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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; 134:4858-4872. [PMID: 39016124 DOI: 10.1002/lary.31646] [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: 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, 134:4858-4872, 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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Kobel MJ, Wagner AR, Merfeld DM. Associations Between Vestibular Perception and Cognitive Performance in Healthy Adults. Ear Hear 2024:00003446-990000000-00365. [PMID: 39506197 DOI: 10.1097/aud.0000000000001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
OBJECTIVES A growing body of evidence has linked vestibular function to the higher-order cognitive ability in aging individuals. Past evidence has suggested unique links between vestibular function and cognition on the basis of end-organ involvement (i.e., otoliths versus canals). However, past studies have only assessed vestibular reflexes despite the diversity of vestibular pathways. Thus, this exploratory study aimed to assess associations between vestibular perception and cognition in aging adults to determine potential relationships. DESIGN Fifty adults (21 to 84 years; mean = 52.9, SD = 19.8) were included in this cross-sectional study. All participants completed a vestibular perceptual threshold test battery designed to target perception predominantly mediated by each end-organ pair and intra-vestibular integration: 1 Hz y-translation (utricle), 1 Hz z-translation (saccule), 2 Hz yaw rotation (horizontal canals), 2 Hz right anterior, left posterior (RALP), and left anterior, right posterior (LARP) tilts (vertical canals), and 0.5 Hz roll tilt (canal-otolith integration). Participants also completed standard assessments of cognition and path integration: Digit Symbol Substitution Test (DSST), Trail Making Test (TMT), and the Gait Disorientation Test (GDT). Associations were assessed using Spearman rank correlation, and multivariable regression analyses. RESULTS For correlation analyses, DSST correlated to RALP/LARP tilt, roll tilt, and z-translation. TMT-A only correlated to z-translation, and TMT-B correlated to roll tilt and z-translation after correcting for multiple comparisons. GDT correlated to RALP/LARP tilt and y-translation. In age-adjusted regression analyses, DSST and TMT-B were associated with z-translation thresholds and GDT was associated with y-translation thresholds. CONCLUSIONS In this cross-sectional study, we identified associations between vestibular perceptual thresholds with otolith contributions and standard measures of cognition. These results are in line with past results suggesting unique associations between otolith function and cognitive performance.
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Affiliation(s)
- Megan J Kobel
- Department of Speech, Language & Hearing Sciences, University of Arizona, Tucson, Arizona, USA
| | - Andrew R Wagner
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| | - Daniel M Merfeld
- Department of Otolaryngology-Head & Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Matthews JC, Agrawal Y, Qian ZJ, Wei EX. Healthcare Utilization Among Adults With Vestibular Vertigo in the United States. Ear Hear 2024; 45:945-951. [PMID: 38503724 DOI: 10.1097/aud.0000000000001487] [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: 03/21/2024]
Abstract
OBJECTIVES Vestibular vertigo has been shown to have a high lifetime prevalence. Previous studies have described the increased morbidities associated with vestibular vertigo. DESIGN In this cross-sectional study of the 2016 National Health Interview Study, we sought to explore whether individuals with vestibular vertigo were more likely to utilize healthcare resources compared with those without vestibular vertigo. We characterized utilization of specific healthcare resources including general doctors, specialist doctors, emergency departments, mental health professionals, and others among individuals with vestibular vertigo to better understand how individuals with vertigo interact with the US healthcare system. RESULTS In multivariable analyses, participants with vestibular vertigo had an increased number of nights in the hospital in the last 12 months (mean difference = 0.67 days, 95% confidence interval [CI] = 0.37 to 0.97), increased odds of receiving healthcare 10 or more times in the last 12 months (odds ratio = 2.22, 95% CI = 1.99 to 2.48) and increased number of visits to a healthcare professional in the last 2 weeks (mean difference = 0.17 visits, 95% CI = 0.14 to 0.21). In addition, participants with vestibular vertigo had increased odds of visiting both general doctors, specialist doctors, and other healthcare professionals. CONCLUSIONS These findings characterize how individuals with vestibular vertigo utilize and interact with healthcare resources compared with those without vestibular vertigo.
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Affiliation(s)
- Jacob C Matthews
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
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Tyner CE, Boulton AJ, Slotkin J, Cohen ML, Weintraub S, Gershon RC, Tulsky DS. Exploring symptom clusters in mild cognitive impairment and dementia with the NIH Toolbox. J Int Neuropsychol Soc 2024; 30:603-614. [PMID: 38361424 PMCID: PMC11327385 DOI: 10.1017/s1355617724000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Symptom clustering research provides a unique opportunity for understanding complex medical conditions. The objective of this study was to apply a variable-centered analytic approach to understand how symptoms may cluster together, within and across domains of functioning in mild cognitive impairment (MCI) and dementia, to better understand these conditions and potential etiological, prevention, and intervention considerations. METHOD Cognitive, motor, sensory, emotional, and social measures from the NIH Toolbox were analyzed using exploratory factor analysis (EFA) from a dataset of 165 individuals with a research diagnosis of either amnestic MCI or dementia of the Alzheimer's type. RESULTS The six-factor EFA solution described here primarily replicated the intended structure of the NIH Toolbox with a few deviations, notably sensory and motor scores loading onto factors with measures of cognition, emotional, and social health. These findings suggest the presence of cross-domain symptom clusters in these populations. In particular, negative affect, stress, loneliness, and pain formed one unique symptom cluster that bridged the NIH Toolbox domains of physical, social, and emotional health. Olfaction and dexterity formed a second unique cluster with measures of executive functioning, working memory, episodic memory, and processing speed. A third novel cluster was detected for mobility, strength, and vision, which was considered to reflect a physical functioning factor. Somewhat unexpectedly, the hearing test included did not load strongly onto any factor. CONCLUSION This research presents a preliminary effort to detect symptom clusters in amnestic MCI and dementia using an existing dataset of outcome measures from the NIH Toolbox.
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Affiliation(s)
- Callie E Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Matthew L Cohen
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
- Department of Communication Sciences & Disorders, University of Delaware, Newark, DE, USA
- Delaware Center for Cognitive Aging Research, University of Delaware, Newark, DE, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Thorman IB, Schrack JA, Schubert MC. Epidemiology and Comorbidities of Vestibular Disorders: Preliminary Findings of the AVOCADO Study. Otol Neurotol 2024; 45:572-579. [PMID: 38728561 DOI: 10.1097/mao.0000000000004185] [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: 05/12/2024]
Abstract
INTRODUCTION Studies on incidence and prevalence of vestibular disorders tend to focus on small pockets of patients recruited from specialized clinics and often exclude measures of vestibular function. The objectives of the study were to characterize patients with common vestibular disorders, estimate the prevalence of common vestibular disorders, and ascertain whether patients with vestibular disorders experience increased risks of falls and morbidity. MATERIALS AND METHODS This retrospective cohort study includes both inpatient and outpatient routine clinical care data culled from a nationally representative, population-based sample. Patients were included if their record in the TriNetX Diamond Cohort comprised at least one vestibular function test or vestibular diagnosis. The main outcome measures were diagnosis with a vestibular disorder, a fall, or a common medical comorbidity (e.g., diabetes, cerebrovascular disease). RESULTS The cohort includes n = 4,575,724 patients, of which 55% (n = 2,497,136) had a minimum of one vestibular diagnosis. Patients with vestibular diagnoses were 61.3 ± 16.6 years old (mean ± standard deviation), 67% women, 28% White race (69% unknown race), and 30% of non-Hispanic or Latino ethnicity (66% unknown ethnicity). The prevalence of vestibular disorders was estimated at 2.98% (95% confidence interval [CI]: 2.98-2.98%). Patients with vestibular diagnoses experienced a significantly greater odds of falls (odds ratio [OR] = 1.04; 95% CI: 1.02-1.05), cerebrovascular disease (OR = 1.42; 95% CI: 1.40-1.43), ischemic heart disease (OR = 1.17; 95% CI: 1.16-1.19), and diabetes (OR = 1.14; 95% CI: 1.13-1.15), among others. DISCUSSION Vestibular disorders affect an estimated 3% of the U.S. population, after weighting. Patients with these disorders are at greater risk for many common, consequential medical conditions.
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Pan S, Hu Y, Zhang H, He Y, Tian C, Lei J. The Current Status and Trends of Research Related to Vestibular Disorders, Vertigo, and Cognitive Impairment in the Elderly Population: A Bibliometric Analysis. EAR, NOSE & THROAT JOURNAL 2024:1455613241257396. [PMID: 38818829 DOI: 10.1177/01455613241257396] [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: 06/01/2024] Open
Abstract
Background: The vestibular system not only supports reflex function at the brainstem level, but is also associated with higher levels of cognitive function. Vertigo due to vestibular disorders may lead to or be associated with cognitive dysfunction. Patients with deficits of both vestibular as well as cognitive function may be at particularly high risk for events like falls or certain diseases, such as Alzheimer's. Objective: To analyze the current state of research and trends in the global research literature regarding the correlation between vestibular disorders, vertigo, and cognitive impairment. Methods: We utilized Bibliometrix package to search databases including PubMed, Web of Science, etc for search terms. Results: Databases were searched up to December 15, 2022, and a total of 2222 publications were retrieved. Ultimately, 53 studies were included. A total of 261 authors published in 38 journals and conferences with an overall increasing annual growth rate of 6.94%. The most-published journal was Frontiers in Neurology. The most-published country was the United States, followed by Italy and Brazil. The most-published institution was Johns Hopkins University with a total of 13 articles. On performing trend analysis, we found that the most frequent focus of research in this field include the testing of vestibular perception, activation of the brain-related cortex, and the influence of stimulus-triggered vestibular snail reflex on visual space. The potential focal points are the risk of falling and the ability to extract spatial memory information, and the focus of research in recent decades has revolved around balance, falling, and Alzheimer's disease. Conclusions: Vestibular impairment in older adults affects cognitive function, particularly immediate memory, visuospatial cognition, and attention, with spatial cognition being the most significantly affected. In the future, virtual reality-based vestibular rehabilitation techniques and caloric stimulation could be potential interventions for the treatment of cognitive impairment.
