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Abstract

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-
Laryngology
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
(NVI)
Emilie Lacroix, Naima Deggouj, Samuel
Salvaggio, Valérie Wiener, Michel Debue
& Martin Gareth Edwards
1 23
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OTOLOGY
The development of a new questionnaire for cognitive complaints
in vertigo: the Neuropsychological Vertigo Inventory (NVI)
Emilie Lacroix
1,2,3
Naima Deggouj
1,2
Samuel Salvaggio
3
Vale
´rie Wiener
1,2
Michel Debue
1
Martin Gareth Edwards
2,3
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
Introduction
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
´nie
`re’s
disease (MD) [912], leading to a profound deterioration of
patients’ quality of life [13].
&Emilie Lacroix
emile.lacroix@uclouvain.be
1
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
2
Institute of Neuroscience (IONS), Universite
´Catholique de
Louvain, Louvain-la-Neuve, Belgium
3
Institute for Research in Psychological Science (IPSY),
Universite
´Catholique de Louvain, Louvain-la-Neuve,
Belgium
123
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
´nie
`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
questionnaire.
Development of the NVI questionnaire
Methods
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
Physical
symptoms
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
Ò
(https://www.limesurvey.org). 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.
Analyses
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
subscales).
Results for structural validity and internal
consistency
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
(N=108)
Cronbach’s
alpha
(N=108)
Before
PCA
a
After
PCA
b
After PCA
b
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
a
Before items reduction
b
After items reduction
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Extreme groups validity of the NVI
Methods
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
p
2
)
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
p
2
=0.128; vision subscale, F(1.207) =31.90,
p=0.000, and g
p
2
=0.134; attention subscale,
F(1.207) =20.43, p=0.000, and g
p
2
=0.090; and emo-
tion subscale, F(1.207) =23.54, p=0.000, and
g
p
2
=0.102). There was also a significant effect for the
total score, F(1.207) =27.90, p=0.000, and g
p
2
=0.119].
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
p
2
=0.016,
space perception, F(1.207) =0.720, p=0.397, and
g
p
2
=0.003, and time perception, F(1.207) =1.45,
p=0.230, and g
p
2
=0.007) subscales.
The ANCOVA analyses showed significant main effects
of age for attention F(1.207) =8.71, p=0.03, and
g
p
2
=0.04 and emotion subscales, F(1.207) =21.56,
p=0.000, and g
p
2
=0.094. Spearman’s rho correlation
coefficient analyses showed an inverse correlation between
age and total NVI score for vertigo participants
(r
s
=-0.303 and p=0.001). This effect was also present
for the subscales of attention, emotion, and vision
(r
s
=-0.271 and p=0.005; r
s
=-0.473 and p=0.000;
and r
s
=-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.
Discussion
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
(N=108)
Non-vertigo-participants
(N=104)
Deaf/HOF participants
(N=99)
Non-Deaf/HOF participants
(N=113)
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
participants
(N=108)
Age of non-vertigo
participants
(N=104)
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
disorder.
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
report.
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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... The Slovenian DHI and NVI are valid and accurate tools for the diagnosis and measurement of health-related quality of life in patients with vertigo. They could aid general practitioners, occupational health specialists, neurologists and otorhinolaryngologists. ekonomskih in čustvenih nevropsiholoških vplivov vrtoglavice na kakovost življenja (4,5). Prevedena sta bila v različne svetovne jezike, a ne v slovenščino. ...
... predmetov v prostoru. Bolniki jo pogosto zamenjujejo s simptomi omotice, motnjami vida ali motnjami ravnotežja (5). Poleg normalnega delovanja vestibularnega aparata so za normalno ravnovesje potrebni dober vid, propriocepcija in dobro delovanje centralnega živčnega sistema, kjer poteka integracija signalov iz teh sistemov. ...
... DHI je najpogosteje uporabljeni referenčni vprašalnik za vrednotenje težav, povezanih z vrtoglavico (5). Razvit je bil za ocenjevanje težav z ravnotežjem, saj so rezultati vestibulometrije (npr. ...
