Journal of Neurology

, Volume 264, Issue 3, pp 554–563 | Cite as

Cognitive deficits in patients with a chronic vestibular failure

  • Pauline Popp
  • Melanie Wulff
  • Kathrin Finke
  • Maxine Rühl
  • Thomas Brandt
  • Marianne Dieterich
Original Communication


Behavioral studies in rodents and humans have demonstrated deficits of spatial memory and orientation in bilateral vestibular failure (BVF). Our aim was to explore the functional consequences of chronic vestibular failure on different cognitive domains including spatial as well as non-spatial cognitive abilities. Sixteen patients with a unilateral vestibular failure (UVF), 18 patients with a BVF, and 17 healthy controls (HC) participated in the study. To assess the cognitive domains of short-term memory, executive function, processing speed and visuospatial abilities the following tests were used: Theory of Visual Attention (TVA), TAP Alertness and Visual Scanning, the Stroop Color-Word, and the Corsi Block Tapping Test. The cognitive scores were correlated with the degree of vestibular dysfunction and the duration of the disease, respectively. Groups did not differ significantly in age, sex, or handedness. BVF patients were significantly impaired in all of the examined cognitive domains but not in all tests of the particular domain, whereas UVF patients exhibited significant impairments in their visuospatial abilities and in one of the two processing speed tasks when compared independently with HC. The degree of vestibular dysfunction significantly correlated with some of the cognitive scores. Neither the side of the lesion nor the duration of disease influenced cognitive performance. The results demonstrate that vestibular failure can lead to cognitive impairments beyond the spatial navigation deficits described earlier. These cognitive impairments are more significant in BVF patients, suggesting that the input from one labyrinth which is distributed into bilateral vestibular circuits is sufficient to maintain most of the cognitive functions. These results raise the question whether BVF patients may profit from specific cognitive training in addition to physiotherapy.


Vertigo Cognition Vestibular failure Vestibular rehabilitation Attention Memory 


Compliance with ethical standards

Conflicts of interest

PP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and reports no disclosures. MW, KF, MR, TB, and MD report no disclosures.

Ethical statement

The study was approved by the local ethics committee of the Ludwig-Maximilians University, Munich. All subjects gave their informed written consent to participate in the study.


This work was supported by funds from the German Research Foundation (GRK Grant Code 1091. to PP, MW, MD), the German Federal Ministry of Education and Research (BMBF Grant Code 01 EO 0901 to MD, TB), the Hertie–Foundation (TB), and the German Foundation for Neurology (MD, MR). The funding sources played no role in the design and performance of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.


