1
|
Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res 2024; 242:1797-1806. [PMID: 38839617 DOI: 10.1007/s00221-024-06864-1] [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: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
Collapse
Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Applied Vestibular Physiology Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, College of Health, University of Montana, Missoula, MT, USA
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
2
|
du Plessis M, Heinze B, Reddy TM, Kiderman A, González JE. Computerized Rotational Head Impulse Test: Age-Dependent Normative Data. Am J Audiol 2024:1-9. [PMID: 38889375 DOI: 10.1044/2024_aja-22-00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
PURPOSE The objective of this study was to determine the normative vestibulo-ocular reflex gain output values of the computerized rotational head impulse test (crHIT) with stationary visual targets (earth bound) in healthy participants in each decade age band of life: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70+ years. METHOD Seventy-seven community-dwelling participants (10-85 years of age) with normal lateral semicircular canal (SCC) functioning and no symptoms or history of vestibular dysfunction were recruited through convenience sampling and assessed with the crHIT using stationary targets. These participants were assessed using two standard protocols in a randomized order. RESULTS Results from 77 participants (M age = 46 years; 43 women, 34 men) were analyzed. Pearson's correlation coefficient and simple linear regression indicated a statistically significant relationship between crHIT gain output and age (p > .05) for right gain, 1030°/s2, and left gain, 1005°/s2. Although a statistically significant relationship was found, the slope was minor, demonstrating that the clinical effect of age on crHIT gain output was insignificant. Furthermore, no statistically significant relationship exists between crHIT gain output and gender (p > .05). Age-dependent normative data were calculated using the 2.5th and 97.5th confidence interval (CI) percentile method. The responses of angular vestibulo-ocular reflex (aVOR) gain values for crHIT are expected to occur within the range for lower limit reference interval (RI) of 0.85-0.9 and upper limit RI of 1.11-1.18 for 1030°/s2 and lower limit RI of 0.86-0.92 and upper limit RI of 1.13-1.16 for 1005°/s2. It can be expected that 90% CI of the population with normal lateral SCC functioning will have aVOR gain values that fall within this range. CONCLUSION Despite a statistically significant relationship that exists with aVOR gain output and age, the changes are minor, declining by 0.0088 units per 10 years, justifying the same normative data for all decade age bands.
Collapse
Affiliation(s)
- Mangelique du Plessis
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Barbara Heinze
- Ear Science Institute Australia, Perth, Western Australia, Australia
| | - Tarryn M Reddy
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | | | - Jorge E González
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| |
Collapse
|
3
|
Bae S, Yun J, Kwak S, Jung H, Lee H, Kim J, Kim C, Lee Y, Kim S. High-Frequency Vestibular Function Is Vulnerable to Presbyvestibulopathy. Diagnostics (Basel) 2024; 14:1224. [PMID: 38928640 PMCID: PMC11202626 DOI: 10.3390/diagnostics14121224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION In 2019, mild vestibular function deficiency in elder populations was defined as presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. The diagnostic criteria include tests for low-, mid-, and high-frequency vestibular function, represented by caloric testing, rotary chair testing, and head impulse testing, respectively. However, there is still a lack of large-scale reports supporting the relationship between vestibular function tests (VFTs) and aging. In this study, we evaluated whether each test is correlated with aging in the elderly population aged over 50. METHODS This study retrospectively enrolled 1043 subjects from a single university hospital database after excluding those with unilateral and bilateral vestibulopathy, central dizziness, and acute dizziness. Enrolled subjects had caloric canal paresis <20%, vHIT lateral canal gain >0.6, vHIT interaural difference <0.3, and age >50 years old. RESULTS Significant negative correlations with age were identified in the vHIT (p < 0.001) and rotary chair test (RCT) 1.0 Hz gain (p = 0.030). However, the caloric test (p = 0.739 and 0.745 on the left and right sides, respectively) and RCT 0.12 Hz gain (p = 0.298) did not show a significant correlation with age. A total of 4.83% of subjects aged 70 years or older showed sub-normal vHIT gain that met the criteria of PVP, whereas only 0.50% of subjects aged 60 to 69 did. The prevalence of sub-normal caloric test results, however, was not significantly different between the two age groups (21.55% in the 60-69 age group and 26.59% in the >70 age group). CONCLUSIONS The high-frequency range vestibular function seems vulnerable to aging, and this is more discernible at age >70 years. The weak correlation between age and low-frequency vestibular function tests, such as the caloric test and low-frequency rotary chair testing, suggests the need to revisit the diagnostic criteria for PVP.
Collapse
Affiliation(s)
- Seonghoon Bae
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Jimin Yun
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seungmin Kwak
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyuntaek Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hancheol Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Juyoung Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Chanhee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yujin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sunghuhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| |
Collapse
|
4
|
Mutlu B, Cesur S, Mutlu A, Kalcioglu MT. Vestibulo-Ocular Reflex in the Aging Population. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:45-54. [PMID: 38808050 PMCID: PMC11128693 DOI: 10.14744/semb.2023.31967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 05/30/2024]
Abstract
Objectives The aim of this study was to evaluate vestibulo-ocular reflex (VOR) of individuals over 60 years of age who have not been diagnosed with a specific vestibular pathology. Methods Bilateral six-semicircular canal video head impulse test (vHIT), Dizziness Handicap Inventory and European Evaluation of Vertigo scales were applied to participants. Results In total, 103 participants were included in the study (75 male, 28 female), and the mean age was 69.35 ± 7.41 years. The mean age of 7th decade group was 64.32±3.12 (59 participants; 38 male, 21 female), and the mean age of 8th decade and older group was 76.11±5.93 (44 participants; 37 male, 7 female). No significant differences were found between the VOR gains of the lateral or vertical semicircular canals between the 7th decade and 8th decade and older groups (p>0.05). In the 8th decade and older group, the presence of right lateral semicircular canal corrective saccade and left posterior semicircular canal corrective saccade showed a positively moderate correlation with VOR gains of the same semicircular canals (r=0.455, p=0.002, and r=0.518, p=0.001, respectively). No significant correlation was found between age and VOR gain in the 7th decade group, however, there was a negatively weak correlation between age and left lateral semicircular canal VOR gain (r=-0.366, p=0.017) in the 8th decade and older group. Conclusion While assessing the age-related changes in VOR using vHIT, it must be considered that the changes related to aging of the vestibular system begin to emerge in the population over 70 years of age, and corrective saccade findings may be more informative than VOR gains in revealing these changes.
Collapse
Affiliation(s)
- Basak Mutlu
- Department of Audiology, Istanbul Medeniyet University Faculty of Health Sciences, Istanbul, Türkiye
| | - Sidika Cesur
- Department of Audiology, Istanbul Medeniyet University Faculty of Health Sciences, Istanbul, Türkiye
| | - Ahmet Mutlu
- Department of Otorhinolaryngology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
- Department of Otorhinolaryngology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Mahmut Tayyar Kalcioglu
- Department of Otorhinolaryngology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
- Department of Otorhinolaryngology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| |
Collapse
|
5
|
Sayyid ZN, Wang H, Cai Y, Gross AL, Swenor BK, Deal JA, Lin FR, Wanigatunga AA, Dougherty RJ, Tian Q, Simonsick EM, Ferrucci L, Schrack JA, Resnick SM, Agrawal Y. Sensory and motor deficits as contributors to early cognitive impairment. Alzheimers Dement 2024; 20:2653-2661. [PMID: 38375574 PMCID: PMC11032563 DOI: 10.1002/alz.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Age-related sensory and motor impairment are associated with risk of dementia. No study has examined the joint associations of multiple sensory and motor measures on prevalence of early cognitive impairment (ECI). METHODS Six hundred fifty participants in the Baltimore Longitudinal Study of Aging completed sensory and motor function tests. The association between sensory and motor function and ECI was examined using structural equation modeling with three latent factors corresponding to multisensory, fine motor, and gross motor function. RESULTS The multisensory, fine, and gross motor factors were all correlated (r = 0.74 to 0.81). The odds of ECI were lower for each additional unit improvement in the multisensory (32%), fine motor (30%), and gross motor factors (12%). DISCUSSION The relationship between sensory and motor impairment and emerging cognitive impairment may guide future intervention studies aimed at preventing and/or treating ECI. HIGHLIGHTS Sensorimotor function and early cognitive impairment (ECI) prevalence were assessed via structural equation modeling. The degree of fine and gross motor function is associated with indicators of ECI. The degree of multisensory impairment is also associated with indicators of ECI.