Article
Full-text available
BACKGROUNDS. To our knowledge, no questionnaires for assessing patients with vertigo and its impact on the quality of life exist in the Slovenian language. As a result, evaluating the impact of vertigo on patients’ quality of life is difficult. The purpose of this paper is to present the process of intercultural adaptation and its confirmation in the Slovenian language for the Dizziness Handicap Inventory (DHI) and the Neuropsychological Vertigo Inventory (NVI). METHODS. The DHI and NVI were translated into the Slovenian language and completed by patients treated at our department for vertigo. The control group consisted of healthy volunteers. Internal consistency, test-retest reliability, discriminant validity, diagnostic accuracy and cut-off value were determined for each questionnaire. RESULTS. Test-retest reliability was excellent for DHI (ICC (intraclass correlation coefficient) A=0.946) and NVI (p=0.315, ICC A=0.975). Discriminant validity was confirmed for each questionnaire (p>0.05) using the Mann-Whitney U test (DHI, THI) or the Welch t-test (NVI). DHI had acceptable (α=0.910), and NVI (α=0.950) perfect internal consistency. The DHI had excellent and the NVI acceptable diagnostic accuracy (AUC (area under curve)=0.999 and AUC=0.781, respectively). Cutoff values determined by Youden’s index were 9 for DHI and 56 for NVI. DISCUSSION. The Slovenian DHI and NVI are valid and accurate tools for the diagnosis and measurement of health-related quality of life in patients with vertigo. They could aid general practitioners, occupational health specialists, neurologists and otorhinolaryngologists.
... [6][7][8] Cognitive function is primarily evaluated using scales and individual tests related to visuospatial ability, memory, and executive function. 9 However, studies on vestibular disorders and cognitive function are lacking. Therefore, in this systematic review, we conducted a comprehensive literature search to highlight the correlation between vestibular disorders and cognitive dysfunction, providing evidence that vestibular dysfunction may be a risk factor for cognitive dysfunction in patients. ...
... The AHRQ inventory, a commonly used tool to evaluate observational studies, comprises 11 items with the following responses: "yes" (score 1), "no" (score 0), and "unclear" (score 0). Quality was categorized into three levels: low quality (0-3), medium quality (4)(5)(6)(7), and high quality (8)(9)(10)(11). ...
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Objectives The purpose of this study is to consolidate and condense the available evidence about the potential association between vestibular diseases and cognitive impairment. Data Sources and Methods A systematic search was conducted on four English databases (PubMed, Embase, Web of Science, Cochrane Library) from the time of library construction to March 2024. The study incorporated various keywords such as “vestibular disorders,” “vertigo,” “dizziness,” “Meniere's disease,” “benign paroxysmal positional vertigo,” “vestibular migraine,” “vestibular neuritis,” “labyrinthitis,” “bilateral vestibular disease,” as well as “cognitive function” and “cognitive dysfunction.” A qualitative review was conducted to look for and assess pertinent studies. Results A total of 45 publications were incorporated, encompassing prevalent vestibular disorders, mostly targeting individuals in the middle‐aged and older demographic. The findings indicate that individuals with vestibular disorders experience varying levels of cognitive impairment, which is evident in different aspects, with visuospatial cognitive deficits being more prominent. Furthermore, patients with chronic vestibular syndromes are more prone to cognitive dysfunction. Lastly, the hippocampus plays a crucial role in the intricate vestibular neural network. Conclusion The findings of this comprehensive review indicate that vestibular disorders can result in impairments across various aspects of cognitive functioning, particularly in visuospatial cognition. The underlying mechanism may be associated with a decrease in the size of the hippocampus. Individuals suffering from chronic vestibular dysfunction exhibit a higher likelihood of experiencing cognitive deficits. Level of Evidence NA Laryngoscope, 134:4858–4872, 2024
... Several previous studies have reported a prevalence of dizziness of 30-50% in patients with various dementia syndromes [5,6]. Despite this obvious interrelation, the simultaneous appraisal of dizziness and cognitive impairment in clinical route diagnostics is often neglected [6,7]. The primary reasons for this shortcoming may be firstly that routine cognitive screening of elderly dizzy patients might be too time-consuming and secondly that there are to date no validated questionnaires or rating scales available, which are sufficiently sensitive to detect both vestibular and cognitive complaints [7]. ...
