Cognitive Dysfunction in Patients with Common Peripheral Vestibular Disorders: A Comparative Study Using the Persian Version of the Neuropsychological Vertigo Inventory

Cognitive Dysfunction in Patients with Common Peripheral Vestibular Disorders: A Comparative Study Using the Persian Version of the Neuropsychological Vertigo Inventory | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cognitive Dysfunction in Patients with Common Peripheral Vestibular Disorders: A Comparative Study Using the Persian Version of the Neuropsychological Vertigo Inventory Zahra Abaeian, Homa Zarrinkoob, Mehraban Salaryfar, Ali Mohammadzadeh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6542170/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Purpose Cognitive impairments are increasingly acknowledged in individuals affected by vestibular disorders, particularly those with peripheral etiologies such as benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine. This study aimed to compare the extent cognitive dysfunction among patients with these three common peripheral vestibular conditions using the Persian version of the Neuropsychological Vertigo Inventory (P-NVI). Methods A total of 133 patients aged 25–80 years diagnosed with BPPV, Ménière’s disease, or vestibular migraine completed the Persian version of the NVI. The NVI assesses cognitive function across seven domains: spatial perception, temporal perception, attention, memory, emotions, vision, and movement. Descriptive statistics, one-way ANOVA, two-way ANOVA, and Tukey’s test were used for statistical analysis. Results Patients with vestibular migraine exhibited the highest mean P-NVI scores (M = 42.00), followed by Ménière’s disease (M = 27.82), and BPPV (M = 19.45). Significant differences were observed across disease groups in total and subscale P-NVI scores (p < 0.05). Age and gender interactions were also significant. Notably, patients with vestibular migraine demonstrated higher impairments in attention and visual processing. Conclusion The Persian version of the NVI(P-NVI ) appears to be a reliable tool for assessing cognitive dysfunction in vestibular patients. Vestibular migraine is associated with more severe cognitive deficits compared to BPPV and Ménière’s disease. These findings highlighted the clinical value of incorporating cognitive screening into vestibular evaluations to optimize diagnosis and management. Vestibular migraine Ménière’s disease Benign paroxysmal positional vertigo Neuropsychological Vertigo Inventory Cognitive dysfunction Introduction Maintaining postural equilibrium relies on the coordinated integration of sensory input from the visual, vestibular, and proprioceptive systems, integrated within the brainstem. Among individuals experiencing balance disturbances, peripheral vestibular dysfunction is one of the most frequently encountered causes [ 1 , 2 ]. Vestibular system impairment commonly presents with dizziness and vertigo, paticularly when the peripheral components are involved. Patients often describe 'dizziness' as a broad spectrum of sensations, including lightheadedness, imbalance, a floating or heavy-headed feeling, near-fainting episodes, or presyncopal states. In contrast, 'vertigo' specifically refers to a false sensation of motion either of the indivituals relative to the environment, or vice versa [ 3 ]. Among the various peripheral vestibular disorders, the most prevalent include benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine [ 4 ]. BPPV, recognized as the most frequent form of vertigo, is typically diagnosed based on brief episodes of rotational vertigo accompanied by nystagmus, triggered by sudden head movements [ 4 ]. The main symptom is sudden vertigo triggered by changes in head position, such as lying down, rolling over in bed, looking upward, or bending forward [ 5 ]. Ménière’s disease is believed to result from endolymphatic hydrops due to impaired absorption and obstructed endolymph flow. It presents with the constellation of symptoms including episodic vertigo, fluctuating hearing loss, aural fullness, and tinnitus [ 6 ]. Vestibular migraine is a common cause of positional vertigo associated with head movements, spontaneous vertigo accompanied by a sensation of self-motion or environmental motion, dizziness or vertigo triggered by head movements, and visually-induced vertigo caused by large or complex visual stimuli [ 7 ]. The severity and persistence of dizziness or vertigo can substantially affect daily life and physical stability. When these symptoms co-occur with degenerative changes,they may contribute to the development of cognitive deficits [ 8 ]. Recent studies have identified associations between vestibular function and several cognitive domains, including visuospatial skills, memory, attention, and executive functioning [ 9 ]. Consequently, patients with vestibular disorders frequently report cognitive difficulties—such as attention deficits, memory problems, and challenges with visuospatial perception—likely due to reduced cognitive resources needed for spatial orientation and balance [ 10 ]. The evaluation of vestibular dysfunction typically begins with a detailed patient history, and the use of targeted questionnaires can enhance the diagnostic process for identifying the underlying cause of dizziness or vertigo [ 11 ]. The Neuropsychological Vertigo Inventory (NVI), originally developed in French by Lacroix et al., was designed to assess the cognitive and emotional aspects associated with dizziness and vertigo. The NVI consistsof seven subscales evaluating spatial perception, temporal perception, attention, memory, emotions, vision, and movement.Early identification and proper management of these impairments are crucial in improving the quality of life of affected individuals. Using the NVI questionnaire alongside