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Affiliation(s)
- Sijia Pan
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuanjia Hu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huiying Zhang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunfan He
- School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenghua Tian
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianbo Lei
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Center for Medical Informatics, Health Science Center, Peking University, Beijing, China
- School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, Sichuan, China
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Benjamin RS, Cushing SL, Blakeman AW, Campos JL, Papsin BC, Gordon KA. Effects of the BalanCI on Working Memory and Balance in Children and Young Adults With Cochleovestibular Dysfunction. Ear Hear 2024; 45:378-389. [PMID: 37759357 DOI: 10.1097/aud.0000000000001433] [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: 09/29/2023]
Abstract
OBJECTIVES This study aimed to: (1) determine the interaction between cognitive load and balance in children and young adults with bilateral cochleovestibular dysfunction who use bilateral cochlear implants (CIs) and (2) determine the effect of an auditory balance prosthesis (the BalanCI) on this interaction. Many (20 to 70%) children with sensorineural hearing loss experience some degree of vestibular loss, leading to poorer balance. Poor balance could have effects on cognitive resource allocation which might be alleviated by the BalanCI as it translates head-referenced cues into electrical pulses delivered through the CI. It is hypothesized that children and young adults with cochleovestibular dysfunction will demonstrate greater dual-task costs than typically-developing children during dual balance-cognition tasks, and that BalanCI use will improve performance on these tasks. DESIGN Study participants were 15 typically-developing children (control group: mean age ± SD = 13.6 ± 2.75 years, 6 females) and 10 children and young adults who use bilateral CIs and have vestibular dysfunction (CI-V group: mean age ± SD=20.6 ± 5.36 years, 7 females). Participants completed two working memory tasks (backward auditory verbal digit span task and backward visuospatial dot matrix task) during three balance conditions: seated, standing in tandem stance with the BalanCI off, and standing in tandem stance with the BalanCI on. Working memory performance was quantified as total number of correct trials achieved. Postural stability was quantified as translational and rotational path length of motion capture markers worn on the head, upper body, pelvis, and feet, normalized by trial time. RESULTS Relative to the control group, children and young adults in the CI-V group exhibited poorer overall working memory across all balance conditions ( p = 0.03), poorer translational postural stability (larger translational path length) during both verbal and visuospatial working memory tasks ( p < 0.001), and poorer rotational stability (larger rotational path length) during the verbal working memory task ( p = 0.026). The CI-V group also exhibited poorer translational ( p = 0.004) and rotational ( p < 0.001) postural stability during the backward verbal digit span task than backward visuospatial dot matrix task; BalanCI use reduced this stability difference between verbal and visuospatial working memory tasks for translational stability overall ( p > 0.9), as well as for rotational stability during the maximum working memory span (highest load) participants achieved in each task ( p = 0.91). CONCLUSIONS Balance and working memory were impaired in the CI-V group compared with the control group. The BalanCI offered subtle improvements in stability in the CI-V group during a backward verbal working memory task, without producing a negative effect on working memory outcomes. This study supports the feasibility of the BalanCI as a balance prosthesis for individuals with cochleovestibular impairments.
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Affiliation(s)
- Rebecca S Benjamin
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alan W Blakeman
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Campos
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Blake C Papsin
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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Janky K, Steyger PS. Mechanisms and Impact of Aminoglycoside-Induced Vestibular Deficits. Am J Audiol 2023; 32:746-760. [PMID: 37319406 PMCID: PMC10721243 DOI: 10.1044/2023_aja-22-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Acquired vestibulotoxicity from hospital-prescribed medications such as aminoglycoside antibiotics affects as many as 40,000 people each year in North America. However, there are no current federally approved drugs to prevent or treat the debilitating and permanent loss of vestibular function caused by bactericidal aminoglycoside antibiotics. This review will cover our current understanding of the impact of, and mechanisms underlying, aminoglycoside-induced vestibulotoxicity and highlight the gaps in our knowledge that remain. CONCLUSIONS Aminoglycoside-induced vestibular deficits have long-term impacts on patients across the lifespan. Additionally, the prevalence of aminoglycoside-induced vestibulotoxicity appears to be greater than cochleotoxicity. Thus, monitoring for vestibulotoxicity should be independent of auditory monitoring and encompass patients of all ages from young children to older adults before, during, and after aminoglycoside therapy.
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Affiliation(s)
- Kristen Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
| | - Peter S. Steyger
- Bellucci Translational Hearing Center, Creighton University, Omaha, NE
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Yeo SS, Nam SM, Cho IH. Injury of the Vestibulocerebellar Tract and Signs of Ataxia in Patients with Cerebellar Stroke. J Clin Med 2023; 12:6877. [PMID: 37959342 PMCID: PMC10649050 DOI: 10.3390/jcm12216877] [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: 09/12/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The vestibulocerebellar tract (VCT) is responsible for maintaining balance, spatial orientation, and coordination. Damage to the vestibular system is accompanied by symptoms of balance disorder or ataxia. This study aimed to compare cerebellar dysfunction according to VCT damage in patients with cerebellar stroke. METHODS Six patients with cerebellum injury were recruited. This study measured ataxia and hand function related to visuomotor integration and manual dexterity using the Purdue pegboard test. The primary and bilateral secondary VCTs were reconstructed to investigate the integrity of pathways using diffusion tensor imaging (DTI). RESULTS The ataxia sign was positive in five patients (83%) at onset. In the result of the pegboard test, all patients had hand dysfunction in the dominant hand (100%). Likewise, all patients also had non-dominant hand dysfunction (100%). On the DTI tractography, the left and right primary VCTs of the patients demonstrated a 25% injury rate. Furthermore, the injury rates of ipsilateral and contralateral secondary VCTs were 50% and 58%. CONCLUSIONS Ataxia is related to secondary VCTs, and hand dysfunction is also related to VCTs. Therefore, we believe that the current study will be helpful in evaluating and providing a clinical intervention strategy for patients with ataxia and hand dysfunction following cerebellar injury.
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Affiliation(s)
- Sang-Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si 31116, Chungnam, Republic of Korea;
| | - Seung-Min Nam
- Department of Sports Rehabilitation and Exercise Management, Yeungnam University College, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Gyeongsangbuk-do, Republic of Korea;
| | - In-Hee Cho
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si 31116, Chungnam, Republic of Korea
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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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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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Kim RW, An Y, Zukley L, Ferrucci L, Mauro T, Yaffe K, Resnick SM, Abuabara K. Skin Barrier Function and Cognition among Older Adults. J Invest Dermatol 2023; 143:1085-1087. [PMID: 36641132 DOI: 10.1016/j.jid.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Richard W Kim
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Yang An
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Linda Zukley
- Clinical Research Unit, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Clinical Research Unit, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Theodora Mauro
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA; Dermatology Service, Veterans Affairs Health Care System, San Francisco, California, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA; Department of Neurology, University of California San Francisco, San Francisco, California, USA; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
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13
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Suzuki Y, Tsubaki T, Nakaya K, Kondo G, Takeuchi Y, Aita Y, Murayama Y, Shikama A, Masuda Y, Suzuki H, Kawakami Y, Shimano H, Arai T, Hada Y, Yahagi N. New balance capability index as a screening tool for mild cognitive impairment. BMC Geriatr 2023; 23:74. [PMID: 36739383 PMCID: PMC9899403 DOI: 10.1186/s12877-023-03777-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/27/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is not just a prodrome to dementia, but a very important intervention point to prevent dementia caused by Alzheimer's disease (AD). It has long been known that people with AD have a higher frequency of falls with some gait instability. Recent evidence suggests that vestibular impairment is disproportionately prevalent among individuals with MCI and dementia due to AD. Therefore, we hypothesized that the measurement of balance capability is helpful to identify individuals with MCI. METHODS First, we developed a useful method to evaluate balance capability as well as vestibular function using Nintendo Wii balance board as a stabilometer and foam rubber on it. Then, 49 healthy volunteers aged from 56 to 75 with no clinically apparent cognitive impairment were recruited and the association between their balance capability and cognitive function was examined. Cognitive functions were assessed by MoCA, MMSE, CDR, and TMT-A and -B tests. RESULTS The new balance capability indicator, termed visual dependency index of postural stability (VPS), was highly associated with cognitive impairment assessed by MoCA, and the area under the receiver operating characteristic (ROC) curve was more than 0.8, demonstrating high sensitivity and specificity (app. 80% and 60%, respectively). CONCLUSIONS Early evidence suggests that VPS measured using Nintendo Wii balance board as a stabilometer helps identify individuals with MCI at an early and preclinical stage with high sensitivity, establishing a useful method to screen MCI.
