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Vertigo patients frequently complain of emotional and associated cognitive problems, yet currently, there is no satisfactory questionnaire to measure these associated problems. In the present paper, we propose a new internet-based Neuropsychological Vertigo Inventory (NVI; French) that evaluates attention, memory, emotion, space perception, time perception, vision, and motor abilities. The questionnaire was created using four steps: (1) open interviews with patients suffering from vertigo; (2) semi-structured interviews with an analysis grid to quantify and define the various cognitive and emotional problems reported by the patients; (3) a first version of an internet questionnaire tested on 108 vertigo participants; and (4) the selection of subscale items using principal component analyses (PCA). From the development phase, the revised NVI was composed of seven subscales, each with four items (28 items). In the validation phase, Cronbach’s alphas were performed on the revised NVI for total and each subscale score, and to test extreme groups validity, the analyses of covariance (ANCOVAs) taking into account age were performed between 108 vertigo and 104 non-vertigo participants. The Cronbach’s alphas showed good to satisfactory coefficients for the total and for all subscale scores, demonstrating acceptable reliability. The extreme groups validity analyses (ANCOVAs) were reliable for the total scale and for four subscales. Supplementary analyses showed no effect of hearing difficulties and an inverse age effect for attention and emotion subscales, with reduced problems with increased age in the vertigo participants. The NVI provides a useful new questionnaire to determine cognitive and emotional neuropsychological complaints that are associated with vertigo.
1 23
European Archives of Oto-Rhino-
and Head & Neck
ISSN 0937-4477
Eur Arch Otorhinolaryngol
DOI 10.1007/s00405-016-4135-x
The development of a new questionnaire
for cognitive complaints in vertigo: the
Neuropsychological Vertigo Inventory
Emilie Lacroix, Naima Deggouj, Samuel
Salvaggio, Valérie Wiener, Michel Debue
& Martin Gareth Edwards
1 23
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The development of a new questionnaire for cognitive complaints
in vertigo: the Neuropsychological Vertigo Inventory (NVI)
Emilie Lacroix
Naima Deggouj
Samuel Salvaggio
´rie Wiener
Michel Debue
Martin Gareth Edwards
Received: 24 February 2016 / Accepted: 3 June 2016
ÓSpringer-Verlag Berlin Heidelberg 2016
Abstract Vertigo patients frequently complain of emo-
tional and associated cognitive problems, yet currently,
there is no satisfactory questionnaire to measure these
associated problems. In the present paper, we propose a
new internet-based Neuropsychological Vertigo Inventory
(NVI; French) that evaluates attention, memory, emotion,
space perception, time perception, vision, and motor abil-
ities. The questionnaire was created using four steps: (1)
open interviews with patients suffering from vertigo; (2)
semi-structured interviews with an analysis grid to quantify
and define the various cognitive and emotional problems
reported by the patients; (3) a first version of an internet
questionnaire tested on 108 vertigo participants; and (4) the
selection of subscale items using principal component
analyses (PCA). From the development phase, the revised
NVI was composed of seven subscales, each with four
items (28 items). In the validation phase, Cronbach’s
alphas were performed on the revised NVI for total and
each subscale score, and to test extreme groups validity, the
analyses of covariance (ANCOVAs) taking into account
age were performed between 108 vertigo and 104 non-
vertigo participants. The Cronbach’s alphas showed good
to satisfactory coefficients for the total and for all subscale
scores, demonstrating acceptable reliability. The extreme
groups validity analyses (ANCOVAs) were reliable for the
total scale and for four subscales. Supplementary analyses
showed no effect of hearing difficulties and an inverse age
effect for attention and emotion subscales, with reduced
problems with increased age in the vertigo participants.
The NVI provides a useful new questionnaire to determine
cognitive and emotional neuropsychological complaints
that are associated with vertigo.
Keywords Dizziness Vertigo Balance Questionnaire
Neuropsychological function
Vertigo is a common symptom that occurs in various
central and peripheral pathologies, and has been reported to
affect up to 48.3 % of the north-eastern France population
[1]. The term vertigo is usually defined as a feeling that
things are spinning or moving around [25]. However, in
the general population, this term is frequently associated
with symptoms in dizziness (feeling of being light-headed
or ‘swimmy’), visual perception, and/or balance. All these
symptoms could be sustained by overlapping cerebral
networks, notably the vestibular system [68]. Damage to
this system could lead to vertigo/dizziness/imbalance, but
also to more general cognitive or emotional complaints.
For example, abnormal emotional processing and vertigo
symptoms have been frequently reported in Me
disease (MD) [912], leading to a profound deterioration of
patients’ quality of life [13].
&Emilie Lacroix
Department of Oto-Rhino-Laryngology and Head and Neck
Surgery, Cliniques universitaires Saint-Luc, Universite
Catholique de Louvain, Brussels, Belgium,
10, Avenue Hippocrate, 1200 Bruxelles, Belgique
Institute of Neuroscience (IONS), Universite
´Catholique de
Louvain, Louvain-la-Neuve, Belgium
Institute for Research in Psychological Science (IPSY),
´Catholique de Louvain, Louvain-la-Neuve,
Eur Arch Otorhinolaryngol
DOI 10.1007/s00405-016-4135-x
Author's personal copy
In addition to the frequent association between vertigo
and emotional disorders, clinician reports suggest that
vertigo patients also frequently complain of associated
cognitive symptoms, including attention, memory, and
space perception. For example, Grimm et al. [14] reported
evidence of memory, disorientation, anxiety, and mood
problems in patients with perilympathic fistula associated
with mild cranio-cervical trauma. Since in this paper,
research has either followed-up the study by evaluating
cognitive disorders (with behavioural experiments) or by
evaluating emotional disorders (with questionnaires) asso-
ciated to vestibular/vertigo disorders. In these latter studies,
the majority of the questionnaires used to evaluate emo-
tional disorders have particularly focused on anxiety and
depression symptoms.
The role of anxiety in vertigo has been intensively
investigated, showing that the percentage of vertigo
patients (and dizziness) with anxiety can vary from 13.3 %
[15] to 28.3 % [16]. Anxiety is considered to be either an
indirect cause of vertigo in vestibular disorders, or the
consequence of the vestibular affection [1719]. In support
of the latter, the evolution of anxiety presented by some
patients with vestibular neuritis has been explained, at least
partially, by a specific anxious personality style (such as
insecure personality type) [20]. The psychological distress
(anxiety and depression) associated with vertigo is more
linked to the severity of the vertigo (evaluated by the
Dizziness Handicap Inventory—DHI) compared to the type
of disease causing the vertigo (Me
`re’s disease,
vestibular neuritis, etc.) [21].
For behavioural research, the study by Grimm et al. [14]
reported a series of cognitive symptoms in patients with
perilymph fistula associated with mild cranio-cervical
trauma. These patients showed significant impairments in
cognitive tasks, such as block design and paired associate
learning despite having normal intellectual functioning.
