Tobener Elizabeth, Searer Ashlee, Doettl Steven, Plyler Patrick
Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee.
J Am Acad Audiol. 2023 Feb;34(1-02):11-18. doi: 10.1055/s-0042-1760437. Epub 2024 Sep 17.
When performing oculomotor testing during standard videonystagmography (VNG), the vestibular system is not actively stimulated. Therefore, responses are generated from the cerebellum, brainstem, and oculomotor tract. Many patients seen for vestibular testing fall outside of the standard age norms, making it difficult to determine whether an abnormal finding is due to age or oculomotor dysfunction.
The purpose of this study was to further evaluate the effect of age on a standard clinical VNG oculomotor test battery consisting of saccades, smooth pursuit, and optokinetic (OPK) testing.
This is a cross-sectional, between-group prospective study comparing oculomotor tests between age groups.
Twenty-one older adults between the ages of 60 and 90 years with no history of central or peripheral vestibular dysfunction were included in the study. Previously collected data from 29 children aged 4 to 6 years and 33 adults aged 20 to 60 years were also included.
Participants completed oculomotor testing using infrared goggles consisting of saccades, smooth pursuit, and OPK. Statistical analyses were completed using multivariate analysis of variance and analysis of variance and follow-up analysis when indicated.
Significant group differences were noted for saccade latency and speed, smooth pursuit gain, and OPK gain and speed. Children and older adults demonstrated longer saccade latencies compared with the controls, and older adults exhibited slower saccade speed than the controls and children. These results also indicated that smooth pursuit gain was reduced for children and older adults compared with controls, and gain decreased across all groups as frequency increased. Analyses of OPK results indicated older adults had reduced gain and speed compared with the children and control group.
The findings of prolonged saccade latencies and reduced smooth pursuit gain in both children and older adults suggest possible cerebellar rather than attentional effects. However, other findings such as reduced saccade speed and reduced OPK gain were noted only in the older adults, which suggests oculomotor degeneration and/or insufficient coverage of the visual field during testing, respectively. These results also indicate the importance of age-specific normative data for use in clinical oculomotor testing.
在标准视频眼震图（VNG）检查期间进行动眼神经测试时，前庭系统未受到主动刺激。因此，反应由小脑、脑干和动眼神经传导束产生。许多前来进行前庭测试的患者超出了标准年龄范围，这使得难以确定异常结果是由年龄还是动眼神经功能障碍所致。
本研究的目的是进一步评估年龄对由扫视、平稳跟踪和视动（OPK）测试组成的标准临床VNG动眼神经测试组的影响。
这是一项横断面、组间前瞻性研究，比较不同年龄组之间的动眼神经测试。
本研究纳入了21名年龄在60至90岁之间、无中枢或外周前庭功能障碍病史的老年人。还纳入了先前收集的29名4至6岁儿童和33名20至60岁成年人的数据。
参与者使用红外护目镜完成了包括扫视、平稳跟踪和OPK的动眼神经测试。在需要时，使用多变量方差分析、方差分析和后续分析完成统计分析。
在扫视潜伏期和速度、平稳跟踪增益以及OPK增益和速度方面发现了显著的组间差异。与对照组相比，儿童和老年人的扫视潜伏期更长，老年人的扫视速度比对照组和儿童慢。这些结果还表明，与对照组相比，儿童和老年人的平稳跟踪增益降低，并且随着频率增加，所有组的增益均降低。OPK结果分析表明，与儿童和对照组相比，老年人的增益和速度降低。
儿童和老年人中扫视潜伏期延长和平稳跟踪增益降低的结果表明可能存在小脑效应而非注意力效应。然而，其他结果，如扫视速度降低和OPK增益降低，仅在老年人中出现，这分别表明动眼神经退变和/或测试期间视野覆盖不足。这些结果还表明了年龄特异性规范数据在临床动眼神经测试中的重要性。
