Relationship between Vestibular Dysfunction and Cognitive Impairment in Elderly Patients: Peripheral Vertigo or Central Vertigo

Background: Recent research suggests an association between vestibular impairment and cognitive impairment. Mild cognitive impairment (MCI) and dementia patients are associated with increased rate of vestibular loss. The vestibular system consists of the peripheral vestibular organs and the associated extensive vestibular cortical pathway. We investigate whether vertigo (peripheral vertigo or central vertigo) is correlated with an increased risk of dementia or MCI and clinical relevance of vertigo types. Methods: From August 2019 to January 2020, 300 patients, aged ≥ 32 years and vertigo with/without cognitive impairment symptoms were retrospectively enrolled. A logistic regression analysis was performed for vertigo types that showed a significant difference between dementia/MCI and non cognitive impairment groups. First, we reviewed vertigo with previous diagnosed 177 dementia/ MCI and 123 non cognitive impairment control groups, and the differences in relevance of vertigo types between these groups were examined. Second, the patients with vertigo were classified into 2 groups: peripheral (Acute vestibular neuritis, Meniere's disease, Benign paroxysmal positional vertigo, Autonomic related vertigo, and so on) or central (Stroke, Vertiginous migraine and Epilepsy vertigo) types. Third, dementia groups included AD, VaD and Mixed types. Finally, this study evaluated risk factors for vertigo in cognitive impairment patients. Results: Among 177 MCI/dementia patients with a mean age of 75.30 years, 56 (31.63%) developed vertigo. The frequency of vertigo types (peripheral vertigo or central vertigo) was different in dementia with vertiginous patients compared to non dementia/MCI groups {peripheral vertigo 14.70% vs. 79.70%; central vertigo 18.10% vs. 24.40%}. In this study, total 56 vertigo patients were divided into two groups based on peripheral type (n=31) or central type (n=25). Among, 300 patients with vertigo, there was that negative relevance in cognitive impairment patients and peripheral vertigo groups compared to positive relevance in MCI/ dementia patients and central vertigo types {odds ratio (OR) 52.73 vs 8.71; 95% confidence interval (CI) 23.08-120.45 and 3.55-21.39, respectively]. Conclusion: The classification of vertigo is different depending on dementia/MCI or not. The proportion of central vertigo has a tendency to positive relevance with cognitive impairment groups. The findings of our study may provide direction for potentially useful diagnostic tests and vestibular-targeted therapy such problem in cognitive impairment patients.