1
|
Liu X, Li X, Wang X, Xu A. Causal effect of cerebral small vessel disease on unexplained dizziness: A Mendelian randomization study. J Stroke Cerebrovasc Dis 2024; 33:107948. [PMID: 39153583 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Previous cohort studies have suggested an association between cerebral small vessel disease (cSVD) and "unexplained dizziness". The causality of this link remains uncertain, but it would be of significant clinical importance, considering the substantial number of patients presenting with unexplained dizziness is large. We aimed to investigate the causal effect of cSVD-related phenotypes on unexplained dizziness using a Mendelian randomization approach. METHODS Genetic instruments for each cSVD-related phenotype - white matter hyperintensity (WMH) volume, lacunar stroke (LS), perivascular spaces (PVS), and cerebral microbleeds (CMBs) - as well as unexplained dizziness were identified through large-scale genome-wide association studies. We conducted 2-sample Mendelian randomization analyses. The random-effects inverse-variance weighted (IVW) method was chosen for the primary analysis. For sensitivity analyses, we employed the weighted-median, MR-Egger, MR pleiotropy residual sum and outlier (MR-PRESSO), and leave-one-out analysis methods were implemented for the sensitivity analyses. RESULTS We successfully identified a significant causal effect of WMH volume on unexplained dizziness (odds ratio [95% CI], 1.12 [1.01-1.23]). However, we were unable to detect any significant causal effects of the other cSVD-related phenotypes on unexplained dizziness, with odds ratios [95% CI] of 1.03 [0.98-1.09] for LS, 0.75 [0.55-1.02] for white matter PVS, 1.02 [0.68-1.52] for basal ganglia PVS, 0.80 [0.43-1.51] for hippocampal PVS, 0.95 [0.90-1.00] for lobar CMBs, and 0.97 [0.92-1.01] for mixed CMBs respectively. The results from the sensitivity analyses were generally consistent with those of the primary analyses. CONCLUSIONS This MR study supports a causal relationship between WMH, a phenotype associated with cSVD, and the risk of unexplained dizziness, but does not support such a relationship between other cSVD-related phenotypes and unexplained dizziness. These findings require further validation through randomized controlled trials, larger cohort studies, and MR studies based on more extensive GWASs.
Collapse
Affiliation(s)
- Xinjian Liu
- Department of Neurology, The First Affiliated Hospital of Jinan University, No. 601 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China; Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong 518000, China
| | - Xiuwen Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xiaojie Wang
- Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong 518000, China
| | - Anding Xu
- Department of Neurology, The First Affiliated Hospital of Jinan University, No. 601 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.
| |
Collapse
|
2
|
Castro P, Ibitoye R, Ellmers T, Kaski D, Arshad Q, Bronstein AM. Towards an explanation for 'unexplained' dizziness in older people. Age Ageing 2024; 53:afae137. [PMID: 38965033 PMCID: PMC11223895 DOI: 10.1093/ageing/afae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/29/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Subjective unsteadiness or dizziness, usually without increase in body sway, is common in older people. The absence of mechanistic understanding of such symptoms renders clinical management difficult. Here, we explore the mechanisms behind such idiopathic dizziness (ID), focusing on postural control abnormalities. METHODS Thirty patients with ID and 30 age-matched controls stood on a moving platform. Platform oscillations were randomly delivered at different velocities (from 0 to 0.2 m/s). Markers of postural control, including objective sway (trunk sway path, recorded via a sensor attached to vertebrae C7), stepping responses, subjective instability and anxiety ratings were obtained. MRI scans were available for correlations with levels of cerebral small vessel disease in 28 patients and 24 controls. RESULTS We observed a significant relationship between objective and subjective instability in all groups. The slope of this fit was significantly steeper for patients than controls, indicating greater perceived instability for the same body sway. Stepwise linear regression showed that the slopes of this objective-subjective instability relationship were best explained by concerns about falling (Falls Efficacy Scale-International), clinical physical functioning (Short Physical Performance Battery) and, to some degree, by neuroimaging markers of cerebral small vessel disease. In addition, patients had a reduced stepping threshold, suggesting an overly cautious postural response. CONCLUSION The distorted perception of instability and subtle impairments in balance control, including abnormal and overly cautious stepping responses, underlies the emergence of ID. It appears to relate to changes in postural performance, psychological functioning and disruption of postural brain networks associated with cerebral small vessel disease.