Collapse
Affiliation(s)
- Zahra N. Sayyid
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Hang Wang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Yurun Cai
- Department of Health and Community SystemsUniversity of Pittsburgh School of NursingPittsburghPennsylvaniaUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Bonnielin K. Swenor
- The Johns Hopkins School of NursingBaltimoreMarylandUSA
- The Johns Hopkins Disability Health Research Center, Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Amal A. Wanigatunga
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Ryan J. Dougherty
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Qu Tian
- Intramural Research Program, National Institute on Aging, BaltimoreBaltimoreMarylandUSA
| | - Eleanor M. Simonsick
- Intramural Research Program, National Institute on Aging, BaltimoreBaltimoreMarylandUSA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, BaltimoreBaltimoreMarylandUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Susan M. Resnick
- Intramural Research Program, National Institute on Aging, BaltimoreBaltimoreMarylandUSA
| | - Yuri Agrawal
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
6
|
Cleworth T, Tondat A, Goomer K, Kalra M, Laing AC. Effects of flooring on static and dynamic balance in young and older adults. Gait Posture 2024; 107:42-48. [PMID: 37734190 DOI: 10.1016/j.gaitpost.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/30/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Reducing fall-related injuries is difficult due to the multi-factorial nature of falls, and challenges in implementing injury-preventative strategies. While safety floors are effective at absorbing energy and reducing fall-related impact forces, the low stiffness component of these floors may impair an individual's balance and mobility, thereby increasing fall risk. RESEARCH QUESTION Therefore, the objective of this study was to investigate the influence of compliant flooring (i.e., safety flooring) on balance and mobility in young and older adults. METHODS Kinematics were measured with inertial measurement units from 20 young and 10 older adults. Static balance was evaluated during quiet stance on three flooring surfaces (traditional, safety, foam) with three stance positions (regular, tandem, one-legged). Mobility was evaluated using the 3 m timed-up-and-go test on two flooring surfaces (traditional, safety). RESULTS All participants were able to complete quiet standing trials on normal and safety flooring surfaces; however, most older adults could not complete one-legged stance trials or standing on foam. Significant age-related effects were observed for several balance and mobility tasks, particularly during the more challenging tandem stance condition, and the dynamic timed-up-and-go mobility test. In contrast, the introduction of safety flooring (compared to traditional flooring) had limited effects on balance/mobility (1 of 16 outcome variables showed negative effects). SIGNIFICANCE Overall, the findings demonstrate minimal effects of a novel safety floor compared to the age-related differences, and provide insights to assist researchers, consumers, and industry stakeholders in the development of environments that support safe movement and maintained independence for older adults.
Collapse
Affiliation(s)
- Taylor Cleworth
- School of Kinesiology and Health Science, York University, Toronto, Canada; York University Centre for Aging Research and Education, York University, Toronto, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Alyssa Tondat
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Kanishk Goomer
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Mayank Kalra
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Andrew C Laing
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada.
| |
Collapse
|
7
|
Li Q, Xu H, Chen W, Su A, Fu MJ, Walker MF. Short-term learning of the vestibulo-ocular reflex induced by a custom interactive computer game. J Neurophysiol 2024; 131:16-27. [PMID: 37964728 DOI: 10.1152/jn.00130.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Retinal image slip during head rotation drives motor learning in the rotational vestibulo-ocular reflex (VOR) and forms the basis of gaze-stability exercises that treat vestibular dysfunction. Clinical exercises, however, are unengaging, cannot easily be titrated to the level of impairment, and provide neither direct feedback nor tracking of the patient's adherence, performance, and progress. To address this, we have developed a custom application for VOR training based on an interactive computer game. In this study, we tested the ability of this game to induce VOR learning in individuals with normal vestibular function, and we compared the efficacy of single-step and incremental learning protocols. Eighteen participants played the game twice on different days. All participants tolerated the game and were able to complete both sessions. The game scenario incorporated a series of brief head rotations, similar to active head impulses, that were paired with a dynamic acuity task and with a visual-vestibular mismatch (VVM) intended to increase VOR gain (single-step: 300 successful trials at ×1.5 viewing; incremental: 100 trials each of ×1.13, ×1.33, and ×1.5 viewing). Overall, VOR gain increased by 15 ± 4.7% (mean ± 95% CI, P < 0.001). Gains increased similarly for active and passive head rotations, and, contrary to our hypothesis, there was little effect of the learning strategy. This study shows that an interactive computer game provides robust VOR training and has the potential to deliver effective, engaging, and trackable gaze-stability exercises to patients with a range of vestibular dysfunctions.NEW & NOTEWORTHY This study demonstrates the feasibility and efficacy of a customized computer game to induce motor learning in the high-frequency rotational vestibulo-ocular reflex. It provides a physiological basis for the deployment of this technology to clinical vestibular rehabilitation.
Collapse
Affiliation(s)
- Qi Li
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Honglu Xu
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Weicong Chen
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Andrew Su
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Michael J Fu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
- Functional Electrical Stimulation Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- MetroHealth Rehabilitation Institute, The MetroHealth System, Cleveland, Ohio, United States
| | - Mark F Walker
- Neurology Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, United States
- Advanced Platform Technology Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
| |
Collapse
|
8
|
Hong JP, Kwon H, Park E, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. The semicircular canal function is preserved with little impact on falls in patients with mild Parkinson's disease. Parkinsonism Relat Disord 2024; 118:105933. [PMID: 38007917 DOI: 10.1016/j.parkreldis.2023.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Postural instability is a cardinal symptom of Parkinson's disease (PD), which suggests the vestibular system may be affected in PD. This study aimed to determine whether vestibular dysfunction is associated with the risk of falls in PD. METHODS We prospectively recruited patients with de-novo PD at a tertiary medical center between December 2019 and March 2023. During initial assessment, each patient was queried about falls within the preceding year. All patients underwent evaluation of video head-impulse tests (video-HITs), motion analysis, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MOCA). We determined whether head impulse gain of the vestibulo-ocular reflex (VOR) was associated with clinical severity of PD or risk of falls. RESULTS Overall, 133 patients (mean age ± SD = 68 ± 10, 59 men) were recruited. The median Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III) was 23 (interquartile range = 16-31), and 81 patients (61 %) scored 2 or less on the Hoehn and Yahr scale. Fallers were older (p = 0.001), had longer disease duration (p = 0.001), slower gait velocity (p = 0.009), higher MDS-UPDRS-III (p < 0.001) and H&Y scale (p < 0.001), lower MMSE (p = 0.018) and MOCA scores (p = 0.001) than non-fallers. Multiple logistic regression showed that MDS-UPDRS-III had a positive association with falling (p = 0.004). Falling was not associated with VOR gain (p = 0.405). The VOR gain for each semicircular canal showed no correlation with the MDS-UPDRS-III or disease duration. CONCLUSIONS The semicircular canal function, as determined by video-HITs, is relatively spared and has little effect on the risk of falls in patients with mild-to-moderate PD.
Collapse
Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| |
Collapse
|
9
|
Geno O, Critelli K, Arduino C, Crane BT, Anson ER. Psychometrics of inertial heading perception. J Vestib Res 2024; 34:83-92. [PMID: 38640182 DOI: 10.3233/ves-230077] [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: 04/21/2024]
Abstract
BACKGROUND Inertial self-motion perception is thought to depend primarily on otolith cues. Recent evidence demonstrated that vestibular perceptual thresholds (including inertial heading) are adaptable, suggesting novel clinical approaches for treating perceptual impairments resulting from vestibular disease. OBJECTIVE Little is known about the psychometric properties of perceptual estimates of inertial heading like test-retest reliability. Here we investigate the psychometric properties of a passive inertial heading perceptual test. METHODS Forty-seven healthy subjects participated across two visits, performing in an inertial heading discrimination task. The point of subjective equality (PSE) and thresholds for heading discrimination were identified for the same day and across day tests. Paired t-tests determined if the PSE or thresholds significantly changed and a mixed interclass correlation coefficient (ICC) model examined test-retest reliability. Minimum detectable change (MDC) was calculated for PSE and threshold for heading discrimination. RESULTS Within a testing session, the heading discrimination PSE score test-retest reliability was good (ICC = 0. 80) and did not change (t(1,36) = -1.23, p = 0.23). Heading discrimination thresholds were moderately reliable (ICC = 0.67) and also stable (t(1,36) = 0.10, p = 0.92). Across testing sessions, heading direction PSE scores were moderately correlated (ICC = 0.59) and stable (t(1,46) = -0.44, p = 0.66). Heading direction thresholds had poor reliability (ICC = 0.03) and were significantly smaller at the second visit (t(1,46) = 2.8, p = 0.008). MDC for heading direction PSE ranged from 6-9 degrees across tests. CONCLUSION The current results indicate moderate reliability for heading perception PSE and provide clinical context for interpreting change in inertial vestibular self-motion perception over time or after an intervention.
Collapse
Affiliation(s)
- Olivia Geno
- Department of Neuroscience, University of Rochester, Rochester NY, USA
| | - Kyle Critelli
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| | - Cesar Arduino
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| | - Benjamin T Crane
- Department of Neuroscience, University of Rochester, Rochester NY, USA
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| | - Eric R Anson
- Department of Neuroscience, University of Rochester, Rochester NY, USA
- Department of Otolaryngology, University of Rochester, Rochester NY, USA
| |
Collapse
|
10
|
Marois C, Quirins M, Seassau M, Demeret S, Demoule A, Naccache L, Weiss N. Bedside video-oculography to assess the caloric vestibulo-ocular reflex in ICU patients, a preliminary study. Rev Neurol (Paris) 2023; 179:1030-1034. [PMID: 37479626 DOI: 10.1016/j.neurol.2023.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 07/23/2023]
Affiliation(s)
- C Marois
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - M Quirins
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - M Seassau
- Suricog, 130, rue de Lourmel, 75015 Paris, France; Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - S Demeret
- Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - A Demoule
- Inserm, UMRS_1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France; Service de Pneumologie, médecine intensive et réanimation (Département "R3S"), AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France
| | - L Naccache
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Department of Neurophysiology, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurology, Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France; Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - N Weiss
- Inserm U 1127, Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, Sorbonne Université, 75013 Paris, France; Département de Neurologie, Unité de médecine intensive - réanimation à orientation neurologique, Sorbonne Université, AP-HP.SorbonneSorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France; Inserm UMR_S 938, Centre de recherche Saint-Antoine (CRSA), Maladies métaboliques, biliaires et fibro-inflammatoire du foie & Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Paris, France
| |
Collapse
|
11
|
Grove CR, Klatt BN, Wagner AR, Anson ER. Vestibular perceptual testing from lab to clinic: a review. Front Neurol 2023; 14:1265889. [PMID: 37859653 PMCID: PMC10583719 DOI: 10.3389/fneur.2023.1265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.
