Objective: To evaluate the potential efficacy of a software-controlled, solid-state, time-varying caloric vestibular stimulation (tvCVS) device for the treatment of cognitive impairment in Parkinson’s disease (PD).

Background: CVS works by transferring heat to and from the petrous bone which modulates the firing rate of the vestibular nerves, and in turn elicits compensatory responses across cortical and sub-cortical structures. Results from a recent randomized double-blind, placebo-controlled study demonstrated that 8 weeks of daily tvCVS treatments using a tvCVS device was associated with robust reductions in both non-motor and motor symptom burden in PD. These effects persisted for several weeks past treatment cessation and were obtained with excellent treatment blinding and high treatment adherence/participant satisfaction. Here we further explore the therapeutic efficacy of the device for cognitive impairment.

Method: Eligible and consenting participants taking stable anti-Parkinsonian medications were randomly allocated 1:1 to a placebo or active arm. After a 4-week baseline period, they self-administered ~19 minutes of active or placebo treatment twice daily in the home for 8 weeks. Outcome measures were administered every 4 weeks from the start of baseline to the end of the treatment period and also 5 weeks and 24 weeks after treatment cessation. Only subjects with signs of cognitive dysfunction, as evidenced by scores ≤ 25 on the Montreal Cognitive Assessment (MoCA), were included in this post-hoc exploratory analysis.

Results: Active-arm subjects (n = 11) exhibited significantly greater improvements in MoCA total scores relative to placebo-arm subjects (n = 15) both at treatment end and five weeks after treatment cessation [figure 1]. Therapeutic gains were driven largely by improvements in delayed recall memory. Gains in the performance-based MoCA were also accompanied by improvements in patient-reported measures of cognition.

Conclusion: Daily use of the tvCVS device may provide a feasible and effective adjunct therapy for the management of cognitive impairment associated with PD. Hypothesized mechanisms of action center on improved neurovascular coupling and down-stream sequela and are currently being explored. Evidence for improved memory with tvCVS device treatments suggests potential efficacy across additional neurological disorders. This potential will be explored in future research.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effects-of-time-varying-caloric-vestibular-stimulation-therapy-on-cognition-impairment-in-parkinsons-disease/