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Ma YM, Zhang DP, Zhang HL, Cao FZ, Zhou Y, Wu B, Wang LZ, Xu B. Why is vestibular migraine associated with many comorbidities? J Neurol 2024:10.1007/s00415-024-12692-8. [PMID: 39302416 DOI: 10.1007/s00415-024-12692-8] [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: 06/27/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
Vestibular migraine (VM) is a usual trigger of episodic vertigo. Patients with VM often experience spinning, shaking, or unsteady sensations, which are usually also accompanied by photophobia, phonophobia, motor intolerance, and more. VM is often associated with a number of comorbidities. Recurrent episodes of VM can affect the patient's emotions, sleep, and cognitive functioning to varying degrees. Patients with VM may be accompanied by adverse moods such as anxiety, fear, and depression, which can gradually develop into anxiety disorders or depressive disorders. Sleep disorders are also a common concomitant symptom of VM, which significantly lower patients' quality of life. The influence of anxiety disorders and sleep disorders may reduce cognitive functions of VM, such as visuospatial ability, attention, and memory decline. Clinically, it is also common to see VM comorbid with other vestibular disorders, making the diagnosis more difficult. VM episodes are relieved but lingering, in which case VM may coexist with persistent postural-perceptual dizziness (PPPD). Anxiety may be an important bridge between recurrent VM and PPPD. The clinical manifestations of VM and Meniere's disease (MD) overlap considerably, and those who meet the diagnostic criteria for both can be said to have VM/MD comorbidity. VM can also present with positional vertigo, and some patients with VM present with typical benign paroxysmal positional vertigo (BPPV) nystagmus on positional testing. In this paper, we synthesize and analyze the pathomechanisms of VM comorbidity by reviewing the literature. The results show that it may be related to the extensive connectivity of the vestibular system with different brain regions and the close connection of the trigeminovascular system with the periphery of the vestibule. Therefore, it is necessary to pay attention to the diagnosis of comorbidities in VM, synthesize its pathogenesis, and give comprehensive treatment to patients.
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Affiliation(s)
- Yan-Min Ma
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Dao-Pei Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan Province, Zhengzhou City, China
| | - Huai-Liang Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan Province, Zhengzhou City, China
| | - Fang-Zheng Cao
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Yu Zhou
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Bin Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Ling-Zhe Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Bin Xu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, 310053, China.
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Li J, Xu X, Deng X, Li S, Guo T, Xie H. Association of Vestibular Disorders and Cognitive Function: A Systematic Review. Laryngoscope 2024. [PMID: 39016124 DOI: 10.1002/lary.31646] [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: 02/01/2024] [Revised: 05/25/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES The purpose of this study is to consolidate and condense the available evidence about the potential association between vestibular diseases and cognitive impairment. DATA SOURCES AND METHODS A systematic search was conducted on four English databases (PubMed, Embase, Web of Science, Cochrane Library) from the time of library construction to March 2024. The study incorporated various keywords such as "vestibular disorders," "vertigo," "dizziness," "Meniere's disease," "benign paroxysmal positional vertigo," "vestibular migraine," "vestibular neuritis," "labyrinthitis," "bilateral vestibular disease," as well as "cognitive function" and "cognitive dysfunction." A qualitative review was conducted to look for and assess pertinent studies. RESULTS A total of 45 publications were incorporated, encompassing prevalent vestibular disorders, mostly targeting individuals in the middle-aged and older demographic. The findings indicate that individuals with vestibular disorders experience varying levels of cognitive impairment, which is evident in different aspects, with visuospatial cognitive deficits being more prominent. Furthermore, patients with chronic vestibular syndromes are more prone to cognitive dysfunction. Lastly, the hippocampus plays a crucial role in the intricate vestibular neural network. CONCLUSION The findings of this comprehensive review indicate that vestibular disorders can result in impairments across various aspects of cognitive functioning, particularly in visuospatial cognition. The underlying mechanism may be associated with a decrease in the size of the hippocampus. Individuals suffering from chronic vestibular dysfunction exhibit a higher likelihood of experiencing cognitive deficits. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Jiongke Li
- Department of Otorhinolaryngology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xianpeng Xu
- Department of Otorhinolaryngology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinxing Deng
- Department of Otorhinolaryngology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sha Li
- Department of Otorhinolaryngology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Guo
- Department of Otorhinolaryngology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Xie
- Department of Otorhinolaryngology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Lu X, Yi H. Editorial: Vertigo, tinnitus, and cognition. Front Neurosci 2024; 18:1399340. [PMID: 38779511 PMCID: PMC11109397 DOI: 10.3389/fnins.2024.1399340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
| | - Haijin Yi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Bhattacharyya R, Barman A, Antony F. Influence of BPPV and Meniere's Disease on Cognitive Abilities: A Questionnaire-Based Study. J Otol 2024; 19:10-18. [PMID: 38313758 PMCID: PMC10837562 DOI: 10.1016/j.joto.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 02/06/2024] Open
Abstract
The vestibular system connects the inner ear to the midbrain and subcortical structures and can affect cognition. Patients with vertigo often experience cognitive symptoms such as attention deficits, memory problems, and spatial perception difficulties. This study aimed to explore the cognitive impairments associated with Benign paroxysmal positional vertigo (BPPV) and Meniere's Disease (MD). A non-experimental group comparison design was used with 107 participants divided into three groups: Group I (clinically normal), Group II (BPPV), and Group III (MD). Participants completed a questionnaire with 10 cognition-related questions, and their responses were scored. The data were found to be non-normally distributed. The analysis revealed a significant difference in scores between Group I and both Group II and Group III. Chi-square tests showed that the responses to cognition-related questions varied among the groups, with Group II exhibiting more cognitive problems. Associated conditions like hypertension, diabetes, and hearing loss did not significantly influence the responses within each group. This study suggests a significant relationship between cognitive problems and patients with BPPV and MD. However, there was no association found between the cognitive problems experienced in BPPV and MD patients. These findings align with previous research indicating that vestibular disorders can lead to deficits in spatial memory, attention, and other cognitive functions. By understanding the link between cognition and vestibular disorders, we can improve diagnosis and rehabilitation services to enhance the quality of life for these patients.
