Investigation of the Effects of Age-Related Changes in the Vestibular System on Balance: A Review

Öz

The vestibular system (VS) undertakes vital tasks for the survival of the individual by perceiving the movement of the head according to gravity and adjusting on balance, autonomic function, spatial perception, and orientation. In addition to being the first system to develop in the intrauterine period, the VS continues to develop with childhood. Although the onset time varies depending on various factors, it is known that VS degenerates with aging. It has also been shown in the literature that the number of sensory vestibular hair cells decreases by approximately 6% per decade from birth to old age. In addition, neurons in the vestibular nuclei are known to decrease by about 3% per decade between the ages of 40 and 90. These age-related changes in VS may cause dizziness, loss of balance, unsteady gait, increased falls and even agitation, loneliness, and loss of self-confidence in elderly individuals. In addition, it is reported in the literature that falls due to vestibular disorder are among the third to tenth leading causes of death among older adults. In this sense, it is very important to determine age-related VS dysfunctions in the healthy aging action plans of the health systems of the countries and in the development of strategies to prevent age-related falls. At the same time, it is very valuable for physiotherapists working in the field of geriatric rehabilitation to know well the age-related changes of VS and its effects on balance in the creation of possible vestibular rehabilitation programs. We think that virtual reality applications applied in addition to vestibular rehabilitation for vestibular disorders are promising, especially hearing problems in the elderly population should not be overlooked and hearing aids should be prescribed if needed.

Anahtar Kelimeler

• geriatric rehabilitation
• postural balance
• vestibular dysfunction
• vestibular rehabilitation

Vestibüler Sistemde Yaşa Bağlı Değişikliklerin Denge Üzerine Etkilerinin Araştırılması: Bir Derleme

Öz

Vestibüler sistem (VS), başın yer çekimine göre hareketini algılayıp denge, otonomik fonksiyon, uzaysal algı ve oryantasyon üzerine düzenlemeler yaparak bireyin hayatta kalabilmesi için hayati görevler üstlenir. VS’nin intraüterin dönemde gelişmeye başlayan ilk sistem olmasının yanı sıra çocukluk dönemiyle birlikte gelişimine devam etmektedir. Başlangıç zamanı çeşitli faktörlere bağlı olarak değişmekle birlikte yaşlanmayla VS dejenere olduğu bilinmektedir. Literatürde duyusal vestibüler tüylü hücre sayısının doğumdan yaşlılığa her on yılda yaklaşık %6 oranında azaldığı da gösterilmiştir. Bunun yanı sıra vestibüler çekirdeklerdeki nöronlar, 40 ila 90 yaşları arasında her on yılda yaklaşık %3 oranında azaldığı da bilinmektedir. VS’deki yaşa bağlı bu değişiklikler yaşlı bireylerde baş dönmesi, denge kaybı, dengesiz yürüme, artan düşmeler ve hatta ajitasyona, yalnızlık ve özgüven kayıplarına neden olabilmektedir. Bunun yanı sıra literatürde vestibüler bozukluğa bağlı düşmelerin yaşlı yetişkinler arasında ölüm sebepleri arasında üçüncü ila onuncu önde gelen ölüm nedeni arasında olduğu da bildirilmektedir. Bu anlamda ülkelerin sağlık sistemlerinin sağlıklı yaşlanma eylem planlamalarında ve yaşa bağlı düşmeleri engelleyici stratejilerin geliştirilmesinde yaşa bağlı VS disfonksiyonlarının belirlenmesi oldukça önemlidir. Aynı zamanda özellikle geriatrik rehabilitasyon alanında çalışan fizyoterapistlerin muhtemel vestibüler rehabilitasyon programlarının oluşturulmasında VS’nin yaşa bağlı değişimlerini ve denge üzerine olan etkilerini iyi bilmeleri oldukça değerlidir. Vestibüler bozukluklar için vestibüler rehabilitasyona ek olarak uygulanan sanal gerçeklik uygulamalarının ümit vadettiği, yaşlı popülasyonda özellikle işitme problemlerinin gözden kaçırılmaması ve ihtiyaç halinde işitme cihazlarının reçete edilmesi gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• geriatrik rehabilitasyon
• postural denge
• vestibüler disfonksiyon
• vestibüler rehabilitasyon