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Affiliation(s)
- Yasuhiro Suzuki
- grid.20515.330000 0001 2369 4728JST START University Ecosystem Promotion Type (University Promotion Type) Project Team, Headquarters for International Industry-University Collaboration, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan ,grid.412814.a0000 0004 0619 0044Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, 305-8596 Japan
| | - Takumi Tsubaki
- grid.412814.a0000 0004 0619 0044Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, 305-8596 Japan
| | - Kensuke Nakaya
- grid.412814.a0000 0004 0619 0044Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, 305-8596 Japan
| | - Genta Kondo
- grid.20515.330000 0001 2369 4728JST START University Ecosystem Promotion Type (University Promotion Type) Project Team, Headquarters for International Industry-University Collaboration, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan
| | - Yoshinori Takeuchi
- grid.20515.330000 0001 2369 4728Nutrigenomics Research Group, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan ,grid.20515.330000 0001 2369 4728Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Yuichi Aita
- grid.20515.330000 0001 2369 4728Nutrigenomics Research Group, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan ,grid.20515.330000 0001 2369 4728Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Yuki Murayama
- grid.20515.330000 0001 2369 4728Nutrigenomics Research Group, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan ,grid.20515.330000 0001 2369 4728Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Akito Shikama
- grid.20515.330000 0001 2369 4728Nutrigenomics Research Group, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan ,grid.20515.330000 0001 2369 4728Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Yukari Masuda
- grid.20515.330000 0001 2369 4728Nutrigenomics Research Group, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Hiroaki Suzuki
- grid.20515.330000 0001 2369 4728Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Yasushi Kawakami
- grid.20515.330000 0001 2369 4728Department of Laboratory Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Hitoshi Shimano
- grid.20515.330000 0001 2369 4728Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Tetsuaki Arai
- grid.20515.330000 0001 2369 4728Department of Psychiatry, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Yasushi Hada
- grid.412814.a0000 0004 0619 0044Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, 305-8596 Japan
| | - Naoya Yahagi
- JST START University Ecosystem Promotion Type (University Promotion Type) Project Team, Headquarters for International Industry-University Collaboration, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Nutrigenomics Research Group, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Internal Medicine (Endocrinology and Metabolism), Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Laboratory Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
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Huang Y, Xu J, Zhang X, Liu Y, Yu E. Research progress on vestibular dysfunction and visual-spatial cognition in patients with Alzheimer's disease. Front Aging Neurosci 2023; 15:1153918. [PMID: 37151847 PMCID: PMC10158930 DOI: 10.3389/fnagi.2023.1153918] [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: 01/30/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Alzheimer's disease (AD) or vestibular dysfunction may impair visual-spatial cognitive function. Recent studies have shown that vestibular dysfunction is increasingly common in patients with AD, and patients with AD with vestibular impairment show more visual-spatial cognitive impairment. By exploring the relationship and interaction mechanism among the vestibular system, visual-spatial cognitive ability, and AD, this study aims to provide new insights for the screening, diagnosis, and rehabilitation intervention of patients with AD. In contrast, routine vestibular function tests are particularly important for understanding the vestibular function of patients with AD. The efficacy of vestibular function test as a tool for the early screening of patients with AD must also be further studied. Through the visual-spatial cognitive ability test, the "spatial impairment" subtype of patients with AD, which may be significant in caring for patients with AD to prevent loss and falls, can also be determined. Additionally, the visual-spatial cognitive ability test has great benefits in preventing and alleviating cognitive decline of patients with AD.
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Affiliation(s)
- Yan Huang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaxi Xu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuehao Zhang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuhe Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yuhe Liu,
| | - Enyan Yu
- Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
- Enyan Yu,
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Chepisheva MK. Spatial orientation, postural control and the vestibular system in healthy elderly and Alzheimer's dementia. PeerJ 2023; 11:e15040. [PMID: 37151287 PMCID: PMC10162042 DOI: 10.7717/peerj.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background While extensive research has been advancing our understanding of the spatial and postural decline in healthy elderly (HE) and Alzheimer's disease (AD), much less is known about how the vestibular system contributes to the spatial and postural processing in these two populations. This is especially relevant during turning movements in the dark, such as while walking in our garden or at home at night, where the vestibular signal becomes central. As the prevention of falls and disorientation are of serious concern for the medical service, more vestibular-driven knowledge is necessary to decrease the burden for HE and AD patients with vestibular disabilities. Overview of the article The review briefly presents the current "non-vestibular based" knowledge (i.e. knowledge based on research that does not mention the "vestibular system" as a contributor or does not investigate its effects) about spatial navigation and postural control during normal healthy ageing and AD pathology. Then, it concentrates on the critical sense of the vestibular system and explores the current expertise about the aspects of spatial orientation and postural control from a vestibular system point of view. The norm is set by first looking at how healthy elderly change with age with respect to their vestibular-guided navigation and balance, followed by the AD patients and the difficulties they experience in maintaining their balance or during navigation. Conclusion Vestibular spatial and vestibular postural deficits present a considerable disadvantage and are felt not only on a physical but also on a psychological level by all those affected. Still, there is a clear need for more (central) vestibular-driven spatial and postural knowledge in healthy and pathological ageing, which can better facilitate our understanding of the aetiology of these dysfunctions. A possible change can start with the more frequent implementation of the "vestibular system examination/rehabilitation/therapy" in the clinic, which can then lead to an improvement of future prognostication and disease outcome for the patients.
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Huang Y, Zhang X, Tang J, Xia Y, Yang X, Zhang Y, Wei C, Ruan R, Ying H, Liu Y. Vestibular cognition assessment system: Tablet-based computerized visuospatial abilities test battery. Front Psychol 2023; 14:1095777. [PMID: 36910755 PMCID: PMC9992172 DOI: 10.3389/fpsyg.2023.1095777] [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: 11/11/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The vestibular system is anatomically connected to extensive regions of the cerebral cortex, hippocampus, and amygdala. However, studies focusing on the impact of vestibular impairment on visuospatial cognition ability are limited. This study aimed to develop a mobile tablet-based vestibular cognitive assessment system (VCAS), enhance the dynamic and three-dimensional (3D) nature of the test conditions, and comprehensively evaluate the visuospatial cognitive ability of patients with vestibular dysfunction. Materials and methods First, the VCAS assessment dimensions (spatial memory, spatial navigation, and mental rotation) and test content (weeding, maze, card rotation, and 3D driving tests) were determined based on expert interviews. Second, VCAS was developed based on Unity3D, using the C# language and ILruntime hot update framework development technology, combined with the A* algorithm, prime tree algorithm, and dynamic route rendering. Further, the online test was built using relevant game business logic. Finally, healthy controls (HC) and 78 patients with vertigo (VP) were recruited for the VCAS test. The validity of VCAS was verified using the test results of random controls. Results In the weeding test, the HC group had a significantly longer span and faster velocity backward than did the VP group. In the 12 × 12 maze, statistically significant differences in step and time were observed between the two groups, with VP taking longer time and more steps. In the mental rotation task, no significant difference was observed between the two groups. Similarly, no significant difference was found in the performance of the two groups on maps 2, 3, and 4 in the 3D driving task. Discussion Thus, impaired visuospatial cognition in patients with vestibular dysfunction is primarily related to spatial memory and navigation. VCAS is a clinically applicable visuospatial cognitive ability test for VP.
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Affiliation(s)
- Yan Huang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuehao Zhang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia Tang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yuqi Xia
- Department of Otolaryngology, Head, and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Xiaotong Yang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanmei Zhang
- Department of Otolaryngology, Head, and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Chaogang Wei
- Department of Otolaryngology, Head, and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Ruiqi Ruan
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hang Ying
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuhe Liu
- Department of Otolaryngology, Head, and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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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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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.
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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.
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Lucas JC, Arambula Z, Arambula AM, Yu K, Farrokhian N, D'Silva L, Staecker H, Villwock JA. Olfactory, Auditory, and Vestibular Performance: Multisensory Impairment Is Significantly Associated With Incident Cognitive Impairment. Front Neurol 2022; 13:910062. [PMID: 35899262 PMCID: PMC9309388 DOI: 10.3389/fneur.2022.910062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDysfunction in the olfactory, auditory, and vestibular systems are commonly seen in aging and are associated with dementia. The impact of sensory loss(es) on cognition is not well understood. Our aim was to assess the relationships between performance on objective multisensory testing and quantify the impact of dysfunction on cognition.MethodsPatients presenting with subjective hearing loss presenting to a tertiary care otologic/audiologic clinic were identified and underwent multisensory testing using the Affordable, Rapid Olfactory Measurement Array (AROMA), pure tone audiometric evaluations, and the Timed “Up and Go” test. Cognitive impairment (CI) was assessed via the Montreal Cognitive Assessment (MoCA) was also administered.Key Results180 patients were enrolled. Thirty one percentage (n = 57) screened positive for cognitive impairment. When evaluating single sensory impairments, we found that olfactory dysfunction, gait impairment, and sensorineural hearing loss were all statistically significantly (p < 0.05) associated with a higher risk of cognitive impairment (ORs 3.89, 3.49, and 2.78, respectively) for CI. Multisensory impairment was significantly associated with cognitive impairment. Subjects with dysfunction in all domains were at the highest risk for cognitive impairment (OR 15.7, p < 0.001) vs. those with impairment in 2 domains (OR 5.32, p < 0.001).ConclusionDysfunction of the olfactory, auditory, and vestibular systems is associated with a significantly increased risk of CI. The dramatically increased risk of CI with multisensory dysfunction in all three systems indicated that MSD may synergistically contribute to CI.