... Despite this obvious interrelation, the simultaneous appraisal of dizziness and cognitive impairment in clinical route diagnostics is often neglected [6,7]. The primary reasons for this shortcoming may be firstly that routine cognitive screening of elderly dizzy patients might be too time-consuming and secondly that there are to date no validated questionnaires or rating scales available, which are sufficiently sensitive to detect both vestibular and cognitive complaints [7]. ...
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Background The current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center. Methods One hundred patients (age: 74.7 ±\pm ± 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients’ total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25). Results The linear regression model explained almost half of the variance of patients’ total MoCA score ( R ² = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age ( β = − 0.75), pathological Romberg’s sign ( β = − 1.05), normal caloric test results ( β = − 0.8), slower timed-up-and-go test ( β = − 0.67), frontal ( β = − 0.6) and temporal ( β = − 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70–0.98) in distinguishing between cognitively normal and impaired patients. Conclusions The need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center.
... We added one subjective measure of executive impairments (Frontal System Behaviour Scale, [40]). Beside executive functions, we measured the impact of PVD on daily life functioning (Neuropsychological Vertigo Inventory, [55]). As control variables, we assessed intelligence and global cognitive level. ...
... Impact of PVD on daily life functioning was assessed with the Neuropsychological Vertigo Inventory (NVI, [55]). The Neuropsychological Vertigo Inventory is a 28-item Content courtesy of Springer Nature, terms of use apply. ...
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Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.
... For example, the MoCA is commonly applied but includes domains not commonly affected in vestibular disorders (e.g., orientation to time and date), while navigation and multitasking are absent. Therefore, the design and selection of assessments capable of assessing cognitive domains most impacted by vestibular disorders is important (164). Assessment selection should also consider the delivery format to account for sensory difficulties experienced by people with vestibular disorders (e.g., hearing loss and tinnitus in Ménière's disease, and visual dominance in vestibular migraine and Persistent Postural Perceptual Dizziness (PPPD)), which are not cognitive in nature (52). ...
... Self-report measures are likely to be important in understanding the perceived impact of vestibular cognitive dysfunction, particularly until more specific and naturalistic paradigms are developed (165). The Neuropsychological Vertigo Inventory targets vestibular cognitive domains (affective state, temporal memory, spatial memory, visual spatial cognition) across 22 items (164,166). Developing a briefer version of this questionnaire may prove more practical for in-clinic monitoring. Anxiety, depression, and stress are also prevalent among people with vestibular disorders and correlate with self-reported cognitive dysfunction (167). ...
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Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.
... Among the included RCTs, for the evaluation of QoL the Dizziness Handicap Inventory (DHI) (7), Tinnitus Handicap Inventory (THI) (8), and the Functional Level Scale (FLS) defined by the AAO-HNS criteria (1), were predominantly used. Additionally, a variety of questionnaires were used to measure quality of life in relation to dizziness, including the European Evaluation of Vertigo (EEV) scale (9), Vertigo Symptom Scale short form (VSS-SF) (10), Menière's Disease Patient-Oriented Symptom Severity Index (MD-POSI) (11), Dizziness Beliefs Questionnaire (DBQ) (12), Vestibular Disorders Activities of Daily Living (VDADL) score (13), the Menière's Disease Outcomes Questionnaire (MDOQ) (14) and the Neuropsychological Vertigo Inventory (NVI) (15). Furthermore, some studies addressed general health-related QoL or aspects related to psychological health, although these aspects were explored in a limited number of studies. ...
