aging of the human vestibular system.pptx

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THE AGING HUMAN VESTIBULAR SYSTEM &

THE SILVER TSUNAMI

CHRIS ZALEWSKI, PH.D. NIH, AUDIOLOGY

[email protected]

“We would accomplish many more things if we did not think of them as impossible” - Vince Lombardi

DISCLOSURES  I have relevant financial relationship(s) with:   National Institutes of Health

  Employed and receives salary.

  University of Maryland and Gallaudet University

  Employed as adjunct faculty

  Washington Hospital Center

  Employed as a PRN Clinical Audiologist

 I have relevant non-financial relationship(s) with:   American Balance Society

  Currently on the Board of Directors

  American Academy of Audiology   Currently on the Board of Directors

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PRESENTATION OBJECTIVES LEARNER OUTCOMES

1.  Getting acquainted with the aging population

2.  Epidemiology of falls and dizziness in the elderly

3.  Role(s) of the vestibular system in balance

4.  Histology associated with aging of the vestibular system

5.  Clinical finding associated with an aging vestibular system

THE SILVER TSUNAMI

Who are they? When are they arriving? Are we ready?

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ADVANCING BABY BOOMER GENERATION

 In 2009, the U.S. senior population (65 years and older) was 39.6 million

 In 2030, the senior population is expected to balloon to 72.1 million

 In 2050, the senior population is expected to peak at 86 million – a greater than 200% increase than the census in 2012

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https://familyinequality.wordpress.com/2014/10/07/this-word-generation-i-do-not-think-it-means-what-you-think-it-meants/

PROJECTED HEALTH CARE COSTS WITH A RISE IN SENIOR HEALTH CARE

 With a near exponential rise in the number of senior citizens, the increase in health care spending is projected to be as much as three times the current cost for areas like Medicare.

 When normalized against the overall effect of the aging population, the effective cost for caring for the elderly shows an exponential growth faster than the overall GDP of the United States

Spending on Social Security, Medicare, and Medicaid as a Percentage of GDP, 2005–2050

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PROJECTED HEALTH CARE NEED

 Projected need of 5,600 Audiologist jobs by 2020 to maintain current levels of care

 The U.S. Census Bureau estimates that the last of the baby boomers will die in the year 2070, leaving 53 years of potentially intense health care issues related to balance disorders as well as complications arising from this health care epidemic (Overberg, 2000)

https://www.healthit.gov/sites/default/files/chws_bls_report_2012.pdf https://www.healthit.gov/sites/default/files/chws_bls_report_2012.pdf

EPIDEMIOLOGY OF FALLS & DIZZINESS IN THE ELDERLY

A Review of the Literature

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PREVALENCE OF BALANCE DISORDERS IN THE GERIATRIC POPULATION

 At least half of the overall U.S. population is affected by a balance or vestibular disorder sometime during their lives (NIDCD, 1997)

 Vestibular / Balance disorders currently impact the daily functional capacity of approximately 12.5 million Americans over the age of 65 (NIDCD, 2002)

 When considering only vestibular origins to dizziness, nearly 20% of the general population is affected by a vestibular disorder (Univ of Iowa, 2002)

…MOREOVER  An astounding 70% of elderly patients present with some type of dizziness complaint in the primary care setting (Sloan et al, 2001)

 The diagnosis of non-specific dizziness (⅓ of patients over 75 years of age) is often very difficult to diagnose, particularly in the elderly in whom it is often secondary to multi-system dysfunction (Univ. of Iowa Health Care, 2002)

 It is estimated that 65% of individuals over 60 years of age experience loss of balance or dizziness (Hobeika, 1999)

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OVERALL IMPACT…FALLS  Balance disorders, particularly in the elderly, often leads to falls

 Mortality rates following the first fall are often only 1 year

 Falls are one of the major complications of dizziness and balance dysfunction that contributes to one of the principal causes of fatal and non-fatal injuries in older adults (Center for Disease Control, 2001)

 Every year, one-third to one-half of the population over 65 years of age and older experience falls (Hausdorff et al, 2001).

