Clinical Application of the Vestibular Stimulation Effect on Balance Disorders with Dementia

Author(s): Kiyotaka Nakamagoe*, Shiori Yamada, Rio Kawakami, Takami Maeno, Tadachika Koganezawa, Akira Tamaoka

Journal Name: Current Alzheimer Research

Volume 18 , Issue 1 , 2021


  Journal Home
Translate in Chinese
Become EABM
Become Reviewer
Call for Editor

Abstract:

Background: In a previous study on Alzheimer’s disease (AD), we showed that vestibular dysfunction derived from cerebral disorders contributes to balance disorders. No previous clinical study has attempted to prevent the progression of balance disorders in dementia patients through vestibular stimulation using an air caloric device.

Objective: The purpose of this pilot study was to delay the progression of balance disorders by inducing vestibular compensation, specifically by utilizing the effect of vestibular stimulation to activate the cerebrum.

Methods: Fifteen individuals were randomized and classified into a stimulation group or a nonstimulation group. Eight AD patients underwent vestibular stimulation every 2 weeks for 6 months in the stimulation group. Seven AD patients participated in the nonstimulation group (the control group). Both groups were subsequently evaluated using a Mini-Mental State Examination (MMSE), stepping test, caloric test, and smooth pursuit eye movement test just before starting the study and 6 months later.

Results: For balance parameters, the various tests did not show any significant differences between the two groups. However, in the stepping test, the decline rate tended to be higher in the nonstimulation group than in the stimulation group. The stimulation group’s rate of decline in MMSE scores was lower than that of the nonstimulation group (p=0.015). No adverse events were tracked during the present study.

Conclusion: Repeated vestibular stimulation might help patients retain greater balance and higher function. To prove these effects, the future clinical application will require an increased number of cases and longer periods of vestibular stimulation. This study showed that vestibular stimulation by air caloric device is safe and tolerable in patients with AD.

Keywords: Alzheimer's disease, vestibular stimulation, electronystagmography, visual suppression, smooth pursuit, vestibular cortex.