other vestibular assessment tools may improve detection of cognitive dysfunction, with significant implications for patients and their families [ 12 ]. This study was conducted to assess and compare the extent of cognitive dysfunction in patients with three common peripheral vestibular disorders (patients with benign paroxysmal positional vertigo, Ménière’s disease, and vestibular migraine) using the Persian version of the NVI(P-NVI) .Furthermore it aimed to provide baseline cognitive scores for Persian-speaking patients with vestibular disorders. Materials and Methods This cross-sectional study involved 133 patients between the ages of 25 to 80 who were diagnosed with one of the following peripheral vestibular disorders: benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine. This age range was selected based on its association with increased susceptibility to vestibular-related dizziness- older adults often presents with vestibular degeneration, while younger adults with certain disorders, such as vestibular migraine, may experience significant disruptions in daily and occupational functioning. Patients were recruited from the balance evaluation units at the Amir Alam Hospital in Tehran, Iran. The diagnosis was confirmed by a specialist otolaryngologist based on clinical criteria and diagnostic findings. Inclusion criteria included: (1) age between 25 and 80 years; (2) confirmed diagnosis of BPPV, Ménière’s disease, and vestibular migraine; (3) experience of vertigo or dizziness for at least two weeks; (4) absence of neurological disorders such as multiple sclerosis, Alzheimer’s disease, or dementia; (5) ability to walk independently and perform daily activities; (6) fluency in Persian; and (7) for patients aged 60–80 years, a Montreal Cognitive Assessment (MoCA) score of 26 or higher. Exclusion criteria included: (1) withdrawal from the study at any time; (2) onset of new medical conditions during the study that interfere with participation; and (3) failure to meet any of the eligibility requirements. Participants completed the Persian version of the Neuropsychological Vertigo Inventory (P-NVI), a self-report questionnaire consisting of 28 items rated on a 5-point Likert scale (0 = never, 4 = always). The P-NVI evaluates cognitive function across seven domains: spatial perception, temporal perception, attention, memory, emotions, vision, and movement. The total score ranges from 0 to 140, with higher scores indicating greater cognitive dysfunction.In addition to the P-NVI, patients aged 60–80 years were screened using the MoCA to exclude cognitive impairment unrelated to vestibular dysfunction. Statistical Analysis Statistical analysis was conducted using SPSS (version 17).A one-way analysis of variance (ANOVA) was used to compare total and subscale P-NVI scores among the three disease groups (benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine). A two-way ANOVA was employed to assess interaction effects between age, gender, and disease type. Tukey’s test was used for pairwise comparisons. Results A total of 133 patients diagnosed with benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine completed the P-NVI scale in this study. Descriptive results indicated that the majority of patients were female aged 41 to 60 years (48.9%). Most were married(79.7%), and homemakers (44.4%). Gender-based analysis showed that among patients with BPPV, females had higher mean P-NVI score (M = 20.33, SD = 10.86) compared to males (M = 17.41, SD = 6.66). Conversely, male patients with Ménière’s disease exhibited higher mean score (M = 34.75, SD = 12.98) than females counterparts (M = 25.60, SD = 12.10).Notably, all patients in the vestibular migraine group were female, with a mean score of 42.00 (SD = 14.67). A one-way ANOVA revealed a statistically significant difference in total P-NVI scores among the three vestibular disorder groups (F = 19.673, p < 0.05), with vestibular migraine patients exhibiting the highest cognitive impairment (M = 42.00), followed by Ménière’s disease (M = 27.82), and BPPV (M = 19.45). While gender alone did not significantly affect the total score (F = 1.492, p > 0.05), a significant interaction between gender and disease type was observed (F = 5.612, p = 0.020). Analysis across age groups (25–40, 41–60, 61–75 years) showed that in the youngest group, vestibular migraine patients reported the highest mean score (M = 45.88, SD = 16.42), followed by those with Ménière’s disease (M = 23.64, SD = 11.69) and BPPV (M = 16.50, SD = 9.90). Similarly, in the 41–60 group, vestibular migraine patients scored highest (M = 38.25, SD = 10.99), followed by Ménière’s disease (M = 27.75, SD = 12.58) and BPPV (M = 19.34, SD = 10.46). In the 61–75 group, Ménière’s disease patients had the highest scores (M = 35.67, SD = 13.82), followed by vestibular migraine (M = 31.33, SD = 2.51) and BPPV (M = 23.57, SD = 6.30). Two-way ANOVA indicated that while the main effect of age was not statistically significant (F = 0.140, p > 0.05), the main effect of disease type (F = 19.976, p < 0.05) and the interaction between disease type and age group (F = 2.632, p = 0.037) were significant. Tukey’s post hoc test indicated that patients with vestibular migraine had significantly higher total and subscale scores compared to those with Ménière’s disease and BPPV. Additionally, patients with Ménière’s disease had significantly higher scores than those with BPPV. Subscale analysis of the P-NVI revealed the following mean scores in each group: • BPPV: Spatial perception: 2.40, Temporal perception: 2.03, Attention: 3.26, Memory: 2.32, Emotions: 3.75, Vision: 3.11, Movement: 2.59. • Ménière’s disease: Spatial perception: 2.97, Temporal perception: 3.12, Attention: 4.55, Memory: 3.88, Emotions: 5.88, Vision: 3.88, Movement: 3.55. • Vestibular migraine: Spatial perception: 