Collapse
Affiliation(s)
- Patricia Castro
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Escuela de Fonoaudiología, Santiago, Chile
| | - Richard Ibitoye
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Toby Ellmers
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Qadeer Arshad
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Adolfo M Bronstein
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| |
Collapse
|
3
|
Ellmers TJ, Kal EC. Exploring the role of attention towards balance in chronic dizziness: Development of the Balance Vigilance Questionnaire. Eur J Neurol 2024; 31:e16148. [PMID: 38015469 PMCID: PMC11235928 DOI: 10.1111/ene.16148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Vigilance towards balance has been proposed to underpin various chronic dizziness disorders, including persistent postural-perceptual dizziness (PPPD). The objective of this study was to develop (through patient input) a validated balance-specific measure of vigilance that comprehensively assesses the varied ways in which this construct may manifest. METHODS We developed the Balance Vigilance Questionnaire (Balance-VQ) through patient and clinician feedback, designed to assess vigilance towards balance. We then validated the questionnaire in 497 participants consisting of patients diagnosed with chronic dizziness disorders (including 97 individuals diagnosed with PPPD) and healthy controls. RESULTS The final six-item Balance-VQ was shown to be a valid and reliable way to assess vigilance towards balance. Scores were significantly higher in individuals diagnosed with PPPD compared to controls. Although scores were also higher in the PPPD group compared to individuals with diagnosed vestibular disorders other than PPPD, Balance-VQ scores did not discriminate between the two groups when confounding factors (including dizziness severity) were controlled for. Scores did, however, independently discriminate between the PPPD group and individuals who experience dizziness in daily life, but who have not been diagnosed with a neuro-otological disorder. CONCLUSIONS Our findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. As symptom vigilance has been identified as a key risk factor for developing chronic dizziness following acute vestibular symptoms or balance disruption, we recommend using the Balance-VQ as a screening tool in people presenting with such symptoms.
Collapse
Affiliation(s)
- Toby J. Ellmers
- Centre for Vestibular Neurology, Department of Brain SciencesImperial College LondonLondonUK
| | - Elmar C. Kal
- Centre for Cognitive Neuroscience, Department of Health Sciences, College of Health, Medicine, and Life SciencesBrunel University LondonUxbridgeUK
| |
Collapse
|
4
|
Bronstein AM, Kattah J. Vascular neuro-otology: vestibular transient ischemic attacks and chronic dizziness in the elderly. Curr Opin Neurol 2024; 37:59-65. [PMID: 38032270 PMCID: PMC10779463 DOI: 10.1097/wco.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE OF REVIEW To explore the differential diagnosis of posterior fossa transient ischemic attacks (TIA) associated with vertigo and/or imbalance.To review the contribution of cerebral small vessel (SVD) disease to balance dysfunction and dizziness in the elderly. MAIN FINDINGS TIAs involving vestibular structures that mediate the vestibulo-ocular and vestibulospinal reflexes remain a diagnostic challenge because they overlap with causes of benign episodic vertigo. Here, we summarize the results of multidisciplinary specialty efforts to improve timely recognition and intervention of peripheral and central vestibular ischemia. More papers confirm that SVD is a major cause of gait disability, falls and cognitive disorder in the elderly. Recent work shows that early stages of SVD may also be responsible for dizziness in the elderly. The predominant location of the white matter changes, in the frontal deep white matter and genu of the corpus callosum, explains the association between cognitive and balance dysfunction in SVD related symptoms. SUMMARY The evaluation of patients with intermittent vascular vertigo represent a major diagnostic challenge, recent reviews explore the ideal design approach for a multidisciplinary study to increase early recognition and intervention. Hemispheric white matter microvascular ischemia has been the subject of research progress - advanced stages are known to cause gait disorder and dementia but early stages are associated with "idiopathic" dizziness in the elderly.