Collapse
Affiliation(s)
- Colin R. Grove
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation School of Medicine, Emory University, Atlanta, GA, United States
| | - Brooke N. Klatt
- Physical Therapy Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Eric R. Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, United States
- Physical Therapy Department, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
| |
Collapse
|
12
|
Poppi L, Bigland M, Cresswell E, Tabatabaee H, Lorincz D, Drury H, Callister R, Holt J, Lim R, Brichta A, Smith D. Molecular and Functional Changes to Postsynaptic Cholinergic Signaling in the Vestibular Sensory Organs of Aging C57BL/6 Mice. J Gerontol A Biol Sci Med Sci 2023; 78:920-929. [PMID: 36840917 PMCID: PMC10235202 DOI: 10.1093/gerona/glad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Indexed: 02/26/2023] Open
Abstract
Cholinergic circuits in the central nervous system are vulnerable to age-related functional decline, but it is not known if aging impacts cholinergic signaling in the vestibular sensory organs, which are critically important to balance maintenance and visual gaze stability. We have previously shown cholinergic neurotransmission between vestibular efferent terminals and type II mechanosensory hair cells requires the alpha9 (Chrna9) nicotinic receptor subunit. Homozygous knockout of the alpha9 subunit causes vestibulo-ocular reflex adaptation deficits that mirror those observed in aged mice. This prompted examination of cholinergic signaling in the vestibular sensory organs of aged mice. We confirmed older (>24 months) mice had impaired performance in a balance beam task compared to young (3-4 months) adult mice. While there was no qualitative loss of cholinergic axon varicosities in the crista ampullaris of old mice, qPCR analysis revealed reduced expression of nicotinic receptor subunit genes Chrna1, Chrna9, and Chrna10 in the cristae of old relative to young mice. Functionally, single-cell patch clamp recordings taken from type II vestibular hair cells exposed to acetylcholine show reduced conductance through alpha9/10 subunit-containing nicotinic receptors in older mice, despite preserved passive membrane properties and voltage-activated conductances. These findings suggest that cholinergic signaling in the peripheral vestibular sensory organs is vulnerable to aging processes, manifesting in dynamic molecular and functional age-related changes. Given the importance of these organs to our everyday activities, and the dramatic increase in fall incidence in the older, further investigation into the mechanisms of altered peripheral vestibular function in older humans is warranted.
Collapse
Affiliation(s)
- Lauren A Poppi
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mark J Bigland
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Ethan T Cresswell
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Hessam Tabatabaee
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - David Lorincz
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Hannah R Drury
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Robert J Callister
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Joseph C Holt
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, USA
| | - Rebecca Lim
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Alan M Brichta
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Doug W Smith
- Neurobiology of Aging and Dementia and Vestibular Neurobiology Laboratories, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| |
Collapse
|
13
|
Cai Y, Schrack JA, Gross AL, Armstrong NM, Swenor BK, Deal JA, Lin FR, Wang H, Tian Q, An Y, Simonsick EM, Ferrucci L, Resnick SM, Agrawal Y. Sensory impairment and algorithmic classification of early cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12400. [PMID: 37063388 PMCID: PMC10103182 DOI: 10.1002/dad2.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Sensory impairment (SI) is linked to cognitive decline, but its association with early cognitive impairment (ECI) is unclear. METHODS Sensory functions (vision, hearing, vestibular function, proprioception, and olfaction) were measured between 2012 and 2018 in 414 Baltimore Longitudinal Study of Aging (BLSA) participants (age 74 ± 9 years; 55% women). ECI was defined as 1 standard deviation below age-, sex-, race-, and education-specific mean performance in Card Rotations or California Verbal Learning Test immediate recall. Log binomial models (cross-sectional analysis) and Cox regression models (time-to-event analysis) were used to examine the association between SI and ECI. RESULTS Cross-sectionally, participants with ≥3 SI had twice the prevalence of ECI (prevalence ratio = 2.10, p = 0.02). Longitudinally, there was no significant association between SI and incident ECI over up to 6 years of follow-up. DISCUSSION SI is associated with higher prevalence, but not incident ECI. Future studies with large sample sizes need to further elucidate the relationship between SI and ECI. Highlights Sensory impairment is associated with high prevalence of early cognitive impairmentMultisensory impairment may pose a strong risk of early changes in cognitive functionIdentifying multisensory impairment may help early detection of dementia.
Collapse
Affiliation(s)
- Yurun Cai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Health and Community SystemsUniversity of Pittsburgh School of NursingPittsburghPennsylvaniaUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nicole M. Armstrong
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Intramural Research ProgramNational Institute on AgingBaltimoreMarylandUSA
| | - Bonnielin K. Swenor
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
- The Johns Hopkins Disability Health Research CenterJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- The Johns Hopkins Disability Health Research CenterJohns Hopkins UniversityBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology ‐ Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Hang Wang
- Center on Aging and HealthJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Qu Tian
- Intramural Research ProgramNational Institute on AgingBaltimoreMarylandUSA
| | - Yang An
- Intramural Research ProgramNational Institute on AgingBaltimoreMarylandUSA
| | | | - Luigi Ferrucci
- Intramural Research ProgramNational Institute on AgingBaltimoreMarylandUSA
| | - Susan M. Resnick
- Intramural Research ProgramNational Institute on AgingBaltimoreMarylandUSA
| | - Yuri Agrawal
- Department of Otolaryngology ‐ Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
14
|
Zainon Sayed S, Haniza Abdul Wahat N, Ali Raymond A, Hussein N, Omar M, Omar M. Test-Retest Reliability, Effects of Age and Comparison of Horizontal 2 Semicircular Canals Gain Values between Head Impulse and Suppression Head Impulse Paradigms. J Int Adv Otol 2023; 19:33-40. [PMID: 36718034 PMCID: PMC9984981 DOI: 10.5152/iao.2023.21387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study investigates the test-retest reliability, aging effects, and differences in horizontal semicircular canals gain values between the head impulse paradigm and suppression head impulse paradigm. METHODS Sixty healthy adult subjects aged 22-76-year-old (mean ± standard deviation=47.27 ± 18.29) participated in the head impulse paradigm and suppression head impulse paradigm using the video head impulse test. The Head impulse paradigm was used to assess all 6 semicircular canals, while suppression head impulse paradigm measured only the horizontal canals. Twenty subjects aged 22-40-year-old (25.25 ± 4.9) underwent a second session for the test-retest reliability. RESULTS There were good test-retest reliability for both measures (right horizontal head impulse paradigm, intraclass correlation coefficient=0.80; left horizontal head impulse paradigm, intraclass correlation coefficient=0.77; right anterior head impulse paradigm, intraclass correlation coefficient=0.86; left anterior head impulse paradigm, intraclass correlation coefficient=0.78; right posterior head impulse paradigm, intraclass correlation coefficient=0.78; left posterior head impulse paradigm, intraclass correlation coefficient=0.75; right horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.76; left horizontal suppression head impulse paradigm, intraclass correlation coefficient=0.79). The test-retest reliability for suppression head impulse paradigmanti-compensatory saccade latency and amplitude were moderate (right latency, intraclass correlation coefficient=0.61; left latency, intraclass correlation coefficient=0.69; right amplitude, intraclass correlation coefficient=0.69; left amplitude, intraclass correlation coefficient=0.58). There were no significant effects of age on head impulse paradigm and suppression head impulse paradigm vestibulo-ocular reflex gain values and suppression head impulse paradigmsaccade latency. However, the saccade amplitude became smaller with increasing age, P < .001. The horizontal suppression head impulse paradigm vestibuloocular reflex gain values were significantly lower than the head impulse paradigm for both sides (right, P = .004; left, P = .004). CONCLUSION There was good test-retest reliability for both measures, and the gain values stabilized with age. However, suppression head impulse paradigm anti-compensatory saccade latency and amplitude had lower test-retest reliability than the gain. The suppression head impulse paradigm vestibulo-ocular reflex gain was lower than the head impulse paradigm and its anti-compensatory saccade amplitude reduced with increasing age.
Collapse
Affiliation(s)
- Sharifah Zainon Sayed
- Audiology Programme, Centre for Rehabilitation & Special Needs Studies (iCaRehab), Universiti Kebangsaan Malaysia Faculty of Health Sciences, Kuala Lumpur, Malaysia
| | - Nor Haniza Abdul Wahat
- Audiology Programme, Centre for Rehabilitation & Special Needs Studies (iCaRehab), Universiti Kebangsaan Malaysia Faculty of Health Sciences, Kuala Lumpur, Malaysia,Corresponding author: Nor Haniza Abdul Wahat, e-mail:
| | - Azman Ali Raymond
- Department of Medicine, Universiti Teknologi MARA Faculty of Medicine, Selangor, Malaysia
| | - Norhayati Hussein
- Department of Rehabilitation Medicine, Hospital Rehabilitasi Cheras, JalanYaacob Latif, Kuala Lumpur, Malaysia
| | - Marniza Omar
- Audiology Programme, Centre for Rehabilitation & Special Needs Studies (iCaRehab), Universiti Kebangsaan Malaysia Faculty of Health Sciences, Kuala Lumpur, Malaysia
| | | | | | | | | | | |
Collapse
|
15
|
Cheng Y, Zhang Y, Ma W, Chen Y, Zhang Q, Xu M. Effect of age on virtual reality-assisted subjective visual vertical and subjective visual horizontal at different head-tilt angles. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S139-S146. [DOI: 10.1016/j.bjorl.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
|
16
|
Yesantharao LV, Rosenberg P, Oh E, Leoutsakos J, Munro CA, Agrawal Y. Vestibular therapy to reduce falls in people with Alzheimer's disease: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2022; 8:167. [PMID: 35918757 PMCID: PMC9344717 DOI: 10.1186/s40814-022-01133-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Falls are highly common in patients with Alzheimer's disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed. METHODS The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task). DISCUSSION As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution. TRIAL REGISTRATION ClinicalTrial.Gov identifier - NCT03799991 . Registered 01 August 2019.