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Affiliation(s)
| | - Animesh Barman
- All India Institute of Speech and Hearing, Mysore, Mysuru, India
| | - Freddy Antony
- All India Institute of Speech and Hearing, Mysore, Mysuru, India
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Rizk HG, Velozo C, Shah S, Hum M, Sharon JD, Mcrackan TR. Item Level Psychometrics of the Dizziness Handicap Inventory in Vestibular Migraine and Meniere's Disease. Ear Hear 2024; 45:106-114. [PMID: 37415269 DOI: 10.1097/aud.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Evaluate the measurement properties of the Dizziness Handicap Inventory (DHI) using item response theory in patients diagnosed with vestibular migraine (VM) and Meniere's disease (MD). DESIGN One hundred twenty-five patients diagnosed with VM and 169 patients diagnosed with MD by a vestibular neurotologist according to the Bárány Society criteria in two tertiary multidisciplinary vestibular clinics and who completed the DHI at their initial visit, were included in the study. The DHI (total score and individual items) was analyzed using the Rasch Rating Scale model for patients in each subgroup, VM and MD, and as a whole group. The following categories were assessed: rating-scale structure, unidimensionality, item and person fit, item difficulty hierarchy, person-item match, and separation index, standard error of measurement, and minimal detectable change (MDC). RESULTS Patients were predominantly female (80% of the VM subgroup and 68% of the MD subgroup) with a mean age of 49.9 ± 16.5 years and 54.1 ± 14.2 years, respectively. The mean total DHI score for the VM group was 51.9 ± 22.3 and for the MD group was 48.5 ± 26.6 ( p > 0.05). While neither all items nor the separate constructs met all criteria for unidimensionality (i.e., items measuring a single construct), post hoc analysis showed that the all-item analysis supported a single construct. All analyses met the criterion for showing a sound rating scale and acceptable Cronbach's alpha (≥0.69). The all-item analysis showed the most precision, separating the samples into three to four significant strata. The separate-construct analyses (physical, emotional, and functional) showed the least precision, separated the samples into less than three significant strata. Regarding MDC, the MDC remained consistent across the analyses of the different samples; approximately 18 points for the full analyses and approximately 10 points for the separate construct (physical, emotional, and functional). CONCLUSIONS Our evaluation of the DHI using item response theory shows that the instrument is psychometrically sound and reliable. The all-item instrument fulfills criteria for essential unidimensionality but does seem to measure multiple latent constructs in patients with VM and MD, which has been reported in other balance and mobility instruments. The current subscales did not show acceptable psychometrics, which is in line with multiple recent studies favoring the use of the total score. The study also shows that the DHI is adaptable to episodic recurrent vestibulopathies. The total score shows better precision and separation of subjects in up to four strata compared to the separate construct that separate subjects into less than three strata. The measurement error smallest detectable change was found in our analysis to be 18 points, which means any change in the DHI of less than 18 points is not likely to be clinically significant. The minimal clinically important difference remains indeterminate.
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Affiliation(s)
- Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Craig Velozo
- Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sunny Shah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maxwell Hum
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Theodore R Mcrackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Mowery TM, Wackym PA, Nacipucha J, Dangcil E, Stadler RD, Tucker A, Carayannopoulos NL, Beshy MA, Hong SS, Yao JD. Superior semicircular canal dehiscence and subsequent closure induces reversible impaired decision-making. Front Neurol 2023; 14:1259030. [PMID: 37905188 PMCID: PMC10613502 DOI: 10.3389/fneur.2023.1259030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023] Open
Abstract
Background Vestibular loss and dysfunction has been associated with cognitive deficits, decreased spatial navigation, spatial memory, visuospatial ability, attention, executive function, and processing speed among others. Superior semicircular canal dehiscence (SSCD) is a vestibular-cochlear disorder in humans in which a pathological third mobile window of the otic capsule creates changes to the flow of sound pressure energy through the perilymph/endolymph. The primary symptoms include sound-induced dizziness/vertigo, inner ear conductive hearing loss, autophony, headaches, and visual problems; however, individuals also experience measurable deficits in basic decision-making, short-term memory, concentration, spatial cognition, and depression. These suggest central mechanisms of impairment are associated with vestibular disorders; therefore, we directly tested this hypothesis using both an auditory and visual decision-making task of varying difficulty levels in our model of SSCD. Methods Adult Mongolian gerbils (n = 33) were trained on one of four versions of a Go-NoGo stimulus presentation rate discrimination task that included standard ("easy") or more difficult ("hard") auditory and visual stimuli. After 10 days of training, preoperative ABR and c+VEMP testing was followed by a surgical fenestration of the left superior semicircular canal. Animals with persistent circling or head tilt were excluded to minimize effects from acute vestibular injury. Testing recommenced at postoperative day 5 and continued through postoperative day 15 at which point final ABR and c+VEMP testing was carried out. Results Behavioral data (d-primes) were compared between preoperative performance (training day 8-10) and postoperative days 6-8 and 13-15. Behavioral performance was measured during the peak of SSCD induced ABR and c + VEMP impairment and the return towards baseline as the dehiscence began to resurface by osteoneogenesis. There were significant differences in behavioral performance (d-prime) and its behavioral components (Hits, Misses, False Alarms, and Correct Rejections). These changes were highly correlated with persistent deficits in c + VEMPs at the end of training (postoperative day 15). The controls demonstrated additional learning post procedure that was absent in the SSCD group. Conclusion These results suggest that aberrant asymmetric vestibular output results in decision-making impairments in these discrimination tasks and could be associated with the other cognitive impairments resulting from vestibular dysfunction.
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Affiliation(s)
- Todd M. Mowery
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Rutgers Brain Health Institute, New Brunswick, NJ, United States
| | - P. Ashley Wackym
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Rutgers Brain Health Institute, New Brunswick, NJ, United States
| | - Jacqueline Nacipucha
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Evelynne Dangcil
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Ryan D. Stadler
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Aaron Tucker
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Nicolas L. Carayannopoulos
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Mina A. Beshy
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Sean S. Hong
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Justin D. Yao
- Department of Otolaryngology – Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
- Rutgers Brain Health Institute, New Brunswick, NJ, United States
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Patel EJ, Hum M, Gardi A, Steenerson KK, Rizk HG, Sharon JD. VM-PATHI Correlates With Cognitive Function Improvement After Successful Treatment in Patients With Vestibular Migraine. Otol Neurotol 2023; 44:813-816. [PMID: 37525385 DOI: 10.1097/mao.0000000000003976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To assess changes in cognitive function in vestibular migraine patients undergoing treatment. STUDY DESIGN Prospective cohort. SETTING Single-institution tertiary-care center. PATIENTS Thirty-four patients with vestibular migraine were included in the study. Average age at diagnosis was 47.9 years. A majority of patients (91.2%) were female. INTERVENTIONS Vestibular therapies included pharmacologic treatment (67.6%), mindfulness-based stress reduction (58.8%), vestibular physical therapy (20.6%), and lifestyle changes only (2.9%). MAIN OUTCOME MEASURES Pretreatment and posttreatment questionnaires were collected including the Cognitive Failures Questionnaire (CFQ), Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI), and Dizziness Handicap Inventory. RESULTS Median time between pretreatment and posttreatment questionnaire was 4.4 months (range, 2.8-15.6. mo). CFQ scores decreased in subjects who responded to treatment, as defined by those with a positive change in VM-PATHI score (average decrease, 6.5; p = 0.03). CFQ scores did not improve in subjects who had no improvement in their vestibular condition, as defined by no change or an increase in VM-PATHI score (average increase, 2.0; p = 0.53). Univariate linear regression showed that VM-PATHI score change was highly predictive of CFQ change ( p < 0.01, r2 = 0.36). Multivariate regression demonstrated that the VM-PATHI ( p = 0.03) and not the Dizziness Handicap Inventory ( p = 0.10) predicted changes in CFQ score. CONCLUSIONS Self-reported cognitive dysfunction improves with successful treatment of vestibular migraine.
