The association between peripheral vestibular function, balance, and cognition : from inner ear to the brain
The number of older adults, including those affected by dementia, continues to grow. Alzheimer’s disease is the most common cause of dementia. Recent evidence suggests that vestibular loss is associated with Alzheimer’s disease and may contribute to its onset. This hypothesis is known as the vestibular loss hypothesis. People with Alzheimer’s disease demonstrate vestibular-related symptoms; people with vestibular loss have been shown to present with impaired spatial cognition; and hippocampal atrophy (an important biomarker for Alzheimer’s disease) has been reported in bilateral vestibulopathy. However, every argument comes with certain limitations in literature, and the potentially substantial impact of concomitant hearing loss is currently understudied. As such, this thesis focuses on (1) evaluating functioning of the peripheral vestibular end-organ as well as balance in older adults with Mild Cognitive Impairment and Alzheimer’s disease, (2) evaluating cognition and the cognitive subdomains in older adults with bilateral vestibular loss, and (3) evaluating whole-brain and hippocampal brain morphology in older adults with bilateral vestibular loss. These three objectives are met while taking hearing status into account. In the first part, vestibular and balance function was evaluated in older adults with Mild Cognitive Impairment and Alzheimer’s disease. In this part, a delayed p13 latency as a measure of saccular function is observed in Alzheimer’s disease. On the other hand, measures of semicircular canal function remained preserved. Furthermore, balance worsened in Mild Cognitive Impairment and Alzheimer’s disease. Future studies should evaluate vestibular therapy in Mild Cognitive Impairment and Alzheimer’s disease and the potential positive impact on reducing fall risk and preserving cognition. A second part of this thesis reversed the previous association: instead of evaluating vestibular function in a population with impaired cognition, cognition is now evaluated in a population with impaired vestibular function. People with bilateral vestibular loss demonstrated a general deficit in cognition, which was most pronounced in the immediate memory, visuospatial cognition, and attention subdomains. On the other hand, the language and delayed memory subdomains remained preserved. Even more, these observed cognitive deficits were associated with balance difficulties rather than reduced functioning of the peripheral vestibular end-organ. A third part of this thesis explored structural brain imaging in older adults with bilateral vestibular loss. However, no differences in whole-brain or hippocampal volume were observed in bilateral vestibulopathy in comparison with healthy controls. When exploring whole-brain surface-based measures such as cortical thickness or sulcus depth, also no differences were observed between the two groups.
Antwerpen : University of Antwerp, Faculty of Medicine and Health Sciences, Department of Translational Neurosciences , 2023
xxiii, 186 p.
Supervisor: Van Rompaey, Vincent [Supervisor]
Supervisor: Mertens, Griet [Supervisor]
Supervisor: Cras, Patrick [Supervisor]
Supervisor: Gilles, Annick [Supervisor]
Supervisor: Van Ombergen, Angelique [Supervisor]
Supervisor: Eulenburg, zu, Peter [Supervisor]
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Creation 12.10.2023
Last edited 26.11.2023
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