Collapse
Affiliation(s)
- Adolfo M. Bronstein
- Centre for Vestibular Neuroscience, Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Jorge Kattah
- University of Illinois at Chicago | UIC Department of Neurology (Peoria), Chicago, Illinois, USA
| |
Collapse
|
5
|
Trinidade A, Cabreira V, Goebel JA, Staab JP, Kaski D, Stone J. Predictors of persistent postural-perceptual dizziness (PPPD) and similar forms of chronic dizziness precipitated by peripheral vestibular disorders: a systematic review. J Neurol Neurosurg Psychiatry 2023; 94:904-915. [PMID: 36941047 DOI: 10.1136/jnnp-2022-330196] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The literature on predictors of persistent postural-perceptual dizziness (PPPD) following peripheral vestibular insults has not been systematically reviewed. METHODS We systematically reviewed studies on predictors of PPPD and its four predecessors (phobic postural vertigo, space-motion discomfort, chronic subjective dizziness and visual vertigo). Investigations focused on new onset chronic dizziness following peripheral vestibular insults, with a minimum follow-up of 3 months. Precipitating events, promoting factors, initial symptoms, physical and psychological comorbidities and results of vestibular testing and neuroimaging were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We identified 13 studies examining predictors of PPPD or PPPD-like chronic dizziness. Anxiety following vestibular injury, dependent personality traits, autonomic arousal and increased body vigilance following precipitating events and visual dependence, but not the severity of initial or subsequent structural vestibular deficits or compensation status, were the most important predictors of chronic dizziness. Disease-related abnormalities of the otolithic organs and semi-circular canals and age-related brain changes seem to be important only in a minority of patients. Data on pre-existing anxiety were mixed. CONCLUSIONS After acute vestibular events, psychological and behavioural responses and brain maladaptation are the most likely predictors of PPPD, rather than the severity of changes on vestibular testing. Age-related brain changes appear to have a smaller role and require further study. Premorbid psychiatric comorbidities, other than dependent personality traits, are not relevant for the development of PPPD.
Collapse
Affiliation(s)
- Aaron Trinidade
- Department of Otolaryngology, Southend University Hospital, Southend-on-Sea, UK
- Faculty of Medicine, Anglia Ruskin University Medical School, Chelmsford, UK
| | - Verónica Cabreira
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joel A Goebel
- Department of Neuro-otology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diego Kaski
- Department of Neuro-otology, University College London, London, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Ibitoye RT, Castro P, Ellmers TJ, Kaski DN, Bronstein AM. Vestibular loss disrupts visual reactivity in the alpha EEG rhythm. Neuroimage Clin 2023; 39:103469. [PMID: 37459699 PMCID: PMC10368920 DOI: 10.1016/j.nicl.2023.103469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/11/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
The alpha rhythm is a dominant electroencephalographic oscillation relevant to sensory-motor and cognitive function. Alpha oscillations are reactive, being for example enhanced by eye closure, and suppressed following eye opening. The determinants of inter-individual variability in reactivity in the alpha rhythm (e.g. changes with amplitude following eye closure) are not fully understood despite the physiological and clinical applicability of this phenomenon, as indicated by the fact that ageing and neurodegeneration reduce reactivity. Strong interactions between visual and vestibular systems raise the theoretical possibility that the vestibular system plays a role in alpha reactivity. To test this hypothesis, we applied electroencephalography in sitting and standing postures in 15 participants with reduced vestibular function (bilateral vestibulopathy, median age = 70 years, interquartile range = 51-77 years) and 15 age-matched controls. We found participants with reduced vestibular function showed less enhancement of alpha electroencephalography power on eye closure in frontoparietal areas, compared to controls. In participants with reduced vestibular function, video head impulse test gain - as a measure of residual vestibulo-ocular reflex function - correlated with reactivity in alpha power across most of the head. Greater reliance on visual input for spatial orientation ('visual dependence', measured with the rod-and-disc test) correlated with less alpha enhancement on eye closure only in participants with reduced vestibular function, and this was partially moderated by video head impulse test gain. Our results demonstrate for the first time that vestibular function influences alpha reactivity. The results are partly explained by the lack of ascending peripheral vestibular input but also by central reorganisation of processing relevant to visuo-vestibular judgements.