[1]
Buchner DM, Larson EB. Falls and fractures in patients with Alzheimer-type dementia. JAMA 1987; 257(11): 1492-5.
[http://dx.doi.org/10.1001/jama.1987.03390110068028] [PMID: 3820464]
[2]
Leandri M, Cammisuli S, Cammarata S, et al. Balance features in Alzheimer’s disease and amnestic mild cognitive impairment. J Alzheimers Dis 2009; 16(1): 113-20.
[http://dx.doi.org/10.3233/JAD-2009-0928] [PMID: 19158427]
[3]
Nakamagoe K, Fujimiya S, Koganezawa T, et al. Vestibular function impairment in Alzheimer’s disease. J Alzheimers Dis 2015; 47(1): 185-96.
[http://dx.doi.org/10.3233/JAD-142646] [PMID: 26402767]
[4]
Nakamagoe K, Kadono K, Koganezawa T, et al. Vestibular impairment in frontotemporal dementia syndrome. Dement Geriatr Cogn Disord Extra 2016; 6(2): 194-204.
[http://dx.doi.org/10.1159/000445870] [PMID: 27350780]
[5]
Nakamagoe K, Yamada S, Kawakami R, et al. Vestibular dysfunction as cortical damage with amyotrophic lateral sclerosis. J Neurol Sci 2019; 397: 4-8.
[http://dx.doi.org/10.1016/j.jns.2018.12.006] [PMID: 30551075]
[6]
McCabe BF, Ryu JH. Experiments on vestibular compensation. Laryngoscope 1969; 79(10): 1728-36.
[http://dx.doi.org/10.1288/00005537-196910000-00004] [PMID: 5345406]
[7]
Kitahara T, Takeda N, Saika T, Kubo T, Kiyama H. Role of the flocculus in the development of vestibular compensation: Immunohistochemical studies with retrograde tracing and flocculectomy using Fos expression as a marker in the rat brainstem. Neuroscience 1997; 76(2): 571-80.
[http://dx.doi.org/10.1016/S0306-4522(96)00374-0] [PMID: 9015339]
[8]
Friberg L, Olsen TS, Roland PE, Paulson OB, Lassen NA. Focal increase of blood flow in the cerebral cortex of man during vestibular stimulation. Brain 1985; 108(Pt 3): 609-23.
[http://dx.doi.org/10.1093/brain/108.3.609] [PMID: 3876134]
[9]
Brandt T, Bartenstein P, Janek A, Dieterich M. Reciprocal inhibitory visual-vestibular interaction. Visual motion stimulation deactivates the parieto-insular vestibular cortex. Brain 1998; 121(Pt 9): 1749-58.
[http://dx.doi.org/10.1093/brain/121.9.1749] [PMID: 9762962]
[10]
Naito Y, Tateya I, Hirano S, et al. Cortical correlates of vestibulo-ocular reflex modulation: A PET study. Brain 2003; 126(Pt 7): 1562-78.
[http://dx.doi.org/10.1093/brain/awg165] [PMID: 12805122]
[11]
Rubens AB. Caloric stimulation and unilateral visual neglect. Neurology 1985; 35(7): 1019-24.
[http://dx.doi.org/10.1212/WNL.35.7.1019] [PMID: 4010940]
[12]
Been G, Ngo TT, Miller SM, Fitzgerald PB. The use of tDCS and CVS as methods of non-invasive brain stimulation. Brain Res Brain Res Rev 2007; 56: 346-61.
[http://dx.doi.org/10.1016/j.brainresrev.2007.08.001]
[13]
McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7(3): 263-9.
[http://dx.doi.org/10.1016/j.jalz.2011.03.005] [PMID: 21514250]
[14]
Cockrell JR, Folstein MF. Mini-Mental State Examination (MMSE). Psychopharmacol Bull 1988; 24(4): 689-92.
[PMID: 3249771]
[15]
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: A frontal assessment battery at bedside. Neurology 2000; 55(11): 1621-6.
[http://dx.doi.org/10.1212/WNL.55.11.1621] [PMID: 11113214]
[16]
Fukuda T. The stepping test: Two phases of the labyrinthine reflex. Acta Otolaryngol 1959; 50(2): 95-108.
[http://dx.doi.org/10.3109/00016485909129172] [PMID: 13636842]
[17]
Takemori S. Visual suppression test. Ann Otol Rhinol Laryngol 1977; 86(1 Pt 1): 80-5.
[http://dx.doi.org/10.1177/000348947708600113] [PMID: 299997]
[18]
Takemori S, Ono M, Maeda T. Cerebral contribution to the visual suppression of vestibular nystagmus. Arch Otolaryngol 1979; 105(10): 579-81.
[http://dx.doi.org/10.1001/archotol.1979.00790220013003] [PMID: 314795]
[19]
Zaccara G, Gangemi PF, Muscas GC, et al. Smooth-pursuit eye movements: Alterations in Alzheimer’s disease. J Neurol Sci 1992; 112(1-2): 81-9.
[http://dx.doi.org/10.1016/0022-510X(92)90136-9] [PMID: 1469444]
[20]
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates 1998.
[21]
Cohen J. A power primer. Psychol Bull 1992; 112(1): 155-9.
[http://dx.doi.org/10.1037/0033-2909.112.1.155] [PMID: 19565683]
[22]
Sato Y, Kawasaki T. Identification of the Purkinje cell/climbing fiber zone and its target neurons responsible for eye-movement control by the cerebellar flocculus. Brain Res Brain Res Rev 1991; 16(1): 39-64.
[http://dx.doi.org/10.1016/0165-0173(91)90019-5] [PMID: 1863816]
[23]
Fushiki H, Sato Y, Miura A, Kawasaki T. Climbing fiber responses of Purkinje cells to retinal image movement in cat cerebellar flocculus. J Neurophysiol 1994; 71(4): 1336-50.
[http://dx.doi.org/10.1152/jn.1994.71.4.1336] [PMID: 8035218]
[24]
Hopfinger JB, Buonocore MH, Mangun GR. The neural mechanisms of top-down attentional control. Nat Neurosci 2000; 3(3): 284-91.
[http://dx.doi.org/10.1038/72999] [PMID: 10700262]
[25]
Besnard S, Machado ML, Vignaux G, et al. Influence of vestibular input on spatial and nonspatial memory and on hippocampal NMDA receptors. Hippocampus 2012; 22(4): 814-26.
[http://dx.doi.org/10.1002/hipo.20942] [PMID: 21538662]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 18
ISSUE: 1
Year: 2021
Published on: 23 March, 2021
Page: [1 - 7]
Pages: 7
DOI: 10.2174/1567205018666210324105642
Price: $65

Article Metrics

PDF: 46
HTML: 1