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Functional Dizziness as a Spatial Cognitive Dysfunction.

Hayo A Breinbauer1,2, Camilo Arévalo-Romero1, Karen Villarroel1

  • 1Laboratory for Clinical Neuro-Otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago 8331150, Chile.

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|January 22, 2024
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Summary

Persistent postural-perceptual dizziness (PPPD) significantly impairs spatial navigation and cognitive functions. This suggests disrupted spatial cognition may be a key factor in the pathophysiology of PPPD.

Keywords:
chronic dizzinesschronic vertigofunctional dizzinessfunctional neurological disorderpersistent postural perceptual dizzinessspatial cognitionspatial navigation

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Area of Science:

  • Neuroscience
  • Cognitive Psychology
  • Otolaryngology

Background:

  • Persistent postural-perceptual dizziness (PPPD) is a prevalent chronic dizziness condition with an unknown cause.
  • Spatial cognition disruption is hypothesized as a central feature of PPPD.
  • Understanding PPPD's pathophysiology is crucial for effective treatment.

Purpose of the Study:

  • To investigate the role of spatial cognition in Persistent postural-perceptual dizziness (PPPD).
  • To compare cognitive and vestibular functions in PPPD patients versus healthy controls and other vestibular disorder patients.
  • To identify potential pathophysiological mechanisms underlying PPPD.

Main Methods:

  • Psycho-cognitive testing, including virtual Morris water maze for spatial navigation, was performed on 19 PPPD patients.
  • Participants also underwent assessments for anxiety, depression, memory, attention, planning, and executive functions.
  • Comparison groups included 12 healthy controls and 20 patients with other vestibular disorders; vestibular function and brain MRI were also assessed.

Main Results:

  • PPPD patients showed significant deficits in allocentric spatial navigation and visuospatial cognitive tasks (Towers of London, Trail Making B).
  • Factor analysis identified spatial navigation and advanced visuospatial functions as core to PPPD, correlating with symptom severity.
  • No confounding pathology was found via MRI, and vestibular function tests were used for comparison.

Conclusions:

  • Persistent postural-perceptual dizziness (PPPD) appears to broadly affect higher cognitive functions, particularly spatial cognition.
  • A disruption in forming detailed cognitive spatial maps is proposed as a potential cause of PPPD.
  • These findings highlight the importance of cognitive assessment in PPPD diagnosis and management.