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Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Maxwell Hum
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Adam Gardi
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Kristen K Steenerson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
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Sun J, Ma X, Yang Y, He K, Wang W, Shen J, Wang L, Chen X, Jin Y, Yang J, Chen J. Associations between cognition, anxiety, depression, and residual dizziness in elderly people with BPPV. Front Aging Neurosci 2023; 15:1208661. [PMID: 37719876 PMCID: PMC10500068 DOI: 10.3389/fnagi.2023.1208661] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To investigate the associations between cognition, anxiety, depression, and residual dizziness after successful repositioning maneuvers in the elderly with benign paroxysmal positional vertigo (BPPV). Methods We enrolled 40 elderly patients with BPPV in our outpatient department. We used the Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Questionnaire-7 (GAD-7) to assess the degree of dizziness, anxiety, and depression of participants before repositioning therapy, respectively. At the 1-week follow-up after BPPV treatment, each participant will be reassessed and divided into a group with residual dizziness (RD) and a group without residual dizziness (NRD) based on the follow-up DHI score. The Mini-Mental State Examination (MMSE) evaluated the cognitive function of the participants. Results The age, gender, duration of BPPV, and involved semicircular canals in the two groups did not show a significant difference. The RD group scored significantly higher on the DHI (p = 0.006), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) before the repositioning treatment than the NRD group. The two groups had no significant difference in MMSE score (p = 0.381). Anxiety and depression scores before repositioning treatment significantly and positively correlated with follow-up DHI scores (r = 0.678 and 0.522, respectively), but the MMSE score did not significantly relate to it. The univariate linear regression showed that the DHI (p < 0.001), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) scores before treatment could predict residual dizziness. The multivariate linear regression showed that GAD-7 before treatment was the only significant predictor of residual dizziness (p < 0.001). Conclusion The level of dizziness, anxiety, and depression before treatment can predict residual dizziness after successful repositioning maneuvers in the elderly with BPPV. Anxiety may be the strongest predictor of residual dizziness after successful repositioning treatment in elderly BPPV patients.
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Affiliation(s)
- Jin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiaobao Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Ying Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Kuan He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Wei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Xiangping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
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Ma X, Shen J, Sun J, Wang L, Wang W, He K, Chen X, Zhang Q, Jin Y, Gao D, Duan M, Yang J, Chen J, He J. P300 Event-Related Potential Predicts Cognitive Dysfunction in Patients with Vestibular Disorders. Biomedicines 2023; 11:2365. [PMID: 37760807 PMCID: PMC10525252 DOI: 10.3390/biomedicines11092365] [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: 08/01/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Our aim was to determine the correlation between cognitive impairment and P300 event-related potential (ERP) in older adults with vertigo and imbalance, which further provides a reference for clinical diagnosis and patients' rehabilitation. METHODS A total of 79 older adult patients with vertigo and imbalance in our outpatient department from January 2022 to December 2022 were selected and divided into the mild group (n = 20), moderate group (n = 39), and severe group (n = 20) according to the Dizziness Handicap Inventory (DHI). The auditory P300 component of event-related potentials (ERPs), Generalized Anxiety Disorder Questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Mini-Mental State Examination (MMSE) were used to evaluate depression, anxiety, and cognitive function in these patients, respectively. RESULTS The P300 latencies of the different severity groups were 292 ± 10 ms, 301 ± 8 ms, and 328 ± 5 ms, respectively, and the differences were statistically significant (p = 0.010). The P300 amplitudes of the different severity groups were 14.4 ± 2.6 μV, 3.9 ± 0.8 μV, and 5.1 ± 1.4 μV, respectively, and the differences were also statistically significant (p = 0.004). There was no statistically significant difference in the DHI evaluation or VAS visual simulation scoring between the two groups (p = 0.625, and 0.878, respectively). Compared with the short-course group, the long-course group showed prolonged P300 latency and decreased amplitude, higher scores in PHQ-9 and GAD-7, and lower scores in MMSE, and all the differences were statistically significant (p = 0.013, 0.021, 0.006, 0.004, and 0.018, respectively). CONCLUSION Older patients with more severe symptoms of vertigo and imbalance are at higher risk of developing abnormal cognitive function. The P300 can be used as an objective neurophysiological test for the assessment of cognitive function relevant to elderly patients with vertigo and imbalance.
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Affiliation(s)
- Xiaobao Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Wei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Kuan He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Xiangping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Qin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Dekun Gao
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden;
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jingchun He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
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10
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Smith PF. Interpreting the meaning of changes in hippocampal volume associated with vestibular loss. Front Integr Neurosci 2023; 17:1254972. [PMID: 37608860 PMCID: PMC10440551 DOI: 10.3389/fnint.2023.1254972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
Many studies have documented cognitive deficits, especially spatial cognitive deficits, in patients with some form of vestibular loss. Almost 20 years ago, hippocampal (HPC) atrophy was reported to be correlated with spatial memory deficits in such patients and the idea has gradually emerged that HPC atrophy may be causally responsible for the cognitive deficits. However, the results of studies of HPC volume following vestibular loss have not always been consistent, and a number of studies have reported no evidence of HPC atrophy. This paper argues that HPC atrophy, if it does occur following vestibular loss, may not be directly, causally responsible for the cognitive deficits, and that it is more likely that rapid functional changes in the HPC are responsible, due to the interruption of the transmission of vestibular information to the HPC. The argument presented here rests on 3 tranches of evidence: (1) Cognitive deficits have been observed in humans even in the absence of HPC atrophy; (2) HPC atrophy has not been reported in animal studies following vestibular loss, despite cognitive deficits; and (3) Animal studies have shown that the interruption of the transmission of vestibular information to the HPC has immediate consequences for HPC place cells, far too quickly to be explained by HPC atrophy. It is possible that HPC atrophy, when it does occur, is related to the longer-term consquences of living with vestibular loss, which are likely to increase circulating cortisol.