  1. 1.
    Smith PF, Zheng Y (2013) From ear to uncertainty: vestibular contributions to cognitive function. Front Integr Neurosci 7:84CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Besnard S, Lopez C, Brandt T et al (2015) The vestibular system in cognitive and memory processes in mammalians. Front Integr Neurosci 9:55CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Baek JH, Zheng Y, Darlington CL, Smith PF (2010) Evidence that spatial memory deficits following bilateral vestibular deafferentation in rats are probably permanent. Neurobiol Learn Mem 94(3):402–413CrossRefPubMedGoogle Scholar
  4. 4.
    Besnard S, Machado ML, Vignaux G et al (2012) Influence of vestibular input on spatial and nonspatial memory and on hippocampal NMDA receptors. Hippocampus 22(4):814–826CrossRefPubMedGoogle Scholar
  5. 5.
    Brandt T, Schautzer F, Hamilton DA et al (2005) Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans. Brain 128:2732–2741CrossRefPubMedGoogle Scholar
  6. 6.
    Yardley L, Burgneay J, Nazareth I, Luxon L (1998) Neuro-otological and psychiatric abnormalities in a community sample of people with dizziness: a blind, controlled investigation. J Neurol Neurosurg Psychiatry 65(5):679–684CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Black FO, Pesznecker S, Stallings V (2004) Permanent gentamicin vestibulotoxicity. Otol Neurotol 25(4):559–569CrossRefPubMedGoogle Scholar
  8. 8.
    Bigelow RT, Agrawal Y (2015) Vestibular involvement in cognition: visuospatial ability, attention, executive function, and memory. J Vestib Res 25(2):73–89PubMedGoogle Scholar
  9. 9.
    Risey J, Briner W (1990) Dyscalculia in patients with vertigo. J Vestib Res 1(1):31–37PubMedGoogle Scholar
  10. 10.
    Redfern MS, Talkowski ME, Jennings JR, Furman JM (2004) Cognitive influences in postural control of patients with unilateral vestibular loss. Gait Posture 19(2):105–114CrossRefPubMedGoogle Scholar
  11. 11.
    Péruch P, Lopez C, Redon-Zouiteni C et al (2011) Vestibular information is necessary for maintaining metric properties of representational space: evidence from mental imagery. Neuropsychologia 49(11):3136–3144CrossRefPubMedGoogle Scholar
  12. 12.
    Hüfner K, Hamilton DA, Kalla R et al (2007) Spatial memory and hippocampal volume in humans with unilateral vestibular deafferentation. Hippocampus 17(6):471–485CrossRefPubMedGoogle Scholar
  13. 13.
    Kremmyda O, Huefner K, Flanagin VL et al (2016) Beyond dizziness: virtual navigation, spatial anxiety and hippocampal volume in bilateral vestibulopathy. Front Hum Neurosci 10:139. doi: 10.3389/fnhum.2016.00139 (eCollection) CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dieterich M, Bense S, Lutz S et al (2003) Dominance for vestibular cortical function in the non-dominant hemisphere. Cereb Cortex 13(9):994–1007CrossRefPubMedGoogle Scholar
  15. 15.
    Bense S, Bartenstein P, Lutz S et al (1004) Three determinants of vestibular hemispheric dominance during caloric stimulation. Ann N Y Acad Sci 1:440–445Google Scholar
  16. 16.
    Zingler VC, Cnyrim C, Jahn K et al (2007) Causative factors and epidemiology of bilateral vestibulopathy in 255 patients. Ann Neurol 61(6):524–532CrossRefPubMedGoogle Scholar
  17. 17.
    Zingler VC, Weintz E, Jahn K et al (2008) Follow-up of vestibular function in bilateral vestibulopathy. J Neurol Neurosurg Psychiatry 79:284–288CrossRefPubMedGoogle Scholar
  18. 18.
    Jongkees LB, Maas JP, Philipzoon AJ (1962) Clinical nystagmography: a detailed study of electro-nystagmography in 341 patients with vertigo. Pract Otorhinolaryngol 24:65–93Google Scholar
  19. 19.
    Honrubia V (1994) Quantitative vestibular function tests and the clinical examination. In: Herdman SJ (ed) Vestibular rehabilitation. Davis, Philadelphia, pp 113–164Google Scholar
  20. 20.
    Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9:97–113CrossRefPubMedGoogle Scholar
  21. 21.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMedGoogle Scholar
  22. 22.
    Tschan R, Wiltink J, Best C et al (2008) Validation of the German version of the Vertigo Symptom Scale (VSS) in patients with organic or somatoform dizziness and healthy controls. J Neurol 255(8):1168–1175CrossRefPubMedGoogle Scholar
  23. 23.
    Finke K, Bublak P, Krummenacher J et al (2005) Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I: evidence from normal subjects. Int Neuropsychol Soc 11(7):832–842Google Scholar
  24. 24.
    Jensen AR, Rohwer WD Jr (1966) The Stroop color-word test: a review. Acta Psychol (Amst) 25(1):36–93CrossRefGoogle Scholar
