Department of Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
University Department of Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
JAMA Otolaryngol Head Neck Surg. 2022 Aug 1;148(8):731-739. doi: 10.1001/jamaoto.2022.1303.
Recent literature suggests there may be a significant effect of the vestibular system on cognition and visuospatial processing. Given the increasing prevalence of dementia and individuals at risk for it, exploring possible modifiable risk factors, including vestibular dysfunction, is vital.
To explore the association of bilateral vestibulopathy (BV) with cognitive function in older adults, taking hearing status into account, and to explore multiple vestibular characteristics and their potential associations with cognition in patients with BV.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed older adults (age 55-84 years) with diagnosed BV from a single center using baseline measurements from the Gehoor, Evenwicht en Cognitie (GECKO) study, an ongoing prospective longitudinal cohort study. Each participant was individually matched with a healthy control based on age, sex, and hearing performance. Data were analyzed in January 2022.
The primary outcome measure was cognition, measured by the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing-Impaired Individuals (RBANS-H).
A total of 68 patients were assessed, including 34 patients with BV (mean [SD] age, 63.3 [6.0] years; 18 [53%] men) matched with 34 control individuals without BV. Overall, participants with BV had a clinically meaningful lower score on the RBANS-H total scale compared with those without BV (mean [SD] score, 98.62 [12.70] vs 105.91 [11.03]). This decline was most pronounced in the subdomains of immediate memory (mean [SD] score, 107.74 [10.66] vs 112.26 [10.66]), visuospatial cognition (mean [SD] score, 90.06 [13.34] vs 100.47 [13.91]), and attention (mean [SD] score, 94.79 [16.39] vs 102.06 [12.97]). There were no differences in language or delayed memory subdomains. Within the BV population, 1 vestibular parameter (the Performance-Oriented Mobility Assessment, in particular the balance subscale) was associated with lower cognitive scores (r32 = 0.51; 95% CI, 0.20 to 0.72; η2 = 0.26). Other vestibular parameters, including measurements of the peripheral vestibular end organ and questionnaires, showed no association.
These findings suggest there was an association between vestibular loss and cognitive impairment. Further research on the causal mechanisms underlying this association and the possible impact of vestibular rehabilitation on cognition is needed.
最近的文献表明，前庭系统可能对认知和视空间处理有显著影响。鉴于痴呆症及其高危人群的患病率不断增加，探索可能的可改变的风险因素，包括前庭功能障碍，至关重要。
探讨双侧前庭病变（BV）与老年人认知功能的关系，并考虑听力状况，探讨 BV 患者的多种前庭特征及其与认知的潜在关联。
设计、地点和参与者：本横断面研究使用正在进行的前瞻性纵向队列研究 Gehoor、Evenwicht en Cognitie（GECKO）研究中的基线测量值，评估了来自单一中心的被诊断为 BV 的老年人（55-84 岁）。每个患者均根据年龄、性别和听力表现与健康对照个体进行个体匹配。数据于 2022 年 1 月进行分析。
主要结局指标为认知功能，通过听力受损个体的重复神经心理状态评估量表（RBANS-H）进行测量。
共评估了 68 名患者，包括 34 名 BV 患者（平均[标准差]年龄 63.3[6.0]岁；18 名[53%]男性）和 34 名无 BV 的匹配对照个体。总体而言，与无 BV 患者相比，BV 患者的 RBANS-H 总分有临床意义上的较低得分（平均[标准差]得分，98.62[12.70] vs 105.91[11.03]）。这种下降在即刻记忆（平均[标准差]得分，107.74[10.66] vs 112.26[10.66]）、视空间认知（平均[标准差]得分，90.06[13.34] vs 100.47[13.91]）和注意力（平均[标准差]得分，94.79[16.39] vs 102.06[12.97]）等亚域最为明显。语言和延迟记忆亚域无差异。在 BV 人群中，1 个前庭参数（表现导向的移动评估，特别是平衡子量表）与较低的认知评分相关（r32=0.51；95%CI，0.20 至 0.72；η2=0.26）。其他前庭参数，包括外周前庭末端器官的测量和问卷调查，均无相关性。
这些发现表明前庭丧失与认知障碍之间存在关联。需要进一步研究这种关联的因果机制以及前庭康复对认知的可能影响。