Following this original work, research focused on the
potential links between visuo-spatial cognition and
vestibular function. Specific spatial navigation path deficits
have been reported in patients with compared to without
vestibular deficits [2226]. Brandt et al. [25] showed that
patients with acquired chronic bilateral vestibular loss from
neurofibromatosis type 2 had more difficulties to find an
immersed platform in a virtual variant of the Morris water
task if the patient had to remember the location of the
platform compared to when the platform was always pre-
sent during the task. These results were correlated to hip-
pocampal atrophy (16.9 %), demonstrating a relation
between vestibular impairment and memory. However, the
performance on the classical Weschler Memory Scale did
not show any significant difference between patients and
control participants, suggesting that the impairment was
specific to spatial memory in the navigational task.
A related field of research has focused on measuring the
influence of vestibular stimulation on cognitive perfor-
mance in healthy (non-vestibular) participants. For exam-
ple, Galvanic vestibular stimulation has been shown to
modify attention on a line bisection task, creating a bias
towards the side of stimulation [27]. In addition, rotatory
vestibular stimulation has been shown to alter self-centred
mental imagery, demonstrating a role of vestibular function
in perspective [28].
Despite the growing body of the literature about the role
of vestibular function in visuo-spatial cognitive processing,
few studies have investigated (in a single instrument), the
subjective cognitive complaints of vertigo patients. Instead,
most questionnaires that have investigated vertigo have
evaluated physical symptoms and their impact on patient
quality of life (mostly from an emotional point of view).
The DHI is the most commonly used questionnaire in
vertigo. Its original internal consistency (Cronbach’s Alpha
from 0.72 to 0.89) and test–retest reliability [interclass
correlation coefficient (ICC) from 0.72 to 0.97] are con-
sidered as established [29]. However, the validity has been
investigated only with item-total correlation instead of
factor analysis [30,31]. Furthermore, there are only a few
questions about cognitive complaints (difficulty of reading
and difficulty to concentrate).
Other questionnaires have used general patient quality
of life not specific to vertigo or dizziness [30]. In Table 1,
we summarise the different questionnaires that have been
used in research for evaluating vertigo/dizziness symptoms
and their impact on quality of life and/or on the emotional
statute of the patients. None of these questionnaires eval-
uated specific cognition disorders that could be linked to
vestibular impairments.
In the present paper, we propose a new questionnaire,
for the first time specifically evaluating physical, emo-
tional, and cognitive complaints in one single inventory.
Our aim was to provide a new accurate clinical tool to
refine the diagnosis of vertigo patients. As a newly devel-
oped instrument, our new questionnaire must show some
psychometrics qualities. Reliability could be evaluated
through the reproducibility/repeatability of participants’
score after a certain period (test–retest reliability), in
another form of the questionnaire (parallel form reliabil-
ity), or it could also be evaluated through the internal
consistency of the items within each subscale [32]. This
last option was used to confirm each of the subscales and
the total score of our new questionnaire using Cronbach’s
alpha analyses. In addition, validity (does our new ques-
tionnaire measure what it intends to measure) could be
demonstrated using face, content, criterion-related, con-
struct, concurrent, predictive, discriminant, convergent, or
extreme groups validity analyses [32]. In this study, we
choose to explore extreme groups validity to show that
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participants with vertigo had a higher score of complaints
compared to control participants, and thus, that our new
questionnaire is valid for the specific vertigo population.
We first present the methods and results for the develop-
ment of the NVI questionnaire, followed by the methods
and results for the extreme groups validity of the NVI
Development of the NVI questionnaire
Participants, design, and procedure
The NVI questionnaire was created using a four-step pro-
cess. First, we conducted open interviews on patients suf-
fering from vertigo (following various vestibular disorders,
such as vestibular neuritis, MD, etc.) who consulted in the
Ear-Nose and Throat Department of our clinic. Second,
from these open interviews, we created a grid of general
question categories and we performed a semi-structured
interview with a new group of 14 vertigo patients to define
different subcategories of cognitive complaints. We for-
mulated 17 general question categories using ‘‘before/
after’’ questioning, such as ‘‘how was your memory before
your balance difficulties?’’, with supplementary sub-ques-
tions used to facilitate patient responses if they could not
find a spontaneous answer. The 17 question categories
consist of difficulties in: (1) general perception of balance;
environment perception in (2) dynamic or (3) static con-
ditions; (4) fine motor skills; (5) spatio-temporal orienta-
tion; (6) two-dimensional motor abilities; (7) three-
dimensional motor abilities; (8) two-dimensional repro-
duction abilities; (9) three-dimensional reproduction abili-
ties; (10) two-dimensional mental imagery abilities; (11)
three-dimensional mental imagery abilities; (12) mental
rotation; (13) planning; (14) attention; (15) memory; (16)
emotions, and (17) other complaints (17). In the third step,
we created a first version of the questionnaire by selecting
the seven most relevant question categories that we
renamed as subscales of cognitive complaints based on the
previous steps. These subscales were Space Perception;
Time Perception; Attention; Memory; Emotion; Vision;
and Motor. Each subscale was composed of six items
making a total of 42 (for example, ‘‘I read slowly’’ in
Vision Subscale. To ensure that each question was clearly
understandable, we pre-tested the first original version of
the questionnaire on naı
¨ve control participants (25) and
corrected any unclear items.
Table 1 Classification of commonly used questionnaires and their related domains in vestibular studies
Instrument (abbreviation name) Domains evaluated References
Daily activities/
quality of life
Emotion Cognition
Activities-specific Balance Confidence (ABC) X [33]
Activity of Daily Living Questionnaire (ADLQ) X [34]
Dizzy Factor Inventory (DFI) X X X 2 questions [35]
Dizziness Handicap Inventory (DHI) ?short form X X X 2 questions [29]
European Evaluation of Vertigo (EEV) X [36]
Falls efficacy scale X [37]
Medical outcomes study short form 36 (SF-36) X X X [38]
Meniere’s Disease Patients-Oriented Severity Index (MD-POSI) X X X 2 questions [39,40]
Modified falls efficacy scale (MFES) X [41]
Patient Heath Questionnaire (PHQ-9) X X 1 question [42]
Prototype Questionnaire (PQ) X X X 2 questions [43]
Situational Characteristics Questionnaire (SitQ) X [44]
UCLA Dizziness questionnaire (UCLA-DQ) X X X [45]
Vestibular Activities and Participation (VAP) X X 1 question [46]
Vertigo-Dizziness-Imbalance Questionnaire (VDI) X X X 2 questions [47]
Vertigo Handicap Questionnaire (VHQ) X X [48]
Vertigo Symptom Scale (VSS) ?short form X 1 question [49]
Vestibular Disorders of Daily Living Scale (VADL) X [23,50]
Vestibular Rehabilitation Benefit Questionnaire (VRBQ) X X X 1 question [51]
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The final step of the questionnaire development
involved new participants completing the questionnaire
online. The participants rated each item using a five-point
Likert scale (1, never; 2, rare; 3, sometimes; 4, very often;
5, permanently). This was selected to reduce the time
needed to complete the questionnaire and to provide the
patient with an opportunity to make a non-dichotomous
response. We added a ‘‘Distractor’’ subscale to analyse
extreme groups validity. We expected to observe signifi-
cant differences between vertigo and non-vertigo partici-
pants in the target subscales, but no difference in the
distractor subscale. Differences for this last subscale would
suggest a higher level of non-specific complaints in vertigo
participants. In addition to the online questionnaire, addi-
tional demographic questions were given to the partici-
pants. These included questions asking for the sex, age,
associated health conditions, etc., of the participant.