Collapse
Affiliation(s)
- Richard T Ibitoye
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London W6 8RP, United Kingdom; Department of Neurology, Gloucestershire Hospital NHS Foundation Trust, Gloucester GL1 3NN, United Kingdom; Department of Clinical and Motor Neurosciences, Centre for Vestibular and Behavioural Neurosciences, University College London, London WC1N 3BG, United Kingdom
| | - Patricia Castro
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London W6 8RP, United Kingdom; Universidad del Desarrollo, Escuela de Fonoaudiología, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Toby J Ellmers
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London W6 8RP, United Kingdom
| | - Diego N Kaski
- Universidad del Desarrollo, Escuela de Fonoaudiología, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Adolfo M Bronstein
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London W6 8RP, United Kingdom.
| |
Collapse
|
7
|
Ma L, Marshall PJ, Wright WG. The order of attentional focus instructions affects how postural control processes compensate for multisensory mismatch: a crossover study. Exp Brain Res 2023; 241:1393-1409. [PMID: 37027041 DOI: 10.1007/s00221-023-06610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
Directing attention during balance training can have an immediate and lasting impact on a patient's balance and ultimately decrease the risk of future falls. However, it is unclear how attention can best be utilized to improve postural control. The current study uses a 2 × 2 crossover design to investigate the potential impact of receiving multiple verbal instructions during a single session of sensorimotor control testing for balance. Twenty-eight healthy adults were tasked to balance on a rocker board while immersed in virtual reality (VR). The VR created a multisensory mismatch between visual VR motion and body motion. The strength of the relationship between visual motion and body motion was measured to assess visual dependence. Alpha and theta frequency bands in electroencephalography (EEG) recordings were also analyzed to identify potential neural correlates of visual dependence and postural stability. Participants were randomized into two groups: one group was first instructed to keep the board leveled (external focus) and then instructed to keep both feet leveled (internal focus) to help maintain stability. The other group was given these two instructions in reverse order. Analyses focused on time, instruction, and group effects from receiving multiple instructions. Results revealed that when participants are given external focus first, and internal focus second, they are more likely to demonstrate lower visual dependence and better postural stability throughout the entire session than participants given internal focus first and external focus second. However, channel-level EEG analyses did not reveal differences between the groups. Current findings suggest that the order of attentional focus instructions may influence how the postural control system resolves sensory incongruence during a single testing session.
Collapse
Affiliation(s)
- Lei Ma
- (Department of Neurology), University of California, Los Angeles, CA, USA
| | - Peter J Marshall
- (Department of Psychology and Neuroscience), Temple University, Philadelphia, PA, USA
| | - W Geoffrey Wright
- (Department of Health and Rehabilitation Sciences), Temple University, Philadelphia, PA, USA.
