Falls Among People With Bilateral Vestibulopathy: A Review of Causes, Incidence, Injuries, and Methods.

Importance: People with bilateral vestibulopathy experience severe balance and mobility issues. Fear and anxiety are associated with reduced activity, which can further affect balance and fall risk. Understanding and intervening on falls in this population is essential. The aims of this narrative review are to provide an overview of the current knowledge and applied methods on fall incidence, causes, and injuries in bilateral vestibulopathy. Observations: Eleven articles reporting falls incidence in people with bilateral vestibulopathy were deemed eligible, including 3 prospective and 8 retrospective studies, with a total of 359 participants, of whom 149 (42%) fell during the assessed period. When reported, the most common perceived causes of falls were loss of balance, darkness, and uneven ground. Information on sustained injuries was limited, with bruises and scrapes being the most common, and only 4 fractures were reported. As most studies included falls as a secondary, descriptive outcome measure, fall data obtained using best practice guidelines were lacking. Only 6 studies reported their definition of a fall, of which 2 studies explicitly reported the way participants were asked about their fall status. Only 3 studies performed a prospective daily fall assessment using monthly fall diaries (a recommended practice), whereas the remaining studies retrospectively collected fall-related data through questionnaires or interviews. While most studies reported the number of people who did and did not fall, the number of total falls in individual studies was lacking. Conclusions and Relevance: The findings from this review suggest that falls in people with bilateral vestibulopathy are common but remain an understudied consequence of the disease. Larger prospective studies that follow best practice guidelines for fall data collection with the aim of obtaining and reporting fall data are required to improve current fall risk assessments and interventions in bilateral vestibulopathy.

Impact of Bilateral Vestibulopathy on Spatial and Nonspatial Cognition: A Systematic Review.

OBJECTIVES: Hearing loss is considered an independent risk factor for dementia. Growing evidence in animal and human studies suggest that not only hearing loss but also vestibular loss might result in cognitive deficits. The objective of this study is to evaluate the presence of spatial and nonspatial cognitive deficits in patients with bilateral vestibulopathy. As different causes of bilateral vestibulopathy are associated with hearing loss, the objective is to evaluate if these cognitive deficits are due to the vestibular loss of the patients with bilateral vestibulopathy, or to their hearing loss, or both. DESIGN: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. (1) Data sources: MEDLINE and the Cochrane Library. (2) Study selection: Cross-sectional studies investigating cognitive performances in human patients with bilateral vestibulopathy confirmed by quantitative vestibular testing. (3) Data extraction: Independent extraction of articles by three authors using predefined data fields, including patient- and control characteristics and cognitive outcomes. RESULTS: Ten studies reporting on 126 patients with bilateral vestibulopathy matched the inclusion criteria. Cognitive domains evaluated in patients with bilateral vestibulopathy included visuospatial abilities, memory, language, attention, and executive function. In only three studies, hearing performance of the included patients was briefly described. Nearly all studies demonstrated a significant impairment of spatial cognition in patients with bilateral vestibulopathy. In the few papers investigating nonspatial cognition, worse outcome was demonstrated in patients with bilateral vestibular loss performing cognitive tasks assessing attentional performance, memory, and executive function. CONCLUSIONS: Strong evidence exists that patients with bilateral vestibulopathy suffer from impaired spatial cognition. Recent studies even suggest impairment in other cognitive domains than spatial cognition. However, in all previous studies, conclusions on the link between cognitive performance and vestibular loss were drawn without taken hearing loss into consideration as a possible cause of the cognitive impairment.

A pilot study investigating the association between chronic bilateral vestibulopathy and components of a clinical functional assessment tool.

BACKGROUND: This study aimed to analyze the association between prospectively assessed falls and functional abilities in patients with bilateral vestibulopathy (BVP). METHODS: Nineteen BVP patients had functional abilities assessed at baseline with the expanded timed get-up-and-go (ETGUG) test. Falls were prospectively recorded with a monthly "fall calendar" over a one-year period. Association between baseline functional abilities and falls was evaluated by Mann-Whitney U testing. Logistic regression was applied to describe the relationship between falls and functional abilities. Area under the receiver-operating characteristic curve (AUC) was used predicting falls based on gait speed. RESULTS: Eight (45%) of 18 patients (61.11 ± 15.19 years, 12 male) reported 19 falls. Fallers had a significantly faster preferred gait speed (p = 0.03) in the fifth component of the ETGUG. Preferred gait speed was a significant factor in the prediction of falls model (odds ratio = 2.00, p = 0.05, CI = 1.00/4.00 per 10 cm/s). ACU was 0.80 and the cutoff score of 1.35m/s (sensitivity = 75%, specificity = 70%) in predicting falls. DISCUSSION: BVP patients classified as fallers demonstrated significant faster gait speed after a turning maneuver. Future studies in larger BVP patient samples are needed to refute or confirm our findings.