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Affiliation(s)
- Jacob C. Lucas
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
- *Correspondence: Jacob C. Lucas
| | - Zack Arambula
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Alexandra M. Arambula
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Katherine Yu
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Nathan Farrokhian
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Linda D'Silva
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, United States
| | - Hinrich Staecker
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Jennifer A. Villwock
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
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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
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Biju K, Oh E, Rosenberg P, Xue QL, Dash P, Burhanullah MH, Agrawal Y. Vestibular Function Predicts Balance and Fall Risk in Patients with Alzheimer's Disease. J Alzheimers Dis 2022; 86:1159-1168. [PMID: 35180117 DOI: 10.3233/jad-215366] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with Alzheimer's disease (AD) are at high risk for falls. Vestibular dysfunction predicts balance impairment in healthy adults; however, its contribution to falls in patients with AD is not well known. OBJECTIVE The objective of this study was to assess whether vestibular function contributes to balance and fall risk in patients with AD. METHODS In this prospective observational study, we assessed vestibular function using measures of semicircular canal (vestibulo-ocular reflex (VOR) gain) and saccular function (cervical vestibular-evoked myogenic (cVEMP) response), and we assessed balance function using the Berg Balance Scale and quantitative posturography. We evaluated falls incidence for a mean 1-year follow-up period (range 3-21 months) in 48 patients with mild-moderate AD. RESULTS Relative to matched controls, AD patients exhibited increased medio-lateral (ML) sway in eyes-open (0.89 cm versus 0.69 cm; p = 0.033) and eyes-closed (0.86 cm versus 0.65 cm; p = 0.042) conditions. Among AD patients, better semicircular canal function was associated with lower ML sway and antero-posterior (AP) sway in the eyes-closed condition (β= -2.42, 95% CI (-3.89, -0.95), p = 0.002; β= -2.38, 95% CI (-4.43, -0.32), p = 0.025, respectively). Additionally, better saccular function was associated with lower sway velocity (β= -0.18, 95% CI (-0.28, -0.08); p = 0.001). Finally, we observed that better semicircular canal function was significantly associated with lower likelihood of falls when adjusted for age, sex, and MMSE score (HR = 0.65; p = 0.009). CONCLUSION These results support the vestibular system as an important contributor to balance and fall risk in AD patients and suggest a role for vestibular therapy.
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Affiliation(s)
- Kevin Biju
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Oh
- Department of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Rosenberg
- Division of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qian-Li Xue
- Department of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Dash
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Haroon Burhanullah
- Division of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Wang Y, Huang X, Feng Y, Luo Q, He Y, Guo Q, Feng Y, Wang H, Yin S. Resting-State Electroencephalography and P300 Evidence: Age-Related Vestibular Loss as a Risk Factor Contributes to Cognitive Decline. J Alzheimers Dis 2022; 86:1107-1121. [PMID: 35213376 PMCID: PMC9108596 DOI: 10.3233/jad-215467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: In recent years, there have been several meaningful advances in the understanding of the cognitive effects of vestibular loss. However, there has not yet been an investigation exploring the early biomarkers of preclinical cognitive decline in individuals with age-related vestibular loss. Objective: We aim to explore the “early biomarkers” of preclinical cognitive decline based on altered cortical activity (resting-state electroencephalography (EEG) and P300) with a multichannel EEG system in individuals with age-related vestibular loss. Method: This is a case-control study. A total of 21 patients with age-related vestibular loss (66.50±5.79 years, 13 [62% ] females), 19 patients with cognitive decline (68.42±5.82 years, 13 [68% ] females), and 21 age- and sex-matched healthy controls were recruited. All participants underwent a comprehensive battery of neuropsychological tests, audio-vestibular evaluations, resting-state EEG and P300 recordings. Results: Significant visuo-spatial, executive, and attention hypofunction were observed in the age-related vestibular group, reflected by decreased subscale scores. Reduced gamma functional connectivity between the right cuneus (Brodmann area 19, BA19) and the left superior parietal gyrus (BA7) was observed in both the age-related vestibular group and the cognitive impairment group. Smaller P300 amplitudes were observed in the age-related vestibular group (1.43±3.69μV) and cognitive impairment group (1.15±4.24μV) than in the healthy control group (3.97±2.38μV). Conclusion: Decreased P300 amplitude and functional connectivity between the right BA19 and the left BA7 were “early biomarkers” observed in individuals with age-related vestibular loss; these biomarkers may contribute to visuospatial, executive, and attention hypofunction.
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Affiliation(s)
- Ying Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Xuan Huang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yueting Feng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Qiong Luo
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yemeng He
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yanmei Feng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hui Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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23
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Janky KL, Thomas M, Al-Salim S, Robinson S. Does vestibular loss result in cognitive deficits in children with cochlear implants? J Vestib Res 2022; 32:245-260. [PMID: 35275585 PMCID: PMC10141688 DOI: 10.3233/ves-201556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In adults, vestibular loss is associated with cognitive deficits; however, similar relationships have not been studied in children. OBJECTIVE Evaluate the effect of vestibular loss on working memory and executive function in children with a cochlear implant (CCI) compared to children with normal hearing (CNH). METHODS Vestibular evoked myogenic potential, video head impulse, rotary chair, and balance testing; and the following clinical measures: vision, hearing, speech perception, language, executive function, and working memory. RESULTS Thirty-eight CNH and 37 CCI participated (26 with normal vestibular function, 5 with unilateral vestibular loss, 6 with bilateral vestibular loss). Children with vestibular loss demonstrated the poorest balance performance. There was no significant reduction in working memory or executive function performance for either CCI group with vestibular loss; however, multivariate regression analysis suggested balance performance was a significant predictor for several working memory subtests and video head impulse gain was a significant predictor for one executive function outcome. CONCLUSIONS CCI with vestibular loss did not have significantly reduced working memory or executive function; however, balance performance was a significant predictor for several working memory subtests. Degree of hearing loss should be considered, and larger sample sizes are needed.
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Affiliation(s)
- Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE, USA
| | - Megan Thomas
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE, USA
| | - Sarah Al-Salim
- Boys Town National Research Hospital, Center for Childhood Deafness, Language and Learning, Omaha, NE, USA
| | - Sara Robinson
- Boys Town National Research Hospital, Center for Childhood Deafness, Language and Learning, Omaha, NE, USA
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24
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Müller KJ, Becker-Bense S, Strobl R, Grill E, Dieterich M. Chronic vestibular syndromes in the elderly: Presbyvestibulopathy - an isolated clinical entity? Eur J Neurol 2022; 29:1825-1835. [PMID: 35239246 DOI: 10.1111/ene.15308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recently, the Classification Committee of the Bárány Society defined the new syndrome of "presbyvestibulopathy" for elderly patients with chronic vestibular symptoms due to a mild bilateral peripheral vestibular hypofunction. However, control of stance and gait requires multiple functioning systems, e.g. the somatosensory, visual, auditory, musculoskeletal and cardio- and cerebrovascular system. The aim of this cross-sectional database-driven study was to evaluate the frequency and characteristics of presbyvestibulopathy and additional gait relevant comorbidities. METHODS In total 707 patients ≥ 60 years with chronic vertigo/dizziness were admitted to our tertiary hospital and received detailed neurological, neuroorthoptic and laboratory audio-vestibular examination. Medical history, comorbidities, functional impairment and quality of life (DHI, EQ-5D-3L, VAP) were compared between presbyvestibulopathy and bilateral vestibulopathy in a matched-paired study. RESULTS In 95.5% of patients, complaints were better accounted for by another vestibular, neurological, cardiac or psychiatric disease and 32 patients (4.5%) met the diagnostic criteria for presbyvestibulopathy. Out of these 32 patients, the majority showed further relevant comorbidities in other sensorimotor systems. Only one patient out of 707 had "isolated" presbyvestibulopathy (0.14%). The mean total DHI scores indicated lower moderate impairment in presbyvestibulopathy than in bilateral vestibulopathy (40.6 vs. 49.0), which was confirmed by significant differences in the matched-paired analysis (p < 0.001). CONCLUSIONS Isolated presbyvestibulopathy is a very rare entity. It is regularly accompanied by other multisensory dysfunctions. These results indicate a potential role of mild vestibular hypofunction as a co-factor in multifactorial impairment. Thus, patients should be treated in an interdisciplinary setting aware of diverse comorbidities.
