Vestibular Physical Therapy in Individuals With Cognitive Impairment: A Theoretical Framework

Klatt, Brooke N; Ries, Julie D.; Dunlap, Pamela M; Whitney, Susan L.; Agrawal, Yuri

doi:10.1097/npt.0000000000000266

Cited by 13 publications

(9 citation statements)

References 56 publications

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“…On the contrary, the effectiveness of vestibular rehabilitation in cognitively impaired subjects, in this case subjects with MCI or dementia due to AD, has not yet been explored. 68 Future prospective interventional studies may look into the potential benefit of customised vestibular rehabilitation in subjects with varying degrees of cognitive decline, which will be supported by current research.…”

Section: Discussionmentioning

confidence: 76%

Impact of hearing loss and vestibular decline on cognition in Alzheimer’s disease: a prospective longitudinal study protocol (Gehoor, Evenwicht en Cognitie, GECkO)

et al. 2020

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IntroductionDementia is a prevalent disease affecting a growing number of the ageing population. Alzheimer’s disease (AD) is the most common cause of dementia. Previous research investigated the link between hearing loss and cognition, and the effect of vestibular dysfunction on cognition. Hearing loss and, to a lesser extent, vestibular decline both result in a decreasing cognitive function. However, their interaction should not be underestimated. The aim of this study is to assess the effect of hearing loss, vestibular decline and their interaction on cognition in people suffering from mild cognitive impairment (MCI) and dementia due to AD (ADD).Methods and analysisWe designed a prospective longitudinal study to assess the effect of hearing loss and vestibular decline on cognition. A total of 100 cognitively impaired elderly (between 55 and 84 years of age), consisting of 60 patients with MCI due to AD and 40 patients with ADD will be included. The control group will consist of individuals with preserved cognition group-matched based on age, hearing level and vestibular function. A comprehensive assessment is performed at baseline, 12-month and 24-month follow-ups. The primary outcome measure is the change in the Repeatable Battery for the Assessment of Neuropsychological Status adjusted for Hearing-impaired individuals total score, a cognitive test battery assessing different cognitive domains. Secondary outcome measures include additional neuropsychological assessments, cortical auditory-evoked potentials, and evaluation of general and disease-specific health-related quality of life. Variables include cognitive, audiological and vestibular evaluation. Variance analyses will assess the effect of hearing loss and vestibular decline on cognition. More precisely, the link between hearing loss and non-spatial cognitive functioning, the effect of vestibular decline on spatial cognition and the impact of both factors on the rate of conversion from MCI due to AD to ADD will be investigated.Ethics and disseminationThe study protocol was approved by the ethical committee of the Antwerp University Hospital on 4 February 2019 with protocol number B300201938949. The findings will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT04385225).

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Section: Discussionmentioning

confidence: 76%

Impact of hearing loss and vestibular decline on cognition in Alzheimer’s disease: a prospective longitudinal study protocol (Gehoor, Evenwicht en Cognitie, GECkO)

et al. 2020

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“…Each weekly set of 4 exercises will be performed 3 times on the day of VT (2 min per task, 8 min per set, ~24 min total for 3 repetitions of the set of exercises). Further detail on vestibular therapy exercises is provided in Reference 35, with explanations for adjustments made to standard VT for individuals with cognitive impairment in Reference 70 [ 35 , 70 ]. Cueing of patients as needed to assist with task completion will be performed, following the VT in AD protocol we recently published [ 71 ].…”

Section: Methodsmentioning

confidence: 99%

Vestibular therapy to reduce falls in people with Alzheimer’s disease: study protocol for a pilot randomized controlled trial

Yesantharao

Rosenberg

et al. 2022

Pilot Feasibility Stud

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Background Falls are highly common in patients with Alzheimer’s disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed. Methods The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer’s Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task). Discussion As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution. Trial registration ClinicalTrial.Gov identifier — NCT03799991. Registered 01 August 2019.

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“…AD is the principal pathology in the world displaying negative impacts on both the health and social ability of patients while inducing considerable economic costs (Dauphinot et al, 2022). AD is one of the greatest health challenges of this century for humanity (DeTure and Dickson, 2019;Klatt et al, 2019;Eftychios et al, 2021). AD is a progressive and devastating neurodegenerative disorder of the brain most often characterized by loss of neurons and synapses.…”

Section: Introductionmentioning

confidence: 99%

“…Physical activity can also improve brain function and memory and may delay the decline in the ability to perform tasks in people who have AD by improving their strength, balance, walking ability, etc. Moderate exercise has been shown to help increase T and decrease C levels in older populations (Blackwood and Martin, 2017;Dawson et al, 2019;Klatt et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Salivary Testosterone and Cortisol Levels in Tunisian Elderly Male Patients With Mild Alzheimer’s Disease. Implications of Musical Therapy And/Or Physical Rehabilitation

Cheour

Chéour²,

Kilani³

et al. 2022

Front. Physiol.

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Changes in salivary testosterone (T) and cortisol (C) levels were assessed in elderly Tunisian male patients with mild Alzheimer’s disease (AD) subjected to music therapy and/or physical rehabilitation. Male patients with mild AD (N = 26; age = 76.23 ± 4.27 years; weight: 74.76 ± 5.36 kg) were randomly assigned into four groups for three 60-min sessions per week for 4 months; including Group1 or control group (Co) (n = 6); Group2 (n = 6), participated in physical rehabilitation (PR); Group3 (n = 7), subjected to music therapy (MT) and Group4 (n = 7), participated simultaneously in music therapy and physical rehabilitation (MT + PR). Salivary T levels increased (ηp2 = 0.7) and C levels decreased (ηp2 = 0.69), significantly (p < 0.001) in the PR, MT and MT + PR groups compared to the Co group respectively. Also, increases in salivary T levels and decreases in C levels in MT + PR group were greater compared to the other groups. MT increased T levels (p < 0.001) and decreased C levels (p < 0.05) to a greater extent than the PR group respectively. Changes in salivary T levels were positively (r = 0.83; p < 0.001) and C levels were negatively (r = -0.86; p < 0.001) correlated in the PR, MT and MT + PR groups with changes in MMSE in AD patients. This study highlights that combination of MT and PR holds potential to treat AD.

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Vestibular Physical Therapy in Individuals With Cognitive Impairment: A Theoretical Framework

Cited by 13 publications

References 56 publications

Impact of hearing loss and vestibular decline on cognition in Alzheimer’s disease: a prospective longitudinal study protocol (Gehoor, Evenwicht en Cognitie, GECkO)

Impact of hearing loss and vestibular decline on cognition in Alzheimer’s disease: a prospective longitudinal study protocol (Gehoor, Evenwicht en Cognitie, GECkO)

Vestibular therapy to reduce falls in people with Alzheimer’s disease: study protocol for a pilot randomized controlled trial

Salivary Testosterone and Cortisol Levels in Tunisian Elderly Male Patients With Mild Alzheimer’s Disease. Implications of Musical Therapy And/Or Physical Rehabilitation

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