The questionnaire was sent to vertigo participants
through patient associations in Belgium using the internet
platform Limesurvey
( One
hundred and eight vertigo participants completed the
questionnaire. Vertigo participants were mostly female
(69) and right-handed (94). Their mean age was
54.3 ±15.2 years. The participants were recorded as suf-
fering from vertigo due to their positive answer to the
question, ‘‘Do you suffer from vertigo?’’. More than the
half of the participants (58) indicated that they suffered
from vertigo for more than five years, and that they
experienced vertigo several times a day (52). The majority
of the participants (78) also suffered from associated
deafness or hard of hearing (D/HOH). Due to the online
administration of the questionnaire, the exact degree of
hearing loss was uncertain or unknown. Of the D/HOH
participants, some indicated that they wore the conven-
tional hearing aids (21) or cochlear implant (33).
The procedure of the online questionnaire first involved
a description of the questionnaire and a consent by the
participant to participate in the study. After consent was
given, the demographic questions were given to the par-
ticipant. This was followed by the main NVI questionnaire.
The items of the questionnaire were randomly assigned by
the internet platform to each participant. All procedures
performed in studies involving human participants were in
accordance with the ethical standards of the institutional
and/or national research committee and with the 1964
Helsinki declaration and its later amendments or compa-
rable ethical standards.
We conducted principal component analyses (PCA) on
each pre-defined subscale and on the total score to refine
the NVI. Analyses were performed with R commander
[52,53]. We determined the items most correlated to the
cognitive subscale and to keep homogeneity, we chose to
remove the two items less represented for each subscale.
This included the same reduction process for the distractor
subscale. After this reduction, the final total number of
items was 28, and the total score for the NVI was 140
without the distractors items (four for each of the seven
Results for structural validity and internal
Table 2shows the results of the PCA for the percentage of
variance for each subscale, before and after the item
reduction for vertigo participants. The results show that
most of the selected subscales after item reduction (to four
items) explained more than 50 % of variance. The sub-
scales of time perception and motor appeared to be more
heterogeneous, with less internal consistency than the other
subscales (matched to the distractor subscale). Cronbach’s
alpha confirmed good internal consistency for the total
scale (without distractors), and for the subscales ‘‘space
perception’’, ‘‘attention’’, and ‘‘memory’’ (Cronbach alpha
coefficients at or higher than 0.8). A satisfactory internal
consistency was demonstrated for two more of the seven
subscales (Cronbach alpha coefficients greater than 0.7 for
‘emotion’’ and ‘‘vision’’). Consistently with the PCA, the
items for the ‘‘time perception’’ and ‘‘motor’’ and for the
distractor subscales were lower, but acceptable for sub-
scales containing only four items as suggested by Bradley
[32] (Cronbach alpha coefficients below 0.7) (see Table 2).
Table 2 Percentage of variance explained before and after PCA and
Cronbach’s alpha on vertigo participants (after PCA)
Categories Percentage of
variance explained
After PCA
Space perception 53.23 65.31 0.82
Time perception 37.19 46.88 0.52
Attention 51.15 62.33 0.80
Memory 54.92 63.39 0.80
Emotion 47.07 60.58 0.77
Vision 42.16 57.03 0.75
Motor 29.26 40.85 0.50
Distractor 30.21 42.63 0.55
Total (without distractors) 0.88
Before items reduction
After items reduction
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Extreme groups validity of the NVI
Participants, stimuli, and procedure
To analyse the extreme groups validity, we used the same
data from the sample of 108 vertigo participants and data
collected from 104 additional control participants (mean
age 43 ±13.2 years). The control group was mostly
female (77) and right-handed (83). They were recorded as
control participants due to their negative response to the
question, ‘‘Do you suffer from vertigo?’’. Some of the
participants (21) suffered from associated deafness or hard
of hearing (D/HOH). Due to the online administration of
the questionnaire, the exact degree of hearing loss was
uncertain or unknown. Some of the 21 D/HOH participants
wore conventional hearing aids (5) or cochlear implants
(4). The comparison between age for the 104 control and
108 vertigo participants was significant [F(1.210) =32.7,
p=0.000; with younger control participants] and age was
taken into account as a covariate in the analyses. The
stimuli and procedure was the same as that described in
step four in the previous section.
Data analysis
We performed analyses of covariance (ANCOVA) analy-
ses using SPSS-22 (SPSS Inc., Chicago, IL). Analyses were
corrected with Bonferroni-adjusted pvalues for multiple
testing, and the factor of age was added as a covariate for
the total score and for all subscales with vertigo and
D/HOH as independent variables. Partial eta-squared (g
was used to measure effect size [0.0099, 0.0588, and
0.1379 for small, medium, and large effects, respectively,
as recommended by Cohen [54] and Richardson [55]. The
age effect was also analysed with Spearman’s rho corre-
lation coefficient.
Supplementary analyses evaluated the role of hearing
difficulties in the sample. This was included, as it is well
known that vestibular impairments (that can lead to ver-
tigo) are frequently associated with hearing difficulties
(odds ratio of 1.9–2.3 [56,57]. It has also been shown that
D/HOH persons might develop different attentional abili-
ties (e.g., enhanced peripheral visual attention) [5860].
Results for extreme groups validity and age effect
After controlling for age, we found a significant extreme
groups validity of having vertigo (e.g., difference between
vertigo and control participants) for four of the seven
subscales: motor subscale, F(1.207) =30.51, p=0.000,
and g
=0.128; vision subscale, F(1.207) =31.90,
p=0.000, and g
=0.134; attention subscale,
F(1.207) =20.43, p=0.000, and g
=0.090; and emo-
tion subscale, F(1.207) =23.54, p=0.000, and
=0.102). There was also a significant effect for the
total score, F(1.207) =27.90, p=0.000, and g
Participants with vertigo had higher scores (more com-
plaints) on all subscales and on the total scale (see
Table 3). As expected, we found no significant effect of
vertigo for the distractor subscale, but more surprisingly,
three other subscales did not show significant effects:
memory, F(1.207) =3.379, p=0.067, and g
space perception, F(1.207) =0.720, p=0.397, and
=0.003, and time perception, F(1.207) =1.45,
p=0.230, and g
=0.007) subscales.
The ANCOVA analyses showed significant main effects
of age for attention F(1.207) =8.71, p=0.03, and
=0.04 and emotion subscales, F(1.207) =21.56,
p=0.000, and g
=0.094. Spearman’s rho correlation
coefficient analyses showed an inverse correlation between
age and total NVI score for vertigo participants
=-0.303 and p=0.001). This effect was also present
for the subscales of attention, emotion, and vision
=-0.271 and p=0.005; r
=-0.473 and p=0.000;
and r
=-0.303 and p=0.001, respectively). There were
no significant correlations for the non-vertigo group (see
Table 4for the complete results). The supplementary
analyses of D/HOH showed no significant effects.
