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Introducción: El mareo perceptual postural persistente (MPPP) es, probablemente, la causa más prevalente de mareo crónico. Sin embargo, su fisiopatología es aún motivo de duda y debate. En el presente artículo, proponemos que el MPPP se caracteriza por disfunciones cognitivas de orden superior, al punto de diferenciarse en estas dimensiones de controles sanos y pacientes con patologías vestibulares no-MPPP. Objetivo: Determinar si pacientes con MPPP presentan alteraciones discriminantes respecto a grupos controles, en ámbitos de atención, memoria de trabajo visoespacial, planificación espacial, funciones ejecutivas y rendimiento cognitivo global. Material y Método: Estudio descriptivo transversal con sujetos de entre 18 y 65 años, reclutados de una unidad de otoneurología ambulatoria. Se aplicaron pruebas Montreal Cognitive Assessment (MoCA), tarea de retención de dígitos, Trail Making Test, Corsi Block-Tapping Task y Torre de Londres. Resultados: 30 pacientes fueron categorizados en tres grupos: grupo MPPP (n = 14), grupo vestibular no-MPPP (n = 11) y grupo control (n = 5). El grupo MPPP exhibió un rendimiento significativamente inferior en pruebas de planificación, velocidad de procesamiento y funciones ejecutivas en ámbitos visoespaciales, mientras que en atención y memoria visoespacial no hubo diferencias entre grupos. Conclusión: El MPPP podría caracterizarse por una disfunción de procesos cognitivos superiores de construcción espacial de mayor complejidad, respetando funciones visoespaciales de menor orden como la memoria de trabajo. Estos hallazgos ofrecen nuevas luces para comprender la fisiopatología del MPPP y sus implicancias clínicas.
Introduction: Persistent postural-perceptual dizziness (PPPD) is probably the most prevalent cause of chronic dizziness. However, its pathophysiology is still a matter of uncertainty and debate. In this article, we propose that PPPD is characterized by higher-order cognitive dysfunctions, to the point of differentiating it from healthy controls and patients with non-PPPD vestibular pathologies. Aim: To determine whether patients with PPPD exhibit discriminant alterations compared to control groups in the areas of attention, visuospatial working memory, spatial planning, executive functions, and global cognitive performance. Materials and Methods: A cross-sectional descriptive study was conducted with subjects between the ages of 18 and 65 years, recruited from an outpatient otoneurology unit. Tests included the Montreal Cognitive Assessment (MoCA), digit retention task, Trail Making Test, Corsi Block-Tapping Task, and the Tower of London. Results: 30 patients were categorized into three groups: PPPD group (n = 14), non-PPPD vestibular group (n = 11), and control group (n = 5). The PPPD group showed significantly lower performance on tests of planning, processing speed, and executive function in visuospatial domains, while there were no differences between groups in attention and visuospatial memory. Conclusion: PPPD may be characterized by dysfunction of higher-order cognitive processes related to spatial construction of greater complexity, while sparing lower-order visuospatial functions such as working memory. These findings offer new insights into the pathophysiology of PPPD and its clinical implications.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Posture/physiology , Dizziness/physiopathology , Motion Perception/physiology , Chronic Disease , Epidemiology, Descriptive , Cognitive Dysfunction/physiopathology , Spatial Navigation/physiology , Memory, Short-Term/physiologyABSTRACT
Persistent postural-perceptual dizziness（PPPD） is the most common chronic vestibular disease, the clinical manifestation is dizziness, unstable and non-rotational dizziness for three months or more. And the symptom is exacerbated by upright posture, active or passive movement, and complex visual stimuli. In addition, PPPD is a functional disease, so routine vestibular function tests and imaging tests are often negative. According to the diagnostic criteria established by the Barany Association, the diagnosis of PPPD often relies on history. This article provides a review of PPPD-related questionnaires.
Subject(s)
Humans , Dizziness/diagnosis , Vertigo/diagnosis , Vestibular Diseases/diagnosis , Surveys and QuestionnairesABSTRACT
@#Persistent postural-perceptual dizziness （PPPD） is a common clinical chronic dizziness disease，with persistent dizziness，instability，or non-rotational vertigo as the main symptom. It may be aggravated by postural changes，active/passive movements，and exposure to complex visual environments. At present，it is believed that the occurrence of PPPD may be related to the failure of postural control readaptation and abnormal cortical multisensory integration，but the specific pathophysiological mechanism is not clear. In recent years，with the continuous application of neuroimaging technology in the field of vertigo diseases，it has been found that in patients with PPPD，the brain structure，function，and connectivity related to vestibular multisensory and spatial orientation are decreased，while the function and connectivity related to visual processing are enhanced. At the same time，various psychiatric factors （such as anxiety，depression，and neuroticism） as well as triggers may be involved in regulating the brain structure of people with PPPD，which helps explain the differences in outcomes between studies. The above neuroimaging findings are helpful for the early diagnosis and treatment of PPPD. Therefore，this paper reviews the neuroimaging studies of PPPD to provide a reference for explaining the pathophysiological mechanism of PPPD.