Collapse
Affiliation(s)
- Lekha V Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Esther Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
| |
Collapse
|
17
|
堀井 新. [Vertigo/dizziness in aging population]. Nihon Ronen Igakkai Zasshi 2022; 59:131-138. [PMID: 35650044 DOI: 10.3143/geriatrics.59.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- 新 堀井
- 新潟大学大学院医歯学総合研究科耳鼻咽喉科・頭頸部外科学分野
| |
Collapse
|
18
|
Agrawal Y, Van de Berg R, Wuyts F, Walther L, Magnusson M, Oh E, Sharpe M, Strupp M. Presbivestibulopatía: criterios diagnósticos. Documento de consenso del Comité de Clasificación de la Bárány Society. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Computational epidemiology study of homeostatic compensation during sensorimotor aging. Neural Netw 2021; 146:316-333. [PMID: 34923219 DOI: 10.1016/j.neunet.2021.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/26/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
The vestibulo-ocular reflex (VOR) stabilizes vision during head motion. Age-related changes of vestibular neuroanatomical properties predict a linear decay of VOR function. Nonetheless, human epidemiological data show a stable VOR function across the life span. In this study, we model cerebellum-dependent VOR adaptation to relate structural and functional changes throughout aging. We consider three neurosynaptic factors that may codetermine VOR adaptation during aging: the electrical coupling of inferior olive neurons, the long-term spike timing-dependent plasticity at parallel fiber - Purkinje cell synapses and mossy fiber - medial vestibular nuclei synapses, and the intrinsic plasticity of Purkinje cell synapses Our cross-sectional aging analyses suggest that long-term plasticity acts as a global homeostatic mechanism that underpins the stable temporal profile of VOR function. The results also suggest that the intrinsic plasticity of Purkinje cell synapses operates as a local homeostatic mechanism that further sustains the VOR at older ages. Importantly, the computational epidemiology approach presented in this study allows discrepancies among human cross-sectional studies to be understood in terms of interindividual variability in older individuals. Finally, our longitudinal aging simulations show that the amount of residual fibers coding for the peak and trough of the VOR cycle constitutes a predictive hallmark of VOR trajectories over a lifetime.
Collapse
|
20
|
Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2021; 46:118-177. [PMID: 34864777 PMCID: PMC8920012 DOI: 10.1097/npt.0000000000000382] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. Discussion: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. Limitations: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. Disclaimer: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).
Collapse
|
21
|
Armstrong NM, Wang H, E JY, Lin FR, Abraham AG, Ramulu P, Resnick SM, Tian Q, Simonsick E, Gross AL, Schrack JA, Ferrucci L, Agrawal Y. Patterns of Prevalence of Multiple Sensory Impairments among Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:2123-2132. [PMID: 34608938 DOI: 10.1093/gerona/glab294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Much is known about individual sensory deficits among older adults, but there is a dearth of information about the prevalence of multiple concurrent sensory deficits in this population. METHODS We evaluated the prevalence of individual and multiple sensory impairments at the most recent clinic visit among participants aged 24 years and older in the Baltimore Longitudinal Study of Aging (BLSA) (hearing, vision, olfaction, proprioception, and vestibular function) and Atherosclerosis Risk in Communities Study (ARIC) (hearing, vision, olfaction). We compared observed prevalence of multiple sensory impairments with expected prevalence based on compounded probabilities of multiple impairments using Fisher Exact Tests. Also, we evaluated the comparability of different measures used between these two studies. RESULTS In both studies, the prevalence of each individual sensory impairment was common (>10%), and higher with older age, and the most common pattern of co-occurring sensory impairments was hearing and visual impairments (17.4% [BLSA]; 50.2% [ARIC]). In BLSA, the pattern that differed the most between observed and expected prevalence was combined hearing, vision, and olfactory impairments (observed 5.2% vs. 1.4% expected, p=0.01). In ARIC, this difference was much smaller (observed 8.1% vs. 7.2% expected, p=0.49). CONCLUSIONS Although concurrent hearing and vision impairments were the most common co-occurring deficits, combined hearing, vision and olfactory impairments are most likely to co-occur above chance, especially at older ages.
Collapse
Affiliation(s)
- Nicole M Armstrong
- Department of Psychiatry and Human Behavior, Alpert Medical School in Brown University, Providence, RI, USA.,Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Hang Wang
- Department of Epidemiology, Biostatistics, and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jian-Yu E
- Department of Epidemiology, Biostatistics, and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frank R Lin
- Department of Epidemiology, Biostatistics, and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison G Abraham
- Department of Epidemiology, Biostatistics, and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pradeep Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan M Resnick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Qu Tian
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Eleanor Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Biostatistics, and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Biostatistics, and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Yuri Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
22
|
Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. Peripheral vestibular system: Age-related vestibular loss and associated deficits. J Otol 2021; 16:258-265. [PMID: 34548873 PMCID: PMC8438634 DOI: 10.1016/j.joto.2021.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Given the interdependence of multiple factors in age-related vestibular loss (e.g., balance, vision, cognition), it is important to examine the individual contributions of these factors with ARVL. While the relationship between the vestibular and visual systems has been well studied (Bronstein et al., 2015), little is known about the association of the peripheral vestibular system with neurodegenerative disorders (Cronin et al., 2017). Further, emerging research developments implicate the vestibular system as an opportunity for examining brain function beyond balance, and into other areas, such as cognition and psychological functioning. Additionally, the bidirectional impact of psychological functioning is understudied in ARVL. Recognition of ARVL as part of a multifaceted aging process will help guide the development of integrated interventions for patients who remain at risk for decline. In this review, we will discuss a wide variety of characteristics of the peripheral vestibular system and ARVL, how it relates to neurodegenerative diseases, and correlations between ARVL and balance, vision, cognitive, and psychological dysfunction. We also discuss clinical implications as well as future directions for research, with an emphasis on improving care for patients with ARVL.
Collapse
Affiliation(s)
- Jennifer Coto
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | | | - Ivette Cejas
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Brett M. Colbert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
- Medical Scientist Training Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie E. Levin
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Joshua Huppert
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami Miller School of Medicine, Department of Neurology and the Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Carey Balaban
- University of Pittsburgh, Departments of Otolaryngology, Neurobiology, Communication Sciences & Disorders, and Bioengineering, Pittsburgh, PA, USA
| | - Susan H. Blanton
- University of Miami Miller School of Medicine, Dr. John T. Macdonald Department of Human Genetics, Miami, FL, USA
| | - David J. Lee
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
| | - David Loewenstein
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
| | - Michael Hoffer
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| | - Xue Zhong Liu
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, FL, USA
| |
Collapse
|
23
|
Nimmo ZM, Hwa TP, Naples JG, Shah R, Brant JA, Eliades SJ, Bigelow DC, Ruckenstein MJ. Age-related Patterns of Vestibular Dysfunction in Dizziness and Imbalance: A Review of Vestibular Testing Results Among 1,116 Patients. Otol Neurotol 2021; 42:897-905. [PMID: 34111051 DOI: 10.1097/mao.0000000000003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize differences in vestibular testing results among patients presenting with balance-related complaints; to stratify patterns of testing abnormalities by age. STUDY DESIGN Retrospective chart review. SETTING Academic Balance Center at a Tertiary Referral Center. PATIENT POPULATION All patients who underwent vestibular testing in a 1-year period from 2017 to 2018. MAIN OUTCOME MEASURE Balance function test results. RESULTS We reviewed 1,116 patients with age ranging from 11 to 94 years, including 521 patients ≥60 years. Most patients had at least 1 abnormal result, with only 21% of patients ≥60 years and 43% of patients <60 years yielding no test abnormalities (p < 0.001). Among 754 individuals with abnormal testing results, caloric testing did not show any significant difference between age groups. Patients ≥60 years of age were more likely to demonstrate abnormalities on saccadic and horizontal tracking eye movements (p < 0.01; sacc 20.8% vs 6.3%; HT 9.2% vs 4.7%), as well as positional and Dix-Hallpike testing with videonystagmography (p < 0.001; pos 52.3% vs 37.5%, DH 14.4% vs 6.8%). On computerized dynamic posturography, there were significantly more abnormal composite scores in the older group for both sensory organization and motor control testing (p < 0.001; SOT 31.8% vs 8.8%, MCT 7.6% vs 1.8%). CONCLUSION Among patients presenting balance-related complaints, a majority demonstrate at least one abnormality on vestibular testing. While caloric abnormalities occur across the life span, patients ≥60 years of age are more likely to have abnormal results in random saccades, positional, Dix-Hallpike testing, and posturography, with greater effect sizes in tests of central function. While the causes of imbalance and vertigo remain multifactorial, vestibular dysfunction can be considered a major contributor to balance dysfunction in the elderly population and should be thoroughly evaluated.