 The elderly represent more than one-third of all hospital injury admissions of which 80% are due to falls

 >85% of hip fractures related to falls are in persons 65 years or older

RISING COSTS…

 Injurious falls rank as the 6th leading cause of death in the “elderly” population

 Medical expenses related to injurious falls amounts to 10-20 billion dollars annually in the U.S., and is projected to climb to 32 billion dollars by the year 2020 (Am Acad Ortho Surg, 2003; CDC, 2001, Bloem, 2003)

 Moreover, the cost of medical care associated with simply the treatment of balance problems and medical care associated with vestibular dysfunction exceeds one billion dollars annually (Univ of VA Health System, 2003)

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AGRAWAL, Y., ET AL. (2009) ARCHIVES OF INTERNAL MEDICINE

 Overall Conclusions:   Odds of vestibular dysfunction increased significantly

with age

  Substantial portion of individuals without a history of self-reported dizziness has evidence of vestibular dysfunction   These individuals have a significantly increased odds of falling

 Recommendation:   Screening for vestibular dysfunction in assisted living or

nursing home facilities could be life saving and cost-effective practice (>$20 billion annually)

AGRAWAL, Y., ET AL. (2009) ARCHIVES OF INTERNAL MEDICINE

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SHOAIR, O., ET AL. (2011) OTOLARYNGOLOGY CLINICS OF NORTH AMERICA

 Medication-related dizziness can be difficult to diagnose, especially in older persons, in whom it can masquerade as a geriatric syndrome.

 Geriatric syndromes are difficult to define, but they are characterized as symptoms with multifactorial causes, which become more common with aging and are in fact often mistaken for normal aging.

PHARMACOKINETICS, POLYPHARMACY & PHARMACODYNAMICS

 Pharmacokinetics describes the relationship between the dose of the drug administered and the resulting drug concentrations achieved in the systemic circulation.   Aging is generally characterized by changes in all

pharmacokinetic processes including absorption, distribution, metabolism, and excretion, although the most clinically important changes are those affecting hepatic and renal drug elimination.

 Pharmacodynamics describes the relationship between drug concentrations in the systemic circulation and drug response.   Pharmacodynamic changes often result in

increased sensitivity to medications, especially for drugs acting on the central nervous system (CNS).

 Polypharmacy refers to the use of multiple medications and/or the administration of more medications than is clinically indicated, representing unnecessary drug use.

* Sloane PD, Coeytaux RR, Beck RS, et al. Dizziness: state of the science. Ann Intern Med 2001;134(9 Pt 2):823–32. Salles N, Kressig RW, Michel JP. Management of chronic dizziness in elderly people. Z Gerontol Geriatr 2003;36(1):10–5.

*

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AMBROSE, A., ET AL. (2013) MATURITAS

 75-80% of falls without injury are not reported

 Falls affect 33% over the age of 65 years

 Falls affect 50% over the age of 80 years

 Injuries (2009)   2.2 million non-fatal injuries requiring ER visits   More than 581,000 requiring hospitalization

  19,000 deaths related to falls (5th leading cause of death in adults >65 years of age)


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 Falls are the leading cause of injury and death among older adults

 Breakdown of fall-related injuries:   30-50% of falls result in minor lesions such as bruises or lacerations

  5-10% of falls result in major injury such as fractures or TBI   Falls are the most common cause of TBI in older adults and account for 46% of

fall-related deaths in TBI patients   90% of all hip fractures are fall-related

 In the first year following a hip fracture:   25% of older patients will die

  76% will have a decline in their mobility   50% will have a decline in their ability to perform daily life activities – setting

up a viscous spiral with further declines in physical fitness, social isolation and depression