Kaynakça

1. 1. Sturnieks DL, St George R, Lord SR. Balance disorders in the elderly. Neurophysiologie Clinique/Clinical Neurophysiology. 2008;38(6):467-78.
2. 2. Kristinsdottir EK, Jarnlo GB, Magnusson M. Asymmetric vestibular function in the elderly might be a significant contributor to hip fractures. Scandinavian journal of rehabilitation medicine. 2000;32(2):56-60.
3. 3. Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2000;122(5):630-4.
4. 4. Pothula VB, Chew F, Lesser TH, Sharma AK. Falls and vestibular impairment. Clinical otolaryngology and allied sciences. 2004;29(2):179-82.
5. 5. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med. 2009;169(10):938-44.
6. 6. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Archives of internal medicine. 2009;169(10):938-44.
7. 7. Lin HW, Bhattacharyya N. Balance disorders in the elderly: epidemiology and functional impact. The Laryngoscope. 2012;122(8):1858-61.
8. 8. Bermúdez Rey MC, Clark TK, Wang W, Leeder T, Bian Y, Merfeld DM. Vestibular perceptual thresholds increase above the age of 40. Frontiers in neurology. 2016;7:162.

9. 9. Fattal D, Hansen M, Fritzsch B. Aging‐related balance impairment and hearing loss. The Wiley handbook on the aging mind and brain. 2018:315-36.
10. 10. Lewis ER, Leverenz EL, Bialek WS. Vertebrate inner ear: CRC-Press; 1985.
11. 11. Majeed S, Farooqi S, Jamshed A. Vestibular Disorders and Their Impact on Balance and Mobility. Pakistan Journal of Medical & Health Sciences. 2023;17(03):686-.
12. 12. Wolfe J, KLUENDER K, LEVI D, BARTOSHUK L, HERZ R, KLATZKY R, et al. Sensation and Perception (Sunderland, MA: Sinauer). 2006.
13. 13. Goldberg JM, Wilson VJ, Cullen KE, Angelaki DE, Broussard DM, Buttner-Ennever J, et al. The vestibular system: a sixth sense: Oxford University Press, USA; 2012.
14. 14. Nandi R, Luxon LM. Development and assessment of the vestibular system. Int J Audiol. 2008;47(9):566-77.
15. 15. Ornitz EM, Atwell CW, Walter DO, Hartmann EE, Kaplan AR. The maturation of vestibular nystagmus in infancy and childhood. Acta Oto-Laryngologica. 1979;88(1-6):244-56.
16. 16. Jones SM, Jones TA, Mills KN, Gaines GC. Anatomical and Physiological Considerations in Vestibular Dysfunction and Compensation. Seminars in hearing. 2009;30(4):231-41.
17. 17. Tian J-R, Shubayev I, Baloh RW, Demer JL. Impairments in the initial horizontal vestibulo-ocular reflex of older humans. Experimental brain research. 2001;137:309-22.
18. 18. Minor LB. Gentamicin-induced bilateral vestibular hypofunction. Jama. 1998;279(7):541-4.
19. 19. McCall AA, Miller DM, Yates BJ. Descending influences on vestibulospinal and vestibulosympathetic reflexes. Frontiers in neurology. 2017;8:112.
20. 20. Murray AJ, Croce K, Belton T, Akay T, Jessell TM. Balance control mediated by vestibular circuits directing limb extension or antagonist muscle co-activation. Cell reports. 2018;22(5):1325-38.
21. 21. Mohl JT, Pearson JM, Groh JM. Monkeys and humans implement causal inference to simultaneously localize auditory and visual stimuli. Journal of Neurophysiology. 2020;124(3):715-27.
22. 22. Agrawal Y, Smith PF, Rosenberg PB. Vestibular impairment, cognitive decline and Alzheimer’s disease: balancing the evidence. Aging & mental health. 2020;24(5):705-8.
23. 23. Gassmann KG, Rupprecht R. Dizziness in an older community dwelling population: a multifactorial syndrome. The journal of nutrition, health & aging. 2009;13(3):278-82.
24. 24. Barin K, Dodson EE. Dizziness in the elderly. Otolaryngologic clinics of North America. 2011;44(2):437-54, x.
25. 25. Boult C, Murphy J, Sloane P, Mor V, Drone C. The relation of dizziness to functional decline. Journal of the American Geriatrics Society. 1991;39(9):858-61.
26. 26. Redfern MS, Jennings JR, Martin C, Furman JM. Attention influences sensory integration for postural control in older adults. Gait & posture. 2001;14(3):211-6.
27. 27. Westlake KP, Culham EG. Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands. Physical therapy. 2007;87(10):1274-83.