4.37, Temporal perception: 4.52, Attention: 7.15, Memory: 5.78, Emotions: 7.37, Vision: 7.78, Movement: 5.04. Discussion This study aimed to evaluate and compare various cognitive functions among adult patients with benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine using the Persian version of the Neuropsychological Vertigo Inventory (P-NVI) [ 13 ]. The vestibular system is critically involved in cognitive processing, including motion perception, spatial awareness, spatial memory, object recognition, and body orientation [ 14 ]. Disruptions in vestibular pathways can result in impairments across perceptual, sensory, motor, and behavioral domains [ 15 ]. Consistent with previous studies, our findings demonstrated that patients with vestibular migraine exhibited more pronounced cognitive dysfunction than those with BPPV or Ménière’s disease .For instance, Hans et al. found that patients with vestibular impairment, including idiopathic benign paroxysmal positional vertigo, endolymphatic hydrops, and perilymph fistula performed significantly worse in tasks requiring short-term and working memory compared to healthy controls. They also struggled more with tasks that required the integration of complex information and learning new content [ 16 , 17 ]. Similarly, Boz et al. assessed cognitive function in patients with Ménière’s disease and reported deficits in attention, verbal and visual memory, visuospatial skills, and executive functioning. These patients also demonstrated lower scores in areas such as recall, information processing speed,, strategic planningwhen compared with healthy individuals [ 18 ]. Donaldson and colleagues observed moderate cognitive impairment in patients with vestibular migraine, who scored an average of 47 on the Cognitive Failures Questionnaire (CFQ)prior to treatment-higher than those with BPPV. Their results indicated that cognitive improvement could be achieved through effective migraine management strategies [ 7 ]. The NVI, originally developed in French, provides a multidimensional measure of cognitive, physical, emotional challenges associated with vestibular disirders. In the present study, the Persian version of the NVI, demonstrated strong psychometric properties and effectively distinguished between cognitive impairments among patients with different vestibular diagnoses [ 12 ]. There was a significant difference in Neuropsychological Vertigo Inventory (NVI) scores among the three patient groups, those with benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine (F = 19.673, p < 0.05). Overall, the mean total NVI score was significantly higher in patients with vestibular migraine (42.00) compared to those with Ménière’s disease and BPPV. Likewise, the mean score in patients with Ménière’s disease (27.82) was significantly higher than in those with BPPV (19.45). Tukey’s test for pairwise comparisons showed that patients with vestibular migraine had a significantly higher mean total score than patients with Ménière’s disease and BPPV. Additionally, patients with Ménière’s disease scored significantly higher than those with BPPV. Interestingly, all patients in the vestibular migraine group were female, which may reflect the higher prevalence of migraine among women- potentially influenced by hormonal and psychosocial variables [ 19 ]. The findings of this study are consistent with those of Liu et al.,who used the NVI scale to assess 65 patients with vestibular disorders (benign paroxysmal positional vertigo, Ménière’s disease, and vestibular migraine), with a mean age range of 35 to 75 years. They reported mean NVI scores of 67.5 for vestibular migraine, 67.3 for Ménière’s disease, and 51.0 for BPPV, suggesting more severe cognitive impairment in the former two groups. According to their results vestibular migraine patients had higher deficits in attention and emotional functioning while those with Ménière’s disease performed more poorly in motor abilities, relative to patients with BPPV [ 20 ]. The type of vestibular disorders significantly influences responses. There was no significant difference in NVI scores between male and female patients (F = 1.492, p > 0.05). However, the interaction between gender and disease type was statistically significant (F = 5.612, p < 0.05). For instance ,female patients with BPPV had higher mean P-NVI scores(20.33) than males(17.41),whereas male patients with Ménière’s disease scored higher(34.75) than their female counterparts(25.60. The results of the Neuropsychological Vertigo Inventory (NVI) scores across different age ranges, analyzed using two-way ANOVA, were as follows: Patients with benign paroxysmal positional vertigo (BPPV) aged 25–40 years had a mean score of 16.50; those aged 41–60 had a mean score of 19.34; and those aged 61–75 had a mean score of 23.57. Patients with Ménière’s disease had mean scores of 23.64 (ages 25–40), 27.75 (ages 41–60), and 35.67 (ages 61–75). In patients with vestibular migraine, the mean NVI scores were 45.88 (ages 25–40), 38.25 (ages 41–60), and 31.33 (ages 61–75). These findings are supported by Bhattacharyya et al., who noted greater cognitive impairments in older adults with BPPV and Ménière’s disease, while younger individuals with vestibular migraine exhibited more dysfunction [ 21 ]. Lacroix et al. also found that younger individuals often experience a stronger impact from dizziness due to theit higher activity levels, leading them to limit their mobility and social engagement [ 12 ]. In the present study, the highest number of patients under the age of 40 were those with vestibular migraine, representing the largest subgroup among all participants across the three vestibular conditions (BPPV, Ménière’s disease, and vestibular migraine). Therefore, the present findings align with the studies by Lacroix et al. and Liu et al., which