Multisensory Impairment Research Articles

Book Review: Inclusive Education for Learners with Multisensory Impairment: Best Practices and Research Priorities

Book Review: Inclusive Education for Learners with Multisensory Impairment: Best Practices and Research Priorities

Association Between Multisensory Impairment and Depression Among Older Adults: A Population-Based Analysis.

In this study, we examine how impairments in vision, hearing, touch, and olfaction relate to depression in older adults, considering both individual and multisensory impairments (MSIs). Analysis of cross-sectional data from a longitudinal investigation involving black and white older adults aged 70 to 79 at enrollment. We studied 1640 black and white participants in the Health ABC study using complete sensory evaluation data from years 3 to 5. Our MSI assessment utilized data obtained for visual acuity, hearing perception, olfactory performance, and tactile function. We performed multivariable logistic regression analyses to examine the associations between the presence of individual and MSIs and depression which was defined as the presence of antidepressants prescribed for depression, or a Center for Epidemiological Studies Depression Scale score of greater than 10. We observed a possible dose-response relationship between the number of sensory impairments and depression. In adjusted models, when compared to no impairments, vision (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.09-1.93) and hearing impairments (OR = 1.49, 95% CI: 1.11-1.99) were significantly associated with depression, whereas olfaction (OR = 1.11, 95% CI: 0.83-1.47) and tactile impairments (OR = 1.28, 95% CI: 0.96-1.70) were not. Participants with 3 sensory impairments had a higher rate of depression (OR = 2.05, 95% CI: 1.22-3.54) compared to those without impairments, and this risk increased further for those with 4 sensory impairments (OR = 2.95, 95% CI: 1.48-5.88). The findings suggest that individuals with MSI represent a high-risk population for depression, warranting close monitoring to screen for depression. The study emphasizes the importance of considering multiple sensory impairments in the context of mental health and supports the early identification and monitoring of depression in this population.

Cross-sectional associations between multisensory impairment and brain volumes in older adults: Baltimore Longitudinal Study of Aging

Sensory impairment and brain atrophy is common among older adults, increasing the risk of dementia. Yet, the degree to which multiple co-occurring sensory impairments (MSI across vision, proprioception, vestibular function, olfactory, and hearing) are associated with brain morphometry remain unexplored. Data were from 208 cognitively unimpaired participants (mean age 72 ± 10 years; 59% women) enrolled in the Baltimore Longitudinal Study of Aging. Multiple linear regression models were used to estimate cross-sectional associations between MSI and regional brain imaging volumes. For each additional sensory impairment, there were associated lower orbitofrontal gyrus and entorhinal cortex volumes but higher caudate and putamen volumes. Participants with MSI had lower mean volumes in the superior frontal gyrus, orbitofrontal gyrus, superior parietal lobe, and precuneus compared to participants with < 2 impairments. While MSI was largely associated with lower brain volumes, our results suggest the possibility that MSI was associated with higher basal ganglia volumes. Longitudinal analyses are needed to evaluate the temporality and directionality of these associations.

Sensory and motor deficits as contributors to early cognitive impairment.

Age-related sensory and motor impairment are associated with risk of dementia. No study has examined the joint associations of multiple sensory and motor measures on prevalence of early cognitive impairment (ECI). Six hundred fifty participants in the Baltimore Longitudinal Study of Aging completed sensory and motor function tests. The association between sensory and motor function and ECI was examined using structural equation modeling with three latent factors corresponding to multisensory, fine motor, and gross motor function. The multisensory, fine, and gross motor factors were all correlated (r=0.74 to 0.81). The odds of ECI were lower for each additional unit improvement in the multisensory (32%), fine motor (30%), and gross motor factors (12%). The relationship between sensory and motor impairment and emerging cognitive impairment may guide future intervention studies aimed at preventing and/or treating ECI. Sensorimotor function and early cognitive impairment (ECI) prevalence were assessed via structural equation modeling. The degree of fine and gross motor function is associated with indicators of ECI. The degree of multisensory impairment is also associated with indicators of ECI.