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Affiliation(s)
- Paul F. Smith
- Department of Pharmacology and Toxicology, Brain Health Research Centre, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- The Brain Research New Zealand Centre of Research Excellence, Eisdell Moore Centre for Hearing and Balance Research, University of Auckland, Auckland, New Zealand
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11
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Ozkul A, Konukseven O. The development of the cognitive vestibular function scale in the elderly complaints of imbalance: a study on validity and reliability. Braz J Otorhinolaryngol 2023; 89:101282. [PMID: 37418851 PMCID: PMC10345315 DOI: 10.1016/j.bjorl.2023.101282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/18/2023] [Accepted: 06/08/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES With a valid and reliable scale, it will make an important contribution to the assessment of cognitive functions such as spatial, spatial-visual, and memory functions, and raise awareness of older people with balance disorders. The purpose of this study is to develop a scale to assess vestibular and cognitive functions in the geriatric population with vestibular disorders and to evaluate its validity and reliability. METHODS The study involved 75 individuals aged 60 years and older who complained of imbalance. In the first phase, scale items on balance, emotional, spatial, spatial-visual, and memory were created using the literature. The item analysis was completed by a pilot application, and 25 scale items were determined for the main application. The item analysis and validity and reliability analyzes were completed, and the scale was given its final form. For the statistical analysis of the data, a principal component analysis was performed for the validity analysis. The Cronbach alpha coefficient was used for the reliability analysis. Descriptive statistics were compiled on the participants' scale scores. RESULTS The Cronbach's alpha value of the scale was found to be highly reliable at 0.86. Statistically significant values were found between the age variable and the spatial subscales, the spatial-visual subscales, and the Cognitive Vestibular Function Scale with a small positive effect (respectively: r = 0.264; p= 0.022; r = 0.237; p= 0.041; r = 0.231; p= 0.046). The results indicate that the Cognitive Vestibular Function Scale is a valid and reliable measurement tool at a good level in elderly people aged 60 years and older. CONCLUSION Cognitive Vestibular Function Scale; was developed to detect cognitive problems related to dizziness/balance. As a result, a preliminary study was conducted to investigate a rapid, easy-to-use, and reliable clinical scale to assess cognitive function in people with balance disorders. Level II Randomized trials Prospective comparative study.
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Affiliation(s)
- Aysenur Ozkul
- Istanbul Aydin University, Institute of Postgraduate Education, Doctorate Programme of Audiology, Istanbul, Turkey; Avrasya University, Vocational School of Health Services, Audiometry Programme, Trabzon, Turkey.
| | - Ozlem Konukseven
- Istanbul Aydin University, Faculty of Health Science, Department of Audiology, Istanbul, Turkey
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12
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Zhong J, Li X, Xu J, Chen W, Gao J, Lu X, Liang S, Guo Z, Lu M, Li Y, Yi H. Analysis of cognitive function and its related factors after treatment in Meniere’s disease. Front Neurosci 2023; 17:1137734. [PMID: 37081934 PMCID: PMC10112666 DOI: 10.3389/fnins.2023.1137734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
A growing body of research recently suggested the association between vestibular dysfunction and cognitive impairment. Meniere’s disease (MD), a common clinical vestibular disorder, is usually accompanied by hearing loss and emotional stress, both of which may mediate the relationship between vestibule dysfunction and cognition. It is currently unknown whether the cognitive decline in MD patients could improve through treatment and how it relates to multiple clinical characteristics, particularly the severity of vertigo. Therefore, in the present study, the MD patients were followed up for 3, 6, and 12 months after treatment, and the cognitive functions, vertigo symptoms, and related physical, functional, and emotional effects of the patients were assessed using the Montreal Cognitive Assessment (MoCA) and Dizziness Handicap Inventory (DHI), aiming to explore the change in cognition before and after therapy and the correlation with various clinical features. It was found that cognitive decline in MD patients compared to healthy controls before therapy. Importantly, this cognitive impairment could improve after effective therapy, which was related to the severity of vertigo, especially in functional and physical impacts. Our results support the view that vestibular dysfunction is a potentially modifiable risk factor for cognitive decline.
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13
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Eraslan Boz H, Kırkım G, Koçoğlu K, Çakır Çetin A, Akkoyun M, Güneri EA, Akdal G. Cognitive function in Meniere's disease. PSYCHOL HEALTH MED 2023; 28:1076-1086. [PMID: 36369758 DOI: 10.1080/13548506.2022.2144637] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Meniere's disease is an otological disease characterized by various symptoms that include episodic peripheral vertigo, sensorineural hearing loss, tinnitus, and aural fullness, all of which deteriorate the maintenance of daily activities. We aimed to investigate cognitive function in Meniere's disease patients and compare their results to those of healthy controls. Eighteen patients diagnosed with definite Meniere's disease without any psychiatric, neurological or otological comorbidity, and 30 healthy controls with normal cognitive functions were included in the study. General cognitive status, attention, verbal memory, visual memory, executive and visuospatial function were measured by detailed neuropsychological tests in both groups. In the patients with Meniere's disease, pure-tone hearing thresholds, and speech discrimination scores were also measured. Patients with Meniere's disease showed lower levels of performance in the trail making test, Oktem verbal memory processes, Rey Complex Figure Test, Wisconsin Card Sorting Test, semantic and phonemic fluency than did healthy controls. In other words, there were deficits in attention, recognition and recall in verbal memory, recall in visual memory, visual spatial construction, and planning skills in patients with Meniere's disease. Education years and depression scores of participants had a significant effect on cognitive function in all groups. This study is an update and confirmation of the findings of studies showing cognitive impairment in patients with Meniere's disease. In addition to previous findings, this study found a decrease in executive function performance in patients with Meniere's disease compared to healthy controls. Unlike previous studies, this study comprehensively addressed all cognitive functions and included a control group. Our results emphasize that executive functions, which are high-level cognitive processes, may affect the compliance of patients with Meniere's disease treatment and follow-up processes.