This present paper provides a new questionnaire, the NVI,
specifically adapted to measure the self-reported associated
neuropsychological cognitive (attention, memory, emotion,
space perception, time perception, vision, and motor)
problems in patients suffering from vertigo. The ques-
tionnaire was created in four steps, and the final revised
version was composed of seven subscales, each with four
items (28 items). Reliability of the NVI was performed
using Cronbach’s alphas and this showed a good to satis-
factory internal consistency for the total score and for five
subscales. The remaining two subscales were less consis-
tent (time perception and motor subscale), suggesting that
the items were perhaps less well-defined. However, for
subscales of four items, it has been suggested that a lower
Cronbach’s alpha value is acceptable [32]. Furthermore,
our choice to use PCA on each predetermined subscale was
justified by the questionnaire novelty. We used focus group
and semi-structured patient interviews to classify items into
subscales based on common content, and then to reduce
item number by PCA. As the time perception and motor
subscales were defined from the original patient interviews
in the development phase of the NVI, we were concerned
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by the fact that some specific complaints could be missed.
For example, a patient with a higher score on these par-
ticular items and subscales would probably express a
higher degree of difficulties in these domains. Excluding
these responses could lead to the potential to miss these
difficulties. This is why we propose to keep the two sub-
scales in the final version of the NVI. However, future
studies should determine whether keeping the two less
valid subscales is worthwhile. Content validity of the items
composing these subscales (and the other subscales) could
be re-examined through specific method, such as the use of
Content Validity Index [61].
The extreme groups validity of the NVI was evaluated
using ANCOVAs that tested age as a covariate. The results
showed significant differences between vertigo and non-
vertigo participants for the total and four subscale scores.
The three subscales that did not show significant differ-
ences between participants with and without vertigo were
time perception, memory, and space perception. For the
subscale of time perception, it is possible that the lack of
extreme groups validity could be explained by the previous
demonstrated lower internal validity. For the space per-
ception subscale, the absence of significant difference was
surprising. The Cronbach’s alphas showed a good internal
consistency (0.821), and we would have expected a sig-
nificant difference between vertigo and non-vertigo par-
ticipants based one the previous literature (see [62] for an
extensive review). There are a number of explanations that
can explain the lack of effect for the space perception
subscale. One potential explanation could be linked to the
item specificity that composed this subscale. Here, and
based on the interviews conducted during the development
of the NVI, items were linked to bodily orientation in space
(‘‘I have a bad orientation sense’’; ‘‘I have difficulty to find
my way on a map’’ etc.). Items in the ‘‘vision’’ subscale
were linked to visual attentional abilities and visual acuity
(‘‘I read slowly’’, ‘‘I experience visual fatigue in computer’
etc.). This difference in these two subscales refers to dif-
ferent cognitive concepts, one oriented on body perception
in space, and the other oriented on visual attention
involving vision process/visual acuity. It might be that
these two subscales are both associated with what has been
defined in the literature as visual spatial cognition, but here,
separated by two scales.
A second explanation is that spatial perception (or
navigational abilities) might be truly altered in patients
with vestibular disorders [22,24,6365], but that the
impairment could be rapidly compensated, or reduced
through vestibular rehabilitation [66]. Furthermore, spatial
perception may be more difficult to self-evaluate because
of the temporary characteristic of their affection in vertigo.
A final explanation could be that the literature reporting
spatial difficulties are particularly true for defined
vestibular pathologies rather than for subjective vertigo
symptoms. Spatial perception disorders may, therefore, be
Table 3 Average score (M) and standard deviation (SD) for NVI total and subscales scores for each participant sample
Scales Vertigo
Deaf/HOF participants
Non-Deaf/HOF participants
Space perception 8.89 (3.97) 8.81 (3.46) 8.62 (4.00) 9.05 (3.46)
Time perception 6.14 (2.16) 5.96 (1.51) 5.95 (2.14) 6.14 (1.60)
Attention 10.27 (3.57) 8.78 (2.88) 9.55 (3.65) 9.53 (3.03)
Memory 9.80 (3.65) 8.71 (2.64) 9.57 (3.62) 9.00 (2.85)
Emotion 11.47 (3.52) 9.85 (2.61) 10.84 (3.50) 10.53 (2.94)
Vision 9.82 (3.62) 7.58 (2.32) 8.99 (3.59) 8.49 (2.91)
Motor 11.21 (3.24) 8.99 (2.64) 10.43 (3.09) 9.85 (3.20)
Distractor 14.06 (3.12) 14.70 (2.53) 14.21 (3.19) 14.51 (2.53)
All items (except distractors) 67.61 (15.69) 58.67 (12.30) 63.94 (16.49) 62.59 (13.17)
Values are expressed as M (SD)
Table 4 Spearman rank correlation among participants’ age and NVI
total and subscales scores
Age of Vertigo
Age of non-vertigo
Space perception -0.128 -0.026
Time perception -0.090 -0.002
Attention -0.271* -0.187
Memory 0.070 -0.025
Emotion -0.473** -0.094
Vision -0.303** -0.015
Motor -0.116 -0.134
Distractor -0.174 0.010
Total -0.303** -0.106
Values are Spearman correlation coefficients: ** correlation is sig-
nificant at 0.001 level (two-tailed); * correlation is significant at the
0.005 level (two-tailed)
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less prevalent in subjects responding to our questionnaire
than in patients diagnosed with a defined vestibular
More research is needed to determine if a difference
truly exists between vestibular and vertigo patients. This
could be disentangled in future studies by analysing the
subscale specifically in patients with complete or partial
vestibular disorders in comparison to patients with vertigo
from another origin.
In addition to the main study, we also observed inter-
esting age effects. It is already well known that with
increased age, there are increased frequencies of vertigo
and vestibular disorders [6769], as well as reduced cog-
nition and increased emotional problems [7074]. Based on
these findings, we might have expected that increased age
might have led to more complaints in the NVI (higher
scores). However, on the contrary, we observed an inverse
age effect, where increased age was related to a reduction
in cognitive complaints in the vertigo patients (particularly
for the attention and emotion subscales). One potential
explanation for this effect could be linked to the fact that
younger people tend to be more active, and so the impact of
vertigo and their cognitive associated complaints might be
more detrimental than for less active people. It has been
reported that vertigo patients have a tendency to stay at
home and avoid some activities that can increase their
discomfort [48,75]. Younger people may not always the
same opportunity to stay at home, and so they may be more
exposed to higher frequencies of physical and cognitive
discomfort than adults of increased age.
In conclusion, the NVI has been developed in response
to the lack of instruments to detect neuropsychological
problems associated with vertigo. Our goal was to create a
new inventory that could detect specific subjective
impaired cognition in vertigo patients, and provide a sim-
ple to use, reliable clinical tool that is quick to administer.
With the NVI, we have created a bridge between the
classical questionnaires that investigate the emotional side
of vertigo, and the behavioural experiments that focus on
the cognitive difficulties associated with vertigo. Our
results shed light on vertigo patients subjective (self-re-
ported) problems in a more extended view than that of the
previous questionnaires that mostly assessed emotional
symptoms and/or quality-of-life (see Duracinsky et al. for
an extensive review [30]). We also bring new information
that could lead to a better comprehension of vestibular-
associated disorders. We show that cognitive processes are
more perceived as dysfunctional by vertigo patients
themselves, and importantly, we can no longer limit the
participant’s complaints to the uncontrollability and
unpredictability of the vertigo, such as is the case with
critical life events [76].