  22% will move into a nursing home


 Older individuals have an increased susceptibility for fall-injury due to the higher prevalence of comorbidities such as:   Older age   Prior history of falls   Functional impairment   Use of a walking aid or assistive device   Cognitive impairment or dementia   Impaired mobility or low activity level of daily life activities   Gait or balance abnormalities   Vestibular impairments   Dizziness   Drop attacks   Confusion   Postural hypotension   Visual disorders   Syncope   Polypharmacy   Reduced strength   Depression   Poor environmental management (footwear)


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ROLE OF THE VESTIBULAR SYSTEM IN BALANCE

VOR & VSR

ANATOMY OF THE PERIPHERAL VESTIBULAR LABYRINTH

Antonio Scarpa, 1789

Aelius Galen (129-216 AD)

During osteological study of the skull, the inner ear reminded him of the Cretan ‘Labyrinthos’. …and hereafter, the term “labyrinth” has been used to describe the inner ear vestibular anatomy.

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VESTIBULAR SENSORY END ORGANS

 Each vestibular system has FIVE distinct sensory end organs  3 Semicircular Canals   Horizontal (lateral)

  Anterior (superior)   Posterior

 2 Maculae (Otoliths)   Saccule   Utricle

Vestibular Nerve •  Superior •  Inferior

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Horizontal Canal

Posterior Canal

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to brainstem

VESTIBULAR AFFERENT & EFFERENT PATHWAYS

Central Vestibular Nuclei

Lateral SCC

Anterior SCC

Posterior SCC

Utricle

Saccule

Lateral SCC

Anterior SCC

Posterior SCC

Utricle

Saccule

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Adaptation

Eye Muscles

Skeletal Muscles

Vestibular Ocular Reflex (VOR)

Saccadic System Tracking

System

Optokinetic System Neck

Receptors

Other

Vestibular Spinal Reflex (VSR)

Proprioceptive

Visual

Tactile

Other

- Adapted from Canalis & Lambert, 2000

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HISTOLOGY OF THE AGING VESTIBULAR SYSTEM

Highlights from the Literature

MERCHANT, ET AL., 2000 ANNALS OF OTOLOGY, RHINOLOGY AND LARYNGOLOGY

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TOTAL HAIR CELL COUNTS (CRISTAE) MERCHANT ET AL., NORMAL VESTIBULAR HAIR CELL DATA (2000)

 Total hair cell counts (density) by age for each of the semicircular canal cristae

 Type I versus Type II epithelial densities for each of the cristae

 Total counts for all 3 canals show a strong negative correlation with an age-effect that was highly significant (p<0.0001)

 No difference observed between any of the 3 canals

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TOTAL HAIR CELL COUNTS (MACULAE) MERCHANT ET AL., NORMAL VESTIBULAR HAIR CELL DATA (2000)

 Total hair cell counts (density) by age for each of the otolith maculae

 Type I versus Type II epithelial densities for each of the maculae

 The mean total hair cell density between maculae at birth were significantly different from each other (p<0.0001)   utricle (68 cells per 0.001 mm2)   saccule (61 cells per 0.01 mm2)

 Total cell counts show a strong negative correlation with an age-effect that was highly significant (p<0.0001)   No difference in age-slopes between maculae

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TOTAL HAIR CELL DENSITIES: CENTRAL VS PERIPHERAL END ORGAN (CRISTAE) MERCHANT ET AL., NORMAL VESTIBULAR HAIR CELL DATA (2000)

 Total hair cell counts (density) by cristae location for each of the semicircular canals

 Hair cell densities were significantly greater at the periphery than at the center (p<0.01) (9/67 normal temporal bones from 0-40 yr age group)

  Center (70 cells per 0.01mm2)   Periphery (87 cells per 0.01mm2)   Density difference between central and peripheral were more marked for type I than for type II hair cells

TOTAL HAIR CELL COUNTS FROM BIRTH TO DEATH MERCHANT ET AL., NORMAL VESTIBULAR HAIR CELL DATA (2000)

