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

Abstract

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.

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

“…As intimated above, vestibular rehabilitation could be a potentially beneficial therapy for dementia patients. To this end, we note that a pilot randomized controlled study is currently underway to explore the impact of vestibular rehabilitation on falls and cognitive outcomes (clock drawing test, Card Rotations test, Money Road Map test, triangle completion task) among Alzheimer’s disease patients ( 192 ).…”

Metode vestibularne terapije in njihov vpliv na kakovost življenja odraslih oseb z motnjami v delovanju vestibularnega sistema

“…Vestibularna terapija obsega treninge za ravnotežje, hojo in treninge stabilnosti pogleda (Sulway & Whitney, 2019). Vse več raziskav dokazuje pomembno povezavo med vestibularno in kognitivno funkcijo ter izboljšanje prostorske kognicije po vestibularni terapiji pri osebah, ki se soočajo z disfunkcijo vestibularnega sistema (Yesantharao et al, 2022).…”

Vestibular perceptual testing from lab to clinic: a review

“…A modification for the delivery of vestibular rehabilitation that is in alignment with clinical practice guidelines has been published that emphasizes motor learning abilities for people with cognitive impairment ( 212 ). Utilizing modified vestibular therapy interventions is currently being investigated in people with Alzheimer’s disease ( 213 ).…”