Cognitive Function in Acquired Bilateral Vestibulopathy: A Cross-Sectional Study on Cognition, Hearing, and Vestibular Loss

Abstract

Background Several studies have demonstrated cognitive deficits in patients with bilateral vestibulopathy (BVP). So far, little attention has been paid to the hearing status of vestibular patients when evaluating their cognition. Given the well-established link between sensorineural hearing loss (SNHL) and cognitive decline and the high prevalence of SNHL in BVP patients, it is therefore uncertain if the cognitive deficits in BVP patients are solely due to their vestibular loss or might be, partially, explained by a concomitant SNHL. Objective To evaluate the link between cognition, hearing, and vestibular loss in BVP patients. Design Prospective cross-sectional analysis of cognitive performance in patients with BVP and control participants without vestibular loss. Both groups included subjects with a variety of hearing (dys)function. Cognition was assessed by means of the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing Impaired Individuals (RBANS-H). Results Sixty-four BVP patients were evaluated and compared with 83 control participants. For each subscale and the totale RBANS-H scale a multiple linear regression model was fitted with the following variables: vestibular loss, hearing loss, age, gender, and education. Hearing loss seemed to be associated with worse outcome on the total RBANS-H scale and subscales immediate memory and language. Vestibular loss, on the other hand, was linked to worse performance on the attention subscale of the RBANS-H. Furthermore, we did not observe a correlation between saccular function and cognition. Conclusion This study has found general cognitive deficits in a large sample size of BVP patients. Multiple linear regression models revealed that both vestibular and hearing dysfunction were associated with different subscales of the cognitive test battery, the RBANS-H. Whereas hearing loss was associated with worse performance on total RBANS-H score, immediate memory and language, vestibular loss was observed to negatively affect attention performance.

Bilateral vestibulopathy: beyond imbalance and oscillopsia

“…Imbalance and oscillopsia were the most commonly reported symptoms. This is congruent with previous literature [8,9]. However, since these symptoms are part of the diagnostic criteria for BV [6], the found percentages could (partially) reflect a possible selection bias.…”

“…This should be acknowledged, since clinical experience and earlier performed retrospective studies showed a wide variety of symptoms and consequences [8]. For example, BV patients reported negative impact on physical and social functioning, and compromised cognitive abilities as well [3,4,[8][9][10][11][12][13]. Therefore, it is important to investigate this whole spectrum of symptoms and consequences, especially when developing candidacy criteria and/or outcome measures for therapeutic interventions in this patient population [14].…”

Vestibular Rehabilitation and Factors That Can Affect Outcome

“…The impact of cognitive impairment on VR outcomes is not well understood, but a recent report suggests that patients with bilateral vestibular loss have attention impairments. 93 Although cognitive impairment may not alter the physiology of vestibular compensation, it could impact recovery if it interferes with a person's ability to comply with exercises and recall what he/she has previously learned in therapy (so-called carry-over effect). Micarelli et al 94 investigated posturography and self-report outcomes in older adults with unilateral vestibular hypofunction who had mild cognitive impairment (MCI) or Alzheimer's disease (AD).…”

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

“…Compared with literature, this prevalence was relatively high. 34 Vice versa, more than half of patients with hearing loss (26-80 dB HL of better ear) presented with vertigo and abnormal vestibular test results (including caloric irrigation and vestibular-evoked myogenic potential (VEMP) testing). 35 This underpins the importance of assessing both hearing and vestibular function in these patient groups.…”