reported [ 12 ] that patients with vestibular migraine were significantly younger than those with BPPV, yet had higher NVI scores, indicating greater cognitive dysfunction. Overall, a significant difference in P-NVI scores was observed among the three patient groups (F = 19.976, p < 0.05). In our study, the emotional subscale scores were relatively high across all three groups: BPPV (3.75), Ménière’s disease (5.88), and vestibular migraine (7.37). This may reflect the high comorbidity of psychological symptoms in patients with vestibular disorders. The vestibular migraine group demonstrated the highest scores in the visual domain (7.78), suggesting that visuospatial processing is more profoundly affected in this population. This aligns with Ahmad et al., who emphasized the particular vulnerability of visuospatial cognition in vestibular dysfunction compared to other sensory-based cognitive processes. High scores on the attention subscale across all groups also mirrored findings by Xie et al., who documented attention-related deficits in patients with chronic dizziness or imbalance. Conclusion In conclusion, the Persian version of the Neuropsychological Vertigo Inventory (P-NVI) proved to be an effective tool for assessing cognitive dysfunction in patients with vestibular disorders. Our study revealed significant differences in cognitive function among patients with BPPV, Ménière’s disease, and vestibular migraine. Vestibular migraine patients exhibited the most severe cognitive impairments, particularly in attention, memory, and spatial perception. Age and gender also played important roles in determining the extent of cognitive dysfunction, with older adults and female patients showing more severe impairments in certain conditions. These findings underscore the importance of early diagnosis and appropriate intervention to address both the vestibular and cognitive impairments in patients with these conditions. Further studies should focus on exploring the underlying mechanisms linking vestibular dysfunction with cognitive deficits and developing targeted therapeutic strategies. Declarations Ethics Approval and Consent to Participate This study was approved by the Research Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1401.612). Written informed consent was obtained from all participants prior to enrollment in the study. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Mehraban Salaryfar and Ali Mohamad Zadeh contributed to the translation of the manuscript from Persian to English, as well as to writing and editing. Zahra Abaeian and Homa Zarrinkoob were responsible for data collection, statistical analysis, gathering the main content, and writing. References Corriveau H, Prince F, Hebert R, Raiche M, Tessier D, Maheux P, et al. 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Liu YF, Locklear TD, Sharon JD, Lacroix E, Nguyen SA, Rizk HGJO, et al. Quantification of cognitive dysfunction in dizzy patients using the neuropsychological vertigo inventory. 2019;40(7):e723-e31. Bhattacharyya R, Barman A, Antony FJJoO. Influence of BPPV and Meniere's disease on cognitive abilities: a questionnaire-based study. 2024;19(1):10-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6542170","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":483436214,"identity":"6445afa8-19f8-40fa-ba94-c8656d9cd815","order_by":0,"name":"Zahra Abaeian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYFACHjCZwMDA2MDAUAFkMjM3ENZyAK7lDEgLI9FagICxDUzi16Lb3nvs84cauzz+9ubGz4XzaqP524FaflRsw6nF7My55BkHjiUXS5w52Cw9c9vx3BmHGRsYe87cxq3lRo4xwwE25sSGG4kN0rzbjuU2ALUwM7bh0XL/DVDLv/rE+fcfNv/mnXMsdz5BLTd4jBkOth1O3HCDsU2at6EmdwNBLWeADjvbd7zY8EximzXPsQO5G4FaDuL1y/EzxgwV36rz5I4ff3ybp6Yud975wwcf/KjArQUdHAaTB4hWDwR1pCgeBaNgFIyCEQIAIEpjNf236pcAAAAASUVORK5CYII=","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Abaeian","suffix":""},{"id":483436215,"identity":"0eb2c8e9-bc42-4473-bb4c-3431a6025297","order_by":1,"name":"Homa Zarrinkoob","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Homa","middleName":"","lastName":"Zarrinkoob","suffix":""},{"id":483436216,"identity":"f67a0384-67bb-4c61-92f3-c167e631b44f","order_by":2,"name":"Mehraban Salaryfar","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mehraban","middleName":"","lastName":"Salaryfar","suffix":""},{"id":483436217,"identity":"a74129e7-7aae-4e73-ac63-0a716fef9c05","order_by":3,"name":"Ali Mohammadzadeh","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Mohammadzadeh","suffix":""}],"badges":[],"createdAt":"2025-04-27 19:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6542170/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6542170/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106210280,"identity":"faa62330-ec21-45b2-bb96-27772aaa32a2","added_by":"auto","created_at":"2026-04-06 06:56:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":554851,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6542170/v1/0d3bca8e-01c4-4a27-a782-e1cedc26d20e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cognitive Dysfunction in Patients with Common Peripheral Vestibular Disorders: A Comparative Study Using the Persian Version of the Neuropsychological Vertigo Inventory","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eMaintaining postural equilibrium relies on the coordinated integration of sensory input from the visual, vestibular, and proprioceptive systems, integrated within the brainstem. Among individuals experiencing balance disturbances, peripheral vestibular dysfunction is one of the most frequently encountered causes\u003c/em\u003e [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eVestibular system impairment commonly presents with dizziness and vertigo, paticularly when the peripheral components are involved.