Vertigo/Vestibular Disorders and Cognitive Impairment in the Elderly

Editors

Lisheng Yu

Peking University People's Hospital

David Z He

School of Medicine, Creighton University

Jun Yang

Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine

Dan Zhang

Department of Psychology, School of Social Sciences, Tsinghua University

Yi Li

Beijing Tongren Hospital, Capital Medical University

Impact

PV neurons project to the contralateral MVN. (A) Schematic illustration of AAV-retro-CMV-DIO-EGFP injection in unilateral MVN of PV-Cre mice to trace the soma in contralateral MVN. (B) Representative photomicrographs showing EGFP-expression PV neurons in bilateral MVNs after virus injection. Arrows (in white) indicate PV neurons. Scale bar, top, 200 μm; bottom, 50 μm. (C) Quantification the distribution of bilateral MVNs PV neurons, n = 3 mice. (D) Schematic illustration of PV neurons in MVN.

Original Research

08 November 2023

Parvalbumin-positive neurons in the medial vestibular nucleus contribute to vestibular compensation through commissural inhibition

Yuejin Zhang

, 5 more and

Bo Liu

2,186 views

1 citations

Seven typing of pure-tone audiogram. (a) Low frequency falling (LFF): The difference between the poor low frequency threshold (i.e., the larger listening threshold in 250 Hz and 500 Hz) and the good high frequency threshold (i.e., the smaller listening threshold in 4 kHz and 8 kHz) is greater than 15 dB, and the former is greater than the latter. (b) High frequency steeply sloping (HFSS): The difference between the mean value of 500 Hz and 1 kHz air conduction hearing thresholds and the average values of high frequency (4 kHz and 8 kHz) air conduction hearing thresholds is greater than 30 dB, and the former was smaller than the latter. (c) High frequency gently sloping (HFGS): The difference between the average values of air conduction threshold (500 Hz and 1 kHz) and the average value of high frequency air conduction thresholds (4 kHz and 8 kHz) is greater than 15 dB, meanwhile less than or equal to 29 dB, and the former is less than the latter. (d) Flat: The difference between the average values of the three air conduction hearing thresholds(low-frequency, medium-frequency, high-frequency) is less than 15 dB. (e) Mid frequency Reverse U-shape (MFRU): The difference between the medium frequency optimal threshold (i.e., the smaller threshold in 1 kHz and 2 kHz), the low frequency optimal threshold (i.e., the smaller threshold in 250 Hz and 500 Hz) and the high frequency optimal threshold (i.e., the smaller threshold in 4 kHz and 8 kHz) is more than 15 dB, and the medium frequency is better than (the threshold is less than) the low frequency and high frequency. (f) Mid frequency U-shape (MFU): The difference between the worst listening threshold of medium frequency (the larger threshold of 1 kHz and 2 kHz), the poor listening threshold of low frequency (the larger threshold of 250 Hz and 500 Hz) and the poor threshold of high frequency (the larger listening threshold of 4 kHz and 8 kHz) is more than 15 dB, and the medium frequency less than (the threshold is greater than) low frequency and high frequency. (g) High frequency notching (HFN): The threshold of 4 kHz is the worst, and the difference between 4kHz and other frequency thresholds is greater than 15 dB.

Original Research

15 September 2023

Investigation of hearing loss in elderly vertigo and dizziness patients in the past 10 years

Qian Wang

, 6 more and

Fei Ji

3,667 views

2 citations

Comparisons of visuospatial cognitive performances between subgroups during the acute and recovery phases with (A) Position Discrimination test, (B) Number Location test, (C) Cube Analysis test, (D) Block Design test, (E) Block Design test-Plus, (F) Corsi Block Tapping test-Block Span, and (G) Corsi Block Tapping test-Total Score. Rt. AUVP, right-sided acute unilateral vestibulopathy; Lt. AUVP, left-sided acute unilateral vestibulopathy. **Indicates p < 0.01; ***indicates p < 0.001. Statistical significance was calculated using the Mann–Whitney U test with a Bonferroni-adjusted significance level of 0.017 (0.05/3).

Original Research

14 September 2023

Visuospatial cognition in acute unilateral peripheral vestibulopathy

Sun-Young Oh

, 5 more and

Marianne Dieterich

1,931 views

9 citations

Modular management flowchart for VN. The flowchart presented in this paper represents a logical sequence of modules that can be used to manage vestibular neuritis effectively. The design incorporates key components such as vestibular rehabilitation, pharmacological interventions, lifestyle modifications, and psychological support. Each module is tailored to address specific needs and challenges encountered during different stages of the condition. VN, Vestibular neuritis; SN, Spontaneous nystagmus; VR, Vestibular rehabilitation; AVS, Acute vestibular syndrome; and VC, Vestibular compensation.