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Affiliation(s)
- Katharina Johanna Müller
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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25
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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]
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26
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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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27
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Cochrane GD, Christy J, Sandroff B, Motl R. Cognitive and Central Vestibular Functions Correlate in People With Multiple Sclerosis. Neurorehabil Neural Repair 2021; 35:1030-1038. [PMID: 34560828 PMCID: PMC8595657 DOI: 10.1177/15459683211046268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Cognitive impairment is common, but poorly managed in people with multiple sclerosis (MS). Balance has been correlated with cognition in people with MS, potentially through shared utilization of central sensory integration pathways. Objective. This study characterized the relationship between central vestibular integration and cognition in people with MS through measurement of several clinical vestibular functions requiring central sensory integration and multiple cognitive domains. Methods. Forty people with MS and 20 controls completed a battery of vestibular and cognitive examinations targeting different central vestibular integration measures and different domains of cognition, respectively. Performance on these measures was compared between people with MS and controls, and then correlational analyses were undertaken between the vestibular and cognitive measures in the MS sample. Results. People with MS performed worse than controls on all vestibular and cognitive measures. There were consistent correlations between vestibular and cognitive measures in the MS sample. Factor analysis of vestibular functions yielded a single factor hypothesized to represent central vestibular integration that demonstrated a significant relationship with a composite cognitive measure in people with MS. Discussion. Our results suggest that vestibular and cognitive dysfunction may both arise from central sensory processing pathways in people with MS. This connection could be targeted through vestibular rehabilitation techniques that improve central sensory processing and both balance and cognition in people with MS.
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Affiliation(s)
- Graham D. Cochrane
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
- NIH Medical Scientist Training Program, School of Medicine, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jennifer Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Brian Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, West Orange, NJ, USA
| | - Robert Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
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28
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D'Silva LJ, Chalise P, Obaidat S, Rippee M, Devos H. Oculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury. Front Neurol 2021; 12:642457. [PMID: 34381408 PMCID: PMC8350131 DOI: 10.3389/fneur.2021.642457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = −0.67, p < 0.001), depth perception (r = −0.5348, p < 0.001), near point convergence (r = −0.4717, p = 0.001), baseline visual acuity (r = −0.4435, p = 0.002); as well as with symptoms on the PCSS (r = −0.668, p < 0.001), and DHI (r = −0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
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Affiliation(s)
- Linda J D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Prabhakar Chalise
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO, United States
| | - Sakher Obaidat
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Health System, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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29
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Association Between Saccule and Semicircular Canal Impairments and Cognitive Performance Among Vestibular Patients. Ear Hear 2021; 41:686-692. [PMID: 31567562 DOI: 10.1097/aud.0000000000000795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Growing evidence suggests that vestibular function impacts higher-order cognitive ability such as visuospatial processing and executive functioning. Despite evidence demonstrating vestibular functional impairment impacting cognitive performance, it is unknown whether cognitive ability is differentially affected according to the type of vestibular impairment (semicircular canal [SCC] versus saccule) among patients with diagnosed vestibular disease. DESIGN Fifty-four patients who presented to an academic neurotologic clinic were recruited into the study. All patients received a specific vestibular diagnosis. Forty-one patients had saccule function measured with the cervical vestibular-evoked myogenic potential, and 43 had SCC function measured using caloric irrigation. Cognitive tests were administered to assess cognitive performance among patients. One hundred twenty-five matched controls were recruited from the Baltimore Longitudinal Study of Aging to compare cognitive performance in patients relative to age-matched healthy controls. RESULTS Using multivariate linear regression analyses, patients with bilaterally absent cervical vestibular-evoked myogenic potential responses (i.e., bilateral saccular impairments) were found to take longer in completing the Trail-Making test (β = 25.7 sec, 95% confidence interval = 0.3 to 51.6) and to make significantly more errors on the Benton Visual Retention test part-C (β = 4.5 errors, 95% confidence interval [CI] = 1.2 to 7.8). Patients with bilateral SCC impairment were found to make significantly more errors on the Benton Visual Retention test part-C (β = 9.8 errors, 95% CI = 0.2 to 19.4). From case-control analysis, for each SD difference in Trail-Making test part-B time, there was a corresponding 142% increase in odds of having vestibular impairment (odds ratio = 2.42, 95% CI = 1.44 to 4.07). CONCLUSIONS These data suggest that bilateral saccule and SCC vestibular impairments may significantly affect various domains of cognitive performance. Notably, the cognitive performance in patients in this study was significantly poorer relative to age-matched healthy adults. Cognitive assessment may be considered in patients with saccule and SCC impairments, and cognitive deficits in vestibular patients may represent an important target for intervention.
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30
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Varadaraj V, Munoz B, Deal JA, An Y, Albert MS, Resnick SM, Ferrucci L, Swenor BK. Association of Vision Impairment With Cognitive Decline Across Multiple Domains in Older Adults. JAMA Netw Open 2021; 4:e2117416. [PMID: 34269806 PMCID: PMC8285732 DOI: 10.1001/jamanetworkopen.2021.17416] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Associations between visual and global cognitive impairments have been previously documented, but there is limited research examining these associations between multiple measures of vision across cognitive domains. OBJECTIVE To examine the association between vision and cognitive across multiple cognitive domains using multiple measures of vision. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from the Baltimore Longitudinal Study of Aging for 2003 to 2019. Participants in the current study were aged 60 to 94 years with vision and cognitive measures. Data analysis was performed from May 2020 to May 2021. MAIN OUTCOMES AND MEASURES Cognitive function was measured across multiple domains, including language, memory, attention, executive function, and visuospatial ability. Cognitive domain scores were calculated as the mean of standardized cognitive test scores within each domain. Visual function was assessed using measures of visual acuity, contrast sensitivity, and stereo acuity at baseline. RESULTS Analyses included 1202 participants (610 women [50.8%]; 853 White participants [71.0%]) with a mean (SD) age of 71.1 (8.6) years who were followed up for a mean (SD) of 6.9 (4.7) years. Worse visual acuity (per 0.1 logarithm of the minimal angle of resolution) at baseline was associated with greater declines in language (β, -0.0035; 95% CI, -0.007 to -0.001) and memory (β, -0.0052; 95% CI, -0.010 to -0.001) domain scores. Worse contrast sensitivity (per 0.1 log units) at baseline was associated with greater declines in language (β, -0.010; 95% CI, -0.014 to -0.006), memory (β, -0.009; 95% CI, -0.015 to -0.003), attention (β, -0.010; 95% CI, -0.017 to -0.003), and visuospatial ability (β, -0.010; 95% CI, -0.017 to -0.002) domain scores. Over the follow-up period, declines on tests of language (β, -0.019; 95% CI, -0.034 to -0.005) and memory (β, -0.032; 95% CI, -0.051 to -0.012) were significantly greater for participants with impaired stereo acuity compared with those without such impairment. CONCLUSIONS AND RELEVANCE These findings suggest that the association between vision and cognition differs between visual acuity, contrast sensitivity, and stereo acuity and that patterns of cognitive decline may differ by type of vision impairment, with impaired contrast sensitivity being associated with declines across more cognitive domains than other measures of visual functioning.
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Affiliation(s)
- Varshini Varadaraj
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Disability Health Research, Johns Hopkins University, Baltimore, Maryland
| | - Beatriz Munoz
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A. Deal
- Center for Disability Health Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yang An
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Disability Health Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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31
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Vestibular cues improve landmark-based route navigation: A simulated driving study. Mem Cognit 2021; 49:1633-1644. [PMID: 34018119 DOI: 10.3758/s13421-021-01181-2] [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] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
It is well established that humans use self-motion and landmark cues to successfully navigate their environment. Existing research has demonstrated a critical role of the vestibular system in supporting navigation across many species. However, less is known about how vestibular cues interact with landmarks to promote successful navigation in humans. In the present study, we used a motion simulator to manipulate the presence or absence of vestibular cues during a virtual navigation task. Participants learned routes to a target destination in three different landmark blocks in a virtual town: one with proximal landmarks, one with distal landmarks, and one with no landmarks present. Afterwards, they were tested on their ability to retrace the route and find the target destination. We observed a significant interaction between vestibular cues and proximal landmarks, demonstrating that the potential for vestibular cues to improve route navigation is dependent on landmarks that are present in the environment. In particular, vestibular cues significantly improved route navigation when proximal landmarks were present, but this was not significant when distal landmarks or no landmarks were present. Overall, our results indicate that landmarks play an important role in the successful incorporation of vestibular cues to human spatial navigation.
