total 23 patients were included. This study showed a moderate correlation between OSQ outcomes and the fHIT [rightwards head rotations (rs = −0.559; p = 0.006) leftwards head rotations (rs = −0.396; p = 0.061)]. No correlation was found between OSQ outcomes and DVAtreadmill, or between DVAtreadmill and fHIT. All patients completed the fHIT, 52% of the patients completed the DVAtreadmill on all speeds. Conclusion: The fHIT seems to be a feasible test to quantify oscillopsia in BV since, unlike DVAtreadmill, it correlates with the experienced oscillopsia measured by the OSQ, and more BV patients are able to complete the fHIT than DVAtreadmill.
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Affiliation(s)
- T S van Dooren
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - F M P Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - S Duijn
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, 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
| | - N Guinand
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - A Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - V Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - H Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - S Ramat
- Department of Computer, Electric and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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54
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55
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Kingma H, Felipe L, Gerards MC, Gerits P, Guinand N, Perez-Fornos A, Demkin V, van de Berg R. Vibrotactile feedback improves balance and mobility in patients with severe bilateral vestibular loss. J Neurol 2018; 266:19-26. [PMID: 30519776 PMCID: PMC6722250 DOI: 10.1007/s00415-018-9133-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/23/2022]
Abstract
The impact of vibrotactile feedback of the gravity vector, provided by a “balance” belt worn around the waist, was evaluated in 39 patients with a severe bilateral vestibular loss, confirmed by extensive laboratory testing and suffering from a low quality of life, mainly due to imbalance. The mobility and balance score (MBS) of all patients prior to the use of the belt was equal or less than 5 out of a scale of 10. Thirty-one out of the 39 patients experienced the effect of the belt on their balance and mobility as positive in a preselection trial of 2 h in the hospital. The 31 positive responders then used the belt for 1 month in daily life. The average MBS increased significantly from 4.2 to 7.9 (paired T test, T = 9.82, p < 0.00001). Twenty-three out of 31 patients reported a benefit ranging from an improvement of 60–200% in their MBS. Eight patients did not experience any benefit. In summary, 23 out of 39 patients with a severe imbalance due to a bilateral vestibular loss experienced a clear benefit of vibrotactile feed = back in daily life. We conclude that vibrotactile feedback via the waist can serve as an effective prothesis for patients with severe bilateral vestibular loss to improve the quality of life.
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Affiliation(s)
- Herman 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, The Netherlands. .,Faculty of Physics, Tomsk State University, Tomsk, Russian Federation.
| | - Lilian Felipe
- Speech and Hearing Sciences Department, Lamar University, Rio de Janeiro, Brazil
| | - Marie-Cecile Gerards
- 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, The Netherlands
| | - Peter Gerits
- IDEE, Maastricht University, Maastricht, The Netherlands
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Perez-Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vladimir Demkin
- Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
| | - Raymond 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, The Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
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