Evaluating vestibulo-ocular reflex gain and catch-up saccades following head impulses in normal aging

The video head impulse test (vHIT) is vital in clinical setting for assessing vestibulo-ocular reflex (VOR) function in patients of all ages. However, how normal aging influence VOR gain and catch-up saccades remains unclear, thus leading to confusion in interpretation of vHIT results. This study aims to compare VOR gain and saccades parameters (frequency, amplitude, and latency) between younger and older adults, while maintaining head velocity and acceleration within the same range. A total of 24 younger and 24 older adults performed horizontal vHIT tests (ICS Impulse, Otometrics, Denmark). Gain and saccades were analyzed using a custom MATLAB script. Three VOR gain algorithms were compared: Area under the curve (AUC), instantaneous gain, and regression gain. In our sample, no significant differences in the VOR gains were observed between younger and older adults using any of the algorithms. Compared to younger adults, older adults had saccades that were significantly more frequent, of greater amplitude, and of shorter latencies. However, a larger sample size is needed to confirm the lack of aging effect on VOR gains. The absence of significant effects of aging on VOR gain in vHIT demonstrates that all three gain algorithms should provide similar values for patients across all ages in clinical practice. The results suggest that small saccades in older adults are unrelated to head impulse parameters, and the mechanisms behind this increase in saccades with normal aging remain to be explored.