Physical Function Trajectories and Mortality in Older Adults With Multisensory Impairment

Single sensory impairment is associated with reduced functional resilience and increased mortality, though the effects of multiple sensory deficits are not known. To investigate longitudinal associations of the type, severity, and number of sensory impairments with physical function trajectories and mortality in older adults. This retrospective analysis of a longitudinal cohort study, the Health, Aging, and Body Composition (Health ABC) study, incorporated data from April 1997 to July 2013, featuring a 16-year follow-up with annual examinations and questionnaires. The cohort comprised 3075 men and women, aged 70 to 79 years at baseline, residing in Memphis, Tennessee, and Pittsburgh, Pennsylvania. All participants with complete sensory testing and covariate data at analytical baseline (year 5, 2002) were included. The data were analyzed September 1, 2022. Visual, olfactory, auditory, and touch sensory functions were assessed between 2000 and 2002. The main outcomes included physical functioning trajectories and mortality risk. Physical function was assessed longitudinally using the Health ABC physical performance battery (HABCPPB). A total of 1825 individuals (mean [SD] age, 77.4 [3.2] years; 957 [52%] female) were included in this study. Multivariable analysis of HABCPPB decline indicated that having 1 sensory impairment (β estimate, -0.01 [95% CI, -0.02 to -0.001]); 2 sensory impairments (β estimate, -0.01 [95% CI, -0.02 to -0.01]); 3 sensory impairments (β estimate, -0.03 [95% CI, -0.04 to -0.02]); or 4 sensory impairments (β estimate, -0.04 [95% CI, -0.05,-0.03]) was significantly associated with a steeper HABCPPB score decline in a dose-dependent manner. Adjusted Cox proportional hazards models indicated that having 1 sensory impairment (hazard ratio [HR], 1.35 [95% CI, 1.01-1.81]), 2 sensory impairments (HR, 1.58 [95% CI, 1.19-2.11]), 3 sensory impairments (HR, 1.79 [95% CI, 1.33-2.42]), or 4 sensory impairments (HR, 1.97 [95% CI, 1.39-2.79]) was significantly associated with increased mortality risk in a similarly dose-dependent manner. In this retrospective cohort study, the degree and number of multiple sensory impairments were associated with worse physical functioning and increased mortality risk. These findings represent an opportunity for further investigation into the value of screening, prevention, and treatment of sensory impairments to reduce morbidity and mortality in older adults.

ASSOCIATIONS OF OBJECTIVE MULTISENSORY IMPAIRMENT WITH COGNITIVE IMPAIRMENT: THE ARIC-NCS STUDY

Abstract Sensory impairments frequently co-occur among older adults. Characterizing the combined impact of a multisensory phenotype on cognitive impairment could help elucidate a potential mode of pathogenesis. We investigated associations between multisensory impairment (co-occurring, objectively-measured hearing loss [pure-tone average ≥25 dB], vision loss [presenting near or distance acuity &amp;gt;0.3 logMAR], anosmia [Sniffin’ Sticks test score ≤6], and peripheral nerve damage [≥1 insensate site on left or right foot]) and cognitive impairment (mild cognitive impairment [MCI] or dementia). Our study sample consisted of Black and White adults aged 70+ years in the Atherosclerosis Risk in Communities (ARIC) study; a longitudinal, community-based cohort. We estimated prevalence ratios (PRs) of baseline (ARIC visit 6, 2016-2017) expert-adjudicated MCI/dementia and odds ratios (ORs) of progression to MCI/dementia through ARIC visit 7 (2019) by number of impairments (0 [reference], 1, 2, 3 or more) using Poisson and logistic regression models, respectively. Overall, among 814 participants (age range: 71-93 years, 62% female, 41% Black race), an increasing number of impairments was associated with increased prevalence of baseline MCI/dementia (1 impairment, PR=1.14 [95% CI: 0.67-2.01]; 2 impairments, PR=1.53 [95% CI: 0.87-2.79]; ≥3 impairments, PR=2.26 [95% CI: 1.18-4.38]; p-trend: .007) and increased progression to MCI/dementia (1 impairment, OR=1.47 [95% CI: 0.67-3.49]; 2 impairments, OR=1.64 [95% CI: 0.69-4.12]; ≥3 impairments, OR=5.68 [95% CI: 2.18-15.52]; p-trend: .001). These findings suggest multiple concurrent sensory impairments contribute additively to greater MCI/dementia prevalence, signaling the importance of considering multiple impairments together in studies of the contribution of sensory losses to cognitive impairment.

Sensory impairment and beta-amyloid deposition in the Baltimore longitudinal study of aging.