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Affiliation(s)
- Hatice Eraslan Boz
- Department of Neurology, Unit of Neuropsychology, Dokuz Eylul University School of Medicine, Izmir, Türkiye.,Department of Neurosciences, Dokuz Eylul University, Institute of Health Sciences, Izmir, Türkiye
| | - Günay Kırkım
- Department of Otolaryngology, Unit of Hearing Speech and Balance, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Koray Koçoğlu
- Department of Neurosciences, Dokuz Eylul University, Institute of Health Sciences, Izmir, Türkiye
| | - Aslı Çakır Çetin
- Department of Otolaryngology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Müge Akkoyun
- Department of Neurosciences, Dokuz Eylul University, Institute of Health Sciences, Izmir, Türkiye
| | - Enis Alpin Güneri
- Department of Otolaryngology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
| | - Gülden Akdal
- Department of Neurosciences, Dokuz Eylul University, Institute of Health Sciences, Izmir, Türkiye.,Department of Neurology, Dokuz Eylul University School of Medicine, Izmir, Türkiye
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14
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Ahmad M, Bola L, Boutabla A, King S, Lewis RF, Chari DA. Visuospatial Cognitive Dysfunction in Patients with Vestibular Loss. Otol Neurotol 2022; 43:e1140-e1147. [PMID: 36201536 DOI: 10.1097/mao.0000000000003696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize visuospatial and nonvisuospatial cognitive domains affected by vestibular loss and determine whether patient-reported outcomes measures (PROMs) correlate with performance on neuropsychological tests. STUDY DESIGN Cross-sectional study. SETTING University-based tertiary medical center. PATIENTS Sixty-nine age-matched subjects: 25 patients with bilateral vestibular loss (BVL), 14 patients with unilateral vestibular loss (UVL), and 30 normal controls (NC). INTERVENTIONS Neuropsychological tests used to assess visuospatial and auditory short-term and working memory, number magnitude representation, executive function, and attention. Validated PROMs used to evaluate quality of life and subjective cognitive impairment. MAIN OUTCOME MEASURES Performance on neuropsychological tests and scores on PROM surveys. RESULTS BVL and UVL patients performed significantly worse than NC subjects on tasks requiring visuospatial representation compared with NC subjects ( p < 0.01). BVL patients demonstrated decreased performance on spatial representation tasks compared with UVL and NC subjects ( p < 0.05 and p < 0.05, respectively). All subject groups performed similarly on tasks assessing nonvisuospatial cognitive domains, such as auditory short-term and working memory, executive function, and attention. PROMs did not seem to correlate with performance on neuropsychological tasks. CONCLUSION Patients with vestibular loss exhibit impairments in tasks requiring visuospatial representation but perform similarly to NC subjects in tasks of auditory working memory, executive function, or attention. Currently available questionnaires may be insufficient to screen patients for cognitive deficits.
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15
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Prevalence of Polypharmacy in Patients With Vestibular and Balance Complaints. Ear Hear 2022; 44:506-517. [PMID: 36377041 DOI: 10.1097/aud.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the prevalence of polypharmacy in patients presenting with dizziness to a tertiary neurotology clinic and analyze the association between polypharmacy and clinical characteristics. DESIGN Retrospective, cross-sectional review. Demographics, symptoms, diagnoses, medications, audiometry, dizziness handicap index (DHI) scores, and cognitive failure questionnaire (CFQ) scores were extracted from charts of patients seen as new patients from September 1, 2019, to March 31, 2020, with a primary complaint of dizziness. RESULTS A total of 382 patients were included. More than two-thirds of the patients (n = 265, 69.4%) met criteria for polypharmacy (≥5 medications), of which most (n = 249, 94.0%) were prescribed a potentially ototoxic drug. Approximately 10% of patients were taking five or more ototoxic medications (oto-polypharmacy). Polypharmacy was correlated to age and was more common for patients with diabetes, hypertension, other cardiovascular comorbidities, and depression (odds ratio [OR], 3.73-6.67; p < 0.05). Polypharmacy was twice as likely in patients with mild to moderate hearing loss (OR 2.02 [1.24-3.29] and OR 2.13 [1.06-4.27], respectively; p < 0.05) and ~1.5× more likely in patients who had moderate to severe DHI scores (OR 1.65 [1.05-2.59] and OR 1.63 [1.00-2.65], respectively; p < 0.05). Patients with polypharmacy also had higher CFQ scores compared to those without polypharmacy (CFQ 32.5 [19.0-48.0] versus CFQ 25.0 [13.0-40.0]; p = 0.002. Oto-polypharmacy was more common for patients with lightheadedness as a dizziness descriptor (OR 3.16 [1.56-6.41]; p < 0.01). However, oto-polypharmacy was only more common for patients with mild to moderate hearing loss (OR 2.69 [1.33-5.45] and OR 2.86 [1.31-6.20], respectively; p < 0.01) and severe DHI scores (2.31 [1.12-4.77], p = 0.02). CONCLUSIONS The prevalence of polypharmacy in patients with vestibular disorders is high. Some of the medications that patients are on are also potentially ototoxic at variable degrees. Polypharmacy is more common when lightheadedness is one of the dizziness descriptors and seems to be associated with worse scores on patient-reported outcome measures (DHI, CFQ). Medication reconciliation and multidisciplinary involvement could help to better address polypharmacy in this patient population. However, further investigation is needed to elucidate polypharmacy's role in symptom presentation, vestibular testing results, and therapeutic strategies.
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16
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Demirhan MA, Celebisoy N. Cognitive functions in episodic vestibular disorders: Meniere's disease and vestibular migraine. J Vestib Res 2022; 33:63-70. [PMID: 36120750 DOI: 10.3233/ves-220025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive deficits have been defined in patients with bilateral and unilateral vestibular loss. OBJECTIVE To investigate cognitive functions in patients with episodic vestibular disorders. METHODS Nineteen patients with Meniere's disease (MD), 19 patients with vestibular migraine (VM) and 21 age and education matched healthy controls were studied. Mini Mental State Examination assessing global mental status, Reading Span Test and the Stroop Test evaluating working memory, cognitive processing, reading comprehension and attention, Trail Making Test and Benton's Judgment of Line Orientation Test investigating visual processing, visuospatial skills, processing speed were used. Beck depression and anxiety inventories were given to evaluate the emotional status. RESULTS Cognitive test results of the MD and VM patients were not significantly different from the healthy controls (p > 0.05) as well as Beck depression scores (p = 0.14). Beck anxiety scores showed significant difference (p = 0.003). VM patients had significantly higher scores than the healthy controls (p = 0.002) on pairwise comparisons. The scores of the MD patients did not reach statistical significance (p = 0.15). CONCLUSION Episodic vestibular disorders like MD and VM without inter-ictal vestibular deficits do not seem to be associated with cognitive impairment. Patients with VM have significantly higher anxiety scores than the healthy controls and MD patients.
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Affiliation(s)
- Mehmet Alp Demirhan
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey
| | - Nese Celebisoy
- Department of Clinical Neuroscience, Ege University Institute of Health Sciences, Izmir, Turkey.,Department of Neurology, Ege University Medical School, Bornova, Izmir, Turkey
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17
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Mallampalli MP, Rizk HG, Kheradmand A, Beh SC, Abouzari M, Bassett AM, Buskirk J, Ceriani CEJ, Crowson MG, Djalilian H, Goebel JA, Kuhn JJ, Luebke AE, Mandalà M, Nowaczewska M, Spare N, Teggi R, Versino M, Yuan H, Zaleski-King A, Teixido M, Godley F. Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit. Front Neurol 2022; 12:812678. [PMID: 35046886 PMCID: PMC8762211 DOI: 10.3389/fneur.2021.812678] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.