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePatients often describe 'dizziness' as a broad spectrum of sensations, including lightheadedness, imbalance, a floating or heavy-headed feeling, near-fainting episodes, or presyncopal states. In contrast, 'vertigo' specifically refers to a false sensation of motion either of the indivituals relative to the environment, or vice versa\u003c/em\u003e [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eAmong the various peripheral vestibular disorders, the most prevalent include benign paroxysmal positional vertigo (BPPV), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine\u003c/em\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cem\u003eBPPV, recognized as the most frequent form of vertigo, is typically diagnosed based on brief episodes of rotational vertigo accompanied by nystagmus, triggered by sudden head movements\u003c/em\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cem\u003eThe main symptom is sudden vertigo triggered by changes in head position, such as lying down, rolling over in bed, looking upward, or bending forward\u003c/em\u003e [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. \u003cem\u003eM\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease is believed to result from endolymphatic hydrops due to impaired absorption and obstructed endolymph flow. It presents with the constellation of symptoms including episodic vertigo, fluctuating hearing loss, aural fullness, and tinnitus\u003c/em\u003e [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. \u003cem\u003eVestibular migraine is a common cause of positional vertigo associated with head movements, spontaneous vertigo accompanied by a sensation of self-motion or environmental motion, dizziness or vertigo triggered by head movements, and visually-induced vertigo caused by large or complex visual stimuli\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe severity and persistence of dizziness or vertigo can substantially affect daily life and physical stability. When these symptoms co-occur with degenerative changes,they may contribute to the development of cognitive deficits\u003c/em\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. \u003cem\u003eRecent studies have identified associations between vestibular function and several cognitive domains, including visuospatial skills, memory, attention, and executive functioning\u003c/em\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. \u003cem\u003eConsequently, patients with vestibular disorders frequently report cognitive difficulties\u0026mdash;such as attention deficits, memory problems, and challenges with visuospatial perception\u0026mdash;likely due to reduced cognitive resources needed for spatial orientation and balance\u003c/em\u003e [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. \u003cem\u003eThe evaluation of vestibular dysfunction typically begins with a detailed patient history, and the use of targeted questionnaires can enhance the diagnostic process for identifying the underlying cause of dizziness or vertigo\u003c/em\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe Neuropsychological Vertigo Inventory (NVI), originally developed in French by Lacroix et al., was designed to assess the cognitive and emotional aspects associated with dizziness and vertigo. The NVI consistsof seven subscales evaluating spatial perception, temporal perception, attention, memory, emotions, vision, and movement.Early identification and proper management of these impairments are crucial in improving the quality of life of affected individuals. Using the NVI questionnaire alongside other vestibular assessment tools may improve detection of cognitive dysfunction, with significant implications for patients and their families\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThis study was conducted to assess and compare the extent of cognitive dysfunction in patients with three common peripheral vestibular disorders (patients with benign paroxysmal positional vertigo, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine) using the Persian version of the NVI(P-NVI) .Furthermore it aimed to provide baseline cognitive scores for Persian-speaking patients with vestibular disorders.\u003c/em\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cem\u003eThis cross-sectional study involved 133 patients between the ages of 25 to 80 who were diagnosed with one of the following peripheral vestibular disorders: benign paroxysmal positional vertigo (BPPV), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine. This age range was selected based on its association with increased susceptibility to vestibular-related dizziness- older adults often presents with vestibular degeneration, while younger adults with certain disorders, such as vestibular migraine, may experience significant disruptions in daily and occupational functioning.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePatients were recruited from the balance evaluation units at the Amir Alam Hospital in Tehran, Iran. The diagnosis was confirmed by a specialist otolaryngologist based on clinical criteria and diagnostic findings.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eInclusion criteria included: (1) age between 25 and 80 years; (2) confirmed diagnosis of BPPV, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine; (3) experience of vertigo or dizziness for at least two weeks; (4) absence of neurological disorders such as multiple sclerosis, Alzheimer\u0026rsquo;s disease, or dementia; (5) ability to walk independently and perform daily activities; (6) fluency in Persian; and (7) for patients aged 60\u0026ndash;80 years, a Montreal Cognitive Assessment (MoCA) score of 26 or higher. Exclusion criteria included: (1) withdrawal from the study at any time; (2) onset of new medical conditions during the study that interfere with participation; and (3) failure to meet any of the eligibility requirements. Participants completed the Persian version of the Neuropsychological Vertigo Inventory (P-NVI), a self-report questionnaire consisting of 28 items rated on a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;never, 4\u0026thinsp;=\u0026thinsp;always). The P-NVI evaluates cognitive function across seven domains: spatial perception, temporal perception, attention, memory, emotions, vision, and movement. The total score ranges from 0 to 140, with higher scores indicating greater cognitive dysfunction.In addition to the P-NVI, patients aged 60\u0026ndash;80 years were screened using the MoCA to exclude cognitive impairment unrelated to vestibular dysfunction.