As a potential new clinical instrument, some comple-
mentary research is needed to complete this first study. For
example, a forward–backward translation procedure is
necessary to make the original NVI available in other
languages. This rigorous procedure guarantees that the
original meanings of each item are preserved. Future
research should also evaluate test–retest effects and con-
vergent validity with other scales. If the NVI is to be used
for a diagnosis of vertigo/vestibular associated cognitive
problems, it will be necessary to determine a cutoff score.
This could be used to determine which patients with ver-
tigo might benefit from a more comprehensive neuropsy-
chological assessment. This direction might be critical, as
the difficulties described by these patients might lead to
vertigo patients requiring a higher use of health care [16]
and leading to substantial costs for society [77]. Cognitive
rehabilitation therapies should be developed for vertigo
patients, as it has been shown that cognitive deficits may
persist even after complete vertigo recovery [76].
Acknowledgments This study was funded by the Saint-Luc hospital
Foundation. The authors would like to specially thank Ce
´dric Taverne
for his helpful comments regarding the data analyses, the members of
the E.N.T department and the Centre d’audiophonologie of Cliniques
Universitaires Saint-Luc for their comments and feedback on the
questionnaire development, and for all of the participants of the study.
Compliance with ethical standards
Funding This study was funded by the Cliniques universitaires
Saint-Luc Foundation (no grant number).
Conflict of interest All the authors have no competing interests to
Ethical approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards (Clinical-Trial-Number NCT02533739).
Informed consent Informed consent was obtained from all individ-
ual participants included in the study.
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... When evaluating the structure validity of the CVFS, the explanatory factor analysis was used and it was observed that the Scree Plot graph had a 7-factor structure validity as 5 + 2 (5 breaking points + 2, over 1 component). However, since subscales have already been defined, the ''Principal Component Analysis'' method was used for the structure validity of the subscales by referencing the methodology of Lacroix et al. 7 The individual variance values of the subscales created are examined by this method. Lacroix et al. 7 recognized 50% as a benchmark for variances of subscales while developing the ''Neuropsychological Vertigo Scale'' in its study. ...
... However, since subscales have already been defined, the ''Principal Component Analysis'' method was used for the structure validity of the subscales by referencing the methodology of Lacroix et al. 7 The individual variance values of the subscales created are examined by this method. Lacroix et al. 7 recognized 50% as a benchmark for variances of subscales while developing the ''Neuropsychological Vertigo Scale'' in its study. In our study, it was observed that two of the four subscales (V and TM scales) explained more than 50% of the variance after the principal component analysis was performed. ...
... Cronbach's alpha coefficients were examined to calculate the reliability within the scope of internal consistency of the total scale and the subscales. 7,8 Cronbach's alpha coefficient, calculated with a total of 25 items of the CVFS, was 0.678. When the Emotion subscale was removed from the scale, Cronbach's alpha coefficient increased and the new Cronbach's alpha coefficient, calculated after subtracting the five-item Emotional subscale, was found to be 0.86. ...
Full-text available
Objectives: With a valid and reliable scale, it will make an important contribution to the assessment of cognitive functions such as spatial, spatial-visual, and memory functions, and raise awareness of older people with balance disorders. The purpose of this study is to develop a scale to assess vestibular and cognitive functions in the geriatric population with vestibular disorders and to evaluate its validity and reliability. Methods: The study involved 75 individuals aged 60 years and older who complained of imbalance. In the first phase, scale items on balance, emotional, spatial, spatial-visual, and memory were created using the literature. The item analysis was completed by a pilot application, and 25 scale items were determined for the main application. The item analysis and validity and reliability analyzes were completed, and the scale was given its final form. For the statistical analysis of the data, a principal component analysis was performed for the validity analysis. The Cronbach alpha coefficient was used for the reliability analysis. Descriptive statistics were compiled on the participants' scale scores. Results: The Cronbach's alpha value of the scale was found to be highly reliable at 0.86. Statistically significant values were found between the age variable and the spatial subscales, the spatial-visual subscales, and the Cognitive Vestibular Function Scale with a small positive effect (respectively: r = 0.264; p= 0.022; r = 0.237; p= 0.041; r = 0.231; p= 0.046). The results indicate that the Cognitive Vestibular Function Scale is a valid and reliable measurement tool at a good level in elderly people aged 60 years and older. Conclusion: Cognitive Vestibular Function Scale; was developed to detect cognitive problems related to dizziness/balance. As a result, a preliminary study was conducted to investigate a rapid, easy-to-use, and reliable clinical scale to assess cognitive function in people with balance disorders. Level II Randomized trials Prospective comparative study.
... Regarding patient studies, the variety of cognitive and emotional measures impairs the comparison to studies using artificial stimulation. Original patient studies have mostly used subjective questionnaires, consistently showing significant increases of emotional, physical, and cognitive complaints compared to control participant responses (Eagger et al., 1992;Yardley and Putman, 1992;Godemann et al., 2004;Gómez-Alvarez and Jáuregui-Renaud, 2011;Alghwiri et al., 2013;Lahmann et al., 2015;Lacroix et al., 2016;Semenov et al., 2016;Liu et al., 2019). Comparison with animal and artificial stimulation research is difficult, as no questionnaires are used in animal research and very few questionnaires have been used with human artificial stimulation research. ...
... Functionally compensated patients regarding the physiological impairment may nonetheless continue to present subjective complaints about their quality of life, with emotional and cognitive difficulties. These dimensions can be measured with specific questionnaires (Lacroix et al., 2016). Although several premorbid patient characteristics such as age (Gauchard et al., 2012); psychological factors (Yardley and Redfern, 2001); illness perception and coping strategies (Ribeyre et al., 2016); or the level of physical activity (Gauchard et al., 2013) seem to play a role in the recovery process, the way these different variables interact remains largely unknown. ...
... We propose to use specific subjective cognitive measures to test this hypothesis. The cognitivefailure questionnaire (CFQ; Broadbent et al., 1982), or the neuropsychological vertigo inventory (NVI; Lacroix et al., 2016), may offer helpful insight into patients' own perception of their cognitive state. These questionnaires have already demonstrated their sensitivity by allowing for the identification of different profiles among different types of VL (Liu et al., 2019). ...
Full-text available
Previous research in vestibular cognition has clearly demonstrated a link between the vestibular system and several cognitive and emotional functions. However, the most coherent results supporting this link come from rodent models and healthy human participants artificial stimulation models. Human research with vestibular-damaged patients shows much more variability in the observed results, mostly because of the heterogeneity of vestibular loss (VL), and the interindividual differences in the natural vestibular compensation process. The link between the physiological consequences of VL (such as postural difficulties), and specific cognitive or emotional dysfunction is not clear yet. We suggest that a neuropsychological model, based on Kahneman’s Capacity Model of Attention, could contribute to the understanding of the vestibular compensation process, and partially explain the variability of results observed in vestibular-damaged patients. Several findings in the literature support the idea of a limited quantity of cognitive resources that can be allocated to cognitive tasks during the compensation stages. This basic mechanism of attentional limitations may lead to different compensation profiles in patients, with or without cognitive dysfunction, depending on the compensation stage. We suggest several objective and subjective measures to evaluate this cognitive-vestibular compensation hypothesis.
