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Related Experiment Video

Updated: Nov 7, 2025

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Subtypes of Persistent Postural-Perceptual Dizziness.

Chihiro Yagi1, Yuka Morita1, Meiko Kitazawa1

  • 1Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Frontiers in Neurology
|May 3, 2021
PubMed
Summary

Persistent postural-perceptual dizziness (PPPD) can be categorized into three subtypes: visual-dominant, active motion-dominant, and mixed. Visual stimuli were the most common trigger for PPPD symptoms across all subtypes.

Keywords:
chronic dizzinesscluster analysisfactor analysispersistent postural-perceptual dizzinesssubtypes

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Area of Science:

  • Neuroscience
  • Otolaryngology
  • Psychiatry

Background:

  • Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular syndrome triggered by posture, motion, and visual stimuli.
  • PPPD shares features with four precursor conditions: phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness.
  • The study investigates whether PPPD is a single entity or a composite of its precursors, necessitating subtyping.

Purpose of the Study:

  • To determine if Persistent Postural-Perceptual Dizziness (PPPD) is a singular disorder or can be subtyped.
  • To classify PPPD patients based on their symptom-exacerbating factors.

Main Methods:

  • Factor analysis of the Niigata PPPD Questionnaire (NPQ) responses from 108 untreated PPPD patients.
  • Cluster analysis to group patients based on identified exacerbating factors (visual, active motion, passive motion/standing).
  • Validation of clusters using ANOVA and multiple comparison analyses on demographic, clinical, and vestibular test data.

Main Results:

  • Factor analysis identified three primary exacerbating factors: visual stimuli (47.4% variance), active motion (12.0% variance), and passive motion/standing (7.67% variance).
  • Cluster analysis revealed three PPPD subtypes: visual-dominant (n=49), active motion-dominant (n=20), and mixed (n=39).
  • The active motion-dominant subtype patients were significantly older than the visual-dominant subtype; no other significant differences were found in demographics or vestibular tests.

Conclusions:

  • Persistent Postural-Perceptual Dizziness (PPPD) can be classified into three distinct subtypes based on symptom triggers.
  • Visual exacerbation is the most prevalent factor in PPPD.
  • Standard vestibular function tests do not differentiate between the identified PPPD subtypes.