Psychometric Properties of Cognitive-Motor Dual-Task Studies With the Aim of Developing a Test Protocol for Persons With Vestibular Disorders: A Systematic Review

Abstract

Objectives: Patients suffering from vestibular disorders (VD) often present with impairments in cognitive domains such as visuospatial ability, memory, executive function, attention, and processing speed. These symptoms can be attributed to extensive vestibular projections throughout the cerebral cortex and subcortex on the one hand, and to increased cognitive-motor interference (CMI) on the other hand. CMI can be assessed by performing cognitive-motor dual-tasks (DTs). The existing literature on this topic is scarce and varies greatly when it comes to test protocol, type and degree of vestibular impairment, and outcome. To develop a reliable and sensitive test protocol for VD patients, an overview of the existing reliability and validity studies on DT paradigms will be given in a variety of populations, such as dementia, multiple sclerosis, Parkinson’s disease, stroke, and elderly. Design: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive literature search on psychometric properties of cognitive-motor DTs was run on MEDLINE, Embase, and Cochrane Databases. The studies were assessed for eligibility by two independent researchers, and their methodological quality was subsequently evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Results and Conclusions: Thirty-three studies were included in the current review. Based on the reliability and validity calculations, including a static as well as dynamic motor task seems valuable in a DT protocol for VD patients. To evoke CMI maximally in this population, both motor tasks should be performed while challenging the vestibular cognitive domains. Out of the large amount of cognitive tasks employed in DT studies, a clear selection for each of these domains, except for visuospatial abilities, could be made based on this review. The use of the suggested DTs will give a more accurate and daily life representation of cognitive and motor deficiencies and their interaction in the VD population.

2BALANCE: a cognitive-motor dual-task protocol for individuals with vestibular dysfunction

“…Similarly, a higher sensitivity using dynamic motor tasks compared with static motor tasks in DT setting has also been observed in various other populations presenting with cognitive and motor deficiencies. 35 These studies highlight the lack of a standardised DT protocol in persons with VD.…”

“…Additionally, the rationale for the chosen cognitive task was often unclear. 35 Serial subtraction tasks or naming tasks were included in most DTs. 27 28 36–38 These tasks are user friendly and have been routinely used in other populations; however, a clear rationale for their use is lacking in the vestibular population.…”

“…For the motor task, static balance was assessed most frequently, 28 36 39 40 whereas, interestingly, dynamic postural DTs seemed to be most sensitive in evoking CMI in patients with VD as well as other populations. 35 However, these dynamic postural tasks were combined with easy to administer cognitive tasks such as serial subtraction and naming tasks. 27 37 38 …”

“…Because of the heterogeneity of the used test protocols and their outcomes, Danneels et al 35 performed a systematic review assessing test–retest reliability and validity of DT protocols in a variety of populations showing similarities with the VD population, such as Parkinson’s disease, multiple sclerosis, Alzheimer’s disease and elderly fallers and non-fallers. 35 This review article suggested combining both a static and dynamic motor task with the following cognitive domains: visuospatial abilities, memory, executive function, processing speed and attention. Based on these findings, the 2BALANCE protocol for the VD population was developed and will be presented below.…”

Making the Case for Research on Disease-Modifying Treatments to Tackle Post-lingual Progressive Sensorineural Hearing Loss

“…Because of its close relationship to the cochlea, the vestibular system has also been implicated in cognitive decline (27). However, because earlier studies did not take a potentially concomitant sensorineural hearing loss in to account or were performed in a static condition, further research will be necessary to identify its role (28)(29)(30)(31)(32).…”