Collapse
Affiliation(s)
- Zachary M Nimmo
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Heravian Shandiz J, Jafarzadeh S, Fathi H, Foroughipour M, Karimpour M. Vestibulo ocular reflex in multiple sclerosis patients without any optic neuritis. JOURNAL OF OPTOMETRY 2021; 14:282-286. [PMID: 32868242 PMCID: PMC8258128 DOI: 10.1016/j.optom.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. METHODS 26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. RESULTS Mean spherical equivalent (SE) was - 0.40 ± 0.93 D and - 0.04 ± 0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ± 75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). CONCLUSION Our study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups.
Collapse
Affiliation(s)
- Javad Heravian Shandiz
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sadegh Jafarzadeh
- Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibeh Fathi
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Foroughipour
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Maliheh Karimpour
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
25
|
Emekci T, Erbek HS. The relationship between functional head impulse test and age in healthy individuals. J Vestib Res 2021; 32:123-134. [PMID: 34120922 DOI: 10.3233/ves-210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND fHIT is an easily applicable test battery that indirectly evaluates the vestibulo-ocular reflex (VOR) from a functional perspective. AIMS/OBJECTIVES The aim of this study was to Individuals determine the correlation between age and the percentage of correct answers (% CA) obtained in the functional head impulse test (fHIT) in healthy individuals. MATERIAL AND METHODS A total of 105 volunteers, 50 males and 55 females, between the ages of 18 and 70 years, participated in the study. A Beon Solution fHIT system (Zero Branco (TV), Italy) was used in the study. RESULTS In our study, a decrease in the mean % CA was observed in all semicircular canals (SCCs) with increasing age. Between age and mean % CA, a significant negative moderate (-0.311) correlation was observed in lateral SCCs, and a significant negative low (-0.257) correlation was observed in posterior SCCs (p < 0.05). In anterior SCCs, there was no statistically significant relationship between age and mean % CA (p > 0.05). CONCLUSIONS The present study performed in a healthy population will be helpful in terms of making comparisons in studies to be conducted in various vestibular diseases. It will also be a guide for identifying pathological consequences in vestibular diseases.
Collapse
Affiliation(s)
- Tuğba Emekci
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
| | | |
Collapse
|
26
|
Self-Reported Sense of Direction and Vestibular Function in the Baltimore Longitudinal Study of Aging (BLSA). J Assoc Res Otolaryngol 2021; 22:207-214. [PMID: 33449237 DOI: 10.1007/s10162-020-00780-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022] Open
Abstract
Sense of direction is an individual's ability to navigate within an environment and generate a mental map of novel environments. Although sense of direction is correlated with psychometric tests of spatial ability, it also reflects an individual's real-world spatial ability that is not fully captured by laboratory-based assessments. Sense of direction is known to vary widely in the population and has been shown to decline with age. However, other factors that contribute to an individual's sense of direction have not been well-characterized. Vestibular impairment has been linked to reduced spatial cognitive ability, which encompasses spatial memory and navigation skills. Several studies have shown that vestibular input is necessary for effective spatial cognition, notably accurate spatial navigation ability. These studies have typically considered laboratory-based spatial navigation assessments; however, the influence of vestibular function on variation in real-world sense of direction is unknown. In this study, we evaluated whether vestibular function is associated with self-reported sense of direction. Participants for this cross-sectional study were recruited from the Baltimore Longitudinal Study of Aging, a longstanding cohort study of healthy aging. In a modified version of the Santa Barbara Sense-of-Direction (SBSOD) Scale, participants rated statements about spatial and navigational abilities. A lower average score indicates poorer self-reported sense of direction. Vestibular function testing included cervical vestibular-evoked myogenic potential (VEMP) to assess saccular function, ocular VEMP to assess utricular function, and the video head-impulse test to assess semicircular canal function based on vestibular ocular reflex. The study sample included 82 participants with mean age of 71.0 (± 16.9) years and mean SBSOD score of 4.95(± 1.07). In a multivariate linear regression model, female sex and bilateral saccular loss were associated with a lower average SBSOD score. These data suggest that vestibular impairment contributes to the known variation in spatial navigation ability.
Collapse
|
27
|
Anson E, Ehrenburg MR, Simonsick EM, Agrawal Y. Association between vestibular function and rotational spatial orientation perception in older adults. J Vestib Res 2021; 31:469-478. [PMID: 33579887 PMCID: PMC11172369 DOI: 10.3233/ves-201582] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spatial orientation is a complex process involving vestibular sensory input and possibly cognitive ability. Previous research demonstrated that rotational spatial orientation was worse for individuals with profound bilateral vestibular dysfunction. OBJECTIVE Determine whether rotational and linear vestibular function were independently associated with large amplitude rotational spatial orientation perception in healthy aging. METHODS Tests of rotational spatial orientation accuracy and vestibular function [vestibulo-ocular reflex (VOR), ocular and cervical vestibular evoked myogenic potentials (VEMP)] were administered to 272 healthy community-dwelling adults participating in the Baltimore Longitudinal Study of Aging. Using a mixed model multiple linear regression we regressed spatial orientation errors on lateral semicircular canal function, utricular function (ocular VEMP), and saccular function (cervical VEMP) in a single model controlling for rotation size, age, and sex. RESULTS After adjusting for age, and sex, individuals with bilaterally low VOR gain (β= 20.9, p = 0.014) and those with bilaterally absent utricular function (β= 9.32, p = 0.017) made significantly larger spatial orientation errors relative to individuals with normal vestibular function. CONCLUSIONS The current results demonstrate for the first time that either bilateral lateral semicircular canal dysfunction or bilateral utricular dysfunction are associated with worse rotational spatial orientation. We also demonstrated in a healthy aging cohort that increased age also contributes to spatial orientation ability.
Collapse
Affiliation(s)
- E Anson
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology, University of Rochester, Rochester, NY, USA
| | - M R Ehrenburg
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E M Simonsick
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Y Agrawal
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
28
|
Ohara A, Yasuhiro M, Mochizuki F, Shinohe T, Sasano Y, Suzuki K, Mikami K, Koizuka I. Effects of using cane and vestibular rehabilitation on the walking function in elderly patients with dizziness. Auris Nasus Larynx 2020; 48:571-576. [PMID: 33223340 DOI: 10.1016/j.anl.2020.10.010] [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: 06/28/2020] [Revised: 10/07/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Adults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder. METHODS Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane. RESULTS A total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4-53.7 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6-53.2 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7-98.4 cm/s) to 96.1 cm/s (95% CI, 88.3-103.9 cm/s) (p = 0.005). CONCLUSIONS Walking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.
Collapse
Affiliation(s)
- Akihiro Ohara
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan.
| | - Miyamoto Yasuhiro
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Fumihiro Mochizuki
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Tatsuya Shinohe
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Yoshiyuki Sasano
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Kaori Suzuki
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Koshi Mikami
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Izumi Koizuka
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| |
Collapse
|
29
|
Johnson C, Hallemans A, Verbecque E, Vestel CD, Herssens N, Vereeck L. Aging and the Relationship between Balance Performance, Vestibular Function and Somatosensory Thresholds. J Int Adv Otol 2020; 16:328-337. [PMID: 33136012 DOI: 10.5152/iao.2020.8287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was two-fold: (1) To evaluate the impact of the physiological aging process on somatosensory, vestibular, and balance functions, and (2) To examine the extent to which age and somatosensory and vestibular functions can predict balance performance. MATERIALS AND METHODS In this cross-sectional study, 141 asymptomatic subjects were assessed for touch pressure thresholds (TPT) with Semmes-Weinstein monofilaments (SWF), vibration thresholds (VT) with a neurothesiometer (NT) and a Rydel-Seiffer tuning fork 128Hz (RSTF). Horizontal vestibulo-ocular reflexes (HVOR gain and asymmetry) were assessed using the video Head Impulse Test (vHIT). A modified version of the Romberg test was used to assess standing balance and the Timed Up and Go test (TUG) and tandem gait (TG) to evaluate dynamic balance. RESULTS Significant age effects were found for TPT, VT, and balance but not for HVOR gain or asymmetry. Standing balance was explained for 47.2% by age, metatarsal 1 (MT1) (NT), and heel (SWF). The variance in TUG performance was explained for 47.0% by age, metatarsal 5 (MT5) (SWF), and medial malleolus (MM) (NT). Finally, the variance in TG performance was predicted for 43.1% by age, MT1 (NT), HVOR gain, and heel (SWF). CONCLUSION Among asymptomatic adult population, both somatosensation and balance performance deteriorate with aging. In contrast, HVOR remains rather constant with age, which is possibly explained by the process of vestibular adaptation. Furthermore, this study provides evidence that the VT, TPT, HVOR gain, and age partly predict balance performance. Still, further research is needed, especially with bigger samples in decades 8 and 9.