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GENERAL FINDINGS… MERCHANT ET AL., NORMAL VESTIBULAR HAIR CELL DATA (2000)

 Density in the cristae and maculae (as expressed as number of cells per 0.01 mm2 of the neuroepithelial surface)

 FIRST DECADE OF LIFE: 80-90 cells per 0.01 mm2

 NINTH DECADE OF LIFE: 40-60 cells per 0.01 mm2

 Rate of cell loss with age was significantly greater for the cristae than for the maculae (p<0.0001) highlighted by a more rapid degeneration rate of type I hair cells located within the central epithelial regions

 No differences observed between male and female or between right and left ears

IGARASHI, M., ET AL., (1993) ACTA OTO-LARYNGOLOGICA

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OTOCONIA VOLUME LOSS FROM AGING

 The otonconia volume in senile temporal bones was less than that of young persons.

 Utricle-to-Saccule ration of 100:70 in the young age group, that degraded to a ratio of 100:35 in the elderly group. This result suggests for an increased rate of age-related saccular degeneration.

 This may be due to saccular orientation or reduced mitigation of calcite seeding (Lim, 1984)

*

2-month old child 58/61 y/o adult

ROSS, M., ET AL., (1976) ANNALS OF OTOLOGY

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ROSS, M., ET AL., (1976) ANNALS OF OTOLOGY

21 Young Adult (Utricle) 21 Young Adult (Saccule) 21 Young Adult (Utricle)

52 year old early pitting and cavitation

83 year old pitting and fibrous (rough) appearance

65 year old mid-section fracturing and fibrous appearance

65 year old splitting and separation

Aged otoconia bodies are pitted, fissured, fragmented, finely serrated, weaken or broken filaments

VELAZQUEZ-VILLASEÑOR, ET AL., 2000 ANNALS OF OTOLOGY, RHINOLOGY AND LARYNGOLOGY

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SCARPA’S GANGLION CELL DATA

 Highly significant age effect for a strong negative decline in total cell counts (p=0.0001)

 Superior division cell loss (37.2/yr) statistically greater than inferior division cell loss (19.6/yr) (p=0.025)

 Significant gender effect (independent of age) with male demonstrating a higher cell count than women at any age.   However, the age-related rate of decline

failed to reach statistical significance between male (49.9/yr) and female (69.5/yr)

 No significance right / left difference

Normal Aging Cell Counts Superior Division vs Inferior Division

Male vs Female Right vs Left

ALVAREZ, ET AL., 2000 MECHANISMS OF AGEING AND DEVELOPMENT

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ALVAREZ, ET AL., 2000 MECHANISMS OF AGEING AND DEVELOPMENT

 Neuronal loss occurs with aging in the descending (DVN), medial (MVN), and lateral (LVN) vestibular nuclei, but not in the superior (SVN).

 Neuronal loss could be related with the problems that elderly people have to compensate unilateral vestibular lesions and the alterations of the vestibulospinal reflexes.

 The preservation of SVN neurons could, in part, explain why vestibulo-ocular reflexes are compensated after unilateral vestibular injuries.   A moderate vestibular dysfunction, that would not to cause problems in a young adult, could produce symptoms

and signs in the elderly, when there are also poor sight and loss of proprioception and neuromuscular function.

SUMMARY OF VESTIBULAR AGING HISTOLOGY 1.  Significant age-related deterioration in the number of type I and type II

hair vestibular hair cells in the periphery

2.  Significant age-related deterioration of central vestibular sensory neurons in the vestibular nuclei and the cerebellum

3.  More rapid degeneration rate of type I vestibular hair cells with a concomitant higher rate of hair cell loss for the cristae than the maculae

4.  Greater loss of hair cells in the central epithelial regions of the sensory end organs than the periphery

5.  Hair cell loss is most prominent in the 7th to 8th decade of life, which is also the same time that many sexagenarians and septuagenarians begin reporting the onset of unrelenting dizziness and function imbalance

6.  Concomitant compensation mechanisms could both mask clinical findings and exacerbate function disabilities in the elderly populations, making prebystasis a difficult “disorder” to clinically segregate and treat.