... They found that patients reported greater memory difficulties than controls, but the degree of impairment was better predicted by comorbid psychological distress than the severity of vertigo. Lacroix et al. [2016] developed a French language questionnaire specifically for patients with vertigo, the Neuropsychological Vertigo Inventory (NVI) [Lacroix et al., 2016]. The questionnaire had 4 subscales addressing aspects of cognition (Attention, Space Perception, Time Perception, and Memory) and 3 subscales on Emotion, Vision, and Motor function. ...
... They found that patients reported greater memory difficulties than controls, but the degree of impairment was better predicted by comorbid psychological distress than the severity of vertigo. Lacroix et al. [2016] developed a French language questionnaire specifically for patients with vertigo, the Neuropsychological Vertigo Inventory (NVI) [Lacroix et al., 2016]. The questionnaire had 4 subscales addressing aspects of cognition (Attention, Space Perception, Time Perception, and Memory) and 3 subscales on Emotion, Vision, and Motor function. ...
... Neuropsychological Vertigo Inventory An English language version of the NVI was provided by its authors [Lacroix et al., 2016]. This version was translated by Dr. R. Srinivasa Raghavan's team using a double translation method. ...
Introduction: Patients with vestibular disorders sometimes report cognitive difficulties, but there is no consensus about the type or degree of cognitive complaint. We therefore investigated subjective cognitive dysfunction in a well-defined sample of neuro-otology patients and used demographic factors and scores from a measure of depression, anxiety, and stress to control for potential confounding factors. Methods: We asked 126 neuro-otology clinic outpatients whether they experienced difficulties with thinking, memory, or concentration as a result of dizziness or vertigo. They and 42 nonvertiginous control subjects also completed the Neuropsychological Vertigo Inventory (NVI, which measures cognitive, emotional, vision, and motor complaints), the Everyday Memory Questionnaire (EMQ), and Depression, Anxiety, and Stress Scales (DASS). Results: In the initial interview questions, 60% of patients reported experiencing cognitive difficulties. Cognitive questionnaire scores were positively correlated with the overall DASS score and to a lesser extent with age and gender. Therefore, we compared patients and controls on the NVI and EMQ, using these mood and demographic variables as covariates. Linear regression analyses revealed that patients scored significantly worse on the total NVI, NVI cognitive composite, and 3 individual NVI cognition subscales (Attention, Space Perception, and Time Perception), but not the EMQ. Patients also scored significantly worse on the NVI Emotion and Motor subscales. Conclusions: Patients with dizziness and vertigo reported high levels of cognitive dysfunction, affecting attention, perceptions of space and time. Although perceptions of cognitive dysfunction were correlated with emotional distress, they were significantly elevated in patients over and above the impact of depression, anxiety, or stress.
... Consequently, clinicians often rely on patient reported outcome measures such as the Dizziness Handicap Inventory (DHI). However, the DHI provides minimal insight into cognitive dysfunction [13], which is better assessed with other metrics such as the Cognitive Failures Questionnaire (CFQ). In fact, some patients become free of dizziness but still complain of fogginess and other vague symptoms that impact their productivity and daily life. ...
... In addition, dizziness has significant impact on productivity and absenteeism with one study stating that 51% of dizzy patients miss work to some extent and up to 12% claim disability related to their dizziness [21]. Finally, we describe a fourth dimension that we have entitled spatial awareness, comprising questions 4, 12, and 17, which assess errors in spatial representation in order to mirror the space perception subscale questions of the psychometrically validated Neuropsychological Vertigo Inventory [13]. This subscale aims to better assess impairments in spatial memory, a cognitive task that has shown impairment independent of otherwise normal cognitive performance in some patients [22]. ...
... The DHI is a validated clinical measure to assess the emotional, physical, and functional handicaps of vestibular syndromes such as VM. However, few questions on the questionnaire directly address cognitive dysfunction [13]. In this study we have shown the DHI moderately correlates with cognitive dysfunction in VM patients, as measured by the CFQ. ...
Objective To characterize the relationship between dizziness severity and cognitive dysfunction in vestibular migraine (VM) patients. Methods Dizziness Handicap Inventory (DHI) and Cognitive Failures Questionnaire (CFQ) scores were compared pre- and post-treatment in a cohort of definite VM patients who underwent evaluation in a multidisciplinary clinic from 2016 to 2020. Results 44 patients were included. DHI reduction of 11.96 (SD 11.49) (p < 0.001) from an initial mean of 58.36 (22.05) and CFQ reduction of 4.57 (12.20) (p = 0.017) from an initial mean of 47.66 (19.12) were demonstrated. Both pre- and post-treatment DHI scores correlated with pre- and post-treatment CFQ scores (r = 0.537, p < 0.001 and r = 0.667, p < 0.001, respectively). Change in DHI score correlated with change in CFQ score (r = 0.351, p = 0.019). Conclusions Cognitive dysfunction in VM patients is correlated with dizziness severity. The DHI may fail to thoroughly assess cognitive dysfunction in VM patients. Additionally, multidisciplinary treatment of VM reduces both dizziness severity and cognitive dysfunction.
... This study used the most available clinical test questionnaires, namely, the dizziness handicap inventory, the vertigo symptom scale, and the vestibular activities and participation. The questionnaires primarily assess the functional, emotional, and physical impacts of vertigo on patients' daily life, which rarely involve the cognitive dysfunction caused by vertigo (Lacroix et al., 2016). Therefore, cognitive evaluation tools in neuroscience are predominately used to evaluate cognitive function in patients with vestibular dysfunction. ...
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Introduction: The vestibular system is anatomically connected to extensive regions of the cerebral cortex, hippocampus, and amygdala. However, studies focusing on the impact of vestibular impairment on visuospatial cognition ability are limited. This study aimed to develop a mobile tablet-based vestibular cognitive assessment system (VCAS), enhance the dynamic and three-dimensional (3D) nature of the test conditions, and comprehensively evaluate the visuospatial cognitive ability of patients with vestibular dysfunction. Materials and methods: First, the VCAS assessment dimensions (spatial memory, spatial navigation, and mental rotation) and test content (weeding, maze, card rotation, and 3D driving tests) were determined based on expert interviews. Second, VCAS was developed based on Unity3D, using the C# language and ILruntime hot update framework development technology, combined with the A* algorithm, prime tree algorithm, and dynamic route rendering. Further, the online test was built using relevant game business logic. Finally, healthy controls (HC) and 78 patients with vertigo (VP) were recruited for the VCAS test. The validity of VCAS was verified using the test results of random controls. Results: In the weeding test, the HC group had a significantly longer span and faster velocity backward than did the VP group. In the 12 × 12 maze, statistically significant differences in step and time were observed between the two groups, with VP taking longer time and more steps. In the mental rotation task, no significant difference was observed between the two groups. Similarly, no significant difference was found in the performance of the two groups on maps 2, 3, and 4 in the 3D driving task. Discussion: Thus, impaired visuospatial cognition in patients with vestibular dysfunction is primarily related to spatial memory and navigation. VCAS is a clinically applicable visuospatial cognitive ability test for VP.
... Subjects completed the Dizziness Handicap Inventory (DHI) (25), Quality of Life in Neurological Disorders-Cognitive Function questionnaire (Neuro-QOL) (26), Cognitive Failures Questionnaire (CFQ) (27), and the Neuropsychological Vertigo Inventory (NVI) (28) to quantify symptoms of dizziness and cognitive impairment. Subjects also completed the Patient Health Questionnaire-9 (PHQ-9) (29), and General Anxiety Disorder-7 (GAD-7) (30) to evaluate for depression and anxiety, respectively. ...