Collapse
Affiliation(s)
- Charlotte Johnson
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Evi Verbecque
- Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| | - Charlotte De Vestel
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
30
|
Hansson A, Salzer J. Normative video head impulse test data in subjects with and without vascular risk factors. Eur Arch Otorhinolaryngol 2020; 278:2619-2624. [PMID: 32914256 PMCID: PMC8165054 DOI: 10.1007/s00405-020-06332-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022]
Abstract
Purpose There is a paucity of age- and vascular risk factor-stratified video head impulse test (vHIT) vestibulo-ocular reflex (VOR) data in the literature. The aim of this study was to investigate the vHIT VOR properties in healthy subjects of different ages and subjects with vascular risk factors. Methods This was a prospective observational single-center study at a tertiary referral university hospital in northern Sweden. Healthy participants and subjects with vascular risk factors were investigated with a floor standing external camera vHIT device. Age-stratified mean VOR gain among healthy adults and between group gain and gain asymmetry differences were calculated. Results We included eighty-eight healthy adults with a mean (range) age of 50 (22–85) years and n = 48 stroke ward patients with vascular risk factors (but without vestibular disease) with a mean (range) age of 74 (42–92) years. The mean VOR gain of horizontal canals decreased at higher ages in healthy subjects (r = − 0.32, p < 0.01, n = 167 canals). The age-stratified mean (SD) VOR gains were < 30 years: 0.98 (0.07), 30–39 years: 0.97 (0.07), 40–49 years: 0.98 (0.06), 50–59 years: 0.99 (0.06), 60–69 years: 0.93 (0.08), ≥ 70 years: 0.89 (0.15). No consistent differences between healthy subjects and subjects with vascular risk factors were seen except for a trend towards more pronounced gain asymmetries in the latter group. Conclusions Age, but not vascular risk factors influence VOR gain. Age-adjusted vHIT-measurements may be useful in acute vertigo stroke risk differentiation.
Collapse
Affiliation(s)
- Anders Hansson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Jonatan Salzer
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden. .,Department of Neurology, Umeå University, 90187, Umeå, Sweden.
| |
Collapse
|
31
|
Kitajima N, Sugita-Kitajima A. Ocular counter-rolling in scuba divers with motion sickness. Auris Nasus Larynx 2020; 48:214-220. [PMID: 32828593 DOI: 10.1016/j.anl.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Motion sickness (MS) is a familiar condition to scuba divers. The purpose of this study was to compare otolith organ function of scuba divers who have MS to those without MS. METHOD Video-oculography (VOG) goggles were used to measure video ocular counter-roll (vOCR) in 50 healthy scuba divers with no vestibular pathology. Divers with MS (n = 30) had Graybiel motion sickness (GMS) scores of ≥1 point, and divers without MS (n = 20) had GMS scores of 0. Divers with MS also completed the Motion Sickness Susceptibility Questionnaire short form (MSSQs). For all divers, otolith-ocular function of both ears was tested separately via vOCR testing, which was performed during 30° head tilt. An R-L side asymmetry ratio for vOCR values (%OCRA) was compared to divers' static OCR. RESULTS MSSQs and %OCRA scores differed significantly (p<0.01and p<0.001, respectively) between divers with MS and divers without MS. Their %OCRA scores and severity of MS were significantly correlated. Female divers were more susceptible to MS. ROC analysis for %OCRA revealed that the AUC for divers with MS and divers without MS was 0.8967 (95% CI, 0.8114 to 0.9819), the specificity was 1.000, and the sensitivity was 0.700, with a cutoff value of 45.946. CONCLUSION Physiological differences between R-L otolith organ function could affect the severity and susceptibility to MS. Female hormones may also increase susceptibility to MS. Thus, MS may be a physiological phenomenon induced by functional ear differences in the absence of pathology. As MS is caused by multiple factors, otolaryngologists need to consider various causative factors beyond those related to otolith organ function in scuba divers with MS.
Collapse
Affiliation(s)
- Naoharu Kitajima
- Kitajima ENT Clinic, 1-15-15 Tagara Nerima-ku, Tokyo 179-0073, Japan; Department of Otolaryngology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Akemi Sugita-Kitajima
- Kitajima ENT Clinic, 1-15-15 Tagara Nerima-ku, Tokyo 179-0073, Japan; Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| |
Collapse
|
32
|
Abstract
OBJECTIVE To identify differences in the vestibulo-ocular reflex (VOR) gain value and the peak saccade velocity in the suppression video head impulse test paradigms according to the age of the subject and the direction of the impulse. STUDY DESIGN Retrospective chart analysis. SETTING Tertiary referral hospital. PATIENTS/INTERVENTIONS Between October 2017 and May 2019, we enrolled subjects who had previous histories of dizziness but no dizziness over the last 1 month. MAIN OUTCOME MEASURE We conducted cervical vestibular-evoked myogenic potential and caloric tests, as well as video head impulse tests. We excluded the subjects who had abnormal cervical vestibular-evoked myogenic potential results (asymmetry ratio of greater than 30%) and abnormal caloric test results (caloric paresis of greater than 25%). RESULTS We included 647 subjects aged 10 to 87 years. The mean VOR gain and peak saccade velocity were maintained in subjects less than 70 years old (VOR gain, 0.991 ± 0.08, peak saccade velocity, 348.47 ± 142.32). However, the decreases in VOR gain and peak saccade velocity were significant in subjects over 70 years old (VOR gain, 0.928 ± 0.09, peak saccade velocity, 315.51 ± 0.09; p < 0.001). The mean VOR gain of the rightward impulse (1.00 ± 0.09) was higher than the leftward impulse (0.96 ± 0.08, p < 0.001). CONCLUSIONS Both the VOR gain and peak saccade velocity of suppression video head impulse test paradigms declined with increasing age over 70 years. In addition, the VOR gain of the rightward impulse was higher than the leftward impulse in the right-eye recordings.
Collapse
|
33
|
D’Elia A, Quaranta N, Asprella Libonati G, Ralli G, Morelli A, Inchingolo F, Cialdella F, Martellucci S, Barbara F. The cochleo-vestibular secretory senescence. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
34
|
Lerchundi F, Laffue AH, Olivier M, Gualtieri FJ. Bilateral posterior semicircular canal dysfunction: a new finding with video head impulse test. J Neurol 2020; 267:2347-2352. [PMID: 32347336 DOI: 10.1007/s00415-020-09793-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/21/2020] [Accepted: 03/11/2020] [Indexed: 11/24/2022]
Abstract
Development of the video head impulse test (vHIT) assessing all three semicircular canals in both labyrinths has uncovered the existence of new vestibular failure patterns and made bilateral posterior canal dysfunction detection possible. We conducted a retrospective analysis of 41 patients with bilateral posterior semicircular canal failure and compared results to 37 controls, with normal posterior semicircular canal function. Mean calculated gain showed significant difference between patients and controls in right [0.54 (SD 0.016)] and left [0.57 (SD 0.014)] posterior semicircular canals. There was a peak in prevalence between 71 and 80 years. Presentation was chronic in 78% of patients, and gait instability was the most common complaint. Sixty eight percent of cases were classified as idiopathic. Significant difference between groups was seen regarding the presence of Meniere's disease, presbycusis, and positional down-beat nystagmus (posDBN). This new vHIT pattern is most often seen in elderly patients, mainly of idiopathic etiology and presents together with sensorineural hearing loss and posDBN. Our findings suggest idiopathic cases may well contribute to the so-called "presbyastasis".
Collapse
|
35
|
Abstract
Recent applications of eye tracking for diagnosis, prognosis and follow-up of therapy in age-related neurological or psychological deficits have been reviewed. The review is focused on active aging, neurodegeneration and cognitive impairments. The potential impacts and current limitations of using characterizing features of eye movements and pupillary responses (oculometrics) as objective biomarkers in the context of aging are discussed. A closer look into the findings, especially with respect to cognitive impairments, suggests that eye tracking is an invaluable technique to study hidden aspects of aging that have not been revealed using any other noninvasive tool. Future research should involve a wider variety of oculometrics, in addition to saccadic metrics and pupillary responses, including nonlinear and combinatorial features as well as blink- and fixation-related metrics to develop biomarkers to trace age-related irregularities associated with cognitive and neural deficits.
Collapse
Affiliation(s)
- Ramtin Z Marandi
- Department of Health Science & Technology, Aalborg University, Aalborg E 9220, Denmark
| | - Parisa Gazerani
- Department of Health Science & Technology, Aalborg University, Aalborg E 9220, Denmark
| |
Collapse
|
36
|
Anson ER, Ehrenburg MR, Wei EX, Bakar D, Simonsick E, Agrawal Y. Saccular function is associated with both angular and distance errors on the triangle completion test. Clin Neurophysiol 2019; 130:2137-2143. [PMID: 31569041 PMCID: PMC6874399 DOI: 10.1016/j.clinph.2019.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study was designed to determine whether healthy older adults with age-related vestibular loss have deficits in spatial navigation. METHODS 154 adults participating in the Baltimore Longitudinal Study of Aging were tested for semicircular canal, saccular, and utricular function and spatial navigation ability using the blindfolded Triangle Completion Test (TCT). Multiple linear regression was used to investigate the relationships between each measure of vestibular function and performance on the TCT (angular error, end point error, and distance walked) while controlling for age and sex. RESULTS Individuals with abnormal saccular function made larger angular errors (β = 4.2°, p < 0.05) and larger end point errors (β = 13.6 cm, p < 0.05). Independent of vestibular function, older age was associated with larger angular (β's = 2.2-2.8°, p's < 0.005) and end point errors (β's = 7.5-9.0 cm, p's < 0.005) for each decade increment in age. CONCLUSIONS Saccular function appears to play a prominent role in accurate spatial navigation during a blindfolded navigation task. SIGNIFICANCE We hypothesize that gravitational cues detected by the saccule may be integrated into estimation of place as well as heading direction.
