New Research Shows Damage to Inner Ear Contributes to Falling

In a study of about 50 people with Alzheimer’s disease, Johns Hopkins researchers found evidence that damage to the inner ear system that controls balance is a major factor in patients’ well-documented higher risk of falling.

The study found overall that vestibular system impairment was linked to a 50% increase in the risk of falling for patients with Alzheimer’s compared with patients who have Alzheimer’s and normal vestibular function.

Published in the Journal of Alzheimer’s Disease, this research is thought to be one of the first studies to demonstrate the vestibular system is an important contributor to loss of balance and fall risk among Alzheimer’s patients. In fact, the researchers said Alzheimer’s patients fall twice as often as healthy older adults.

To conduct the study, the researchers recruited 48 people diagnosed with mild or moderate Alzheimer’s who were seen at the Johns Hopkins Memory and Alzheimer’s Treatment Center and the Johns Hopkins Alzheimer’s Disease Research Center between March 2018 and January 2020. The mean age of participants was 65, and 27 were male. The team examined the link between vestibular impairment and falls in the patients over a two-year period.

The vestibular system is a complex system deep in the inner ear. Problems with it are a common reason for dizziness, vertigo and balance disorders even in healthy people. Though vestibular conditions can occur at any age, they happen more often in older adults, which is why the researchers focused on the vestibular system as a potential risk factor for falls in Alzheimer’s patients.

The researchers used devices that can track responses to eye and head movement to stimulate and mirror vestibular function. Subjects who had vestibular function impairment on these tests over time were 50% more likely to fall compared with individuals with normal vestibular function. They found that loss of vestibular function leads to an increased sway, causing unstable balance, which in turn leads to more falls.

With a small study size, more research is needed in order to make a direct connection between inner ear damage in Alzheimer’s patients and falling, but it is an important issue to be aware of.

In the meantime, if a friend or family member has been diagnosed with Alzheimer’s and has experienced falls, evaluation by a medical professional or a hearing health professional who specializes in dizziness and balance disorders may be a good idea.

For some individuals, a common inner ear condition known as benign paroxysmal positional vertigo (BPPV), may cause dizziness and balance problems. BPPV is the most common cause of vertigo, which is a false sensation of motion, often reported as a spinning sensation. It occurs when calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the three fluid-filled semicircular canals, where they are not supposed to be. It causes episodes of vertigo, triggered by movement and changes in position.

The good news is that BPPV can be effectively treated with the appropriate mechanical maneuvers performed by a qualified healthcare professional, such as a vestibular audiologist.

According to the Vestibular Disorders Association, studies have been conducted into the effectiveness of the treatment maneuvers for BPPV, with results showing 90% have their dizziness or balance problems resolved after one to three treatments.

It’s also important to note that no research has drawn a conclusion that BPPV is the cause of falls in older adults with Alzheimer’s disease, but BPPV is a common and treatable condition in older patients.

Danielle Dorner, Au.D., is a vestibular disorders specialist with Associated Audiologists. She earned her Doctorate of Audiology degree from Northern Illinois University and her Bachelor’s degree from Augustana College, Rock Island, Illinois. Dr. Dorner performed her clinical externship with Associated Audiologists.

She is a member of the Academy of Doctors of Audiology (ADA), holds a certificate of clinical competence in audiology from the American Speech-Language-Hearing Association (ASHA), and is a member of the Kansas Speech-Language-Hearing Association (KSHA).

For more information about dizziness and falls, visit Associated Audiologists.