Vestibular contribution to spatial orientation and navigation

Zwergal, Andreas; Grabova, Denis; Schöberl, Florian

doi:10.1097/wco.0000000000001230

Cited by 6 publications

(1 citation statement)

References 53 publications

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“…In addition, central pathologies may display a higher caloric response, based on disinhibition of cortico-cerebellar networks. At first sight, the finding of reduced peripheral vestibular function in cognitively unimpaired patients seems to partially contradict the previously reported deficits in visuo-spatial domains in patients with bilateral vestibulopathy [ 30 ]. However, these deficits in single cognitive subdomains are rather mild and may not be reflected optimally by MoCA screening.…”

Section: Discussioncontrasting

confidence: 57%

Evaluation of a multimodal diagnostic algorithm for prediction of cognitive impairment in elderly patients with dizziness

Felfela,

Jooshani,

Möhwald

et al. 2024

J Neurol

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Background The current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center. Methods One hundred patients (age: 74.7 $$\pm$$ ± 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients’ total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25). Results The linear regression model explained almost half of the variance of patients’ total MoCA score (R2 = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age (β = − 0.75), pathological Romberg’s sign (β = − 1.05), normal caloric test results (β = − 0.8), slower timed-up-and-go test (β = − 0.67), frontal (β = − 0.6) and temporal (β = − 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70–0.98) in distinguishing between cognitively normal and impaired patients. Conclusions The need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center.

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Section: Discussioncontrasting

confidence: 57%

Evaluation of a multimodal diagnostic algorithm for prediction of cognitive impairment in elderly patients with dizziness

Felfela,

Jooshani,

Möhwald

et al. 2024

J Neurol

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Unreliable association between self‐reported sense of direction and peripheral vestibular function

Gerb,

Brandt,

Dieterich

2024

Brain and Behavior

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BackgroundUni‐ or bilateral peripheral vestibular impairment causes objective spatial orientation deficits, which can be measured using pen‐and‐paper‐tests or sensorimotor tasks (navigation or pointing). For patients’ subjective orientation abilities, questionnaires are commonly used (e.g., Santa Barbara sense of direction scale [SBSODS]). However, the relationship between subjective assessment of spatial skills and objective vestibular function has only been scarcely investigated.MethodsA total of 177 patients (mean age 57.86 ± 17.53 years, 90 females) who presented in our tertiary Center for Vertigo and Balance Disorders underwent neuro‐otological examinations, including bithermal water calorics, video head impulse test (vHIT), and testing of the subjective visual vertical (SVV), and filled out the SBSODS (German version). Correlation analyses and linear multiple regression model analyses were performed between vestibular test results and self‐assessment scores. Additionally, groupwise vestibular function for patients with low, average, and high self‐report scores was analyzed.ResultsForty‐two patients fulfilled the diagnostic criteria for bilateral vestibulopathy, 93 for chronic unilateral vestibulopathy (68 unilateral caloric hypofunction and 25 isolated horizontal vestibulo‐ocular reflex deficits), and 42 patients had normal vestibular test results. SBSODS scores showed clear sex differences with higher subjective skill levels in males (mean score males: 4.94 ± 0.99, females 4.40 ± 0.94; Student's t‐test: t‐3.78, p < .001***). No stable correlation between objective vestibular function and subjective sense of spatial orientation was found. A multiple linear regression model could not reliably explain the self‐reported variance. The three patient groups with low, average, and high self‐assessment‐scores showed no significant differences of vestibular function.ConclusionSelf‐reported assessment of spatial orientation does not robustly correlate with objective peripheral vestibular function. Therefore, other methods of measuring spatial skills in real‐world and virtual environments are required to disclose orientation deficits due to vestibular hypofunction.

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