28. 28. Adkin AL, Frank JS, Carpenter MG, Peysar GW. Fear of falling modifies anticipatory postural control. Experimental brain research. 2002;143(2):160-70.
29. 29. Hadjistavropoulos T, Carleton RN, Delbaere K, Barden J, Zwakhalen S, Fitzgerald B, et al. The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychology and aging. 2012;27(1):1-13.
30. 30. Wetmore SJ, Eibling DE, Goebel JA, Gottshall KR, Hoffer ME, Magnusson M, et al. Challenges and opportunities in managing the dizzy older adult. Otolaryngology--Head and Neck Surgery. 2011;144(5):651-6.
31. 31. Rauch SD, VELAZQUEZ‐VILLASEÑOR L, Dimitri PS, Merchant SN. Decreasing hair cell counts in aging humans. Annals of the New York Academy of Sciences. 2001;942(1):220-7.
32. 32. Alvarez JC, Díaz C, Suárez C, Fernández JA, González del Rey C, Navarro A, et al. Aging and the human vestibular nuclei: morphometric analysis. Mechanisms of ageing and development. 2000;114(3):149-72.
33. 33. Kevetter GA, Leonard RB. Decreased expression of calretinin and calbindin in the labyrinth of old gerbils. Brain research. 2002;957(2):362-5.
34. 34. Taylor RR, Jagger DJ, Saeed SR, Axon P, Donnelly N, Tysome J, et al. Characterizing human vestibular sensory epithelia for experimental studies: new hair bundles on old tissue and implications for therapeutic interventions in ageing. Neurobiology of aging. 2015;36(6):2068-84.
35. 35. Maes L, Dhooge I, D'Haenens W, Bockstael A, Keppler H, Philips B, et al. The effect of age on the sinusoidal harmonic acceleration test, pseudorandom rotation test, velocity step test, caloric test, and vestibular-evoked myogenic potential test. Ear and hearing. 2010;31(1):84-94.
36. 36. Agrawal Y, Zuniga MG, Davalos-Bichara M, Schubert MC, Walston JD, Hughes J, et al. Decline in semicircular canal and otolith function with age. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2012;33(5):832-9.
37. 37. Wan G, Ji L, Schrepfer T, Gong S, Wang GP, Corfas G. Synaptopathy as a Mechanism for Age-Related Vestibular Dysfunction in Mice. Frontiers in aging neuroscience. 2019;11:156.
38. 38. Tighilet B, Bordiga P, Cassel R, Chabbert C. Peripheral vestibular plasticity vs central compensation: evidence and questions. Journal of neurology. 2019;266:27-32.
39. 39. Deems DA, Deems RO, O’Malley Jr BW. Managing challenges in an aging vestibular system: Rehabilitation strategies normalize balance function in a cohort of patients up to 99 years. Ear, Nose & Throat Journal. 2019;98(1):37-43.
40. 40. Mancini M, Salarian A, Carlson-Kuhta P, Zampieri C, King L, Chiari L, et al. ISway: a sensitive, valid and reliable measure of postural control. Journal of neuroengineering and rehabilitation. 2012;9:59.
41. 41. MacKinnon CD. Sensorimotor anatomy of gait, balance, and falls. Handbook of clinical neurology. 2018;159:3-26.
42. 42. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and ageing. 2006;35 Suppl 2:ii7-ii11.
43. 43. Westlake KP, Johnson BP, Creath RA, Neff RM, Rogers MW. Influence of non-spatial working memory demands on reach-grasp responses to loss of balance: Effects of age and fall risk. Gait & posture. 2016;45:51-5.
44. 44. Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical therapy. 2009;89(5):484-98.
45. 45. Mahoney JR, Cotton K, Verghese J. Multisensory Integration Predicts Balance and Falls in Older Adults. The journals of gerontology Series A, Biological sciences and medical sciences. 2019;74(9):1429-35.
46. 46. Mahoney JR, Verghese J. Does Cognitive Impairment Influence Visual-Somatosensory Integration and Mobility in Older Adults? The journals of gerontology Series A, Biological sciences and medical sciences. 2020;75(3):581-8.
47. 47. Patel P, Lamar M, Bhatt T. Effect of type of cognitive task and walking speed on cognitive-motor interference during dual-task walking. Neuroscience. 2014;260:140-8.
48. 48. Woytowicz EJ, Sours C, Gullapalli RP, Rosenberg J, Westlake KP. Modulation of working memory load distinguishes individuals with and without balance impairments following mild traumatic brain injury. Brain injury. 2018;32(2):191-9.
49. 49. Furman JM, Redfern MS, Jacob RG. Vestibulo-ocular function in anxiety disorders. Journal of vestibular research : equilibrium & orientation. 2006;16(4-5):209-15.