Objective: To characterize visuospatial and nonvisuospatial cognitive domains affected by vestibular loss and determine whether patient-reported outcomes measures (PROMs) correlate with performance on neuropsychological tests. Study design: Cross-sectional study. Setting: University-based tertiary medical center. Patients: Sixty-nine age-matched subjects: 25 patients with bilateral vestibular loss (BVL), 14 patients with unilateral vestibular loss (UVL), and 30 normal controls (NC). Interventions: Neuropsychological tests used to assess visuospatial and auditory short-term and working memory, number magnitude representation, executive function, and attention. Validated PROMs used to evaluate quality of life and subjective cognitive impairment. Main outcome measures: Performance on neuropsychological tests and scores on PROM surveys. Results: BVL and UVL patients performed significantly worse than NC subjects on tasks requiring visuospatial representation compared with NC subjects (p < 0.01). BVL patients demonstrated decreased performance on spatial representation tasks compared with UVL and NC subjects (p < 0.05 and p < 0.05, respectively). All subject groups performed similarly on tasks assessing nonvisuospatial cognitive domains, such as auditory short-term and working memory, executive function, and attention. PROMs did not seem to correlate with performance on neuropsychological tasks. Conclusion: Patients with vestibular loss exhibit impairments in tasks requiring visuospatial representation but perform similarly to NC subjects in tasks of auditory working memory, executive function, or attention. Currently available questionnaires may be insufficient to screen patients for cognitive deficits.
Objectives: Evaluate the measurement properties of the Dizziness Handicap Inventory (DHI) using item response theory in patients diagnosed with vestibular migraine (VM) and Meniere's disease (MD). Design: One hundred twenty-five patients diagnosed with VM and 169 patients diagnosed with MD by a vestibular neurotologist according to the Bárány Society criteria in two tertiary multidisciplinary vestibular clinics and who completed the DHI at their initial visit, were included in the study. The DHI (total score and individual items) was analyzed using the Rasch Rating Scale model for patients in each subgroup, VM and MD, and as a whole group. The following categories were assessed: rating-scale structure, unidimensionality, item and person fit, item difficulty hierarchy, person-item match, and separation index, standard error of measurement, and minimal detectable change (MDC). Results: Patients were predominantly female (80% of the VM subgroup and 68% of the MD subgroup) with a mean age of 49.9 ± 16.5 years and 54.1 ± 14.2 years, respectively. The mean total DHI score for the VM group was 51.9 ± 22.3 and for the MD group was 48.5 ± 26.6 (p > 0.05). While neither all items nor the separate constructs met all criteria for unidimensionality (i.e., items measuring a single construct), post hoc analysis showed that the all-item analysis supported a single construct. All analyses met the criterion for showing a sound rating scale and acceptable Cronbach's alpha (≥0.69). The all-item analysis showed the most precision, separating the samples into three to four significant strata. The separate-construct analyses (physical, emotional, and functional) showed the least precision, separated the samples into less than three significant strata. Regarding MDC, the MDC remained consistent across the analyses of the different samples; approximately 18 points for the full analyses and approximately 10 points for the separate construct (physical, emotional, and functional). Conclusions: Our evaluation of the DHI using item response theory shows that the instrument is psychometrically sound and reliable. The all-item instrument fulfills criteria for essential unidimensionality but does seem to measure multiple latent constructs in patients with VM and MD, which has been reported in other balance and mobility instruments. The current subscales did not show acceptable psychometrics, which is in line with multiple recent studies favoring the use of the total score. The study also shows that the DHI is adaptable to episodic recurrent vestibulopathies. The total score shows better precision and separation of subjects in up to four strata compared to the separate construct that separate subjects into less than three strata. The measurement error smallest detectable change was found in our analysis to be 18 points, which means any change in the DHI of less than 18 points is not likely to be clinically significant. The minimal clinically important difference remains indeterminate.
Dizziness is one of the most common symptoms in the elderly. Various vestibular disorders, such as benign paroxysmal positional vertigo, vestibular neuritis, Meniere’s disease, vestibular migraine, can cause dizziness. The vestibular system consists of the peripheral vestibular organs in the inner ear and the extensive central nervous system from the cerebellum and brainstem to the thalamus to cortex. In particularly, vestibular sensory input plays a important role in spatial cognitive abilities such as spatial memory and spatial navigation. In the elderly, cognitive decline, such as mild cognitive impairment, Alzheimer’s disease and other dementia, is a very frightening disease that worsens the quality of life. It is possible to evaluate vestibular dysfunction through vestibular function test, and there are various evaluation methods for cognitive function. The evidence has been gradually accumulating to suggest that the balance organs or ‘vestibular system,’ might also be important in the development of cognitive dysfunction and dementia. Animal studies, pathologic and imaging evidence, and behavioral assays on the relationship between various diseases related to dizziness and cognitive dysfunction are supporting that. Given that vestibular dysfunction can be treated through physical-therapy such as vestibular rehabilitation, identifying and treating dizziness in older adults with and without cognitive impairment may provide potential benefits in preventing, mitigating cognitive decline.
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The role of the vestibular system in daily functions should not be overlooked. Recent studies have examined the effect of the vestibular system on motor, cognitive, emotional and perceptual functions. Clinical and laboratory studies show the association of vestibular inputs with various higher functions, particularly cognitive functions such as memory. The aim of this study is to develop a scale in which vestibular and cognitive functions will be evaluated in the geriatric population has imbalance complaint and to evaluate its validity and reliability. The 25-item "IAU Cognitive Vestibular Function Scale" developed online via Google Forms and administered to 75 individuals (Age: 678,4; Woman: %61,3 (n=46); Man %38,7 (n=29)) aged 60 and over who stated that they had imbalance complaints on the given scale. The final version of the scale‟s items was created according to the feedback received from experts and according to the literature review. The validity of the scale was evaluated with factor analysis and its reliability was evaluated with the Cronbach's alpha coefficient. As a result of the reliability analysis, the Cronbach's Alpha value of the "IAU Cognitive Vestibular Function Scale" was found to be highly reliable as 0.86. It has been shown that there is a 7-factor construct validity in factor analysis. However, since the 7 factors formed did not meet the predefined groups on the scale, the analyzes made as continuation were made on the existing 5 subscales. Statistically significant values were found between the age variable and spatial subgscales, spatial visual subscales, andIAU Cognitive Vestibular Function Scale in a low positive effect (respectively: r = 0.264; p = 0.022; r = 0.237; p = 0.041; r = 0.231; p = 0.046). The findings support that the IAU Cognitive Vestibular Function Scale is a valid and reliable measurement tool at a good level in the elderly aged 60 and over.
When interviewing a patient presenting with dizziness, it is imperative to both diagnosis and treatment for the clinician to identify the impact dizziness has on the patient's productivity, general function level and cognition. and cognition. Psychiatric comorbidities and concurrent sleep disturbances are common in this patient population and identification of these additional factors is important in implementing a holistic, multidisciplinary treatment plan and ultimately improves the patient's outcome.
