Semenov Yevgeniy R, Bigelow Robin T, Xue Qian-Li, du Lac Sascha, Agrawal Yuri
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology and Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
J Gerontol A Biol Sci Med Sci. 2016 Feb;71(2):243-50. doi: 10.1093/gerona/glv069. Epub 2015 Jul 28.
Vestibular function declines with age, and emerging evidence suggests that vestibular loss is associated with cognitive impairment. Whether vestibular dysfunction is associated with age-related cognitive decline is unknown.
We used data from the 1999-2002 National Health and Nutrition Examination Surveys to evaluate the influence of vestibular function on cognitive performance in a nationally representative sample of U.S. adults aged ≥60 years (n = 1,303). Vestibular function was measured with the modified Romberg test, and cognitive function was measured by the digit symbol substitution (DSS) score test. We also developed structural equation models (SEMs) to explore whether vestibular dysfunction and associated cognitive impairment mediate the effect of age on falls and activities of daily living (ADL) difficulty.
Vestibular dysfunction was present in 58% of the study population. In multivariate analyses, vestibular dysfunction was associated with a 3.4-point lower DSS score (95% confidence interval: -5.2, -1.6; p < .0001), equivalent to the effect of 5 years of age. Vestibular dysfunction was also associated with a significantly higher odds of ADL difficulty (p = .001), and with a 2.6-fold increase in the odds of falling (p = .017). SEMs suggested that vestibular function mediates 14.3% of the effect of age on cognitive performance. Further SEMs suggested that lower cognitive performance mediates the association between vestibular loss and ADL difficulty as well as falls.
This study suggests that vestibular dysfunction partially mediates the association between age and cognitive impairment. Moreover, the cognitive impairment that results from vestibular loss may contribute to ADL difficulty and falls in older individuals.
前庭功能随年龄下降，新出现的证据表明前庭功能丧失与认知障碍有关。前庭功能障碍是否与年龄相关的认知衰退有关尚不清楚。
我们使用了1999 - 2002年国家健康与营养检查调查的数据，以评估前庭功能对年龄≥60岁的美国成年人全国代表性样本（n = 1303）认知表现的影响。采用改良罗姆伯格试验测量前庭功能，用数字符号替换（DSS）评分测试测量认知功能。我们还建立了结构方程模型（SEM），以探讨前庭功能障碍及相关认知障碍是否介导年龄对跌倒和日常生活活动（ADL）困难的影响。
58%的研究人群存在前庭功能障碍。在多变量分析中，前庭功能障碍与DSS评分降低3.4分相关（95%置信区间：-5.2，-1.6；p <.0001），相当于5岁年龄的影响。前庭功能障碍还与ADL困难的几率显著升高相关（p =.001），跌倒几率增加2.6倍（p =.017）。结构方程模型表明，前庭功能介导了年龄对认知表现影响的14.3%。进一步的结构方程模型表明，较低的认知表现介导了前庭功能丧失与ADL困难以及跌倒之间的关联。
本研究表明前庭功能障碍部分介导了年龄与认知障碍之间的关联。此外，前庭功能丧失导致的认知障碍可能导致老年人ADL困难和跌倒。