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32
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Vestibular Function in Older Adults With Cognitive Impairment: A Systematic Review. Ear Hear 2021; 42:1119-1126. [PMID: 33974775 DOI: 10.1097/aud.0000000000001040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Given the rising prevalence of patients with dementia and those at risk for it, early identification is prioritized. As vestibular dysfunction is associated with Alzheimer's disease (AD) and may contribute to its onset, vestibular assessment may yield an opportunity in early dementia screening. OBJECTIVE This systematic review structures and compares the different raw outcome measures used to assess vestibular function while comparing older adults with preserved cognition to individuals with cognitive impairment, either suffering from mild cognitive impairment (MCI) or AD. DESIGN Two investigators independently and systematically searched publications performing objectively measured vestibular testing in a patient population consisting of either MCI or AD, compared with a control group of older adults with preserved cognition. No limitations regarding language or publication date were applied. References of the retrieved articles were hand searched for relevant articles. RESULTS Seven articles were included for analysis. A total of 235 older adults with impaired cognition (150 AD, 85 MCI) were compared with a control group of 481 older adults with preserved cognition. Evaluation of the peripheral vestibular function included video head impulse test (vHIT), videonystagmography (VNG), electronystagmography (ENG) including bithermal caloric irrigation and vestibular evoked myogenic potentials (VEMP). The VEMP test, assessing otolith function and the elicited vestibulocollic reflex (VCR), was able to differentiate subjects with AD and its prodromal stage from healthy controls, with p13 latency (p < 0.05) and amplitude (p < 0.05) having the most discriminating power.No correlation between cognitive decline and vestibulo-ocular reflex measurements in different frequency ranges of the semicircular canals (using vHIT, rotatory chair testing, and caloric irrigation) was found. Because of the limited number of available studies and the large heterogeneity in outcome measures, these results have to be interpreted with caution. CONCLUSIONS Measurements of the VCR, as evoked by the VEMP test, discriminate between patients with cognitive impairment (MCI and AD) and older adults with preserved cognition, whereas measurements of the vestibulo-ocular reflex do not. More studies are needed to further elaborate on these findings.
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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: 7] [Impact Index Per Article: 2.3] [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.
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Nascimento MDM, Silva PST. Sensory assessment of balance regulation of physically active women, 60-79 years old. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To evaluate the performance of sensory regulation of static and dynamic balance in older women, and to verify the sensitivity and specificity levels of the Body Balance Test (Teste de Equilíbrio Corporal, TEC) in relation to its reference standard, determining the best cutoff point for identifying risk of falling. METHODS: 74 women (age 67.59 ± 5.26 years) participated in the study, divided into fallers (n = 18) and non-fallers (n = 56). RESULTS: Comparatively, non-fallers had higher performance scores on static balance exteroceptive regulation (SBER), dynamic balance exteroceptive regulation (DBER), and dynamic balance interoceptive regulation (DBIR). Statistically significant differences were found in DBER (p = ≤0.001) and DBIR (p = 0.031). The area under the ROC curve was 0.73 (95%CI 0.58 – 0.88; p = 0.003), with a sensitivity level of 42.30% and specificity of 84.80%.
CONCLUSIONS: The greatest chance of falling was found for dynamic balance in situations of exteroceptive and interoceptive regulation for older women with and without a history of falls. Deficits in sensory regulation of body balance are common in older women, both fallers and non-fallers.
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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.
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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
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Höbler F, McGilton KS, Wittich W, Dupuis K, Reed M, Dumassais S, Mick P, Pichora-Fuller MK. Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review. J Alzheimers Dis 2021; 84:1115-1138. [PMID: 34633326 PMCID: PMC8673512 DOI: 10.3233/jad-215087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. OBJECTIVE To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. METHODS Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed. RESULTS There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. CONCLUSION Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.
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Affiliation(s)
- Fiona Höbler
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Walter Wittich
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
- Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Kate Dupuis
- Sheridan Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Marilyn Reed
- Audiology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Shirley Dumassais
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Agrawal Y, Merfeld DM, Horak FB, Redfern MS, Manor B, Westlake KP, Holstein GR, Smith PF, Bhatt T, Bohnen NI, Lipsitz LA. Aging, Vestibular Function, and Balance: Proceedings of a National Institute on Aging/National Institute on Deafness and Other Communication Disorders Workshop. J Gerontol A Biol Sci Med Sci 2020; 75:2471-2480. [PMID: 32617555 PMCID: PMC7662183 DOI: 10.1093/gerona/glaa097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/27/2022] Open
Abstract
Balance impairment and falls are among the most prevalent and morbid conditions affecting older adults. A critical contributor to balance and gait function is the vestibular system; however, there remain substantial knowledge gaps regarding age-related vestibular loss and its contribution to balance impairment and falls in older adults. Given these knowledge gaps, the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders convened a multidisciplinary workshop in April 2019 that brought together experts from a wide array of disciplines, such as vestibular physiology, neuroscience, movement science, rehabilitation, and geriatrics. The goal of the workshop was to identify key knowledge gaps on vestibular function and balance control in older adults and develop a research agenda to make substantial advancements in the field. This article provides a report of the proceedings of this workshop. Three key questions emerged from the workshop, specifically: (i) How does aging impact vestibular function?; (ii) How do we know what is the contribution of age-related vestibular impairment to an older adult's balance problem?; and more broadly, (iii) Can we develop a nosology of balance impairments in older adults that can guide clinical practice? For each of these key questions, the current knowledge is reviewed, and the critical knowledge gaps and research strategies to address them are discussed. This document outlines an ambitious 5- to 10-year research agenda for increasing knowledge related to vestibular impairment and balance control in older adults, with the ultimate goal of linking this knowledge to more effective treatment.
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Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Merfeld
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland
| | - Mark S Redfern
- Department of Bioengineering, University of Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pennsylvania
| | - Brad Manor
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Gay R Holstein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand
- Brain Research New Zealand, Dunedin, New Zealand
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Radiology, University of Michigan, Ann Arbor
| | - Lewis A Lipsitz
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Ernst A, Basta D, Mittmann P, Seidl RO. Can hearing amplification improve presbyvestibulopathy and/or the risk-to-fall ? Eur Arch Otorhinolaryngol 2020; 278:2689-2694. [PMID: 33034732 PMCID: PMC8266782 DOI: 10.1007/s00405-020-06414-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022]
Abstract
Purpose The decline of sensory systems during aging has been widely investigated and several papers have correlated the visual, hearing and vestibular systems and the consequences of their functional degeneration. Hearing loss and presbyvestibulopathy have been found to be positively correlated as is with the risk-to-fall.
Material and methods The present study was therefore designed as systematic review (due to PRISMA criteria) which should correlate hearing amplification by hearing aids and/or cochlear implants with balance outcome. However, the literature review (Cochrane, PubMed) revealed ten paper (prospective, controlled trials and acute trials) with heterogenous patient popiulations and non-uniform outcome measures (i.e., gait analysis, questionnaires, postural stabilometry) so that no quantitative, statistical analysis could be performed. Results The qualitative analysis oft he identified studies showed that hearing amplification in the elderly improves spatio-temporal orientation (particularly with cochlear implants) and that the process of utilizing auditory information for balance control takes some time (i.e., the neuroplasticity-based, learning processes), usually some months in cochlear implantees. Discussion Hearing and balance function degenerate independently from each other and large interindividual differences require a separate neurotological examination of each patient. However, hearing amplification is most helpful to improve postural stability, particularly in the elderly. Future research should focus on controlled, prospective clinical trials where a standardized test battery covering the audiological and neurotological profile of each elderly patient pre/post prescription of hearing aids and/or cochlear implantation should be followed up (for at least 1 year) so that also the balance improvements and the risk-to-fall can be reliably assessed (e.g., by mobile posturography and standardized questionnaires, e.g., the DHI).
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Affiliation(s)
- Arne Ernst
- Department of Otolaryngology at UKB, Charité Med School, Hospital of the Univ of Berlin, Warener Str. 7, 12683, Berlin, Germany.
| | - Dietmar Basta
- Department of Otolaryngology at UKB, Charité Med School, Hospital of the Univ of Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology at UKB, Charité Med School, Hospital of the Univ of Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Rainer O Seidl
- Department of Otolaryngology at UKB, Charité Med School, Hospital of the Univ of Berlin, Warener Str. 7, 12683, Berlin, Germany
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Dobbels B, Mertens G, Gilles A, Moyaert J, van de Berg R, Fransen E, Van de Heyning P, Van Rompaey V. The Virtual Morris Water Task in 64 Patients With Bilateral Vestibulopathy and the Impact of Hearing Status. Front Neurol 2020; 11:710. [PMID: 32849193 PMCID: PMC7431773 DOI: 10.3389/fneur.2020.00710] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Previous studies have demonstrated spatial cognitive deficits in patients with bilateral vestibulopathy (BVP). However, BVP patients frequently present with a concomitant sensorineural hearing loss, which is a well-established risk factor of cognitive impairment and incident dementia. Nonetheless, previous research on spatial cognitive deficits in BVP patients have not taken hearing status into account. Objective: This study aims to compare spatial cognition of BVP patients with healthy controls, with analyses adjusting for hearing status. Methods: Spatial cognition was assessed in 64 BVP patients and 46 healthy controls (HC) by use of the Virtual Morris Water Task (VMWT). All statistical analyses were adjusted for hearing (dys)function, sex, age, education, and computer use. Results: Overall, patients with BVP performed worse on all outcome measures of the VMWT. However, these differences between BVP patients and healthy controls were not statistically significant. Nonetheless, a statistically significant link between sensorineural hearing loss and spatial cognition was observed. The worse the hearing, the longer subjects took to reach the hidden platform in the VMWT. Furthermore, the worse the hearing, the less time was spent by the subjects in the correct platform quadrant during the probe trial of the VMWT. Conclusion: In this study, no difference was found regarding spatial cognition between BVP patients and healthy controls. However, a statistically significant link was observed between sensorineural hearing loss and spatial cognition.