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Introduction Menière’s disease (MD) is an inner ear disorder characterized by episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. As of yet, the etiology of MD remains unknown, which contributes to the lack of an evidence-based treatment. Outcomes and outcome measurement instruments (OMIs) used in trials assessing the effectiveness of potential MD treatment are randomly selected due to the absence of established guidelines on this matter. The objective of this review is to give an overview of the outcome domains, outcomes and OMIs used in randomized controlled trials (RCTs) evaluating treatment effects in MD to 2024. This will be the first step of developing a Core Outcome Set (COS) for MD trials. Methods A literature search of the PubMed, Embase and Cochrane library databases was conducted from inception to November 2024. All RCTs on the treatment effect of various therapies for patients suffering from MD were included. Among other details, we extracted and analyzed all outcome domains, outcomes, and OMIs used in these RCTs. Results A total of 76 RCTs were included, revealing a diverse range of outcomes and OMIs used across the included studies. Outcome domains encompassed dizziness, hearing, tinnitus, aural fullness, quality of life (QoL) and other. Outcomes used most frequently included: the severity of vertigo attacks, the number of vertigo attacks, vestibular function, hearing loss, severity of hearing loss, QoL related to dizziness, and Qol related to tinnitus. The latter two were most commonly measured with the Dizziness Handicap Inventory (DHI), the Functional Level Scale (FLS) and the Tinnitus Handicap Inventory (THI) respectively. For the other outcomes, there was little uniformity in the use of OMIs. Moreover, there was a notable lack of validated OMIs used in the included RCTs. Conclusion This scoping review highlights the need for standardizing outcome selection for RCTs focusing on the treatment of MD. In this first step of developing a Core Outcome Set for MD, we identified a potential list of outcomes to be used in the next steps of ‘the Core Outcome Set for Menière’s Disease (COSMED)’ study.
... Medical clinicians might feel more comfortable screening and referring for mental health concerns with more robust vestibular disorder-specific mental health screening tools (e.g., depression and anxiety screeners for this population), and treatments adapted to this population (e.g., CBT and ACT for chronic dizziness). Recent progress includes multiple screening tools for this population including Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) and the Neuropsychological Vertigo Inventory (NVI; Herdman et al., 2022aHerdman et al., , 2022bLacroix et al., 2016). Although application of current treatments like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to patients with vestibular disorders is promising, more randomized controlled trials are needed. ...
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To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate’s degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.
... In the first stage, the research team generated questionnaire items based on a literature review (Jaffar & Rahman, 2017;Lacroix et al., 2016;Teunis, Domico, Ring & Fowler, 2023). The researchers all teach in higher education; one of them has more than three decades of experience in researching teaching methods and training. ...
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Workgroup methodology is often used to promote curricular learning. However, the intentionality in choosing a teaching strategy only sometimes has the best achievement in learning. This study aims to develop and validate an instrument (questionnaire) that is easy to apply and allows the professor to evaluate the effectiveness of the workgroup in learning (curricular) development. An exploratory factor analysis was conducted and three constructs were extracted: Practice, Motivation and Effectiveness. The correlation between the constructs indicates a good relationship and dependence between them. The results show that the instrument is valid and reliable, proving that it could be an essential tool to ascertain whether students see workgroup as a factor that promotes their learning and thus allow the professor to monitor and assess this method´s effectiveness in their teaching strategy. This study leads us to consider developing questionnaires to assess students' perceptions of other teaching–learning methodologies.