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003e\u003cb\u003eStatistical analysis was conducted using SPSS (version 17).A one-way analysis of variance (ANOVA) was used to compare total and subscale P-NVI scores among the three disease groups (benign paroxysmal positional vertigo (BPPV), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine). A two-way ANOVA was employed to assess interaction effects between age, gender, and disease type. Tukey\u0026rsquo;s test was used for pairwise comparisons.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eA total of 133 patients diagnosed with benign paroxysmal positional vertigo (BPPV), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine completed the P-NVI scale in this study. Descriptive results indicated that the majority of patients were female aged 41 to 60 years (48.9%). Most were married(79.7%), and homemakers (44.4%).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGender-based analysis showed that \u0026nbsp; among patients with BPPV, females had higher mean P-NVI score (M = 20.33, SD = 10.86) compared to \u0026nbsp;males (M = 17.41, SD = 6.66). Conversely, male patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease exhibited \u0026nbsp;higher mean score (M = 34.75, SD = 12.98) than females counterparts (M = 25.60, SD = 12.10).Notably, all patients in the vestibular migraine group were female, with a mean score of 42.00 (SD = 14.67).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eA one-way ANOVA revealed a statistically significant difference in total P-NVI scores among the three vestibular disorder groups (F = 19.673, p \u0026lt; 0.05), with vestibular migraine patients exhibiting the highest cognitive impairment (M = 42.00), followed by M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease (M = 27.82), and BPPV (M = 19.45). While \u0026nbsp;gender alone did not significantly affect the total score (F = 1.492, p \u0026gt; 0.05), a significant interaction between gender and disease type was observed (F = 5.612, p = 0.020).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalysis across age groups (25\u0026ndash;40, 41\u0026ndash;60, 61\u0026ndash;75 years) showed that in the youngest group, vestibular migraine patients reported the highest mean score (M = 45.88, SD = 16.42), followed by those with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease (M = 23.64, SD = 11.69) and BPPV (M = 16.50, SD = 9.90). Similarly, in the 41\u0026ndash;60 group, vestibular migraine patients scored highest (M = 38.25, SD = 10.99), followed by M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease (M = 27.75, SD = 12.58) and BPPV (M = 19.34, SD = 10.46). In the 61\u0026ndash;75 group, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease patients had the highest scores (M = 35.67, SD = 13.82), followed by vestibular migraine (M = 31.33, SD = 2.51) and BPPV (M = 23.57, SD = 6.30).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTwo-way ANOVA indicated that while the main effect of age was not statistically significant (F = 0.140, p \u0026gt; 0.05), the main effect of disease type (F = 19.976, p \u0026lt; 0.05) and the interaction between disease type and age group (F = 2.632, p = 0.037) were significant.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTukey\u0026rsquo;s post hoc test indicated that patients with vestibular migraine had significantly higher total and subscale scores compared to those with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease and BPPV. Additionally, patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease had significantly higher scores than those with BPPV.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSubscale analysis of the P-NVI revealed the following mean scores in each group:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026bull; \u0026nbsp; \u0026nbsp;BPPV: Spatial perception: 2.40, Temporal perception: 2.03, Attention: 3.26, Memory: 2.32, Emotions: 3.75, Vision: 3.11, Movement: 2.59.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026bull; \u0026nbsp; \u0026nbsp;M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease: Spatial perception: 2.97, Temporal perception: 3.12, Attention: 4.55, Memory: 3.88, Emotions: 5.88, Vision: 3.88, Movement: 3.55.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026bull; \u0026nbsp; \u0026nbsp;Vestibular migraine: Spatial perception: 4.37, Temporal perception: 4.52, Attention: 7.15, Memory: 5.78, Emotions: 7.37, Vision: 7.78, Movement: 5.04.