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Affiliation(s)
- Monica P Mallampalli
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Amir Kheradmand
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shin C Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Alaina M Bassett
- Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - James Buskirk
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Claire E J Ceriani
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Matthew G Crowson
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye & Ear and Harvard Medical School, Boston, MA, United States
| | - Hamid Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Joel A Goebel
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jeffery J Kuhn
- Department of Research, Bayview Physicians Group, Chesapeake, VA, United States
| | - Anne E Luebke
- Biomedical Engineering and Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
| | - Marco Mandalà
- Otolaryngology Unit, University of Siena, Siena, Italy
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, Laryngological Oncology, Nicolaus Copernicus University, Torun, Poland
| | - Nicole Spare
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberto Teggi
- Department of Otolaryngology, San Raffaele Scientific Hospital, Milan, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashley Zaleski-King
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, MD, United States
| | - Michael Teixido
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Frederick Godley
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
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18
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Bonsu AN, Britton Z, Asif Z, Sharif M, Kaski D, Kheradmand A, Bronstein AM, Arshad Q. Migraine phenotype differentially modulates the attentional network: A cross sectional observation study. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221124264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Signs of distinct brain dysfunction in patients where migraine intersects with vertigo (i.e. vestibular migraine (VM)), remain elusive. As migraine and vertigo can both independently modulate attentional processes, here we seek the utility of the attentional network to functionally differentiate patients. Methods: We used the Attentional Network Task (ANT) to elucidate three separate functional networks: Alerting, orienting and resolving conflict. 120 participants had to attend to the direction of a target visual stimulus, while other parameters were simultaneously manipulated. Reaction times across the networks were assessed in, (i) 30 healthy controls, (ii) 30 VM patients, (iii) 30 patients with migraine without vertigo, and (iv) 30 patients with benign paroxysmal positional vertigo (BPPV) but no migraine. Results: Patients with VM (mean = 737.1 ms, SEM = 28), migraine (mean = 735.3 ms, SEM = 36.4), and BPPV (mean = 720.3 ms SEM = 24.3) all exhibited significantly delayed ANT reaction times compared to healthy controls (mean = 661.3 ms, SEM = 23.4). Specific attentional network deficits were observed for resolving conflict in VM, alerting in migraine and orienting in BPPV. Conclusion: VM patients displayed deficits in executive function characterized by an inability to focus attentional resources and suppress peripheral distractors, whereas migraineurs without vertigo exhibited changes in the alerting network that reflects hypervigilance.
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Affiliation(s)
- Angela N Bonsu
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Zelie Britton
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Zara Asif
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Mishaal Sharif
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Diego Kaski
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
- Department of Clinical and Motor Neurosciences, Institute of Neurology, UCL, UK
| | - Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology and Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adolfo M Bronstein
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Qadeer Arshad
- Neuro-Otology Unit, Department of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
- inAmind Laboratory, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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Hearing loss versus vestibular loss as contributors to cognitive dysfunction. J Neurol 2022; 269:87-99. [PMID: 33387012 DOI: 10.1007/s00415-020-10343-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
In the last 5 years, there has been a surge in evidence that hearing loss (HL) may be a risk factor for cognitive dysfunction, including dementia. At the same time, there has been an increase in the number of studies implicating vestibular loss in cognitive dysfunction. Due to the fact that vestibular disorders often present with HL and other auditory disorders such as tinnitus, it has been suggested that, in many cases, what appears to be vestibular-related cognitive dysfunction may be due to HL (e.g., Dobbels et al. Front Neurol 11:710, 2020). This review analyses the studies of vestibular-related cognitive dysfunction which have controlled HL. It is suggested that despite the fact that many studies in the area have not controlled HL, many other studies have (~ 19/44 studies or 43%). Therefore, although there is certainly a need for further studies controlling HL, there is evidence to suggest that vestibular loss is associated with cognitive dysfunction, especially related to spatial memory. This is consistent with the overwhelming evidence from animal studies that the vestibular system transmits specific types of information about self-motion to structures such as the hippocampus.
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20
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Donaldson LB, Yan F, Liu YF, Nguyen SA, Rizk HG. Does cognitive dysfunction correlate with dizziness severity in patients with vestibular migraine? Am J Otolaryngol 2021; 42:103124. [PMID: 34166962 DOI: 10.1016/j.amjoto.2021.103124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize the relationship between dizziness severity and cognitive dysfunction in vestibular migraine (VM) patients. METHODS Dizziness Handicap Inventory (DHI) and Cognitive Failures Questionnaire (CFQ) scores were compared pre- and post-treatment in a cohort of definite VM patients who underwent evaluation in a multidisciplinary clinic from 2016 to 2020. RESULTS 44 patients were included. DHI reduction of 11.96 (SD 11.49) (p < 0.001) from an initial mean of 58.36 (22.05) and CFQ reduction of 4.57 (12.20) (p = 0.017) from an initial mean of 47.66 (19.12) were demonstrated. Both pre- and post-treatment DHI scores correlated with pre- and post-treatment CFQ scores (r = 0.537, p < 0.001 and r = 0.667, p < 0.001, respectively). Change in DHI score correlated with change in CFQ score (r = 0.351, p = 0.019). CONCLUSIONS Cognitive dysfunction in VM patients is correlated with dizziness severity. The DHI may fail to thoroughly assess cognitive dysfunction in VM patients. Additionally, multidisciplinary treatment of VM reduces both dizziness severity and cognitive dysfunction.
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Lacroix E, Deggouj N, Edwards MG, Van Cutsem J, Van Puyvelde M, Pattyn N. The Cognitive-Vestibular Compensation Hypothesis: How Cognitive Impairments Might Be the Cost of Coping With Compensation. Front Hum Neurosci 2021; 15:732974. [PMID: 34658819 PMCID: PMC8517512 DOI: 10.3389/fnhum.2021.732974] [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: 06/29/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Previous research in vestibular cognition has clearly demonstrated a link between the vestibular system and several cognitive and emotional functions. However, the most coherent results supporting this link come from rodent models and healthy human participants artificial stimulation models. Human research with vestibular-damaged patients shows much more variability in the observed results, mostly because of the heterogeneity of vestibular loss (VL), and the interindividual differences in the natural vestibular compensation process. The link between the physiological consequences of VL (such as postural difficulties), and specific cognitive or emotional dysfunction is not clear yet. We suggest that a neuropsychological model, based on Kahneman's Capacity Model of Attention, could contribute to the understanding of the vestibular compensation process, and partially explain the variability of results observed in vestibular-damaged patients. Several findings in the literature support the idea of a limited quantity of cognitive resources that can be allocated to cognitive tasks during the compensation stages. This basic mechanism of attentional limitations may lead to different compensation profiles in patients, with or without cognitive dysfunction, depending on the compensation stage. We suggest several objective and subjective measures to evaluate this cognitive-vestibular compensation hypothesis.