| |
Collapse
|
8
|
Hu Y, Petruzzello SJ, Hernandez ME. Beta cortical oscillatory activities and their relationship to postural control in a standing balance demanding test: influence of aging. Front Aging Neurosci 2023; 15:1126002. [PMID: 37213543 PMCID: PMC10196243 DOI: 10.3389/fnagi.2023.1126002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Background Age-related changes in the cortical control of standing balance may provide a modifiable mechanism underlying falls in older adults. Thus, this study examined the cortical response to sensory and mechanical perturbations in older adults while standing and examined the relationship between cortical activation and postural control. Methods A cohort of community dwelling young (18-30 years, N = 10) and older adults (65-85 years, N = 11) performed the sensory organization test (SOT), motor control test (MCT), and adaptation test (ADT) while high-density electroencephalography (EEG) and center of pressure (COP) data were recorded in this cross-sectional study. Linear mixed models examined cohort differences for cortical activities, using relative beta power, and postural control performance, while Spearman correlations were used to investigate the relationship between relative beta power and COP indices in each test. Results Under sensory manipulation, older adults demonstrated significantly higher relative beta power at all postural control-related cortical areas (p < 0.01), while under rapid mechanical perturbations, older adults demonstrated significantly higher relative beta power at central areas (p < 0.05). As task difficulty increased, young adults had increased relative beta band power while older adults demonstrated decreased relative beta power (p < 0.01). During sensory manipulation with mild mechanical perturbations, specifically in eyes open conditions, higher relative beta power at the parietal area in young adults was associated with worse postural control performance (p < 0.001). Under rapid mechanical perturbations, specifically in novel conditions, higher relative beta power at the central area in older adults was associated with longer movement latency (p < 0.05). However, poor reliability measures of cortical activity assessments were found during MCT and ADT, which limits the ability to interpret the reported results. Discussion Cortical areas are increasingly recruited to maintain upright postural control, even though cortical resources may be limited, in older adults. Considering the limitation regarding mechanical perturbation reliability, future studies should include a larger number of repeated mechanical perturbation trials.
Collapse
Affiliation(s)
- Yang Hu
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Kinesiology, College of Health and Human Science, San José State University, San Jose, CA, United States
- *Correspondence: Yang Hu,
| | - Steven J. Petruzzello
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Manuel E. Hernandez
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| |
Collapse
|
9
|
Aubonnet R, Shoykhet A, Jacob D, Di Lorenzo G, Petersen H, Gargiulo P. Postural control paradigm (BioVRSea): towards a neurophysiological signature. Physiol Meas 2022; 43. [PMID: 36265477 DOI: 10.1088/1361-6579/ac9c43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/20/2022] [Indexed: 02/07/2023]
Abstract
Objective.To define a new neurophysiological signature from electroencephalography (EEG) during a complex postural control task using the BioVRSea paradigm, consisting of virtual reality (VR) and a moving platform, mimicking the behavior of a boat on the sea.Approach.EEG (64 electrodes) data from 190 healthy subjects were acquired. The experiment is composed of 6 segments (Baseline, PRE, 25%, 50%, 75%, POST). The baseline lasts 60 s while standing on the motionless platform with a mountain view in the VR goggles. PRE and POST last 40 s while standing on the motionless platform with a sea simulation. The 3 other tasks last 40 s each, with the platform moving to adapt to the waves, and the subject holding a bar to maintain its balance. The power spectral density (PSD) difference for each task minus baseline has been computed for every electrode, for five frequency bands (delta, theta, alpha, beta, and low-gamma). Statistical significance has been computed.Main results.All the bands were significant for the whole cohort, for each task regarding baseline. Delta band shows a prefrontal PSD increase, theta a fronto-parietal decrease, alpha a global scalp power decrease, beta an increase in the occipital and temporal scalps and a decrease in other areas, and low-gamma a significant but slight increase in the parietal, occipital and temporal scalp areas.Significance.This study develops a neurophysiological reference during a complex postural control task. In particular, we found a strong localized activity associated with certain frequency bands during certain phases of the experiment. This is the first step towards a neurophysiological signature that can be used to identify pathological conditions lacking quantitative diagnostics assessment.
Collapse
Affiliation(s)
- R Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - A Shoykhet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - D Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - G Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - H Petersen
- Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Akureyri Hospital, Akureyri, Iceland
| | - P Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland.,Department of Science, Landspitalin, National University Hospital of Iceland, Reykjavik, Iceland
| |
Collapse
|
10
|
Ibitoye RT, Castro P, Cooke J, Allum J, Arshad Q, Murdin L, Wardlaw J, Kaski D, Sharp DJ, Bronstein AM. A link between frontal white matter integrity and dizziness in cerebral small vessel disease. Neuroimage Clin 2022; 35:103098. [PMID: 35772195 PMCID: PMC9253455 DOI: 10.1016/j.nicl.2022.103098] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
Idiopathic dizziness in older people is associated with more vascular risk. Idiopathic dizziness is also associated with impaired balance and cognition. These findings co-occur with more frontal markers of cerebral small vessel disease. Small vessel disease may contribute to dizziness through its effects on balance.