Original Research

14 September 2023

Optimizing vestibular neuritis management with modular strategies

Fei Li

, 7 more and

Sulin Zhang

2,508 views

2 citations

Bar chart depicting the DHI subscales and VAS scores of two groups at pre- and post-treatments. *p-value < 0.05; **p-value < 0.01; ***p-value < 0.001. DHI-P indicates physical subscale; DHI-F, functional subscale; DHI-E, emotional subscale; VAS, visual analog scale; RD, residual dizziness; NRD, no residual dizziness.

Original Research

31 August 2023

Associations between cognition, anxiety, depression, and residual dizziness in elderly people with BPPV

Jin Sun

, 9 more and

Jianyong Chen

3,428 views

10 citations

Vestibular threshold motions and the two quiet stance balance conditions focused upon herein are shown. (A) Each vestibular threshold was measured using a direction recognition task, with motion stimuli delivered using a MOOG 6DOF motion platform. Motion profiles of a specific trajectory and frequency were used to identify measures of noise with primary contributions from each vestibular end-organ or end-organ pair. Black arrows show the plane of motion for each threshold. (B) Center of pressure data were collected from force plates during condition 4 of the Modified Romberg Balance Test (MRBT-4; eyes closed, on foam) and a modified condition 5 of the Sensory Organization Test (2D-SOT-5; eyes closed, on a support surface sway referenced in both ML and AP planes) (Wagner and Merfeld, 2023).

Original Research

10 August 2023

Increased roll tilt thresholds are associated with subclinical postural instability in asymptomatic adults aged 21 to 84 years

Andrew R. Wagner

, 1 more and

Daniel M. Merfeld

2,483 views

5 citations

Original Research

01 August 2023

The effect of accompanying anxiety and depression on patients with different vestibular syndromes

Shuai Feng

and

Jian Zang

Objective: This study aims to investigate the situation of vertigo disorder combined with anxiety and depression in patients with different types of vestibular syndrome.

Methods: A total of 330 patients with vertigo in otolaryngology outpatient department were selected, and clinical information such as age, gender, and scores of Dizziness handicap inventory (DHI), Generalized anxiety disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were collected. Analyzed the differences among acute vestibular syndrome (AVS), episodic vestibular syndrome (EVS) and chronic vestibular syndrome (CVS) in terms of age, gender, comorbid anxiety and depression, and the multivariate ordered logistic regression analysis was used to evaluate the relationship between the above factors and the degree of vertigo disorder.

Results: The three types of vestibular syndrome had no significant difference in age composition, sex composition, anxiety and depression. There was no significant difference in the probability of anxiety and depression among vertigo patients of different ages and genders. The total score of vertigo disorder and each sub-item score were higher in patients with anxiety and depression. Patients with anxiety mainly manifested in EVS and CVS, while patients with depression mainly manifested in EVS and AVS. The probability of increased vertigo in anxious patients was 4.65 times that of non-anxious patients, and the probability of increased vertigo in depressed patients was 3.49 times that of non-depressed patients. Age and gender had no statistically significant effect on the degree of vertigo. In patients with EVS, anxiety and depression had a significant effect on the degree of vertigo; in patients with CVS, anxiety had a significant effect on the degree of vertigo, but depression had no significant effect.

Conclusion: Age and gender do not significantly affect the degree of vertigo disorder and mental state in various vestibular syndromes. Instead, anxiety and depression are the risk factors for aggravating the degree of vertigo disorder, and manifest differently in each type of vestibular syndrome. Therefore, it is necessary to use a quick scale tool to conduct a standardized screening of the psychological status of patients with vertigo.

5,494 views

11 citations

Flowchart of the algorithms and results of this subtype-determining questionnaire in geriatrics. PC, posterior canal; AC, anterior canal; GEO, geotropic; APO, apogeotropic.

Original Research

20 June 2023

The reliability of a subtype-determining questionnaire in efficient benign paroxysmal positional vertigo diagnosis in geriatrics

Yichen Wan

, 1 more and

Jianjun Sun

1,900 views

0 citations

Original Research

24 May 2023

Relationship between cognitive dysfunction and the promoter methylation of PER1 and CRY1 in patients with cerebral small vessel disease

Yiwen Xu

, 6 more and

Xiaozhu Shen

Electrophoretic diagram of test samples. (A) PER1; (B) CRY1. After PCR amplification, the amplified products were subjected to 2.0% agarose gel electrophoresis, and the images were recorded by the gel image analysis system. The presence of partial methylation in the DNA promoter region was represented by “M”, while the absence of methylation was represented by “U”.