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CLINICAL ASSESSMENT OF THE AGING VESTIBULAR

SYSTEM

Highlights from the Literature

REVIEW OF CLINICAL VESTIBULAR MEASURES IN THE AGING

 Videonystagmography   Ocular Motor   Positional

  Caloric Irrigation

 Rotational Vestibular Assessment

 Vestibular Evoked Myogenic Potentials   cVEMP   oVEMP

 Video Head Impulse Testing (vHIT)

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IRVING, E., ET. AL., (2006) INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE

 195 subjects aged 3-86 years

 Age effects identified on all saccadic parameters; velocity, latency and accuracy (amplitude gain)

 After the 50 years of age, saccades greater than 20° had hypometria exceeding 20% and the mean hypometria increases to nearly 40% by the ninth decade.

IRVING, E., ET. AL., (2006) INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE

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KANAYAMA, R., ET. AL., (1994) ACTA OTOLARYNGOLOGICA

 The relationship between pursuit gain and target frequency in the older groups was similar to that in the young controls through 400/sec, but in advanced age groups pursuit gain decreased more markedly with stimulus frequency

 Cerebral cortical atrophy and cerebellar Purkinje cell loss is known to accompany senile changes.

 Pursuit gain was lower in groups in their 50’s and 60’s. Therefore, it is important to take patient's age into consideration when evaluating smooth pursuit eye movement.

KANAYAMA, R., ET. AL., (1994) ACTA OTOLARYNGOLOGICA

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SIMMONS & BÜTTNER (1994) EUROPEAN ARCHIVES OF PSYCHIATRY AND NEUROLOGICAL SCIENCES

SIMMONS & BÜTTNER (1994) EUROPEAN ARCHIVES OF PSYCHIATRY AND NEUROLOGICAL SCIENCES

Maximal OKN velocity decreases with increasing age, particularly above stimulus velocities of 500/sec

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ZALEWSKI (2015): CALORIC FINDINGS BETWEEN 1974-1990 - SEMINARS IN HEARING

MALLINSON & LONGRIDGE (2004): JOURNAL OF VESTIBULAR RESEARCH

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MALLINSON & LONGRIDGE (2004): JOURNAL OF VESTIBULAR RESEARCH

 Examined the mean of the warm and cool responses from the better-responding ear from 185 individuals

 Age range from 9-89 years with no history of frank vestibular disease

 No significant correlation for cross-sectional mean peak-caloric response







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PAIGE, G. (1992) JOURNAL OF VESTIBULAR RESEARCH


 Mean VOR gain and phase are remarkably similar between young, middle-aged, and elderly groups with the exception of:   Significant VOR phase lead for the lowest

two frequencies 0.025Hz and 0.1 Hz between elderly and young

  Significant VOR phase lead for 0.025Hz between middle-aged and elderly

  Significant lower VOR gain for 0.025Hz between young and elderly

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 VOR Linearity:

 Mean VOR gain and phase are remarkably similar between young, middle-aged, and elderly groups at 500/sec

 VOR gain and phase progressively depart from one another as peak head velocity increases, and becomes very pronounced at 3000/sec

 Overall:  Age-dependent changes in VOR response

characteristics are amplified as head velocity increases

CHAN, GALATIOTO, AMATO & KIM (2015) LARYNGOSCOPE

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 Youngest group significantly different from all other groups

 Lowest frequencies have greatest sensitivity to detect age-related changes

CHAN, GALATIOTO, AMATO & KIM (2015) LARYNGOSCOPE







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JANKY, K. & SHEPARD, N. (2009) JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY

 Controlled for SMC activation using a BP cuff, conducted cVEMPS using 250 Hz, 500 Hz, 750 Hz, 1000 Hz, and click stimuli

