Department of Psychology, University of Bern, Bern, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
J Neurol. 2024 Jun;271(6):3291-3308. doi: 10.1007/s00415-024-12267-7. Epub 2024 Mar 11.
Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.
先前的研究表明，外周前庭功能障碍（PVD）患者会出现非空间认知问题，包括执行功能障碍。然而，先前评估执行功能的研究结果存在冲突，仅限于单一的执行成分，且评估结果受到其他认知功能的干扰。我们在一项大型 PVD 患者样本（34 例双侧、29 例慢性单侧、20 例急性单侧）中比较了一套全面的执行功能测试，这些患者与健康对照组配对，以年龄、性别和教育程度进行匹配。我们使用经过验证的神经心理学测试来评估基本和复杂的执行功能。双侧 PVD 患者在言语启动和工作记忆广度方面的表现均不如对照组，而其他执行功能则保持不变。慢性单侧 PVD 患者的执行功能与对照组相当。急性单侧 PVD 患者在与双侧 PVD 患者相同的测试中表现不如对照组（言语启动、工作记忆广度）；然而，在对多个比较进行校正后，急性 PVD 患者的这种影响减弱了。听力损失和情感障碍并没有影响我们的结果。前庭相关变量（疾病持续时间、症状、头晕障碍、去传入程度和代偿）并不能预测双侧 PVD 患者的言语启动或工作记忆广度。结果表明，双侧 PVD 不仅表现为解决空间任务困难，还导致更普遍的神经认知缺陷。这一理解对于涉及诊断和治疗 PVD 患者的多学科工作组（例如神经耳科医生、神经科医生、听力学家）非常重要。我们建议对 PVD 患者进行执行功能障碍筛查，如果有需要，为他们提供认知训练或心理教育支持。
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