Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Abstract Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

The Correlation between Dizziness and Anxiety, Depression, and Type D Personality in Patients with Chronic Dizziness / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Dizziness often takes a chronic course and can influence the emotion of life. Dizziness is associated with psychological factors such as anxiety and depression. Type D personality is also related to the negative emotions including anxiety and depression. Therefore, the aim of this study was to determine the correlation between chronic dizziness and anxiety/depression/type D personality. MATERIALS AND METHODS: Chronic dizziness was defined when the dizziness had persisted more than three months. We analyzed the data of 72 patients with chronic dizziness between November 2012 and August 2014. The patients with chronic dizziness were asked to complete a survey regarding demographic data, history of dizziness, Beck depression inventory-II (BDI-II), Hamilton anxiety scale (HAM-A), type D personality scale 14 (DS-14), and dizziness handicap inventory (DHI). RESULTS: The patients with chronic dizziness had a trend of higher frequency of type D personality (52.7%) compared to general population. In the patients with chronic dizziness, there was significant positive correlation between DHI score and BDI-II, HAM-A, and DS-14 score. CONCLUSION: These results suggest that the patients with chronic dizziness, compared to the general population, have a trend of higher frequency of type D personality. There is significant positive correlation between chronic dizziness and anxiety/depression/type D personality.