Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy

Abstract

Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate ( n = 11) or severe ( n = 11). The control group ( n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

Habilidades cognitivas envolvidas na avaliação e reabilitação vestibular

“…Após a análise dos estudos selecionados verificou-se que o número total da amostra foi de 2.390 indivíduos de ambos os sexos e a idade variou entre 18 a 91 anos com média de idade de 74 anos. Dois estudos incluíram participantes apenas do sexo feminino (17,25). Dos 16 artigos incluídos nesta revisão de literatura, cinco trabalhos apresentaram grupo controle pareado por idade e sexo, sendo três estudos transversais, e dois longitudinais 18,20,25,26,30 .…”

“…Dois estudos incluíram participantes apenas do sexo feminino (17,25). Dos 16 artigos incluídos nesta revisão de literatura, cinco trabalhos apresentaram grupo controle pareado por idade e sexo, sendo três estudos transversais, e dois longitudinais 18,20,25,26,30 .…”

“…Os estudos transversais encontraram correlação entre disfunção vestibular uni e bilateral com as habilidades de memória de curto prazo, atenção, funções executivas, visuoespaciais e cognição espacial 15,17,18,19,20,21,23 . Dos estudos que realizaram o topodiagnóstico da lesão, dois estudos que possuem amostra com disfunção vestibular periférica encontraram associação com as habilidades cognitivas de funções executivas e na pontuação total do teste de rastreio cognitivo que avalia orientação, atenção, memória, linguagem, cálculo, praxia, função visuoespacial e funções executivas 15,25 . No estudo que possui amostra com disfunção vestibular central encontrou-se associação com as habilidades cognitivas de memória e funções executivas 18 .…”

Longitudinal prediction of falls and near falls frequencies in Parkinson’s disease: a prospective cohort study

“…For example, FOG and comfortable gait speed < 1.1 m/s together with history of falls are included in the three-step falls prediction model [ 5 , 7 , 10 ]. Both FOG and low gait speed may be related to poor TG performance; FOG directly due to PD specific central mechanisms [ 29 ] and low gait speed may (in addition to PD-related brady-/hypokinesia) be due to non-PD specific pathologies such as peripheral neuropathies or vestibular dysfunction [ 39 , 40 ]. These pathologies may aggravate PD-related gait disorders and worsen TG performance [ 35 ].…”

“…They may, therefore, be of special interest to use in clinical settings as predictive screening tests of increased number of falls/near falls. Such information should serve as a starting point for in-depth examination of additional motor and cognitive symptoms such as FOG [ 29 ], striatal foot deformities [ 36 , 37 ], neuropathies [ 39 ], dizziness [ 40 ], and impaired executive function [ 11 , 41 ], and may facilitate the rapid implementation of fall prevention strategies [ 42 ]. However, further longitudinal studies are needed to explore the external validity of these tests in broader ranges of PD severities and over longer periods of time.…”