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Lu L, Ni W, Liu Y, Sun L, Li F. Anti-saccade as a tool to evaluate cognitive impairment in vestibular migraine. Front Neurol 2024; 15:1419372. [PMID: 38948136 PMCID: PMC11211558 DOI: 10.3389/fneur.2024.1419372] [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: 04/18/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
Background Vestibular migraine (VM), an intricate subtype of migraine, amalgamates the dual attributes of migraine and vestibular disorders. In clinical settings, individuals with VM frequently articulate concerns regarding the manifestation of subjective cognitive impairment. This cognitive dysfunction is intricately linked with diminished mobility, heightened susceptibility to falls, and increased absenteeism in afflicted patients. Consequently, comprehending the features of cognitive impairment in VM patients holds potential clinical significance. The pursuit of rapid and objective methods for detection and assessment is foundational and prerequisite for efficacious cognitive management of VM patients. Methods The study encompassed 50 patients diagnosed with vestibular migraine and recruited 50 age-sex matched healthy controls. All participants underwent anti-saccade tasks, and cognitive evaluation was performed using the MMSE and MoCA to assess overall cognitive function. Additionally, RBANS scales were employed to measure specific cognitive domains. Results The VM patients and normal controls demonstrated statistical parity in terms of age, gender, education, weight, and BMI, with no significant differences observed. Analysis of cognitive scores divulged a marked increase in the incidence of Mild Cognitive Impairment (MCI) in VM patients compared to Healthy Controls (HCs). Both MMSE and MoCA scores were notably lower in VM patients compared to their healthy counterparts. The RBANS cognitive test indicated significant impairment in immediate memory, visuospatial construction, language, attention, and delayed memory among VM patients. Notably, the Trail Making Test and Stroop Color-Word Test revealed compromised processing speed and executive function cognitive domains. The anti-saccadic task highlighted significantly elevated anti-saccadic latency and frequency of direction errors in vestibular migraine patients. Symptom severity, illness duration, and episode frequency in VM patients positively correlated with counter-scanning errors and negatively correlated with cognitive performance across diverse cognitive domains. Conclusion VM patients exhibit cognitive decline across multiple cognitive domains during the interictal period. This cognitive impairment may not be fully reversible, underscoring its potential clinical significance for cognitive management in VM patients. The sensitivity of anti-saccade tasks to the cognitive status of VM patients positions them as promising objective indicators for diagnosis, intervention, and evaluation of cognitive impairment effects in VM in future applications.
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Affiliation(s)
- Lingmei Lu
- Department of Neurology, Qidong People’s Hospital/Affiliated Qidong Hospital of Nantong University, Nantong, China
| | - Wenyu Ni
- Department of Endocrinology, Qidong People’s Hospital/Affiliated Qidong Hospital of Nantong University, Nantong, China
| | - Yin Liu
- Dizziness Clinic, Jilin Provincial Academy of Chinese Medicine Sciences, Changchun, China
| | - Li Sun
- Dizziness Clinic, Jilin Provincial Academy of Chinese Medicine Sciences, Changchun, China
| | - Fei Li
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Li J, Cheng Q, Leng Y, Ma H, Yang F, Liu B, Fan W. Neuroimaging Insights: Structural Changes and Classification in Ménière's Disease. Ear Hear 2024:00003446-990000000-00280. [PMID: 38783421 DOI: 10.1097/aud.0000000000001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES This study aimed to comprehensively investigate the neuroanatomical alterations associated with idiopathic Ménière's disease (MD) using voxel-based morphometry and surface-based morphometry techniques. The primary objective was to explore nuanced changes in gray matter volume, cortical thickness, fractal dimension, gyrification index, and sulcal depth in MD patients compared with healthy controls (HC). Additionally, we sought to develop a machine learning classification model utilizing these neuroimaging features to effectively discriminate between MD patients and HC. DESIGN A total of 55 patients diagnosed with unilateral MD and 70 HC were enrolled in this study. Voxel-based morphometry and surface-based morphometry were employed to analyze neuroimaging data and identify structural differences between the two groups. The selected neuroimaging features were used to build a machine learning classification model for distinguishing MD patients from HC. RESULTS Our analysis revealed significant reductions in gray matter volume in MD patients, particularly in frontal and cingulate gyri. Distinctive patterns of alterations in cortical thickness were observed in brain regions associated with emotional processing and sensory integration. Notably, the machine learning classification model achieved an impressive accuracy of 84% in distinguishing MD patients from HC. The model's precision and recall for MD and HC demonstrated robust performance, resulting in balanced F1-scores. Receiver operating characteristic curve analysis further confirmed the discriminative power of the model, supported by an area under the curve value of 0.92. CONCLUSIONS This comprehensive investigation sheds light on the intricate neuroanatomical alterations in MD. The observed gray matter volume reductions and distinct cortical thickness patterns emphasize the disease's impact on neural structure. The high accuracy of our machine learning classification model underscores its diagnostic potential, providing a promising avenue for identifying MD patients. These findings contribute to our understanding of MD's neural underpinnings and offer insights for further research exploring the functional implications of structural changes.