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In the nineteenth century Pierre–Jean–Marie Flourens (1825) and Ernst Mach described the vestibular system and its peripheral organs while Robert Barany, rewarded by the Nobel prize in 1914, was the first to investigate vestibular disorders with caloric tests making surgical treatments of the vestibular organ possible. Recently, Graf and Klam (2006) have reminded us that this ancient sensory system appeared more than 500 million years ago. Logically its influence would most likely not be restricted to balance reflexes at the brainstem level; it must have also shaped our brain. The vestibular system is the one sensory organ dedicated to gravity perception, which along with light and oxygen served as a motor of evolution. In the 1950s the groups of Otto–Joachim Grusser in Germany, Wilder Penfield in Canada, and later the group of Alain Berthoz in France, demonstrated in elegant experiments on awake monkey (Guldin and Grusser, 1998), epileptic patient (Penfield, 1957), and neurologically-normal human (Lobel et al., 1999) the existence of vestibular projections to the cortex and how they combine with visual and proprioceptive information. An increasing number of researchers, often fervent disciples, have built on these findings to produce a spate of publications that have consolidated the evidence for a sense of verticality and three-dimensional body representations within the vestibular cortical areas. In the 1990s Paul Smith and colleagues examined vestibular processing in the hippocampus and its role in spatial memory. Exploring this topic in the rodent (Smith, 1997), they began to elucidate the secrets and the previously silent functions of the vestibular system. These findings led to increasing clarity about how vestibular degeneration may be related to some aspects of dementia (Previc, 2013), psychiatric diseases (Gurvich et al., 2013), and cognitive impairments in the elderly (Bigelow et al., 2015; Semenov et al., 2015). The research by Marianne Dieterich and Thomas Brandt has examined the bilateral organization of multiple multisensory cortical areas and revealed the vestibular dominance of the non-dominant hemisphere (Dieterich et al., 2003). They addressed the following questions: how is one global percept of motion and orientation in space formed, and does this dominance determine the lateralization of brain function such as handedness (Brandt and Dieterich, 2015)? A vestibular contribution to the most crucial aspects of the human sense of self and self-consciousness has recently been highlighted by neurological and neuroscientific investigations: vestibular signals contribute to the experience that the self is located within the boundaries of the body (Blanke et al., 2004; Lopez et al., 2008) and may even be involved in self-other discrimination and interactions (Lenggenhager and Lopez, 2015). In this Frontiers in Integrative Neuroscience Research Topic initiated by Sidney Simon, twenty-four articles highlight recent discoveries in the field of vestibular cognition, including: (1) Anatomy of the vestibulo-cortical pathways; (2) Spatial navigation and memory; (3) Spatial cognition, bodily and self-motion perception; (4) Vestibular stimulation and rehabilitation; (5) Posture and motor control; (6) Vestibular disorders and compensation; and (7) Development of vestibular function.
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Objective To report the nationwide prevalence of dizziness and vestibular dysfunction in the Korean population and determine the associated factors. Design Cross-sectional analysis of a nationwide health survey. Methods We obtained data from the 2009 to 2010 Korea National Health and Nutrition Examination Surveys, which were cross-sectional surveys of the South Korean civilian, non-institutionalised population aged 40 years and older (N=3267). A field survey team performed interviews and physical examinations. Structured questionnaires were handed out and balance function tests using the modified Romberg test of standing balance on firm and compliant support surfaces were performed on participants. Failure on the modified Romberg test was regarded to indicate vestibular dysfunction. Results The prevalence of dizziness during the past year was 16.70% (95% CI 14.65% to 18.76%). The presence of vestibular dysfunction was noted in 1.84% (95% CI 1.18% to 2.51%). In addition, the prevalence of experiencing falls and positional dizziness were 1.46% (95% CI 0.87% to 2.06%) and 1.73% (95% CI 1.17% to 2.29%), respectively. Multivariable analysis revealed that dizziness was associated with increased age, female gender, hearing loss and stress. Vestibular dysfunction was associated with increased age, history of dizziness and hearing loss. Conclusions Vertigo and dizziness are the greatest contributors to the burden of disability in the aged population. Screening for dizziness and vestibular dysfunction, and management of associated factors might be important for improving compromised quality of life due to postural imbalance caused by vestibular problems.
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Many physicians have observed that psychological factors play a significant role in the course of Meniere's disease (MD), with Meniere's patients being subject to anxiety and tension states. A lot of research attentions from a psychological point of view have been directed at MD, with earlier researchers focusing on psychosomatic causes of the illness as well as its somatopsychic result. However, the question whether MD is caused by psychological factors or whether the psychological manifestation in MD is as a result of the illness is still unresolved. The aim of this study is to provide an overview of interaction that exists between physical and emotional factors in the development of MD and its impact on the quality of life of the sufferers. A structured literature search was carried out, with no restrictions to the dates searched. A vicious circle of interaction seems to exist between the somatic organic symptoms of MD and resultant psychological stress. The frightening attacks of vertigo seem likely to produce and increase the level of anxiety thereby worsening the emotional state and the resultant anxiety provokes various symptoms probably through disorders of the autonomic nervous system occasioned by the increased levels of stress-related hormones.
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The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal) and far (extrapersonal) spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation), and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss.
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Deaf children have been characterized as being impulsive, distractible, and unable to sustain attention. However, past research has tested deaf children born to hearing parents who are likely to have experienced language delays. The purpose of this study was to determine whether an absence of auditory input modulates attentional problems in deaf children with no delayed exposure to language. Two versions of a continuous performance test were administered to 37 deaf children born to Deaf parents and 60 hearing children, all aged 6-13 years. A vigilance task was used to measure sustained attention over the course of several minutes, and a distractibility test provided a measure of the ability to ignore task irrelevant information - selective attention. Both tasks provided assessments of cognitive control through analysis of commission errors. The deaf and hearing children did not differ on measures of sustained attention. However, younger deaf children were more distracted by task-irrelevant information in their peripheral visual field, and deaf children produced a higher number of commission errors in the selective attention task. It is argued that this is not likely to be an effect of audition on cognitive processing, but may rather reflect difficulty in endogenous control of reallocated visual attention resources stemming from early profound deafness.
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In addition to the deficits in the vestibulo-ocular and vestibulo-spinal reflexes that occur following vestibular dysfunction, there is substantial evidence that vestibular loss also causes cognitive disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in spatial orientation. In this review we summarize the evidence that vestibular loss causes cognitive disorders, especially spatial memory deficits, in animals and humans and critically evaluate the evidence that these deficits are not due to hearing loss, problems with motor control, oscillopsia or anxiety and depression. We review the evidence that vestibular lesions affect head direction and place cells as well as the emerging evidence that artificial activation of the vestibular system, using galvanic vestibular stimulation (GVS), can modulate cognitive function.
Classifications and definitions are essential to facilitate communication; promote accurate diagnostic criteria; develop, test, and use effective therapies; and specify knowledge gaps. This article describes the development of the International Classification of Vestibular Disorders (ICVD) initiative. It describes its history, scope, and goals. The Bárány Society has played a central role in organizing the ICVD by establishing internal development processes and outreach to other scientific societies. The ICVD is organized in four layers. The current focus is on disorders with a high epidemiologic importance, such as Menière disease, benign paroxysmal positional vertigo, vestibular migraine, and behavioral aspects of vestibular disorders. Copyright © 2015 Elsevier Inc. All rights reserved.