Quantification of Cognitive Dysfunction in Dizzy Patients Using the Neuropsychological Vertigo Inventory

Abstract

Objective: Currently available patient reported outcomes questionnaires for dizzy patients give limited insight into the cognitive dysfunction patients often report. Using the newly developed English version of the neuropsychological vertigo inventory (NVI), we aimed to quantify the cognitive impairment of dizzy patients. Study Design: Prospective cohort study. Setting: Tertiary neurotology clinic. Patients: Adults with vestibular diagnoses seen between June 2018 and October 2018. Patients with neurologic disorders affecting cognition were excluded. Interventions: None. Main Outcome Measure: NVI score. Secondary measures: dizziness handicap inventory (DHI) score, cognitive failure questionnaire (CFQ) score, 20-item short form health survey scores (SF20). Results: Of 67 subjects, 13 had BPPV, 11 had Menière's disease (MD), and 20 had vestibular migraine (VM). VM patients were significantly younger (43.5 versus 61.1 yrs, p = 0.016), and had significantly higher NVI (67.5 versus 51.0, p = 0.040) scores than BPPV patients. MD patients had significantly higher CFQ scores (44.8 versus 23.4, p = 0.015) than BPPV patients. NVI scores were similar between MD (67.3) and VM (67.5) patients (p = 1.000). DHI scores were similar for all patients (p = 0.102). NVI scores were highly correlated to CFQ scores (r = 0.864, p < 0.001). Conclusions: VM patients have levels of cognitive dysfunction similar to MD patients, but greater than BPPV patients. A lack of difference in DHI scores among these patients reflects its limitation in assessing the cognitive domain.

Slovenian Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12), Vertigo (DHI, NVI) and TINNITUS (THI)

“…This is consistent with other studies (32,56). Since the NVI has only recently been developed, to the best of our knowledge no studies have yet been published regarding its test-retest reliability (35,57). Instead, the Slovenian NVI possesses excellent test-retest reliability and contributes significantly to the current literature.…”

Impact of caloric test asymmetry on response to treatment in vestibular migraine

“…It has been reported that in a variety of vestibular disorders, including vestibular migraine, the Dizziness Handicap Inventory consistently failed to identify cognitive dysfunction that was uncovered by the Cognitive Failure Questionnaire. 2 A more comprehensive instrument would require psychometric analyses of how vestibular migraine patients perform on specific items of the Dizziness Handicap Inventory as well as on other relevant cognitive and psychiatric inventories. Of note, the minimal change in Dizziness Handicap Inventory score for a clinical difference has been cited to be 18 points, which is slightly more than the mean difference (15.2 points) that we found in our cohort.…”

“…1 Patients often also complain of neurological and cognitive symptoms such as 'brain fog' and altered motor and sensory function. 2 In a study examining results of the 2008 National Health Interview Survey, it was found that in respondents who had dizziness (11.9 per cent), 23.4 per cent met criteria for vestibular migraine, representing 2.7 per cent of the general population. 3 As a result of overlap with other vestibular disorders such as Ménière's disease, vestibular migraine has only recently received acceptance as a distinct clinical entity, with most recent diagnostic criteria being established in 2012.…”

Pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine

“…31 In addition, it should be noted that while the Dizziness Handicap Inventory may be imperfect, it is also incomplete, because the level of cognitive dysfunction in vestibular migraine patients is not assessed, even though vestibular migraine patients have higher levels of cognitive impairment relative to those with other vestibular disorders. 32 Competing interests. None declared…”