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@#Objective To analyze the factors influencing the duration of residual dizziness （RD） after successful repositioning in patients with benign paroxysmal positional vertigo （BPPV） and the factors affecting the conversion from BPPV to persistent postural-perceptual dizziness（PPPD）. Methods A total of 575 patients with BPPV with successful repositioning at Shaanxi Provincial People's Hospital from January 2021 to 2022 were enrolled. Among them， 273 patients had RD， which lasted ≤1 week in 116 cases， 1 week to 3 months in 104 cases， and ≥3 months in 53 cases. Among the patients with RD ≥3 months， PPPD was negative in 32 cases and positive in 21 cases. The risk factors for RD converting into PPPD were analyzed. Results The incidence of RD in BPPV was 47.5%. Of the patients with RD，42.5% had a complete recovery within a week， but still 19.4% continued to experience RD for more than three months， which turned into PPPD. Anxiety-depressive state was an independent risk factor for BPPV converting into PPPD（OR=8.148，P=0.011）. Abnormal blood pressure was significantly association with the conversion of BPPV with RD into PPPD（P<0.05）. Conclusion For the conversion of BPPV with RD into PPPD， anxiety-depressive state was an independent risk factor， and abnormal blood pressure levels were an associated risk factor.
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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.
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Objective:To analyze the relation between DNA methylation in the CpG island of dopamine D2 receptor ( DRD2) gene promoter region and persistent postural-perceptual dizziness (PPPD), and explore the molecular mechanism of PPPD. Methods:The disease group consisted of 43 patients diagnosed as having PPPD in our hospital from January 2017 to June 2017, and blood samples were taken at admission. The control group included 45 with acute vestibular peripheral vertigo whose dizziness symptoms did not recrudesce after follow-up for more than 3 months and PPPD diagnosis was excluded in our hospital at the same period; these patients did not take selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs); blood samples in the patients were collected during follow-up. DNA methylation in the CpG island of DRD2 promoter region was detected by disulfite sequencing and the differences between the two groups were compared. Results:The positive rate of DNA methylation in the CpG island of DRD2 promoter region in the disease group was 58.1%, which was significantly higher than that in the control group (15.6%, P<0.05); and the methylation rate of CpG island loci in the disease group (0.15±0.18) was significantly higher than that in the control group (0.04±0.10, P<0.05). Conclusion:The DNA methylation in the CpG island of DRD2 promoter region is associated with onset of PPPD.
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Objective@#To investigate the characteristics of neuropsychological factors in patients with persistent postural-perceptual dizziness(PPPD) and provide the basis for the psychosomatic comprehensive treatment.@*Methods@#Cartel Personality Test (16PF), Symptom Checklist 90 (SCL-90), HAMA, HDMD, SAS and SDS were used to evaluate personality and mental state in patients with PPPD(PPPD group, n=65) and control group(n=63). Dizziness handicap inventory(DHI) was used to evaluate the degree of vertigo.The correlation analysis was carried out between the DHI scores and 16-PF, SCL-90 factor scores.@*Results@#(1)16PF factor scores: the factor scores of assertiveness(8.50±1.84), excitability (6.59±1.73), boldness (7.46±1.78), sensitivity (7.25±1.79), doubtfulness (6.55±1.74), fantasy(6.20±1.60), anxiety(7.67±1.61) and tension(6.81±1.67)in PPPD group were higher than those in the control group, and the differences were statistically significant (all P<0.05). The gregariousness (4.38±1.65), intelligence (4.51±1.67), stability (3.51±1.75), independence (4.39±1.56) and self-discipline (4.70±1.82) factor scores in PPPD group were lower than those in the control group, and the differences were statistically significant (all P<0.05). (2)SCL-90 factor scores: the factor scores of somatization(1.62±0.40), anxiety (1.64±0.56), interpersonal sensitivity (1.79±0.42), terrifying(1.71±0.53), total points(150.77±21.60), total average score (1.62±0.51) in PPPD group were higher than those in control group (all P<0.05). There were no differences in obsessive-compulsive (1.50±0.55), depression (1.45±0.44), hostility (1.69±0.60), paranoia (1.76±0.53), somatization (1.42±0.49) and psychotic (1.29±0.35) between PPPD group and the control group (all P>0.05). (3)The factor scores of HAMA(9.08±1.77) and SAS(37.88±2.96)in patients with PPPD were higher than that in the control group, and the differences were statistically significant (all P<0.05). There was no significant difference in HAMD (6.19±2.82) and SDS (36.36±4.71) scores between PPPD group and control group (all P>0.05). (4)The DHI scores were positively correlated with assertiveness, sensitivity, tension and doubtfulness factors of 16PF.The DHI scores were positively correlated with somatization, interpersonal sensitivity, anxiety and terrifying factors of SCL-90.@*Conclusion@#Patients with persistent postural-perceptual dizziness suffer from personality changes, mental disorders and anxiety disorder.
