Association of Bilateral Vestibulopathy With and Without Hearing Loss With Cognitive-Motor Interference

Abstract

ImportanceThe past years, evidence suggested that the primary symptoms traditionally associated with bilateral vestibulopathy (BV) do not represent the full picture of this patient population. Recent literature also demonstrated cognitive impairment. However, although multitasking and dual-tasking are widely present in everyday activities, most of these studies assessed cognitive function only in single-task conditions.ObjectiveTo uncover the association of BV with and without hearing loss with cognitive and motor performance and cognitive-motor interference.Design, Setting, and ParticipantsThis prospective case-control study assessed persons with an isolated BV and persons with BV and a concomitant hearing loss compared with a healthy control group. Data were analyzed in December 2022. The study was conducted at Ghent University (Ghent, Belgium). Data collection took place between March 26, 2021, and November 29, 2022.Main Outcomes and MeasuresAll participants completed the 2BALANCE dual-task protocol, comprising a static and a dynamic motor task that was combined with 5 visual cognitive tasks. These cognitive tasks assessed mental rotation, visuospatial memory, working memory, response inhibition (executive function), and processing speed. All cognitive tasks were performed in a single-task condition (while seated) and in a dual-task condition (combined with a static and a dynamic motor task). The static task comprised balancing on a force platform with foam pad, and the dynamic task comprised walking at a self-selected speed on the GAITRite Walkway. Both motor tasks were performed in the single-task and dual-task condition.ResultsNineteen persons with BV and hearing loss (mean [SD] age, 56.70 [10.12] years; 10 women [52.6%]), 22 persons with an isolated BV (mean [SD] age, 53.66 [13.35] years; 7 women [31.8%]), and 28 healthy control participants were included (mean [SD] age, 53.73 [12.77] years; 12 women [42.9%]). Both patient groups had mental rotation and working memory impairment in a single-task condition and slower processing speed when walking (ie, during the dynamic dual-task condition). Additionally, the patient group with hearing loss had impaired visuospatial memory and executive function deficits in single-task and dual-task conditions, while this could only be elicited when performing a motor task in persons with isolated BV (ie, when dual-tasking).Conclusion and RelevanceThe findings of this case-control study suggest an association between vestibular function and cognitive and motor performance, even greater in persons with a concomitant hearing loss than in persons with an isolated BV.

Executive functions in patients with bilateral and unilateral peripheral vestibular dysfunction

“…Impaired working memory span in patients with bilateral PVD confirms results from a previous study [ 23 ]. Using the same task, Danneels et al [ 23 ] found impaired working memory span in patients with bilateral PVD with and without hearing loss.…”

“…Impaired working memory span in patients with bilateral PVD confirms results from a previous study [ 23 ]. Using the same task, Danneels et al [ 23 ] found impaired working memory span in patients with bilateral PVD with and without hearing loss. The mean working memory span of our patients with bilateral PVD ( M = 4.35) is highly comparable to the bilateral patient group with hearing loss in the study of Danneels et al ( M = 4.37) [ 23 ].…”

“…However, patients with bilateral PVD performed equally as healthy controls in a verbal fluency task, a subdomain of initiation [ 101 ]. Inhibition and working memory were found to be reduced in patients with bilateral, chronic unilateral, and acute unilateral PVD [ 1 , 4 , 23 , 26 , 31 , 56 , 70 , 71 , 75 , 77 , 98 ]. Some other studies, however, did not find reduced inhibition or working memory performance in patients with bilateral or chronic unilateral PVD [ 1 , 23 , 75 , 98 ].…”

“…Inhibition and working memory were found to be reduced in patients with bilateral, chronic unilateral, and acute unilateral PVD [ 1 , 4 , 23 , 26 , 31 , 56 , 70 , 71 , 75 , 77 , 98 ]. Some other studies, however, did not find reduced inhibition or working memory performance in patients with bilateral or chronic unilateral PVD [ 1 , 23 , 75 , 98 ]. Cognitive flexibility was reduced in patients with chronic unilateral [ 26 , 31 ], but normal in patients with bilateral [ 101 ] or a mixed sample of bilateral and chronic unilateral PVD [ 74 , 98 ].…”

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

“…Smith ( 48 ) reviewed 19 studies of vestibular cognitive dysfunction which controlled for hearing loss, finding at least some cognitive effects (mostly spatial) were likely to be driven by vestibular dysfunction not hearing loss. Recently, Daneels et al ( 109 ) also evidenced an association between vestibular function and dual-task performance involving cognitive and motor components, while the association held in patients with isolated bilateral vestibulopathy, it was stronger among those with concomitant hearing loss. Moving forward, both hearing and vestibular status should be objectively evaluated (not self-reported) within studies to help establish the relative contribution of each to any observed cognitive dysfunction.…”