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Affiliation(s)
- Jing Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- These authors contributed equally to this work and share their first authorship
| | - Qing Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- These authors contributed equally to this work and share their first authorship
| | - Yangming Leng
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Ma
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bo Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Smith LJ, Wilkinson D, Bodani M, Surenthiran SS. Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Front Neurol 2024; 15:1159174. [PMID: 38304077 PMCID: PMC10830645 DOI: 10.3389/fneur.2024.1159174] [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: 02/05/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.
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Affiliation(s)
- Laura J. Smith
- Centre for Preventative Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - David Wilkinson
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - Mayur Bodani
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
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Halmágyi GM, Akdal G, Welgampola MS, Wang C. Neurological update: neuro-otology 2023. J Neurol 2023; 270:6170-6192. [PMID: 37592138 PMCID: PMC10632253 DOI: 10.1007/s00415-023-11922-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.
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Affiliation(s)
- Gábor M Halmágyi
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
- Central Clinical School, University of Sydney, Sydney, Australia.
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
- Neurosciences Department, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Miriam S Welgampola
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Chao Wang
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
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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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Grove CR, Klatt BN, Wagner AR, Anson ER. Vestibular perceptual testing from lab to clinic: a review. Front Neurol 2023; 14:1265889. [PMID: 37859653 PMCID: PMC10583719 DOI: 10.3389/fneur.2023.1265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.
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Affiliation(s)
- Colin R. Grove
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation School of Medicine, Emory University, Atlanta, GA, United States
| | - Brooke N. Klatt
- Physical Therapy Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Eric R. Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, United States
- Physical Therapy Department, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
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7
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Van Hecke R, Danneels M, Deconinck FJA, Dhooge I, Leyssens L, Van Acker E, Van Waelvelde H, Wiersema JR, Maes L. A cross-sectional study on the neurocognitive outcomes in vestibular impaired school-aged children: are they at higher risk for cognitive deficits? J Neurol 2023; 270:4326-4341. [PMID: 37209128 DOI: 10.1007/s00415-023-11774-3] [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: 02/20/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
This study aimed to assess if children with a vestibular impairment (VI) are more prone to have neurocognitive deficits compared to typically developing (TD) peers, taking into account important confounding factors with hearing loss being the most important. The neurocognitive performance of fifteen VI children (6-13 years old) was compared to that of an age-, handedness- and sex-weighted group of TD peers (n = 60). Secondly, their performance was also compared to matched groups of TD and hearing impaired (HI) children to evaluate the involvement of HI. The protocol comprises cognitive tests assessing response inhibition, emotion recognition, visuospatial memory, selective and sustained attention, visual memory and visual-motor integration.Based on the results, the VI group had significantly reduced scores on 'social cognition' (p = 0.018), 'executive functions' (p < 0.01), and 'perceptual-motor functioning' (p = 0.020) compared to their TD and HI peers. For the categories 'complex attention' and 'learning and memory' no differences could be observed. Analogous to the findings of previous literature, the symptoms of a VI are often not limited to the primary functions of the system, but also comprise an impact on emotional and cognitive performance. Therefore, more holistic rehabilitation approaches should be encouraged, with a screening and attention for cognitive, emotional and behavioral dysfunctions in the vestibular population. Since this is one of the first studies to investigate the involvement of a VI in a child's cognitive development, these findings support the need for studies further characterizing the impact of a VI, the underlying pathophysiology and the effect of different rehabilitation procedures.
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Affiliation(s)
- Ruth Van Hecke
- Department of Rehabilitation Sciences-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium.
| | - Maya Danneels
- Department of Rehabilitation Sciences-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium
| | - Frederik J A Deconinck
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology-Corneel, Ghent University Hospital, Heymanslaan 10, 9000, Ghent, Belgium
- Department of Head and Skin-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium
| | - Laura Leyssens
- Department of Rehabilitation Sciences-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium
| | - Emmely Van Acker
- Department of Rehabilitation Sciences-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium
| | - Hilde Van Waelvelde
- Department of Rehabilitation Sciences-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology-Henri, Ghent University, Dunantlaan 2, 9000, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences-Corneel, Ghent University, Heymanslaan 10, 9000, Ghent, Belgium
- Department of Otorhinolaryngology-Corneel, Ghent University Hospital, Heymanslaan 10, 9000, Ghent, Belgium
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