Beta-amyloid (Aβ) plaque deposition is a biomarker of preclinical Alzheimer's disease (AD). Impairments in sensory function are associated with cognitive decline. We sought to investigate the relationship between PET-indicated Aβ deposition and sensory impairment. Using data from 174 participants ≥55 years in the Baltimore Longitudinal Study of Aging, we analyzed associations between sensory impairments and Aβ deposition measured by PET and Pittsburgh Compound B (PiB) mean cortical distribution volume ratio (cDVR). The combinations of hearing and proprioceptive impairment and hearing, vision, and proprioceptive impairment, were positively correlated with cDVR (β=0.087 and p=0.036, β=0.110 and p=0.018, respectively). In stratified analyses of PiB+ participants, combinations of two, three, and four sensory impairments (all involving proprioception) were associated with higher cDVR. Our findings suggest a relationship between multi-sensory impairment (notably proprioceptive impairment) and Aβ deposition, which could reflect sensory impairment as an indicator or potentially a risk factor for Aβ deposition.

Sensory impairment and algorithmic classification of early cognitive impairment.

Sensory impairment (SI) is linked to cognitive decline, but its association with early cognitive impairment (ECI) is unclear. Sensory functions (vision, hearing, vestibular function, proprioception, and olfaction) were measured between 2012 and 2018 in 414 Baltimore Longitudinal Study of Aging (BLSA) participants (age 74±9 years; 55% women). ECI was defined as 1 standard deviation below age-, sex-, race-, and education-specific mean performance in Card Rotations or California Verbal Learning Test immediate recall. Log binomial models (cross-sectional analysis) and Cox regression models (time-to-event analysis) were used to examine the association between SI and ECI. Cross-sectionally, participants with ≥3 SI had twice the prevalence of ECI (prevalence ratio=2.10, p=0.02). Longitudinally, there was no significant association between SI and incident ECI over up to 6 years of follow-up. SI is associated with higher prevalence, but not incident ECI. Future studies with large sample sizes need to further elucidate the relationship between SI and ECI. Sensory impairment is associated with high prevalence of early cognitive impairmentMultisensory impairment may pose a strong risk of early changes in cognitive functionIdentifying multisensory impairment may help early detection of dementia.

MULTISENSORY IMPAIRMENTS AND BRAIN VOLUMES IN MID-TO-LATE LIFE

Abstract Age-related sensory impairment, such as loss in vision or hearing, have been linked to poor brain health. Yet, the relationship between co-occurring sensory impairments and brain volumes remains unclear. We used cross-sectional sensory and brain imaging data from 208 cognitively normal participants of the Baltimore Longitudinal Study of Aging (mean age 72 years; 59% women). Sensory impairments were separately identified with vision, hearing, smell, proprioception, and vestibular function testing. Brain imaging volumes were derived using an automated multi-atlas approach. Multiple linear regression models were used to estimate brain volumetric differences by number of sensory impairments (0-5) or by multisensory impairment status (MSI; ≥2 impairments). For every one additional sensory impairment, there was lower volume in the orbitofrontal gyrus (beta=0.35 cc [SE=0.17], p=0.04) but higher volumes in the caudate (0.14 cc [0.05], p=0.006) and putamen (0.13 cc [0.06], p=0.043). Participants with MSI (versus no MSI) had lower volumes in superior frontal gyrus (-1.01 cc [=0.34], p=0.003), lower orbitofrontal gyrus (-0.91 cc [0.38], p=0.018), superior parietal lobe (0.68 cc [0.27], p=0.011), and precuneus (-0.74 cc [0.35], p=0.038), but similar volumes in the caudate (p=0.12) and putamen (p=0.14). A negative relationship between MSI and brain volume across multiple regions was largely observed yet our exploratory findings raise the possibility that MSI is associated with compensatory maintenance of brain volume structures in the basal ganglia. Future directions include replication of these findings in other studies and longitudinal analyses to determine how MSI relates to brain atrophy.

From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa.

Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.

Olfactory, Auditory, and Vestibular Performance: Multisensory Impairment Is Significantly Associated With Incident Cognitive Impairment