Background and purpose: The prevalence of cerebral small vessel disease (CSVD) is increasing due to the accelerating global aging process, resulting in a substantial burden on all countries, as cognitive dysfunction associated with CSVD is also on the rise. Clock genes have a significant impact on cognitive decline and dementia. Furthermore, the pattern of DNA methylation in clock genes is strongly associated with cognitive impairment. Thus, the aim of this study was to explore the connection between DNA promoter methylation of PER1 and CRY1 and cognitive dysfunction in patients with CSVD.

Methods: We recruited patients with CSVD admitted to the Geriatrics Department of the Lianyungang Second People’s Hospital between March 2021 and June 2022. Based on their Mini-Mental State Examination score, patients were categorized into two groups: 65 cases with cognitive dysfunction and 36 cases with normal cognitive function. Clinical data, 24-h ambulatory blood pressure monitoring parameters, and CSVD total load scores were collected. Moreover, we employed methylation-specific PCR to analyze the peripheral blood promoter methylation levels of clock genes PER1 and CRY1 in all CSVD patients who were enrolled. Finally, we used binary logistic regression models to assess the association between the promoter methylation of clock genes (PER1 and CRY1) and cognitive dysfunction in patients with CSVD.

Results: (1) A total of 101 individuals with CSVD were included in this study. There were no statistical differences between the two groups in baseline clinical data except MMSE and AD8 scores. (2) After B/H correction, the promoter methylation rate of PER1 was higher in the cognitive dysfunction group than that in the normal group, and the difference was statistically significant (adjusted p < 0.001). (3) There was no significant correlation between the promoter methylation rates of PER1 and CRY1 in peripheral blood and circadian rhythm of blood pressure (p > 0.05). (4) Binary logistic regression models showed that the influence of promoter methylation of PER1 and CRY1 on cognitive dysfunction were statistically significant in Model 1 (p < 0.001; p = 0.025), and it still existed after adjusting for confounding factors in Model 2. Patients with the promoter methylation of PER1 gene (OR = 16.565, 95%CI, 4.057–67.628; p < 0.001) and the promoter methylation of CRY1 gene (OR = 6.017, 95%CI, 1.290–28.069; p = 0.022) were at greater risk of cognitive dysfunction compared with those with unmethylated promoters of corresponding genes in Model 2.

Conclusion: The promoter methylation rate of PER1 gene was higher in the cognitive dysfunction group among CSVD patients. And the hypermethylation of the promoters of clock genes PER1 and CRY1 may be involved in affecting cognitive dysfunction in patients with CSVD.

2,587 views

7 citations

Original Research

25 May 2023

The effect of vascular risk factors on the efficacy of endolymphatic sac decompression surgery for Meniere’s disease: a retrospective cohort study

Yiling Li

, 4 more and

Zhanguo Jin

1,452 views

0 citations

Review

20 April 2023

Research progress on vestibular dysfunction and visual–spatial cognition in patients with Alzheimer’s disease

Yan Huang

, 3 more and

Enyan Yu

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.

4,994 views

18 citations

Original Research

10 January 2023

Early detection and monitoring of hearing loss in vestibular migraine: Extended high-frequency hearing

Zhaoqi Guo

, 5 more and

Sulin Zhang

Background: Vestibular migraine (VM) presents mainly with recurrent vestibular symptoms and migraine. A great number of patients with VM have cochlea symptoms such as tinnitus, hearing loss.

Methods: A cross-sectional study was conducted on patients with definite VM (dVM) and probable VM (pVM) who met the diagnostic criteria. Auditory-vestibular tests and psychological assessments were performed. Logistic regression was used to evaluate the predictive effect of EHF pure tone audiometry (PTA) for standard frequency (SF) hearing loss.

Results: Fifteen patients with pVM and 22 patients with dVM were recruited. Overall, the two most vertigo types were vestibulo-visual symptoms (83.78%) and internal vertigo (54.05%). A vertigo attack persisted for <5 min in approximately 57% of patients, compared with 5 min to 72 h in 43%, and lasted longer than 72 h in 8%. Approximately 87% of patients had psychological disorders. Most patients with VM (92%) suffered from some degree of EHF hearing impairment, and 68% had SF hearing loss, which is substantially higher than their complaints (43%). Moreover, the mean EHF hearing threshold cutoff value (57 dB HL) worked well in predicting SF hearing loss (area under curve, AUC, 0.827), outperforming distortion product optoacoustic emission (AUC, 0.748).

Conclusion: VM has a wide range of clinical manifestations. Hearing loss had a considerably higher rate compared to actual complaints. Moreover, patients with VM tended to have bilateral EHF and high-frequency hearing loss. The effectiveness of the mean EHF hearing threshold cutoff value in predicting hearing loss supported its use in the early detection of hearing loss and monitoring disease progression.

4,069 views

5 citations