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eThis study aimed to evaluate and compare various cognitive functions among adult patients with benign paroxysmal positional vertigo (BPPV), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine using the Persian version of the Neuropsychological Vertigo Inventory (P-NVI)\u003c/em\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. \u003cem\u003eThe vestibular system is critically involved in cognitive processing, including motion perception, spatial awareness, spatial memory, object recognition, and body orientation\u003c/em\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. \u003cem\u003eDisruptions in vestibular pathways can result in impairments across perceptual, sensory, motor, and behavioral domains\u003c/em\u003e [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eConsistent with previous studies, our findings demonstrated that patients with vestibular migraine exhibited more pronounced cognitive dysfunction than those with BPPV or M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease .For instance, Hans et al. found that patients with vestibular impairment, including idiopathic benign paroxysmal positional vertigo, endolymphatic hydrops, and perilymph fistula performed significantly worse in tasks requiring short-term and working memory compared to healthy controls. They also struggled more with tasks that required the integration of complex information and learning new content\u003c/em\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eSimilarly, Boz et al. assessed cognitive function in patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease and reported deficits in attention, verbal and visual memory, visuospatial skills, and executive functioning. These patients also demonstrated lower scores in areas such as recall, information processing speed,, strategic planningwhen compared with healthy individuals\u003c/em\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eDonaldson and colleagues observed moderate cognitive impairment in patients with vestibular migraine, who scored an average of 47 on the Cognitive Failures Questionnaire (CFQ)prior to treatment-higher than those with BPPV. Their results indicated that cognitive improvement could be achieved through effective migraine management strategies\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe NVI, originally developed in French, provides a multidimensional measure of cognitive, physical, emotional challenges associated with vestibular disirders. In the present study, the Persian version of the NVI, demonstrated strong psychometric properties and effectively distinguished between cognitive impairments among patients with different vestibular diagnoses\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThere was a significant difference in Neuropsychological Vertigo Inventory (NVI) scores among the three patient groups, those with benign paroxysmal positional vertigo (BPPV), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine (F\u0026thinsp;=\u0026thinsp;19.673, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Overall, the mean total NVI score was significantly higher in patients with vestibular migraine (42.00) compared to those with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease and BPPV. Likewise, the mean score in patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease (27.82) was significantly higher than in those with BPPV (19.45). Tukey\u0026rsquo;s test for pairwise comparisons showed that patients with vestibular migraine had a significantly higher mean total score than patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease and BPPV. Additionally, patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease scored significantly higher than those with BPPV. Interestingly, all patients in the vestibular migraine group were female, which may reflect the higher prevalence of migraine among women- potentially influenced by hormonal and psychosocial variables\u003c/em\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe findings of this study are consistent with those of Liu et al.,who used the NVI scale to assess 65 patients with vestibular disorders (benign paroxysmal positional vertigo, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine), with a mean age range of 35 to 75 years. They reported mean NVI scores of 67.5 for vestibular migraine, 67.3 for M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and 51.0 for BPPV, suggesting more severe cognitive impairment in the former two groups. According to their results vestibular migraine patients had higher deficits in attention and emotional functioning while those with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease performed more poorly in motor abilities, relative to patients with BPPV\u003c/em\u003e [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe type of vestibular disorders significantly influences responses. There was no significant difference in NVI scores between male and female patients (F\u0026thinsp;=\u0026thinsp;1.492, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the interaction between gender and disease type was statistically significant (F\u0026thinsp;=\u0026thinsp;5.612, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For instance ,female patients with BPPV had higher mean P-NVI scores(20.33) than males(17.41),whereas male patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease scored higher(34.75) than their female counterparts(25.60.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe results of the Neuropsychological Vertigo Inventory (NVI) scores across different age ranges, analyzed using two-way ANOVA, were as follows: Patients with benign paroxysmal positional vertigo (BPPV) aged 25\u0026ndash;40 years had a mean score of 16.50; those aged 41\u0026ndash;60 had a mean score of 19.34; and those aged 61\u0026ndash;75 had a mean score of 23.57. Patients with M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease had mean scores of 23.64 (ages 25\u0026ndash;40), 27.75 (ages 41\u0026ndash;60), and 35.67 (ages 61\u0026ndash;75). In patients with vestibular migraine, the mean NVI scores were 45.88 (ages 25\u0026ndash;40), 38.25 (ages 41\u0026ndash;60), and 31.33 (ages 61\u0026ndash;75). These findings are supported by Bhattacharyya et al., who noted greater cognitive impairments in older adults with BPPV and M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, while younger