50. 50. Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. Journal of clinical neurology (Seoul, Korea). 2011;7(4):184-96.
51. 51. Tinetti ME, Williams CS, Gill TM. Health, functional, and psychological outcomes among older persons with chronic dizziness. Journal of the American Geriatrics Society. 2000;48(4):417-21.
52. 52. Han BI, Han BI. Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises. Simplified Vestibular Rehabilitation Therapy. 2021:1-16.
53. 53. Whitney SL, Sparto PJ, Furman JM, editors. Vestibular rehabilitation and factors that can affect outcome. Seminars in neurology; 2020: Thieme Medical Publishers.
54. 54. Hall CD, Herdman SJ, Whitney SL, Anson ER, Carender WJ, Hoppes CW, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy. 2022;46(2):118.
55. 55. Valentina M, Ana Š, Valentina M, Martina Š, Željka K, Mateja Z. Virtual reality in rehabilitation and therapy. Acta Clinica Croatica. 2013;52(4.):453-7.
56. 56. Bergeron M, Lortie CL, Guitton MJ. Use of virtual reality tools for vestibular disorders rehabilitation: a comprehensive analysis. Advances in medicine. 2015;2015.
57. 57. Viziano A, Micarelli A, Augimeri I, Micarelli D, Alessandrini M. Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial. Clinical rehabilitation. 2019;33(1):24-33.
58. 58. Park JH, Jeon HJ, Lim E-C, Koo J-W, Lee H-J, Kim H-J, et al. Feasibility of eye tracking assisted vestibular rehabilitation strategy using immersive virtual reality. Clinical and experimental otorhinolaryngology. 2019;12(4):376-84.
59. 59. Jönsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. Journal of vestibular research. 2004;14(1):47-52.
60. 60. Delgado F, Der Ananian C. The use of virtual reality through head-mounted display on balance and gait in older adults: A scoping review. Games for Health Journal. 2021;10(1):2-12.
61. 61. Micarelli A, Viziano A, Augimeri I, Micarelli D, Alessandrini M. Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial. International Journal of Rehabilitation Research. 2017;40(4):325-32. 62. Micarelli A, Viziano A, Micarelli B, Augimeri I, Alessandrini M. Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display. Archives of gerontology and geriatrics. 2019;83:246-56.
62. 63. Rosiak O, Krajewski K, Woszczak M, Jozefowicz-Korczynska M. Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit. Journal of Vestibular Research. 2018;28(5-6):409-15.
63. 64. Seddighi-Khavidak M, Tahan N, Akbarzadeh-Baghban A. Comparing the effects of vestibular rehabilitation with and without lavender oil scents as an olfactory stimulus on balance, fear of falling down and activities of daily living of people with multiple sclerosis: a randomized clinical trial. Disability and rehabilitation. 2022;44(13):3132-8.
64. 65. Wollesen B, Scrivener K, Soles K, Billy Y, Leung A, Martin F, et al. Dual-task walking performance in older persons with hearing impairment: Implications for interventions from a preliminary observational study. Ear and hearing. 2018;39(2):337-43.
65. 66. Gabriel GA, Harris LR, Gnanasegaram JJ, Cushing SL, Gordon KA, Haycock BC, et al. Vestibular perceptual thresholds in older adults with and without age-related hearing loss. Ear and hearing. 2022;43(2):420-35.
66. 67. Alfakir R. Studying subjective hearing loss in older adults measured by speech, spatial, and quality of hearing scale within the framework of the ICF core set for hearing loss. Hearing, Balance and Communication. 2022;20(4):230-9.
67. 68. Maes L, De Kegel A, Van Waelvelde H, Dhooge I. Association between vestibular function and motor performance in hearing-impaired children. Otology & Neurotology. 2014;35(10):e343-e7. 69 .Negahban H, Nassadj G. Effect of hearing aids on static balance function in elderly with hearing loss. Gait & posture. 2017;58:126-9.
68. 70. Wei J, Hu Y, Zhang L, Hao Q, Yang R, Lu H, et al. Hearing impairment, mild cognitive impairment, and dementia: a meta-analysis of cohort studies. Dementia and geriatric cognitive disorders extra. 2018;7(3):440-52.