Collapse
Affiliation(s)
- E R Anson
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Otolaryngology, University of Rochester, Rochester, NY, USA.
| | - M R Ehrenburg
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E X Wei
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Bakar
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; School of Medicine, Brown University, Providence, RI, USA
| | - E Simonsick
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Y Agrawal
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
37
|
Agrawal Y, Van de Berg R, Wuyts F, Walther L, Magnusson M, Oh E, Sharpe M, Strupp M. Presbyvestibulopathy: Diagnostic criteria Consensus document of the classification committee of the Bárány Society. J Vestib Res 2019; 29:161-170. [PMID: 31306146 PMCID: PMC9249286 DOI: 10.3233/ves-190672] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and thresholds established for bilateral vestibulopathy. The diagnosis of PVP is based on the patient history, bedside examination and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with the video-HIT (vHIT); for the middle frequency range with rotary chair testing; and for the low frequency range with caloric testing. For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < 0.8 and > 0.6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25°/s and > 6°/s, and/or the horizontal angular VOR gain should be > 0.1 and < 0.3 upon sinusoidal stimulation on a rotatory chair. PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar and extrapyramidal function which also contribute and might even be required for the manifestation of the symptoms of unsteadiness, gait disturbance, and falls. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults.
Collapse
Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
| | - Raymond Van de Berg
- Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Floris Wuyts
- Lab for Equilibrium Investigations and Aerospace, University of Antwerp, Antwerp, Belgium
| | - Leif Walther
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medicine Mannheim, University of Heidelberg, Germany
| | - Mans Magnusson
- Department of Otorhinolaryngology, Lund University, Lund, Sweden
| | - Esther Oh
- Department of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, USA
| | | | - Michael Strupp
- Department of Neurology and German Center for Vertigo, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
38
|
Failure on the Foam Eyes Closed Test of Standing Balance Associated With Reduced Semicircular Canal Function in Healthy Older Adults. Ear Hear 2019; 40:340-344. [PMID: 29894381 DOI: 10.1097/aud.0000000000000619] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Standing on foam with eyes closed (FOEC) has been characterized as a measure of vestibular function; however, the relative contribution of vestibular function and proprioceptive function to the FOEC test has not been well described. In this study, the authors investigate the relationship between peripheral sensory systems (vestibular and proprioception) and performance on the FOEC test in a cohort of healthy adults. DESIGN A total of 563 community-dwelling healthy adults (mean age, 72.7 [SD, 12.6] years; range, 27 to 93 years) participating in the Baltimore Longitudinal Study of Aging were tested. Proprioceptive threshold (PROP) was evaluated with passive motion detection at the right ankle. Vestibulo-ocular reflex (VOR) gain was measured using video head impulses. Otolith function was measured with cervical and ocular vestibular-evoked myogenic potentials. Participants stood on FOEC for 40 sec while wearing BalanSens (BioSensics, LLC, Watertown, MA) to quantify center of mass sway area. A mixed-model multiple logistic regression was used to examine the odds of passing the FOEC test based on PROP, VOR, cervical vestibular-evoked myogenic potential, and ocular vestibular-evoked myogenic potential function in a multisensory model while controlling for age and gender. RESULTS The odds of passing the FOEC test decreased by 15% (p < 0.001) for each year of increasing age and by 8% with every 0.1 reduction in VOR gain (p = 0.025). Neither PROP nor otolith function was significantly associated with passing the FOEC test. CONCLUSIONS Failure to maintain balance during FOEC may serve as a proxy for rotational vestibular contributions to postural control. Semicircular canals are more sensitive to low-frequency motion than otoliths that may explain these relationships because standing sway is dominated by lower frequencies. Lower VOR gain and increased age independently decreased the odds of passing the test.
Collapse
|
39
|
Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display. Arch Gerontol Geriatr 2019; 83:246-256. [DOI: 10.1016/j.archger.2019.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
|
40
|
Bigland MJ, Brichta AM, Smith DW. Effects of Ageing on the Mitochondrial Genome in Rat Vestibular Organs. Curr Aging Sci 2019; 11:108-117. [PMID: 30777575 PMCID: PMC6388513 DOI: 10.2174/1874609811666180830143358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/21/2018] [Accepted: 08/01/2018] [Indexed: 01/07/2023]
Abstract
Background: Deterioration in vestibular function occurs with ageing and is linked to age-related falls. Sensory hair cells located in the inner ear vestibular labyrinth are critical to vestibular function. Vestibular hair cells rely predominantly on oxidative phosphorylation (OXPHOS) for ener-gy production and contain numerous mitochondria. Mitochondrial DNA (mtDNA) mutations and perturbed energy production are associated with the ageing process. Objective: We investigated the effects of ageing on mtDNA in vestibular hair and support cells, and vestibular organ gene expression, to better understand mechanisms of age-related vestibular deficits. Methods: Vestibular hair and supporting cell layers were microdissected from young and old rats, and mtDNA was quantified by qPCR. Additionally, vestibular organ gene expression was analysed by microarray and gene set enrichment analyses. Results: In contrast to most other studies, we found no evidence of age-related mtDNA deletion mu-tations. However, we found an increase in abundance of major arc genes near the mtDNA control re-gion. There was also a marked age-related reduction in mtDNA copy number in both cell types. Ves-tibular organ gene expression, gene set enrichment analysis showed the OXPHOS pathway was down regulated in old animals. Conclusion: Given the importance of mtDNA to mitochondrial OXPHOS and hair cell function, our findings suggest the vestibular organs are potentially on the brink of an energy crisis in old animals
Collapse
Affiliation(s)
- Mark J Bigland
- Neurobiology of Ageing and Dementia Laboratory, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.,Preclinical Neurobiology Program, Priority Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Alan M Brichta
- Neurobiology of Ageing and Dementia Laboratory, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.,Preclinical Neurobiology Program, Priority Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Doug W Smith
- Neurobiology of Ageing and Dementia Laboratory, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.,Preclinical Neurobiology Program, Priority Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| |
Collapse
|
41
|
Loyd BJ, Fangman A, Peterson DS, Gappmaier E, Schubert MC, Thackery A, Dibble L. Rehabilitation to improve gaze and postural stability in people with multiple sclerosis: study protocol for a prospective randomized clinical trial. BMC Neurol 2019; 19:119. [PMID: 31179920 PMCID: PMC6556952 DOI: 10.1186/s12883-019-1353-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of vestibular rehabilitation principles in the management of gaze and postural stability impairments in people with multiple sclerosis (PwMS) has shown promise in pilot work completed in our lab and in a recently published randomized clinical trial (RCT). However, further work is needed to fully quantify the gaze and postural impairments present in people with multiple sclerosis and how they respond to rehabilitation. METHODS/DESIGN The study is a single blind RCT designed to examine the benefit of a gaze and postural stability (GPS) intervention program compared to a standard of care (SOC) rehabilitation program in dizzy and balance impaired PwMS. Outcomes will be collected across the domains of body structure and function, activity, and participation as classified by the World Health Organization International Classification of Functioning, Disability, and Health (ICF). Our primary outcomes are the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA). Secondary outcomes include other measures of gaze and postural stability, fatigue, and functional mobility. Participants who are interested and eligible for enrollment will be consented prior to completing a baseline assessment. Following the baseline assessment each participant will be randomized to either the GPS or SOC intervention group and will complete a 6 week treatment period. During the treatment period, both groups will participate in guided exercise 3x/week. Following the treatment period participants will be asked to return for a post-treatment evaluation and again for a follow-up assessment 1 month later. We anticipate enrolling 50 participants. DISCUSSION This study will be an innovative RCT that will utilize gaze and postural stability metrics to assess the efficacy of vestibular rehabilitation in PwMS. It will build on previous work by examining measures across the ICF and improve the current evidence base for treating PwMS. TRIAL REGISTRATION ClinicalTrials.gov, May 29th 2018, NCT03521557 .
Collapse
Affiliation(s)
- Brian J. Loyd
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Annie Fangman
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Daniel S. Peterson
- Arizona State University, College of Health Solutions, 550 N. 3rd Street, Phoenix, AZ 85004-0698 USA
- Phoenix VA Health Care System, 650 Indian School Rd., Phoenix, AZ 85012 USA
| | - Eduard Gappmaier
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Michael C. Schubert
- Department of Otolaryngology Head and Neck Surgery, John Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287 USA
| | - Anne Thackery
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| | - Lee Dibble
- Department of Physical Therapy and Athletic Training, University of Utah College of Health, 520 Wakara Way, Salt Lake City, UT 84108 USA
| |
Collapse
|
42
|
Jay DR, Cane D, Howe S. Age Is a Greater Influence on Small Saccades Than Target Size in Normal Subjects on the Horizontal Video Head Impulse Test. Front Neurol 2019; 10:328. [PMID: 31040813 PMCID: PMC6476940 DOI: 10.3389/fneur.2019.00328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/18/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: This study sought to investigate whether the size of the target used in the horizontal vHIT has an effect on the saccade profile of healthy subjects, and to expand upon previous work linking age to the existence of small vHIT saccades. Methods: Forty eight participants were recruited between 18 and 77 years of age, with no history of vestibular, oculomotor or neurological conditions and a visual acuity of at least 0.3 LogMAR. Participants underwent four consecutive horizontal vHIT trials using the standard target size and three smaller targets. VOR gain and metrics for saccadic incidence, peak eye velocity and latency were then extracted from results. Results: Target size was a statistically significant influence on saccade metrics. As target size increased, saccadic incidence decreased while peak eye velocity and latency increased. However, a potential order effect was also discovered, and once this was corrected for the remaining effect of target size was small and is likely clinically insignificant. The effect of age was much stronger than target size; increasing age was strongly positively correlated with saccadic incidence and showed a medium size correlation with peak velocity, though not with saccadic latency. Conclusion: While this study suggests that target size may have a statistically significant impact on the vHIT saccade profile of normal subjects, age has a greater influence on the incidence and size of small vHIT saccades.