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Affiliation(s)
- Emilie Lacroix
- VIPER Research Unit, LIFE Department, Royal Military Academy, Brussels, Belgium.,Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Naïma Deggouj
- Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute of Neuroscience (IONS), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Otorhinolaryngology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Martin Gareth Edwards
- Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute of Neuroscience (IONS), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Jeroen Van Cutsem
- VIPER Research Unit, LIFE Department, Royal Military Academy, Brussels, Belgium.,Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Martine Van Puyvelde
- VIPER Research Unit, LIFE Department, Royal Military Academy, Brussels, Belgium.,Brain Body and Cognition Research Group, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Clinical and Lifespan Psychology, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nathalie Pattyn
- VIPER Research Unit, LIFE Department, Royal Military Academy, Brussels, Belgium.,Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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22
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Xie D, Welgampola MS, Miller LA, Young AS, D'Souza M, Breen N, Rosengren SM. Subjective Cognitive Dysfunction in Patients with Dizziness and Vertigo. Audiol Neurootol 2021; 27:122-132. [PMID: 34518461 DOI: 10.1159/000518188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with vestibular disorders sometimes report cognitive difficulties, but there is no consensus about the type or degree of cognitive complaint. We therefore investigated subjective cognitive dysfunction in a well-defined sample of neuro-otology patients and used demographic factors and scores from a measure of depression, anxiety, and stress to control for potential confounding factors. METHODS We asked 126 neuro-otology clinic outpatients whether they experienced difficulties with thinking, memory, or concentration as a result of dizziness or vertigo. They and 42 nonvertiginous control subjects also completed the Neuropsychological Vertigo Inventory (NVI, which measures cognitive, emotional, vision, and motor complaints), the Everyday Memory Questionnaire (EMQ), and Depression, Anxiety, and Stress Scales (DASS). RESULTS In the initial interview questions, 60% of patients reported experiencing cognitive difficulties. Cognitive questionnaire scores were positively correlated with the overall DASS score and to a lesser extent with age and gender. Therefore, we compared patients and controls on the NVI and EMQ, using these mood and demographic variables as covariates. Linear regression analyses revealed that patients scored significantly worse on the total NVI, NVI cognitive composite, and 3 individual NVI cognition subscales (Attention, Space Perception, and Time Perception), but not the EMQ. Patients also scored significantly worse on the NVI Emotion and Motor subscales. CONCLUSIONS Patients with dizziness and vertigo reported high levels of cognitive dysfunction, affecting attention, perceptions of space and time. Although perceptions of cognitive dysfunction were correlated with emotional distress, they were significantly elevated in patients over and above the impact of depression, anxiety, or stress.
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Affiliation(s)
- Danica Xie
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Miriam S Welgampola
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Laurie A Miller
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Allison S Young
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mario D'Souza
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nora Breen
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sally M Rosengren
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Rizk HG, Liu YF. Interviewing and Counseling the Dizzy Patient with Focus on Quality of Life. Otolaryngol Clin North Am 2021; 54:853-861. [PMID: 34294434 DOI: 10.1016/j.otc.2021.05.009] [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: 10/20/2022]
Abstract
When interviewing a patient presenting with dizziness, it is imperative to both diagnosis and treatment for the clinician to identify the impact dizziness has on the patient's productivity, general function level and cognition. and cognition. Psychiatric comorbidities and concurrent sleep disturbances are common in this patient population and identification of these additional factors is important in implementing a holistic, multidisciplinary treatment plan and ultimately improves the patient's outcome.
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Affiliation(s)
- Habib G Rizk
- Department of Otolaryngology, Medical University of South Carolina, Otolaryngology H&N Surgery, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
| | - Yuan F Liu
- Department of Otolaryngology, Loma Linda University Health, 11234 Anderson Street, Room: 2586A, Loma Linda, CA 92354, USA
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Subjective Cognitive Symptoms and Dizziness Handicap Inventory (DHI) Performance in Patients With Vestibular Migraine and Menière's Disease. Otol Neurotol 2021; 42:883-889. [PMID: 33606474 DOI: 10.1097/mao.0000000000003081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive symptoms in patients with vestibular disorders are far from rare, but identification of patients at risk for cognitive impairment remains poor. The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome questionnaire for dizzy patients with several questions that address cognitive function. However, the relationship between subjective cognitive symptomatology in patients with vestibular disorders and performance on DHI is poorly characterized. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care vestibular clinic. SUBJECTS Individuals with diagnoses of vestibular migraine (VM), Menière's disease (MD), and concomitant vestibular migraine and Menière's disease (VMMD) presenting to clinic between January 2007 and December 2019. RESULTS Of 761 subjects, 365 had VM, 311 had MD, and 85 had VMMD. Symptoms of brain fog and chronic fatigue occurred more frequently in the VM and VMMD groups compared with the MD group (χ2 (df = 2, n = 761) = 67.8, 20.9, respectively, p < 0.0001). DHI scores were significantly higher in patients with VM and VMMD compared with those with MD (F[2,758] = 63.5, p < 0.001). A DHI score ≥ 13 suggested that the patient suffered from brain fog (sensitivity = 47.4%, specificity = 72.3%), whereas a score ≥ 15 indicated that the patient complained of chronic fatigue (sensitivity = 81.5%, specificity = 57.7%). CONCLUSION Our results indicate a high prevalence of interictal cognitive symptoms in patients with episodic vestibular disorders. The DHI cannot be reliably used to differentiate between vestibular disorders nor detect cognitive impairment in these patient populations. Alternative methods must be used to identify vestibulopathic patients with cognitive symptoms to initiate strategies for prevention and treatment.
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Abstract
OBJECTIVE This study aimed to examine the association between caloric asymmetry and response to treatment in patients with vestibular migraine. METHOD Dizziness Handicap Inventory scores were compared between patients with less than and more than 25 per cent asymmetry (using Cohen effect size) in a cohort of definite vestibular migraine patients who underwent caloric testing between August 2016 and March 2019. RESULTS A total of 31 patients (mean age: 48.7 ± 20.0 years; mean follow up: 9.1 ± 8.1 months) were included. Mean caloric asymmetry was 15.1 ± 15.6 per cent, with 6 (19.4 per cent) patients having asymmetry more than 25 per cent. Overall, patients experienced significant improvement in Dizziness Handicap Inventory total (d = 0.623 (95 per cent confidence interval, 0.007, 1.216)), emotional domain (d = 0.635 (95 per cent confidence interval, 0.019, 1.229)) and functional domain (d = 0.769 (95 per cent confidence interval, 0.143, 1.367)) but not physical domain (d = 0.227 (95 per cent confidence interval, -0.370, 0.815)) scores. Patients with more than 25 per cent asymmetry had no significant improvement in Dizziness Handicap Inventory scores, whereas those with less than 25 per cent asymmetry had significant improvement in Dizziness Handicap Inventory functional domain scores only (d = 0.636 (95 per cent confidence interval, 0.004, 1.244)). CONCLUSION Vestibular migraine patients with peripheral vestibular weakness on caloric testing may be less likely to improve after treatment compared with those without.