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Affiliation(s)
- Bieke Dobbels
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Zuyderland Medical Center, Heerlen, Netherlands
| | - Griet Mertens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Julie Moyaert
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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Jacob A, Tward DJ, Resnick S, Smith PF, Lopez C, Rebello E, Wei EX, Ratnanather JT, Agrawal Y. Vestibular function and cortical and sub-cortical alterations in an aging population. Heliyon 2020; 6:e04728. [PMID: 32904672 PMCID: PMC7457317 DOI: 10.1016/j.heliyon.2020.e04728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/10/2019] [Accepted: 08/12/2020] [Indexed: 01/26/2023] Open
Abstract
While it is well known that the vestibular system is responsible for maintaining balance, posture and coordination, there is increasing evidence that it also plays an important role in cognition. Moreover, a growing number of epidemiological studies are demonstrating a link between vestibular dysfunction and cognitive deficits in older adults; however, the exact pathways through which vestibular loss may affect cognition are unknown. In this cross-sectional study, we sought to identify relationships between vestibular function and variation in morphometry in brain structures from structural neuroimaging. We used a subset of 80 participants from the Baltimore Longitudinal Study of Aging, who had both brain MRI and vestibular physiological data acquired during the same visit. Vestibular function was evaluated through the cervical vestibular-evoked myogenic potential (cVEMP). The brain structures of interest that we analyzed were the hippocampus, amygdala, thalamus, caudate nucleus, putamen, insula, entorhinal cortex (ERC), trans-entorhinal cortex (TEC) and perirhinal cortex, as these structures comprise or are connected with the putative "vestibular cortex." We modeled the volume and shape of these structures as a function of the presence/absence of cVEMP and the cVEMP amplitude, adjusting for age and sex. We observed reduced overall volumes of the hippocampus and the ERC associated with poorer vestibular function. In addition, we also found significant relationships between the shape of the hippocampus (p = 0.0008), amygdala (p = 0.01), thalamus (p = 0.008), caudate nucleus (p = 0.002), putamen (p = 0.02), and ERC-TEC complex (p = 0.008) and vestibular function. These findings provide novel insight into the multiple pathways through which vestibular loss may impact brain structures that are critically involved in spatial memory, navigation and orientation.
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Affiliation(s)
- Athira Jacob
- Center for Imaging Science and Institute for Computational Medicine,
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD,
USA
| | - Daniel J. Tward
- Center for Imaging Science and Institute for Computational Medicine,
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD,
USA
| | - Susan Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging,
Baltimore, MD, USA
| | - Paul F. Smith
- Department Pharmacology and Toxicology, School of Medical Sciences, The
Brain Health Research Centre, University of Otago, New Zealand
| | - Christophe Lopez
- Aix Marseille Universite, Centre National de la Recherche Scientifique,
Marseille, France
| | - Elliott Rebello
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - J. Tilak Ratnanather
- Center for Imaging Science and Institute for Computational Medicine,
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD,
USA
| | - Yuri Agrawal
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
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Prevalence of Cognitive and Vestibular Impairment in Seniors Experiencing Falls. Can J Neurol Sci 2020; 48:245-252. [PMID: 32684199 DOI: 10.1017/cjn.2020.154] [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: 11/05/2022]
Abstract
BACKGROUND Falls are a growing concern in seniors (≥65 yrs). Cognitive impairment (CI) and vestibular impairment (VI) increase fall risk. The aim of this study is to assess the prevalence of CI and VI in seniors experiencing falls. METHODS Participants (≥65 yrs) with falls were recruited from Falls Prevention Programs (FPPs) and a Memory Clinic (MC). CI was assessed using the Montreal Cognitive Assessment at FPPs. VI was assessed at an MC and FFPs using the Head Impulse- (video + bedside), Headshake-, Dix-Hallpike test, and test of sensory interaction in balance. Questionnaires included Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence Scale (ABC). RESULTS Of 41 participants (29 FPPs, 12 MC); mean age was 80.1 ± 7.1 years, and 58.5% were female. Overall, 82.9% had VI. At FPPs, 76.0% had CI, and 72.3% had CI + VI. Bilateral vestibular hypofunction (BVH) was more common than unilateral vestibular hypofunction (UVH) (70.6% vs. 29.4%); p = 0.016. Dizziness Handicap (DHI) was not different between those with a VI (23.5 ± 23.9) versus without VI [PVI + no impairment] (10.0 ± 15.4); p = 0.160. Balance confidence (ABC) was lowest in VI but not significantly different between those with a VI (63.4 ± 27.3) versus without VI [PVI + no impairment] (85.0 ± 16.5); p = 0.053. CONCLUSIONS VI and CI are prevalent in seniors experiencing falls. For seniors with history of falls, both cognitive and vestibular functions should be considered in the assessment and subsequent treatment. Screening enables earlier detection, targeted interventions, and prevention, reducing the clinical and financial impact.
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Wei EX, Anson ER, Resnick SM, Agrawal Y. Psychometric Tests and Spatial Navigation: Data From the Baltimore Longitudinal Study of Aging. Front Neurol 2020; 11:484. [PMID: 32595588 PMCID: PMC7300262 DOI: 10.3389/fneur.2020.00484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/04/2020] [Indexed: 12/02/2022] Open
Abstract
Spatial cognition is the process by which individuals interact with their spatial environment. Spatial cognition encompasses the specific skills of spatial memory, spatial orientation, and spatial navigation. Prior studies have shown an association between psychometric tests of spatial ability and self-reported or virtual measures of spatial navigation. In this study, we examined whether psychometric spatial cognitive tests predict performance on a dynamic spatial navigation task that involves movement through an environment. We recruited 151 community-dwelling adult participants [mean (SD) age 69.7 (13.6), range 24.6–93.2] from the Baltimore Longitudinal Study of Aging (BLSA). Spatial navigation ability was assessed using the triangle completion task (TCT), and two quantities, the angle and distance of deviation, were computed. Visuospatial cognitive ability was assessed primarily using the Card Rotations Test. Additional tests of executive function, memory, and attention were also administered. In multiple linear regression analyses adjusting for age, sex, race, and education, cognitive tests of visuospatial ability, executive function, and perceptual motor speed and integration were significantly associated with spatial navigation, as determined by performance on the TCT. These findings suggest that dynamic spatial navigation ability is related to spatial memory, executive function, and motor processing speed.
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Affiliation(s)
- Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric R Anson
- Department of Otolaryngology, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, United States
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, United States
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Friedmann E, Gee NR, Simonsick EM, Studenski S, Resnick B, Barr E, Kitner-Triolo M, Hackney A. Pet Ownership Patterns and Successful Aging Outcomes in Community Dwelling Older Adults. Front Vet Sci 2020; 7:293. [PMID: 32671105 PMCID: PMC7330097 DOI: 10.3389/fvets.2020.00293] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/29/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction: Diminishing cognitive and physical functions, worsening psychological symptoms, and increased mortality risk and morbidity typically accompany aging. The aging population's health needs will continue to increase as the proportion of the population aged > 50 years increases. Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic conditions. Much of the evidence is weak. Little is known about PO patterns as people age or the contribution of PO to successful aging in community-dwelling older adults. This study examines PO patterns among healthy community-dwelling older adults and the relationship of PO to cognitive and physical functions and psychological status. Methods: Participants in the Baltimore Longitudinal Study of Aging (> 50 years old, N = 378) completed a battery of cognitive, physical function, and psychological tests, as well as a PO questionnaire. Descriptive and non-parametric or general/generalized linear model analyses were conducted for separate outcomes. Results: Most participants (82%) had kept pets and 24% have pets: 14% dogs, 12% cats, 3% other pets. The most frequent reasons for having pets included enjoyment (80%) and companionship (66%). Most owners had kept the pet they had the longest for over 10 years (70%). PO was lower in older decades (p < 0.001). Pet owners were more likely to live in single-family homes and reside with others (p = 0.001) than non-owners. Controlling for age, PO was associated independently with better cognitive function (verbal leaning/memory p = 0.041), dog ownership predicted better physical function (daily energy expenditure, p = 0.018), and cat ownership predicted better cognitive functioning (verbal learning/memory, p = 0.035). Many older adults who did not own pets (37%) had regular contact with pets, which was also related to health outcomes. Conclusion: PO is lower at older ages, which mirrors the general pattern of poorer cognitive and physical function, and psychological status at older ages. PO and regular contact with pets (including PO) are associated with better cognitive status compared with those who did not own pets or had no regular contact with pets independent of age. Dog ownership was related to better physical function. Longitudinal analysis is required to evaluate the association of PO and/or regular contact with maintenance of health status over time.