Collapse
Affiliation(s)
- David R Jay
- Manchester Head and Neck Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Debbie Cane
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, United Kingdom
| | - Simon Howe
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, United Kingdom.,Department of Audiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| |
Collapse
|
43
|
Samartsev IN, Zhivolupov SA, Butakova YS, Morozova MV, Barsukov IN. Efficiency of long-term vinpocetine administration in the treatment of dizziness and associated statodynamic disorders in patients with chronic cerebrovascular insufficiency (EDELWEISS study). ACTA ACUST UNITED AC 2019. [DOI: 10.14412/2074-2711-2019-1-36-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- I. N. Samartsev
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
| | - S. A. Zhivolupov
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
| | | | - M. V. Morozova
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
| | - I. N. Barsukov
- Immanuil Kant Baltic Federal University, Ministry of Education and Science
| |
Collapse
|
44
|
Zakaria MN, Salim R, Tahir A, Zainun Z, Mohd Sakeri NS. The influences of age, gender and geometric pattern of visual image on the verticality perception: A subjective visual vertical (SVV) study among Malaysian adults. Clin Otolaryngol 2019; 44:166-171. [PMID: 30411501 DOI: 10.1111/coa.13255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults. STUDY DESIGN This study employed a repeated measures design. SETTINGS Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia. PARTICIPANTS Eligible Malaysian adults (N = 187, aged 21-75 years) were recruited and categorised into young (N = 60), middle-aged (N = 66) and older (N = 61) groups. Most of them were Malay, and 51.3% were men. MAIN OUTCOME MEASURES Subjective visual vertical angles (in degrees) were determined from each participant in a static upright condition using a computerised SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern). RESULTS Three-way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P > 0.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P = 0.004). CONCLUSION While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (ie, arrow pattern). Further SVV research on vestibular-disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image.
Collapse
Affiliation(s)
- Mohd Normani Zakaria
- Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Rosdan Salim
- Otorhinolaryngology Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Adnan Tahir
- Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Zuraida Zainun
- Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nurul Syarida Mohd Sakeri
- Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| |
Collapse
|
45
|
Community-dwelling adults with a history of falling report lower perceived postural stability during a foam eyes closed test than non-fallers. Exp Brain Res 2019; 237:769-776. [PMID: 30604020 DOI: 10.1007/s00221-018-5458-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/18/2018] [Indexed: 01/27/2023]
Abstract
Perceived postural stability has been reported to decrease as sway area increases on firm surfaces. However, changes in perceived stability under increasingly challenging conditions (e.g., removal of sensory inputs) and the relationship with sway area are not well characterized. Moreover, whether perceived stability varies as a function of age or history of falls is unknown. Here we investigate how perceived postural stability is related to sway area and whether this relationship varies as a function of age and fall history while vision and proprioceptive information are manipulated. Sway area was measured in 427 participants from the Baltimore Longitudinal Study of Aging while standing with eyes open and eyes closed on the floor and a foam cushion. Participants rated their stability [0 (completely unstable) to 10 (completely stable)] after each condition, and reported whether they had fallen in the past year. Perceived stability was negatively associated with sway area (cm2) such that individuals who swayed more felt less stable across all conditions (β = - 0.53, p < 0.001). Perceived stability decreased with increasing age (β = - 0.019, p < 0.001), independent of sway area. Fallers had a greater decline in perceived stability across conditions (F = 2.76, p = 0.042) compared to non-fallers, independent of sway area. Perceived postural stability declined as sway area increased during a multisensory balance test. A history of falling negatively impacts perceived postural stability when vision and proprioception are simultaneously challenged. Perceived postural stability may provide additional information useful for identifying individuals at risk of falls.
Collapse
|
46
|
Ji L, Zhai S. Aging and the peripheral vestibular system. J Otol 2018; 13:138-140. [PMID: 30671091 PMCID: PMC6335476 DOI: 10.1016/j.joto.2018.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022] Open
Abstract
Whereas much has been learned about age-related auditory changes in the inner ear, relatively little is known about the aging effects on the vestibular part of the inner ear-the peripheral vestibular system. Here we review relevant literature with regard to the prevalence of vestibular dysfunction, vestibular functional and structural changes in the elderly. The prevalence of vestibular dysfunction increases with age. Functionally, as age increases, VEMP amplitudes decrease, VEMP thresholds increase, VOR gain of HIT decreases. Due to the complexity of the vestibular system, variations in subject age and measurement techniques, findings in VEMP latency and caloric tests are conflicting. To address this, a direct measure of the peripheral vestibular system should be applied. Structurally, age-related loss in vestibular ganglion and otoconia have been noted; hair cell changes are not well defined; while subcellular changes remain to be explored. Defining how the onset of vestibular dysfunction correlates with structural degeneration will offer insights into the mechanisms underlying vestibular aging.
Collapse
Affiliation(s)
- Lingchao Ji
- Medical School of Chinese PLA, Beijing, China
| | - Suoqiang Zhai
- Medical School of Chinese PLA, Beijing, China.,Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
47
|
Campos J, Ramkhalawansingh R, Pichora-Fuller MK. Hearing, self-motion perception, mobility, and aging. Hear Res 2018; 369:42-55. [DOI: 10.1016/j.heares.2018.03.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/20/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
|
48
|
Micarelli A, Viziano A, Bruno E, Micarelli E, Augimeri I, Alessandrini M. Gradient impact of cognitive decline in unilateral vestibular hypofunction after rehabilitation: preliminary findings. Eur Arch Otorhinolaryngol 2018; 275:2457-2465. [DOI: 10.1007/s00405-018-5109-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
|
49
|
Kamil RJ, Jacob A, Ratnanather JT, Resnick SM, Agrawal Y. Vestibular Function and Hippocampal Volume in the Baltimore Longitudinal Study of Aging (BLSA). Otol Neurotol 2018; 39:765-771. [PMID: 29889787 PMCID: PMC5999049 DOI: 10.1097/mao.0000000000001838] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study evaluated whether reduced vestibular function in aging adults is associated with lower hippocampal volume. STUDY DESIGN Cross-sectional study. SETTING Baltimore Longitudinal Study of Aging, a long-running longitudinal cohort study of healthy aging. PATIENTS Eligible participants were aged ≥ 60 years and had both vestibular physiological testing and brain magnetic resonance imaging at the same visit. INTERVENTION Vestibular function testing consisted of the cervical vestibular-evoked myogenic potential (cVEMP) to assess saccular function, ocular VEMP to assess utricular function, and video head-impulse testing to assess the horizontal semicircular canal vestibulo-ocular reflex. MAIN OUTCOME MEASURE Hippocampal volume calculated using diffeomorphometry. RESULTS The study sample included 103 participants (range of 35-90 participants in subanalyses) with mean (±SD) age 77.2 years (±8.71). Multivariate linear models including age, intracranial volume, sex, and race showed that 1 μV amplitude increase of cVEMP was associated with an increase of 319.1 mm (p = 0.003) in mean hippocampal volume. We did not observe a significant relationship between ocular VEMP amplitude or vestibulo-ocular reflex gain and mean hippocampal volume. CONCLUSIONS Lower cVEMP amplitude (i.e., reduced saccular function) was significantly associated with lower mean hippocampal volume. This is in line with previous work demonstrating a link between saccular function and spatial cognition. Hippocampal atrophy may be a mechanism by which vestibular loss contributes to impaired spatial cognition in older adults. Future work using longitudinal data will be needed to evaluate the causal nature of the association between vestibular loss and hippocampal atrophy.
Collapse
Affiliation(s)
- Rebecca J. Kamil
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD
| | - Athira Jacob
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | | | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore MD
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology, Neurotology, and Skull Base Surgery, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
50
|
Judge PD, Rodriguez AI, Barin K, Janky KL. Impact of Target Distance, Target Size, and Visual Acuity on the Video Head Impulse Test. Otolaryngol Head Neck Surg 2018; 159:739-742. [PMID: 29865935 DOI: 10.1177/0194599818779908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The video head impulse test (vHIT) assesses the vestibulo-ocular reflex. Few have evaluated whether environmental factors or visual acuity influence the vHIT. The purpose of this study was to evaluate the influence of target distance, target size, and visual acuity on vHIT outcomes. Thirty-eight normal controls and 8 subjects with vestibular loss (VL) participated. vHIT was completed at 3 distances and with 3 target sizes. Normal controls were subdivided on the basis of visual acuity. Corrective saccade frequency, corrective saccade amplitude, and gain were tabulated. In the normal control group, there were no significant effects of target size or visual acuity for any vHIT outcome parameters; however, gain increased as target distance decreased. The VL group demonstrated higher corrective saccade frequency and amplitude and lower gain as compared with controls. In conclusion, decreasing target distance increases gain for normal controls but not subjects with VL. Preliminarily, visual acuity does not affect vHIT outcomes.
Collapse
Affiliation(s)
- Paul D Judge
- 1 University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Kamran Barin
- 3 Eye and Ear Institute, The Ohio State University, Columbus, Ohio, USA
| | - Kristen L Janky
- 2 Boys Town National Research Hospital, Omaha, Nebraska, USA
| |
Collapse
|