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Dornhoffer JR, Liu YF, Zhao EE, Rizk HG. Does Cognitive Dysfunction Correlate With Dizziness Severity in Meniére's Disease Patients. Otol Neurotol 2021; 42:e323-e331. [PMID: 33555758 DOI: 10.1097/mao.0000000000002958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Characterize the relationship between cognitive dysfunction and the dizziness severity in Meniére's disease (MD) patients. STUDY DESIGN Retrospective review. SETTING University-based tertiary medical center. PATIENTS Three hundred patients were evaluated for MD from 2015 to 2019. Excluding comorbid or alternative vestibular disorders, 29 patients with definite MD and available pre- and postintervention data were included for analysis. INTERVENTIONS A progressive protocol of salt restriction, diuretics, steroid and/or gentamycin injection, and endolymphatic sac decompression for those refractory to medical therapy. MAIN OUTCOME MEASURES Quality of life measured with the Dizziness Handicap Inventory (DHI) and cognitive function measured with the Cognitive Failures Questionnaire (CFQ). Pre- and posttreatment DHI and DHI subscale scores and change in these scores were correlated with pre- and posttreatment CFQ scores and change in CFQ with therapy. RESULTS Analysis showed a number of limited associations between improvement in DHI and improvement in CFQ. Total DHI scores failed to correlate scores or variation in scores with change in CFQ (p = 0.091 and p = 0.085, respectively). Improvement in the CFQ false-triggering domain was significantly associated with improvement in the DHI physical subscale (r = 0.491, p = 0.007) and was nonsignificantly associated with improvement in total DHI and DHI emotional subscale scores (r = 0.422, p = 0.016 and r = 0.399, p = 0.032). CONCLUSIONS The DHI correlates with several pre- and posttreatment measures of cognitive dysfunction (CFQ) in MD patients. However, change in DHI and CFQ with therapy correlate poorly. Overall, the commonly used DHI may fail to adequately assess cognitive dysfunction in MD patients possibly due to factors not directly implicated by measures of vestibular dysfunction, such as central nervous system or cognitive dysfunction; however, the specific physical and emotional subscales may offer helpful insight into cognitive dysfunction change/improvement with treatment.
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Affiliation(s)
- James R Dornhoffer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Yuan F Liu
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Elise E Zhao
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Habib G Rizk
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Vozel D, Steiner N, Božanić Urbančič N, Mladenov D, Battelino S. Slovenian Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12), Vertigo (DHI, NVI) and TINNITUS (THI). Zdr Varst 2020; 59:120-127. [PMID: 32952712 PMCID: PMC7478096 DOI: 10.2478/sjph-2020-0016] [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: 01/20/2020] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To provide physicians and patients with the tools needed to evaluate patients' problems and health-related quality of life by cross-culturally adapting and validating the Chronic Otitis Media Questionnaire 12 (COMQ-12), the Dizziness Handicap Inventory (DHI), the Neuropsychological Vertigo Inventory (NVI) and the Tinnitus Handicap Inventory (THI). MATERIALS AND METHODS COMQ-12, DHI, NVI and THI were translated into the Slovenian language and completed by patients treated at our department for chronic otitis media, vertigo or tinnitus. The control group for each questionnaire consisted of healthy volunteers. Internal consistency, test-retest reliability, discriminant validity, diagnostic accuracy and cut-off value were determined for each questionnaire. RESULTS Test-retest reliability was excellent for DHI (ICC A=0.946) and NVI (p=0.315, ICC A=0.975), good to excellent for COMQ-12 (p=0.680, ICC A=0.858) and satisfactory for THI (p=0.120). Discriminant validity was confirmed for each questionnaire (p>0.05) using the Mann-Whitney U test (COMQ-12, DHI, THI) or the Welch t-test (NVI). COMQ-12 had acceptable (α=0.796) and DHI (α=0.910), NVI (α=0.950) and THI (α=0.924) perfect internal consistency. COMQ-12 and DHI had excellent, NVI acceptable and THI perfect diagnostic accuracy (AUC=0.987, AUC=0.999, AUC=0.781 and AUC=1.000 respectively). Cut-off values determined by Youden's index were 7, 7, 9 and 56 for COMQ-12, THI, DHI and NVI, respectively. CONCLUSION Slovenian COMQ-12, DHI, NVI and THI are a valid and accurate tool for the diagnosis and measurement of health-related quality of life in patients with chronic otitis media, vertigo and tinnitus. They could aid general practitioners, occupational health specialists, neurologists and otorhinolaryngologists.
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Affiliation(s)
- Domen Vozel
- University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, Zaloška 2, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Otorhinolaringology, Vrazov trg 2, 1000Ljubljana, Slovenia
| | - Nejc Steiner
- University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, Zaloška 2, 1000Ljubljana, Slovenia
| | - Nina Božanić Urbančič
- University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, Zaloška 2, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Otorhinolaringology, Vrazov trg 2, 1000Ljubljana, Slovenia
| | - Dejan Mladenov
- Železniški zdravstveni dom Ljubljana, Celovška cesta 4, 1000Ljubljana, Slovenia
| | - Saba Battelino
- University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, Zaloška 2, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Otorhinolaringology, Vrazov trg 2, 1000Ljubljana, Slovenia
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Pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine. The Journal of Laryngology & Otology 2020; 134:586-591. [DOI: 10.1017/s002221512000095x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveGiven the lack of evidence on patients with medically refractory vestibular migraine, this study aimed to identify factors associated with pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine.MethodsA retrospective cohort study was conducted on definite vestibular migraine patients from September 2015 to July 2019 who completed the Dizziness Handicap Inventory at least six weeks apart..ResultsThe study comprised 47 patients (mean age = 50.2 ± 15.8 years), with a mean follow-up time of 6.0 ± 6.0 months. The mean pre-treatment Dizziness Handicap Inventory score was 57.5 ± 23.5, with a mean reduction of 17.3 ± 25.2 (p < 0.001) at last follow up. Oscillopsia (r = 0.458, p = 0.007), failure of first medication (r = 0.518, p = 0.001) and pre-treatment Dizziness Handicap Inventory question 15 (an emotional domain question) score (r = 0.364, p = 0.019) were the only variables significantly correlated with progression to botulinum toxin injection.ConclusionMotion hypersensitivity, failure of first medication, and fear of social stigmatisation suggest a decreased treatment response. These symptoms may require more aggressive treatment at an earlier stage.
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Dornhoffer JR, Liu YF, Donaldson L, Rizk HG. Factors implicated in response to treatment/prognosis of vestibular migraine. Eur Arch Otorhinolaryngol 2020; 278:57-66. [DOI: 10.1007/s00405-020-06061-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
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