BackgroundDysfunction in the olfactory, auditory, and vestibular systems are commonly seen in aging and are associated with dementia. The impact of sensory loss(es) on cognition is not well understood. Our aim was to assess the relationships between performance on objective multisensory testing and quantify the impact of dysfunction on cognition.MethodsPatients presenting with subjective hearing loss presenting to a tertiary care otologic/audiologic clinic were identified and underwent multisensory testing using the Affordable, Rapid Olfactory Measurement Array (AROMA), pure tone audiometric evaluations, and the Timed “Up and Go” test. Cognitive impairment (CI) was assessed via the Montreal Cognitive Assessment (MoCA) was also administered.Key Results180 patients were enrolled. Thirty one percentage (n = 57) screened positive for cognitive impairment. When evaluating single sensory impairments, we found that olfactory dysfunction, gait impairment, and sensorineural hearing loss were all statistically significantly (p < 0.05) associated with a higher risk of cognitive impairment (ORs 3.89, 3.49, and 2.78, respectively) for CI. Multisensory impairment was significantly associated with cognitive impairment. Subjects with dysfunction in all domains were at the highest risk for cognitive impairment (OR 15.7, p < 0.001) vs. those with impairment in 2 domains (OR 5.32, p < 0.001).ConclusionDysfunction of the olfactory, auditory, and vestibular systems is associated with a significantly increased risk of CI. The dramatically increased risk of CI with multisensory dysfunction in all three systems indicated that MSD may synergistically contribute to CI.

Contribution of Sensory Function to Preclinical Indicators of Physical and Cognitive Functioning With Aging

There are well established associations between sensory loss and physical and cognitive deficits with aging, but gaps remain in our understanding of the associations between sensory function and early preclinical indicators of physical and cognitive decline. This symposium will present data from the Baltimore Longitudinal Study of Aging (BLSA) on a series of studies investigating the links among sensory function, motor function, and physical and cognitive outcomes in older adults. In the first study, Dr. Gross will present an operational definition of early cognitive impairment (ECI) based on a combination of two cognitive measures – the Card Rotations test and the California Verbal Learning Test Immediate Recall – to predict progression to MCI/AD. In the second study, Dr. Cai will evaluate the relationship between multisensory impairment (in vision, hearing, olfaction, proprioception and vestibular function) and the algorithmic definition of ECI. In the third study, Dr. Armstrong will evaluate the association between multisensory impairment and another biomarker of ECI or preclinical AD, specifically PET-PiB deposition. In the fourth study, Dr. Schrack, will present the joint contribution of multisensory (hearing and vision) impairment and motor function (gait speed) on risk of incident MCI/AD in longitudinal analyses. Finally, Dr. Martinez Amezcua will present the longitudinal association between hearing and vestibular function and decline in higher level physical function and endurance performance. Taken together, these studies present compelling data about the contribution of sensory function to preclinical indicators of physical and cognitive functioning with aging.

Does inflammation explain the link between multiple sensory impairment and dementia?

AbstractBackgroundMultiple sensory impairments are associated with increased risk of dementia, but the underlying mechanisms are unclear. One potential explanation is that the association is due to shared risk factors such as inflammation. Our objective was to evaluate whether multisensory impairment was associated with markers of inflammation (interleukin‐6, and C‐Reactive Protein (CRP) independent of other health conditions and test whether inflammation might explain the association between multisensory impairments and dementia risk.MethodWe studied 1,794 black and white older adults from the Health, Aging, and Body Composition Study, a prospective cohort study of older adults who were aged 70‐79 and dementia‐free at enrollment. Sensory abilities were assessed at study years 3‐5, vision was measured by log contrast sensitivity, hearing by pure tone average at 500, 1,000, 2,000, and 4,000 Hz; smell by the 12‐item Cross Cultural Smell Identification Test; and touch by vibration detection threshold of the big toe. A multisensory score (0‐12) was calculated based on sample quartiles and summed across each sensory domain. Interleukin‐6, and CRP were assayed based on blood sample near baseline and log transformed. Incident dementia over follow‐up was determined based on a combination of hospitalization records, dementia medications, or clinically significant cognitive decline. Using regression models, we investigated the associations between inflammation biomarkers, multisensory impairment, and dementia with adjustment for demographics, health conditions, and health behaviors.ResultBoth measures of inflammation were associated with higher multisensory impairment scores. 1‐log interleukin‐6 was associated with 0.25 points worse multisensory score (95%CI: 0.10, 0.40; p&gt;0.001), 1‐log CRP levels was associated with 0.11 points worse multisensory score (95%CI: 0.01, 0.20; p=0.02). Higher level of interleukin‐6 (HR = 1.18; 95% CI: 1.02, 1.37; p=0.03) but not CRP (p=0.84) was associated increased dementia risk. In adjusted models, a 1‐point increase in the multisensory score was associated with a 14% higher risk of dementia (95% CI: 1.08; 1.20), estimates were similar even after including interleukin‐6 as an explanatory variable.ConclusionInflammation was independently associated with worse multisensory impairment scores. Although inflammation is also associated with dementia, it did not explain the association between multisensory impairment and dementia.

Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) Trial: study protocol for a randomized controlled crossover trial

BackgroundA clinical pattern of damage to the auditory, visual, and vestibular sensorimotor systems, known as multi-sensory impairment, affects roughly 2% of the US population each year. Within the population of US military service members exposed to mild traumatic brain injury (mTBI), 15–44% will develop multi-sensory impairment following a mild traumatic brain injury. In the US civilian population, multi-sensory impairment-related symptoms are also a common sequela of damage to the vestibular system and affect ~ 300–500/100,000 population. Vestibular rehabilitation is recognized as a critical component of the management of multi-sensory impairment. Unfortunately, the current clinical practice guidelines for the delivery of vestibular rehabilitation are not evidence-based and primarily rely on expert opinion. The focus of this trial is gaze stability training, which represents the unique component of vestibular rehabilitation. The aim of the Incremental Velocity Error as a New Treatment in Vestibular Rehabilitation (INVENT VPT) trial is to assess the efficacy of a non-invasive, incremental vestibular adaptation training device for normalizing the response of the vestibulo-ocular reflex.MethodsThe INVENT VPT Trial is a multi-center randomized controlled crossover trial in which military service members with mTBI and civilian patients with vestibular hypofunction are randomized to begin traditional vestibular rehabilitation or incremental vestibular adaptation and then cross over to the alternate intervention after a prescribed washout period. Vestibulo-ocular reflex function and other functional outcomes are measured to identify the best means to improve the delivery of vestibular rehabilitation. We incorporate ecologically valid outcome measures that address the common symptoms experienced in those with vestibular pathology and multi-sensory impairment.DiscussionThe INVENT VPT Trial will directly impact the health care delivery of vestibular rehabilitation in patients suffering from multi-sensory impairment in three critical ways: (1) compare optimized traditional methods of vestibular rehabilitation to a novel device that is hypothesized to improve vestibulo-ocular reflex performance, (2) isolate the ideal dosing of vestibular rehabilitation considering patient burden and compliance rates, and (3) examine whether recovery of the vestibulo-ocular reflex can be predicted in participants with vestibular symptoms.Trial registrationClinicalTrials.gov NCT03846830. Registered on 20 February 2019.

Self-reported postural symptoms predict vestibular dysfunction and falls in mitochondrial disease patients with multi-sensory impairment

Mitochondrial diseases (MD) are a genetically heterogenous group of conditions. Large phenotypic variations are seen in people with MD, with presentations ranging from single organ involvement to multisystem disorders, which commonly give rise to multi-sensory impairment including ataxia, neuropathy, myopathy and vestibular dysfunction. We investigated the relative contributions of sensory impairment to postural control in patients with MD as a human model of multi-sensory dysfunction and explore how these impairments relate to falls risk.

Usher syndrome—the most common reason for deaf-blindness

Deaf-blindness is a serious disability, which affects all aspects of life. The most common condition combining deafness and blindness is the Usher syndrome (USH), which is traditionally divided into three major clinical subtypes, including Usher syndrome type 1, Usher syndrome type 2, and Usher syndrome type 3. The frequency of USH occurrence is often undervalued. To date, five genes for USH1 have been identified, three genes are involved in USH2, and one gene in USH3. In summary, USH can be a multisensory impairment associated with hearing impairment, progressive retinal degeneration, and vestibular dysfunction. Management of these patients requires interdisciplinary approach and collaboration.

Multi–sensory impairment: convenient label or recipe for confusion? A scoping review of research conducted in England (2001‐20)

AbstractIn England, the term ‘multi‐sensory impairment’ (MSI) has come to overlap with other labels, which is problematic for both research and practice. We undertook a scoping review of empirical studies conducted in England over the past 20 years on MSI and overlapping labels. We designed and used a review protocol and combined multiple searching methods, including repeated database searches, manual searching of journals and expert recommendations. We identified 29 studies that met the criteria for inclusion in the review, and we analysed these according to three themes: (1) terminology used, (2) topic explored, and (3) methodology adopted. We found that terminology was varied and poorly defined, with a lot of overlap between key terms that were used sometimes interchangeably. Moreover, studies varied in the level of transparency provided when methodology was reported. Finally, there was a dearth of research into inclusion in mainstream schools and research gathering learners’ voices. Implications for future research include the need for: (1) identification of factors that have led to overlapping terminology, (2) greater transparency in how the methodologies used in the field are reported, and (3) more evidence, especially from research on strategies in settings that promote inclusion, and research that includes learners’ voices.