One in three older people (>60 years) complain of dizziness which often remains unexplained despite specialist assessment. We investigated if dizziness was associated with vascular injury to white matter tracts relevant to balance or vestibular self-motion perception in sporadic cerebral small vessel disease (age-related microangiopathy). We prospectively recruited 38 vestibular clinic patients with idiopathic (unexplained) dizziness and 36 age-matched asymptomatic controls who underwent clinical, cognitive, balance, gait and vestibular assessments, and structural and diffusion brain MRI. Patients had more vascular risk factors, worse balance, worse executive cognitive function, and worse ankle vibration thresholds in association with greater white matter hyperintensity in frontal deep white matter, and lower fractional anisotropy in the genu of the corpus callosum and the right inferior longitudinal fasciculus. A large bihemispheric white matter network had less structural connectivity in patients. Reflex and perceptual vestibular function was similar in patients and controls. Our results suggest cerebral small vessel disease is involved in the genesis of dizziness through its effect on balance.
Collapse
Affiliation(s)
- Richard T Ibitoye
- Neuro-otology Unit, Imperial College London, London, UK; The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Imperial College London, London, UK
| | | | - Josie Cooke
- Neuro-otology Unit, Imperial College London, London, UK
| | - John Allum
- Department of Otorhinolaryngology (ORL), University Hospital Basel, Basel, Switzerland
| | - Qadeer Arshad
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Louisa Murdin
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, The University of Edinburgh, UK
| | - Diego Kaski
- Neuro-otology Unit, Imperial College London, London, UK; Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - David J Sharp
- The Computational, Cognitive and Clinical Neuroimaging Laboratory (C3NL), Imperial College London, London, UK
| | | |
Collapse
|
11
|
Castro P, Bancroft MJ, Arshad Q, Kaski D. Persistent Postural-Perceptual Dizziness (PPPD) from Brain Imaging to Behaviour and Perception. Brain Sci 2022; 12:brainsci12060753. [PMID: 35741638 PMCID: PMC9220882 DOI: 10.3390/brainsci12060753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/17/2022] Open
Abstract
Persistent postural-perceptual dizziness (PPPD) is a common cause of chronic dizziness associated with significant morbidity, and perhaps constitutes the commonest cause of chronic dizziness across outpatient neurology settings. Patients present with altered perception of balance control, resulting in measurable changes in balance function, such as stiffening of postural muscles and increased body sway. Observed risk factors include pre-morbid anxiety and neuroticism and increased visual dependence. Following a balance-perturbing insult (such as vestibular dysfunction), patients with PPPD adopt adaptive strategies that become chronically maladaptive and impair longer-term postural behaviour. In this article, we explore the relationship between behavioural postural changes, perceptual abnormalities, and imaging correlates of such dysfunction. We argue that understanding the pathophysiological mechanisms of PPPD necessitates an integrated methodological approach that is able to concurrently measure behaviour, perception, and cortical and subcortical brain function.
Collapse
Affiliation(s)
- Patricia Castro
- Neuro-Otology Department, University College London Hospitals, London WC1E 6DG, UK;
- Department of Brain Sciences, Imperial College London, London W6 8RF, UK
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Matthew J. Bancroft
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London WC1N 3BG, UK;
| | - Qadeer Arshad
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK;
| | - Diego Kaski
- Neuro-Otology Department, University College London Hospitals, London WC1E 6DG, UK;
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London WC1N 3BG, UK;
- Correspondence:
| |
Collapse
|
12
|
Mendelevich E. Chronic cerebral ischemia and dizziness. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:22-26. [DOI: 10.17116/jnevro202212203122] [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]
|