Spatial orientation, postural control and the vestibular system in healthy elderly and Alzheimer’s dementia

Abstract

Background While extensive research has been advancing our understanding of the spatial and postural decline in healthy elderly (HE) and Alzheimer’s disease (AD), much less is known about how the vestibular system contributes to the spatial and postural processing in these two populations. This is especially relevant during turning movements in the dark, such as while walking in our garden or at home at night, where the vestibular signal becomes central. As the prevention of falls and disorientation are of serious concern for the medical service, more vestibular-driven knowledge is necessary to decrease the burden for HE and AD patients with vestibular disabilities. Overview of the article The review briefly presents the current “non-vestibular based” knowledge (i.e. knowledge based on research that does not mention the “vestibular system” as a contributor or does not investigate its effects) about spatial navigation and postural control during normal healthy ageing and AD pathology. Then, it concentrates on the critical sense of the vestibular system and explores the current expertise about the aspects of spatial orientation and postural control from a vestibular system point of view. The norm is set by first looking at how healthy elderly change with age with respect to their vestibular-guided navigation and balance, followed by the AD patients and the difficulties they experience in maintaining their balance or during navigation. Conclusion Vestibular spatial and vestibular postural deficits present a considerable disadvantage and are felt not only on a physical but also on a psychological level by all those affected. Still, there is a clear need for more (central) vestibular-driven spatial and postural knowledge in healthy and pathological ageing, which can better facilitate our understanding of the aetiology of these dysfunctions. A possible change can start with the more frequent implementation of the “vestibular system examination/rehabilitation/therapy” in the clinic, which can then lead to an improvement of future prognostication and disease outcome for the patients.

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“…Shared cortical networks may partially explain the correlation between cognitive impairment and gait impairment (Takakusaki, 2023). Spatial navigation and visuospatial abilities, which are potentially impaired in individuals with AD and MCI, may also affected postural control during gait (Cohen and Verghese, 2019;Plácido et al, 2022;Chepisheva, 2023). Several gait markers have been identified in individuals with AD and MCI, including high variability, slow walking speed, and decreased stride length (Yang et al, 2020;Boripuntakul et al, 2022;Lindh-Rengifo et al, 2022).…”