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Objective To evaluate the levels of inflammatory cytokines and symptom survey scores in patients diagnosed with Menière's disease or vestibular migraine from a single center by a single neurotologist compared to control subjects with no history of dizziness or migraine. Study Design Cross-sectional pilot study. Setting Single-center tertiary referral center in Charleston, SC. Patients Patients were recruited from the neurotology clinic at a tertiary referral center. Patients with definite Menière's disease or definite vestibular migraine as defined by the Barany consensus criteria were eligible. Control subjects presented to clinic without dizziness, vertigo, fluctuating hearing loss, or a history of migraine. Main Outcome Measures Questionnaire scores include DHI, SF-20, CFQ, PHQ-9, PSWQ, GAD-7, NVI, DCS, VM-PATHI, and MD-POSI. Circulating and in vitro levels of cytokines include ENA-78, GROα, IFN-α2a, IFN-γ, IL-10, IL-1α, IL-1β, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-8, MCP-1, MCP-2, MDC, MIP-1α, MIP-1β, and TNF-α. Cytokine levels were compared with effect size analysis. Results There were 20 Menière's disease, 20 vestibular migraine, and 10 control patients enrolled in this study. Episode frequencies ranged from three per week to two to five per year in the MD group and daily to 1 every 2 to 3 months in the VM group. When patient-derived PBMC samples were compared to vestibular migraine, TNF-α ( d = −0.427 [−0.879, 0.025]) and IFN-γ ( d = −0.818 [−1.313, −0.323]) were found to be higher in Menière's disease, whereas ENA-78 ( d = −0.652 [−1.361, 0.056]) was found to be lower. No differences were found when cytokines were measured following stimulation with LPS. Conclusions This pilot study suggests Menière's disease patients may have higher levels of TNF-α and IFN-γ and lower levels of ENA-78 than vestibular migraine patients when measured following in vitro release from patient-derived PBMC. Increased sample size, optimized blood draw timing, and more specific PBMC stimulation may help us further elucidate inflammatory pathways implicated in these disorders.
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Importance Meniere disease accounts for up to 15% of new vestibular diagnoses,; however, the optimal treatment has yet to be identified. A conservative treatment that would reduce or stop the vertigo episodes has not been identified. Objective To determine the efficacy of a serotonin-norepinephrine reuptake inhibitor, venlafaxine, compared to placebo in treating patients with Meniere disease. Design, Setting, and Participants This was a randomized, double-blind, placebo-controlled, crossover pilot study spanning 22 weeks of follow-up. The clinical trial took place at a single-center tertiary referral center in Charleston, South Carolina. Participants were eligible if they were 18 years or older, had definite Meniere disease criteria as defined by Barany criteria, had at least 2 episodes in the last month, had not received intratympanic gentamycin, skull base surgery, or radiation therapy to the head or neck, not currently taking diuretics for Meniere disease, not currently taking oral steroids, and not currently taking serotonin-modulating medication. Patients were enrolled between February 2020 and September 2023. Interventions Patients received either 1 venlafaxine tablet, 37.5 mg, taken daily by mouth for 8 weeks or 1 placebo tablet taken daily by mouth for 8 weeks. Group 1 received placebo during phase 1 of the trial and venlafaxine in phase 2 of the trial. Group 2 received venlafaxine during phase 1 of the trial and placebo in phase 2 of the trial. Main Outcomes and Measures The main outcomes included the number of episodes and scores on the following scales: Dizziness Handicap Inventory, Neuropsychological Vertigo Inventory, Meniere Disease Patient-Oriented Symptom Index, 20-Item Short Form Health Survey, Penn State Worry Questionnaire, Cognitive Failure Questionnaire. Results A total of 182 patients were screened, and 40 participants with Meniere disease enrolled in the trial. The mean (SD) age of participants was 56.6 (14.3) years, and 22 (55%) were female. Participants had a mean (SD) of 13.8 (10.1) episodes per phase at baseline, 5.4 (4.4) episodes (Δ8.4) during the venlafaxine phase, and 5.0 (4.6) episodes (Δ8.8) during the placebo phase. No significant difference was identified between venlafaxine and placebo groups in the number of episodes or quality-of-life metrics. Conclusions and Relevance This randomized clinical trial failed to identify a difference between venlafaxine and placebo in number of episodes and other quality-of-life metrics. Future studies may benefit from different dosing regimens, larger cohorts, and longer lengths of therapy. Trial Registration ClinicalTrials.gov Identifier: NCT04218123
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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.
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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.