 Identified significant mean differences between the youngest age group (20-29 years) and all other age groups for a decrease in P1 latency (250, 750 &1000 Hz) and a lower cVEMP threshold (500 & 1000 Hz)

JANKY, K. & SHEPARD, N. (2009) JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY

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PIKER, E., ET. AL. (2011) JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY

 Age groups:   Youngest (<18 years; n=20)   Middle-aged (18-49 years; n=58)   Oldest (≥50 years; n=22)

 100% subject <50 years had a recordable oVEMP

 Only 77% of subjects ≥50 years had a recordable oVEMP

 Significant amplitude decrease and threshold increase in the oldest group compared to the two younger groups

 Significant correlation identified for oVEMP amplitude (r2=0.139) and threshold (r2=0.105)

PIKER, E., ET. AL. (2011) JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY

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PIKER, E., ET. AL. (2015) OTOLOGY & NEUROTOLOGY

 Sample:   895 patients with cVEMP data   297 patients with oVEMP data   20-87 years of age segregated by 3rd to 9th decade   500 Hz 125 dB pkSPL AC stimuli

 Results:   798 present cVEMP; 97 absent cVEMP (10.8%)   173 present oVEMP; 124 absent oVEMP (41.8%)   22.7x odds ratio of absent cVEMP response in 70’s   54.2x odds ratio of absent cVEMP response in 80’s   6x odds ratio of absent oVEMP response in 40’s, 50’s, & 60’s   13x odds ratio of absent oVEMP response in 70’s   Age alone was a significant predictor for presence/absence of response

PIKER, E., ET. AL. (2015) OTOLOGY & NEUROTOLOGY

* significant

* significant

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HARUN, OH, BIGELOW, STUDENSKI & AGRAWAL (2016) OTOLOGY & NEUROTOLOGY

These data corroborate an emerging literature establishing a link between vestibular and cognitive function. Individuals with dementia had poorer function of both the saccular and utricular otolith organs relative to controls, with relative preservation of horizontal canal function. Moreover, analysis of MCI versus AD compared with age-matched controls, revealed significantly poorer vestibular function among AD patients specifically.

HARUN, OH, BIGELOW, STUDENSKI & AGRAWAL (2016) OTOLOGY & NEUROTOLOGY

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MANTIÑO-SOLER, E., ET AL. (2014) OTOLOGY & NEUROTOLOGY

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 212 adults 5-95 years of age

 Identified stable VOR gain, regardless of head impulse velocity, through 70 years of age

 Progressive decrease in VOR gain for those over 70 years of age but only for higher head impulse velocities with a greater number of re-fixation saccades

 Decrease in VOR gain for all head velocities >90 years of age

MANTIÑO-SOLER, E., ET AL. (2014) OTOLOGY & NEUROTOLOGY

LI, C., ET AL. (2015) OTOLOGY & NEUROTOLOGY

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 109 elderly adults 26-92 years of age

 Relatively stable vHIT VOR gain between 26-79 years of age

 Eight-fold decrease in obtaining vHIT VOR gain greater than 0.80 relative to those less than 80 years of age

 No other significant associations were identified as a contributing factor including cardio-vascular risk factors

LI, C., ET AL. (2015) OTOLOGY & NEUROTOLOGY

MCGARVIE, MACDOUGALL, HALMAGYI, BURGESS, WEBER & CURTHOYS (2015) FRONTIERS IN NEUROLOGY

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 Velocity was significant at every age group with a decrease in VOR gain as head velocity increased

 For all canals, there was minimal decrease in VOR gain with age, at least up to the 80’s such that age was not a significant factor with the exception of a weakly significant decrease in gain for the posterior canal

MCGARVIE, MACDOUGALL, HALMAGYI, BURGESS, WEBER & CURTHOYS (2015) FRONTIERS IN NEUROLOGY

CLINICAL ASSESSMENT OF THE AGING VESTIBULAR

SYSTEM SUMMARY

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 It just may be that the power to segregate a presbystasis phenotype may be more difficult than realized.