Exploring Shared Effects of Multisensory Impairment, Physical Dysfunction, and Cognitive Impairment on Physical Activity: An Observational Study in a National Sample.

Multisensory, physical, and cognitive dysfunction share age-related physiologic disturbances and may have common health effects. We determined whether the effect of multisensory impairment on physical activity (PA) is explained by physical (timed up and go) or cognitive (Short Portable Mental Status Questionnaire) dysfunction. A National Social Life, Health, and Aging Project participant subset (n = 507) underwent objective sensory testing in 2005-2006 and wrist accelerometry in 2010-2011. We related multisensory impairment to PA using multivariate mixed-effects linear regression and compared the effect magnitude after adjusting for physical then cognitive dysfunction. Worse multisensory impairment predicted lower PA across three scales (Global Sensory Impairment: β = -0.04, 95% confidence interval [-0.07, -0.02]; Total Sensory Burden: β = -0.01, 95% confidence interval [-0.03, -0.003]; and Number of Impaired Senses: β = -0.02, 95% confidence interval [-0.04, -0.004]). Effects were similar after accounting for physical and cognitive dysfunction. Findings suggest that sensory, physical, and cognitive dysfunction have unique mechanisms underlying their PA effects.

Global Sensory Impairment Independently Predicts Decreased Social Function Over Time

The classical senses (vision, hearing, touch, taste, and smell) play a key role in social function by allowing interaction and communication. We assessed whether sensory impairment across all 5 modalities (global sensory impairment [GSI]) was associated with social function in older adults. Sensory function was measured in 3,005 home-dwelling older U.S. adults at baseline in the National Social Life, Health, and Aging Project and GSI, a validated measure, was calculated. Social network size and kin composition, number of close friends, and social engagement were assessed at baseline and 5- and 10-year follow-up. Ordinal logistic regression and mixed effects ordinal logistic regression analyzed cross-sectional and longitudinal relationships respectively, controlling for demographics, physical/mental health, disability, and cognitive function (at baseline). Adults with worse GSI had smaller networks (β=-0.159, p=0.021), fewer close friends (β=-0.262, p=0.003) and lower engagement (β=-0.252, p=0.006) at baseline, relationships that persisted at 5 and 10 year follow-up. Men, older people, African-Americans, and those with less education, fewer assets, poor mental health, worse cognitive function, and more disability had worse GSI. Men and those with fewer assets, worse cognitive function, and less education had smaller networks and lower engagement. African-American and Hispanic individuals had smaller networks and fewer close friends, but more engagement. Older respondents also had more engagement. In summary, GSI independently predicts smaller social networks, fewer close friends, and lower social engagement over time, suggesting that sensory decline results in decreased social function. Thus, rehabilitating multisensory impairment may be a strategy to enhance social function as people age.

Veterans with dizziness recruit compensatory saccades in each semicircular canal plane although VOR gain is normal.

Exposure to brain injury via blast or blunt mechanisms disrupts multiple sensorimotor systems simultaneously. Large numbers of US Gulf War era and Operation Iraqi/Enduring Freedom veterans with traumatic brain injury (TBI) are suffering the symptom of dizziness - presumed due to "Multi-Sensory Impairment", a clinical pattern of damage to the auditory, visual and vestibular sensorimotor systems. To describe the oculomotor response to rapid head rotation in a population of veterans with dizziness. We also describe the reliability of using the video head impulse test (vHIT) in a veteran population. We used the vHIT to evaluate the vestibular-ocular reflex (VOR) gain and presence of compensatory saccades (CS) in each semicircular canal of 81 veterans (31% TBI) with dizziness. Data was collected using the ICS Otometric™ vHIT. Data was processed using both the Otometric™ software and custom software written in MATLAB™. This data was evaluated through Kruskal-Wallis rank-sum test and analysis of regression. Veterans with dizziness recruit CS in all semicircular canal planes even though their VOR gain is normal. The vHIT is a reliable clinical test to quantify the metrics of the VOR and CS in veterans. Veterans with dizziness symptoms use compensatory saccades in all planes of semicircular canal rotation, despite having normal peripheral VOR gain during rapid head rotation. The video head impulse test is a stable measure of vestibular slow phase and metrics of compensatory saccades in veterans with dizziness.