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Affiliation(s)
- Erika Friedmann
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Nancy R Gee
- Center for Human Animal Interaction, Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Stephanie Studenski
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Erik Barr
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Melissa Kitner-Triolo
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Alisha Hackney
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
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Groff BR, Wiesman AI, Rezich MT, O'Neill J, Robertson KR, Fox HS, Swindells S, Wilson TW. Age-related visual dynamics in HIV-infected adults with cognitive impairment. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e690. [PMID: 32102916 PMCID: PMC7051212 DOI: 10.1212/nxi.0000000000000690] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/17/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate whether aging differentially affects neural activity serving visuospatial processing in a large functional neuroimaging study of HIV-infected participants and to determine whether such aging effects are attributable to differences in the duration of HIV infection. METHODS A total of 170 participants, including 93 uninfected controls and 77 HIV-infected participants, underwent neuropsychological assessment followed by neuroimaging with magnetoencephalography (MEG). Time-frequency analysis of the MEG data followed by advanced image reconstruction of neural oscillatory activity and whole-brain statistical analyses were used to examine interactions between age, HIV infection, and cognitive status. Post hoc testing for a mediation effect of HIV infection duration on the relationship between age and neural activity was performed using a quasi-Bayesian approximation for significance testing. RESULTS Cognitively impaired HIV-infected participants were distinguished from unimpaired HIV-infected and control participants by their unique association between age and gamma oscillations in the parieto-occipital cortex. This relationship between age and gamma was fully mediated by the duration of HIV infection in cognitively impaired participants. Impaired HIV-infected participants were also distinguished by their atypical relationship between alpha oscillations and age in the superior parietal cortex. CONCLUSIONS Impaired HIV-infected participants exhibited markedly different relationships between age and neural responses in the parieto-occipital cortices relative to their peers. This suggests a differential effect of chronological aging on the neural bases of visuospatial processing in a cognitively impaired subset of HIV-infected adults. Some of these relationships were fully accounted for by differences in HIV infection duration, whereas others were more readily associated with aging.
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Affiliation(s)
- Boman R Groff
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Alex I Wiesman
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Michael T Rezich
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Jennifer O'Neill
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Kevin R Robertson
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Howard S Fox
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Susan Swindells
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE
| | - Tony W Wilson
- From the Center for Magnetoencephalography (B.R.G., A.I.W., T.W.W.), University of Nebraska Medical Center, Omaha, NE; Department of Neurological Sciences (A.I.W., M.T.R., T.W.W.), UNMC, Omaha; Department of Internal Medicine (J.O.N., S.S.), Division of Infectious Diseases, UNMC; Department of Neurology (K.R.R.), University of North Carolina School of Medicine, Chapel Hill, NC; and Department of Pharmacology and Experimental Neuroscience (H.S.F.), UNMC, Omaha, NE.
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Agrawal Y, Smith PF, Rosenberg PB. Vestibular impairment, cognitive decline and Alzheimer's disease: balancing the evidence. Aging Ment Health 2020; 24:705-708. [PMID: 30691295 PMCID: PMC6663651 DOI: 10.1080/13607863.2019.1566813] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The vestibular (inner ear balance) system senses head movement and orientation in space. Vestibular sensory input plays a critical role in spatial cognitive abilities such as spatial memory and spatial navigation. Vestibular function declines with age, and recent studies have shown that age-related vestibular impairment is associated with poorer spatial cognitive skills in healthy older adults. Moreover, vestibular impairment is disproportionately prevalent among individuals with mild cognitive impairment and Alzheimer's disease, and specifically in cognitively-impaired individuals who have spatial deficits such as disorientation and difficulty driving. Indeed, emerging evidence suggests that age-related vestibular impairment contributes to a 'spatial' subtype of Alzheimer's disease, characterized by highly morbid symptoms such as wandering and falls. Given that vestibular impairment can be treated through simple, physical-therapy based exercises, identifying and treating vestibular deficits in older adults with and without cognitive impairment may offer substantial benefit in preventing, mitigating and forestalling cognitive decline.
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Affiliation(s)
- Y Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine,Corresponding author: Yuri Agrawal, 601 North Caroline Street, 6th Floor Outpatient Center, Baltimore, MD 21287 USA,
| | - PF Smith
- Department Pharmacology and Toxicology, School of Medical Sciences, and the Brain Health Research Centre, University of Otago
| | - PB Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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Kotov SV, Isakova EV, Zaitseva EV. [Poststroke cognitive impairment and the possibility of its nonpharmacological treatment with vestibular stimulation based on biological feedback to supporting reaction]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:16-22. [PMID: 32307425 DOI: 10.17116/jnevro202012003216] [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] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is common in poststroke patients. Today in rehabilitation programs the specialists use the vestibular stimulation including biological feedback to supporting reaction for treatment poststroke cognitive impairment. These studies show the relationship of vestibular function with memory, attention, spatial orientation, navigation, mental representation of three-dimensional space and other cognitive functions. It makes possible to build rehabilitation programs for patients with stroke.
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Affiliation(s)
- S V Kotov
- Vladimirsky Moscow Regional Scientific Research Clinical Institute, Moscow, Russia
| | - E V Isakova
- Vladimirsky Moscow Regional Scientific Research Clinical Institute, Moscow, Russia
| | - E V Zaitseva
- Vladimirsky Moscow Regional Scientific Research Clinical Institute, Moscow, Russia
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Abstract
Vertigo and dizziness in advanced age are common complaints in daily clinical practice. The otorhinolaryngologist holds a central position in the differential diagnostic clarification. Age-related disorders (e.g. benign positional vertigo, presbyvestibulopathy, otholith functional disorders) arise due to a physiological, individually distinct and objectively detectable reduction in the sensitivity of sensory and extrasensory elements of the vestibular system. They may reach pathological significance if these dysfunctions affect the physical and emotional well-being (e.g. gait disturbances and falls with subsequent morbidity). Disorders accompanying aging (e.g. neurological, cardiovascular or psychiatric) can occur simultaneously with age-related changes in sensory function. The identification, especially with respect to the risk of falling in older people and the development of individual therapeutic strategies is an interdisciplinary task. Besides a causative therapy, strength, coordination and balance training contribute to the treatment of equilibrium disorders and falls from the perspective of evidence-based medicine.
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48
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Osuka Y, Kojima N, Sakurai R, Watanabe Y, Kim H. Reliability and construct validity of a novel motor-cognitive dual-task test: A Stepping Trail Making Test. Geriatr Gerontol Int 2020; 20:291-296. [PMID: 32064719 DOI: 10.1111/ggi.13878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/15/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
Abstract
AIM This study aimed to examine the reliability and construct validity of the Stepping Trail Making Test (S-TMT) in community-dwelling older adults. METHODS This study comprised a cross-sectional study based on a population sample. Participants comprised 1224 community-dwelling older Japanese women aged 65-81 years without functional disability, dementia, depression, Parkinson's disease, or cognitive and visual impairments. The S-TMT measured the time taken to step on a sequence of numbers (1-16) positioned on a mat (1 m2 ). Participants were instructed to step as quickly and accurately as possible. Motor functions were assessed by walking speed and knee extensor strength tests, while cognitive functions were assessed by the Symbol Digit Substitution Task (SDST) test, verbal and logical memory test, and TMT-A and -B. RESULTS As a result of test-retest reliability over 6 months, the intraclass correlation coefficients of the S-TMT was 0.82 (95% confidence interval, 0.68-0.90). An adjusted multiple regression model indicated that the S-TMT was significantly associated with walking speed for motor function, and associated with the SDST, TMT-A and TMT-B for cognitive functions (P < 0.001). CONCLUSIONS These results suggest that the S-TMT is a reliable dual-task test comprising mobility for motor function and a visual-dependent execution function for cognitive function in older women. Geriatr Gerontol Int 2020; 20: 291-296.
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Affiliation(s)
- Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ryota Sakurai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Coelho AR, Perobelli JLL, Sonobe LS, Moraes R, Barros CGDC, Abreu DCCD. Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy. Int Arch Otorhinolaryngol 2020; 24:e99-e106. [PMID: 31892965 PMCID: PMC6828563 DOI: 10.1055/s-0039-1695025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate ( n = 11) or severe ( n = 11). The control group ( n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.
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Affiliation(s)
- Almir Resende Coelho
- Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
- Department of Physiotherapy, Universidade de Franca, Franca, SP, Brazil
| | | | - Lilian Shizuka Sonobe
- Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renato Moraes
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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50
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Colebatch JG, Rosengren SM. Investigating short latency subcortical vestibular projections in humans: what have we learned? J Neurophysiol 2019; 122:2000-2015. [PMID: 31596627 DOI: 10.1152/jn.00157.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Vestibular evoked myogenic potentials (VEMPs) are now widely used for the noninvasive assessment of vestibular function and diagnosis in humans. This review focuses on the origin, properties, and mechanisms of cervical VEMPs and ocular VEMPs; how these reflexes relate to reports of vestibular projections to brain stem and cervical targets; and the physiological role of (otolithic) cervical and ocular reflexes. The evidence suggests that both VEMPs are likely to represent the effects of excitation of irregularly firing otolith afferents. While the air-conducted cervical VEMP appears to mainly arise from excitation of saccular receptors, the ocular VEMP evoked by bone-conducted stimulation, including impulsive bone-conducted stimuli, mainly arises from utricular afferents. The surface responses are generated by brief changes in motor unit firing. The effects that have been demonstrated are likely to represent otolith-dependent vestibulocollic and vestibulo-ocular reflexes, both linear and torsional. These observations add to previous reports of short latency otolith projections to the target muscles in the neck (sternocleidomastoid and splenius) and extraocular muscles (the inferior oblique). New insights have been provided by the investigation and application of these techniques.
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Affiliation(s)
- James G Colebatch
- Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Sally M Rosengren
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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