Might Vestibular "Noise" Cause Subclinical Balance Impairment and Falls?
Might Vestibular "Noise" Cause Subclinical Balance Impairment and Falls?
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2021
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跌倒是老年人意外伤害的主要原因，每年直接导致全球60多万人死亡。尽管跌倒的问题很复杂，但平衡功能障碍是老年人跌倒发生率增加的主要原因之一。一项对美国老年人进行的具有全国代表性的调查显示，闭着眼睛站在泡沫垫上的能力与报告“跌倒困难”的几率增加了六倍以上。由于“闭眼吸泡沫”状态的稳定性依赖于完整的前庭提示，这些数据暗示年龄相关性前庭丧失是跌倒的潜在诱因，然而，解释年龄相关性前庭丧失与失衡/跌倒之间联系的具体原因机制尚不清楚。在这里，我们回顾了最近的数据表明，前庭感觉阈值，前庭感觉噪声的测试，被发现：(1)占健康老年人亚临床平衡障碍的近一半，(2)与健康年轻人的姿势摆动有关。根据在健康成年人中发现的平衡障碍和前庭噪声之间的联系，我们假设了以下因果链：(A)前庭反馈中的“噪声”增加-导致前庭反馈中的信噪比降低-增加摇摆，(B)过度摇摆导致不平衡，(C)不平衡导致跌倒。确定与年龄相关的平衡功能障碍的“原因”将有助于制定干预措施，以在不断增长的老年人口中预防跌倒和与跌倒相关的伤害。
Falls are the leading causes of accidental injury in older adults and directly contribute to more than 600,000 deaths each year worldwide. Although the issue of falls is complex, balance dysfunction is one the principal contributors to the heightened incidence of falls in older adults. A nationally representative survey of older adults in the United States showed that an inability to stand on a foam pad with the eyes closed was associated with more than a six-fold increase in the odds of reporting “difficulty with falls.” As stability in the “eyes closed, on foam” condition is reliant upon intact vestibular cues, these data implicate age-related vestibular loss as a potential contributor to falls, yet, the specific causal mechanism explaining the link between age-related vestibular loss and imbalance/falls was not known. Here we review recent data showing that, vestibular perceptual thresholds, an assay of vestibular sensory noise, were found to, (1) account for nearly half of subclinical balance impairment in healthy older adults and (2) correlate with postural sway in healthy young adults. Based upon the identified links between balance dysfunction and vestibular noise in healthy adults, we posit the following causal chain: (a) increased “noise” in vestibular feedback - yielding a reduced signal-to-noise ratio in vestibular feedback-increases sway, (b) excessive sway leads to imbalance, and (c) imbalance contributes to falls. Identifying the “cause” of age-related balance dysfunction will inform the development of interventions tailored to prevent falls, and fall-related injuries, in the growing population of older adults.