Vestibular Dysfunction and Cognitive Impairment: A Large Cohort Study

Introduction: Dementia is a devastating condition that affects over 55 million people worldwide. Early diagnosis is imperative for optimal treatment and intervention. Previous studies have shown an association between vestibular dysfunction and cognitive impairment but have been limited by sample size. In this study, we utilize a large cohort of patients with vestibular testing to identify factors associated with cognitive impairment.

Methods: Patients at a single academic institution who presented for vestibular testing due to dizziness between 2015 and 2022 were included. Demographic and clinical data were collected retrospectively. Patients with a diagnosis of dementia or mild cognitive impairment were identified. Patients were noted if they had vestibular dysfunction based on the following criteria: abnormal ocular or cervical vestibular evoked myogenic impulse (VEMP), high or low rotary chair phase, or caloric vestibular weakness. Patients were also noted if they had any degree of hearing loss based on audiometry.

Results: 1,165 patients were included for analysis. Among all patients, 135 (11.6%) were noted to have cognitive impairment before or after testing. Among patients with abnormal vestibular testing (n=760, 65.4%), 93 had cognitive impairment (12.2%). On univariate logistic regression, hearing loss (OR 2.49 [1.55-4.19]), abnormal phase (OR 1.64 [1.10-2.42]), and younger presentation for dizziness (OR 0.94 [0.93-0.96]) were predictive of cognitive impairment. On stepwise multivariable logistic regression, hearing loss (OR 2.33 [1.31-4.42]) and younger presentation (OR 0.94 [0.92-0.96]) were associated with cognitive impairment.

Conclusions: Hearing loss and younger age of presentation for dizziness were associated with cognitive impairment. Abnormal rotary chair phase was predictive on univariate logistic regression. These findings identify vestibular dysfunction as a potential marker for cognitive impairment risk.