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Objective To investigate the characteristics of neuropsychological factors in patients with persistent postural-perceptual dizziness(PPPD) and provide the basis for the psychosomatic comprehen-sive treatment. Methods Cartel Personality Test (16PF),Symptom Checklist 90 ( SCL-90),HAMA,HD-MD,SAS and SDS were used to evaluate personality and mental state in patients with PPPD(PPPD group,n=65) and control group(n=63). Dizziness handicap inventory(DHI) was used to evaluate the degree of ver-tigo. The correlation analysis was carried out between the DHI scores and 16-PF,SCL-90 factor scores. Re-sults (1)16PF factor scores:the factor scores of assertiveness(8. 50±1. 84),excitability (6. 59±1. 73), boldness (7. 46±1. 78),sensitivity (7. 25±1. 79),doubtfulness (6. 55±1. 74),fantasy(6. 20±1. 60),anxie-ty(7. 67±1. 61) and tension(6. 81±1. 67) in PPPD group were higher than those in the control group,and the differences were statistically significant ( all P<0. 05). The gregariousness (4. 38± 1. 65), intelligence (4. 51±1. 67),stability (3. 51±1. 75),independence (4. 39±1. 56) and self-discipline (4. 70±1. 82) fac-tor scores in PPPD group were lower than those in the control group,and the differences were statistically sig-nificant (all P<0. 05). ( 2) SCL-90 factor scores:the factor scores of somatization ( 1. 62 ± 0. 40),anxiety (1. 64±0. 56),interpersonal sensitivity ( 1. 79 ± 0. 42),terrifying ( 1. 71 ± 0. 53),total points ( 150. 77 ± 21. 60),total average score (1. 62±0. 51) in PPPD group were higher than those in control group (all P< 0. 05). There were no differences in obsessive-compulsive (1. 50±0. 55),depression (1. 45±0. 44),hostility (1. 69±0. 60),paranoia (1. 76±0. 53),somatization (1. 42±0. 49) and psychotic ( 1. 29±0. 35) between PPPD group and the control group (all P>0. 05). ( 3) The factor scores of HAMA( 9. 08±1. 77) and SAS (37. 88±2. 96)in patients with PPPD were higher than that in the control group,and the differences were statistically significant (all P<0. 05). There was no significant difference in HAMD (6. 19±2. 82) and SDS (36. 36±4. 71) scores between PPPD group and control group (all P>0. 05). (4)The DHI scores were posi-tively correlated with assertiveness,sensitivity,tension and doubtfulness factors of 16PF. The DHI scores were positively correlated with somatization,interpersonal sensitivity,anxiety and terrifying factors of SCL-90. Con-clusion Patients with persistent postural-perceptual dizziness suffer from personality changes,mental disor-ders and anxiety disorder.
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Objective To analyze the association ofdopamine receptor D2 (DRD2) TaqIA gene polymorphism with persistent postural-perceptual dizziness (PPPD) and explore the molecular mechanism of this disease.Methods The study group consisted of 43 patients diagnosed as having PPPD was chosen in our hospital from January 2017 to June 2017;45 gender-and age-matched control subjects were selected randomly from acute vertigo patients who were fully recovered within 3 months without selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) medication and were normal at 6 months of follow up.Personality characteristics of the two groups were analyzed by adult Essen personality inventory.Frequencies of DRD2 TaqIA gene polymorphism were detected with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).Results Percentage of neurotic individuals in study group (67.4％) was significant higher than that of control subjects (37.8％,P＜0.05).Genotype distribution ofA1/A1,A1/A2,and A2/A2 showed significant difference between the two groups (P＜0.05).In the study group,A1 and A2 allele frequencies in the DRD2 TaqIA gene were 65.1％ and 34.9％ respectively,which had significantly difference as compared with those of control subjects (46.7％ and 53.3％,P＜0.05).Conclusion A 1 allele in DRD2 TaqIA gene may be the susceptibility gene for PPPD.
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Objective To explore the assessment methods of persistent postural-perceptual dizziness(PPPD).Methods A total of 39 patients with PPPD were enrolled as PPPD group,compare with 36 cases with unilateral sudden sensorineural hearing loss(SSHL) with vertigo.The clinic data,DHI/NEO-FFI/SSRC,auditory and vestibular function(bithermal caloric test,vestibular evoked myogenic potential)tests were collected for all the subjects and compared between groups.Results There were statistical differences between two groups in DHI/NEO-FFI/ SSRC (P＜0.05).13 cases of PPPD with mild or moderate sensorineural hearing loss,36 cases of SSHL with severe or extremely severe sensorineural hearing loss;double temperature test and VEMP normal derivation rates of PPPD were significantly higher than SSHL (P＜0.05).Conclusion Neurotic and introverted personality traits are found to be risk factors for PPPD.Patients with PPPD are prone to anxiety.PPPD has a great impact on the social activities and life quality of patients.