  25. 25.
    Kessels RPC, van Zandvoort MJE, Postma A et al (2000) The Corsi Block-Tapping Task: standardization and normative data. Appl Neuropsychol 7(4):252–258CrossRefPubMedGoogle Scholar
  26. 26.
    Glasauer S, Amorim MA, Viaud-Delmon I, Berthoz A (2002) Differential effects of labyrinthine dysfunction on distance and direction during blindfolded walking of a triangular path. Exp Brain Res 145(4):489–497CrossRefPubMedGoogle Scholar
  27. 27.
    Péruch P, Borel L, Magnan J, Lacour M (2005) Direction and distance deficits in path integration after unilateral vestibular loss depend on task complexity. Cogn Brain Res 25(3):862–872CrossRefGoogle Scholar
  28. 28.
    Guidetti G, Monzani D, Trebbi M, Rovatti V (2008) Impaired navigational skills in patients with psychological distress and chronic peripheral vestibular hypofunction without vertigo. Acta Otorhinolaryngol Ital 28(1):21–25PubMedPubMedCentralGoogle Scholar
  29. 29.
    zu Eulenburg P, Caspers S, Roski C, Eickhoff SB (2012) Meta-analytical definition and functional connectivity of the human vestibular cortex. Neuroimage 60(1):162–169CrossRefPubMedGoogle Scholar
  30. 30.
    Mast FW, Preuss N, Hartmann M, Grabherr L (2014) Spatial cognition, body representation and affective processes: the role of vestibular information beyond ocular reflexes and control of posture. Front Integr Neurosci 8:44. doi: 10.3389/fnint.2014.00044 (ECollection) CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Krall SC, Rottschy C, Oberwelland E et al (2015) The role of the right temporoparietal junction in attention and social interaction as revealed by ALE meta-analysis. Brain Struct Funct 220(2):587–604CrossRefPubMedGoogle Scholar
  32. 32.
    Schultz H, Sommer T, Peters J (2012) Direct evidence for domain-sensitive functional subregions in human entorhinal cortex. J Neurosci 32(14):4716–4723CrossRefPubMedGoogle Scholar
  33. 33.
    Dieterich M, Bauermann T, Best C et al (2007) Evidence for cortical visual substitution of chronic bilateral vestibular failure (an fMRI study). Brain 130:2108–2116CrossRefPubMedGoogle Scholar
  34. 34.
    Becker-Bense S, Dieterich M, Buchholz HG et al (2014) The differential effects of acute right- vs. left-sided vestibular failure on brain metabolism. Brain Struct Funct 219(4):1355–1367CrossRefPubMedGoogle Scholar
  35. 35.
    zu Eulenburg P, Stoeter P, Dieterich M (2010) Voxel-based morphometry depicts central compensation after vestibular neuritis. Ann Neurol 68(2):241–249CrossRefPubMedGoogle Scholar
  36. 36.
    Zwergal A, Schlichtiger J, Xiong G et al (2014) Sequential [18F]FDG µPET whole-brain imaging of central vestibular compensation: a model of deafferentation-induced brain plasticity. Brain Struct Funct 221(1):159–170CrossRefPubMedGoogle Scholar
  37. 37.
    Talkowski ME, Redfern MS, Jennings JR, Furman JM (2005) Cognitive requirements for vestibular and ocular motor processing in healthy adults and patients with unilateral vestibular lesions. J Cogn Neurosci 17(9):1432–1441CrossRefPubMedGoogle Scholar
  38. 38.
    Grabherr L, Cuffel C, Guyot JP, Mast FW (2011) Mental transformation abilities in patients with unilateral and bilateral vestibular loss. Exp Brain Res 209(2):205–214CrossRefPubMedGoogle Scholar
  39. 39.
    Kirsch V, Keeser D, Hergenroeder T et al (2016) Structural and functional connectivity mapping of the vestibular circuitry from human brainstem to cortex. Brain Struct Funct 221(3):1291–1308CrossRefPubMedGoogle Scholar
  40. 40.
    Bigelow RT, Semenov YR, Trevino C, Ferrucci L, Resnick SM, Simonsick EM, Q-L Xue, Agrawal Y (2015) Association between visuospatial ability and vestibular function in the baltimore longitudinal study of aging. J Am Geriatr Soc 63(9):1837–1844CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Hüfner K, Stephan T, Hamilton DA et al (2009) Gray-matter atrophy after chronic complete unilateral vestibular deafferentation. Ann N Y Acad Sci 1164:383–385CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of NeurologyLudwig-Maximilians UniversityMunichGermany
  2. 2.Graduate School of Systemic NeurosciencesLudwig-Maximilians UniversityMunichGermany
  3. 3.Department of PsychologyLudwig-Maximilians UniversityMunichGermany
  4. 4.German Center for Vertigo and Balance DisordersLudwig-Maximilians UniversityMunichGermany
  5. 5.Clinical NeuroscienceLudwig-Maximilians UniversityMunichGermany
  6. 6.SyNergy, Munich Cluster of Systems NeurologyMunichGermany

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