 Applying wide variances for normative reference ranges are often employed due to the lumping of all age groups

 However, when viewing the variances across age groups, tight variances for younger age groups are clearly evident. Unfortunately, use of these stratified age ranges will only assist in increasing the diagnostic power for younger individuals – not the elderly.

CLINICAL SUMMARY ON AGING

FINAL THOUGHTS….

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AN AGING POPULATION…  Concomitant with the aging of the population and the dawn of the baby boomer generation reaching 65 years of age, the need for better management of balance disordered patients is essential over the next few decades.

LIN & BHATTACHARYYA (2011) LARYNGOSCOPE NATIONAL AMBULATORY MEDICAL CARE SURVEY

 “There will be an estimated 650,000 additional annual clinic visits by the elderly to all medical specialties for an otologic complaint by 2020.”

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LIN & BHATTACHARYYA (2011) LARYNGOSCOPE NATIONAL AMBULATORY MEDICAL CARE SURVEY

 “As the number of Americans older than 65 years of age steadily increases with a potential to gradually over-whelm the number of clinicians trained to provide for both their basic and complex healthcare needs, the medical community and the United States government must prepare for an imminent crisis in the national health-care system.

 With American population demographics hurriedly moving toward an inverted pyramid scheme generated by a growing and aging baby boomer cohort benefiting from medical advances that extend life expectancy and quality, the nation’s healthcare system is currently ill-prepared to meet and manage the many medical and social challenges an escalating geriatric population is predicted to present in the coming decades.

 Maintaining effective delivery of healthcare to a rapidly growing segment of the population already faced with high rates of comorbidities, frailty, and polypharmacy will require a considerable workforce and financial initiatives specifically aimed at augmenting the number of healthcare providers trained in geriatric medicine and improving access to these resources.

 With the percentage of the American population older than 65 years of age predicted to rise to 20% and double in number from 35 million to 71million by the year 2030, the report concludes that the healthcare workforce is currently anticipated to be much too undersized and grossly unprepared to meet the coming needs of the growing elderly population. “

SO HERE WE STAND AT THE PRECIPICE…

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…LOOKING OVER AN IMPENDING “EPIDEMIC” WITH TWO FUNDAMENTAL CHALLENGES...

Steve Ackley Memorial Conference; Jerry Northern, Ph.D.; November 14, 2014

…WE THINK TO OURSELVES: “ARE WE READY?”

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AUDIOLOGY DOCTORAL GRADUATES & PROJECTED ATTRITION

 Approximately 600 new graduates per year

 (American Academy of Audiology Member Survey, 2012)


…WE THINK TO OURSELVES: “ARE WE READY?”


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…HOW ARE WE TO EFFECTIVELY SEGREGATE AGING “PATHOLOGY”?  “The majority of clinical studies investigating the age-related decline in vestibular physiology have been unable to demonstrate any strong correlation to the histologic reports identifying an obvious decline in sensory hair cell counts, particularly prior to 60-70 years of age.”

“When abnormalities are present, age-related differences are usually subtle, often fall within the lower range of normal limits, and/or exhibit larger variances making statistically discernable differences from younger or middle-aged groups difficult.”

 “As medical diagnoses broaden to include dizziness as its own geriatric syndrome, our approach to discovering the underlying etiology must also broaden. Cross-disciplinary medical care will be imperative to effectively diagnose and treat such a multi-factorial and obscure condition as geriatric dizziness”

 “…it is clear that advancements and alternatives to our current battery of vestibular tests and stimuli are critically needed to better segregate and identify age-related vestibular changes. As we stand on the brink of a rapidly aging population, it is abundantly clear that a tremendous chanllenge lies ahead”

…THANK YOU

“I cannot teach you anything….all I can make you do is think.” - Socrates

[email protected]

aging of the human vestibular system.pptx

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