individuals with vestibular migraine exhibited more dysfunction\u003c/em\u003e [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. \u003cem\u003eLacroix et al. also found that younger individuals often experience a stronger impact from dizziness due to theit higher activity levels, leading them to limit their mobility and social engagement\u003c/em\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eIn the present study, the highest number of patients under the age of 40 were those with vestibular migraine, representing the largest subgroup among all participants across the three vestibular conditions (BPPV, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine). Therefore, the present findings align with the studies by Lacroix et al. and Liu et al., which reported\u003c/em\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] \u003cem\u003ethat patients with vestibular migraine were significantly younger than those with BPPV, yet had higher NVI scores, indicating greater cognitive dysfunction. Overall, a significant difference in P-NVI scores was observed among the three patient groups (F\u0026thinsp;=\u0026thinsp;19.976, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eIn our study, the emotional subscale scores were relatively high across all three groups: BPPV (3.75), M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease (5.88), and vestibular migraine (7.37). This may reflect the high comorbidity of psychological symptoms in patients with vestibular disorders. The vestibular migraine group demonstrated the highest scores in the visual domain (7.78), suggesting that visuospatial processing is more profoundly affected in this population. This aligns with Ahmad et al., who emphasized the particular vulnerability of visuospatial cognition in vestibular dysfunction compared to other sensory-based cognitive processes. High scores on the attention subscale across all groups also mirrored findings by Xie et al., who documented attention-related deficits in patients with chronic dizziness or imbalance.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cem\u003eIn conclusion, the Persian version of the Neuropsychological Vertigo Inventory (P-NVI) proved to be an effective tool for assessing cognitive dysfunction in patients with vestibular disorders. Our study revealed significant differences in cognitive function among patients with BPPV, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, and vestibular migraine. Vestibular migraine patients exhibited the most severe cognitive impairments, particularly in attention, memory, and spatial perception. Age and gender also played important roles in determining the extent of cognitive dysfunction, with older adults and female patients showing more severe impairments in certain conditions. These findings underscore the importance of early diagnosis and appropriate intervention to address both the vestibular and cognitive impairments in patients with these conditions. Further studies should focus on exploring the underlying mechanisms linking vestibular dysfunction with cognitive deficits and developing targeted therapeutic strategies.\u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;This study was approved by the Research Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1401.612). Written informed consent was obtained from all participants prior to enrollment in the study.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eMehraban Salaryfar and Ali Mohamad Zadeh contributed to the translation of the manuscript from Persian to English, as well as to writing and editing. Zahra Abaeian and Homa Zarrinkoob were responsible for data collection, statistical analysis, gathering the main content, and writing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCorriveau H, Prince F, Hebert R, Raiche M, Tessier D, Maheux P, et al. 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Meniere\u0026apos;s disease: overview, epidemiology, and natural history. 2002;35(3):455-95.\u003c/li\u003e\n\u003cli\u003eDonaldson LB, Yan F, Liu YF, Nguyen SA, Rizk HGJAJoO. Does cognitive dysfunction correlate with dizziness severity in patients with vestibular migraine? 2021;42(6):103124.\u003c/li\u003e\n\u003cli\u003eLee H-W, Lim Y-H, Kim S-HJJoVR. Dizziness in patients with cognitive impairment. 2020;30(1):17-23.\u003c/li\u003e\n\u003cli\u003eBigelow RT, Agrawal YJJovr. Vestibular involvement in cognition: Visuospatial ability, attention, executive function, and memory. 2015;25(2):73-89.\u003c/li\u003e\n\u003cli\u003eNa S, Im JJ, Jeong H, Lee E-S, Lee T-K, Chung Y-A, et al. Altered regional cerebral blood perfusion in mild cognitive impairment patients with dizziness. 2020;10(10):777.\u003c/li\u003e\n\u003cli\u003eNewman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh Y-H, Zee DS, editors. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clinic Proceedings; 2007: Elsevier.\u003c/li\u003e\n\u003cli\u003eLacroix E, Deggouj N, Salvaggio S, Wiener V, Debue M, Edwards MGJEAoO-R-L. The development of a new questionnaire for cognitive complaints in vertigo: the Neuropsychological Vertigo Inventory (NVI). 2016;273:4241-9.\u003c/li\u003e\n\u003cli\u003eAbaeian Z, Zarrinkoob H, Rezazadeh N, Baghban AAJA, Research V. The Translation and Psychometric Evaluation of the Persian Version of the Neuropsychological Vertigo Inventory. 2024.\u003c/li\u003e\n\u003cli\u003eHitier M, Besnard S, Smith PFJFiin. Vestibular pathways involved in cognition. 2014;8:59.\u003c/li\u003e\n\u003cli\u003eBrandt T, Strupp M, Dieterich MJFiin. Towards a concept of disorders of \u0026ldquo;higher vestibular function\u0026rdquo;. 2014;8:47.\u003c/li\u003e\n\u003cli\u003eHanes DA, McCollum GJJovr. Cognitive-vestibular interactions: a review of patient difficulties and possible mechanisms. 2006;16(3):75-91.\u003c/li\u003e\n\u003cli\u003eBrookes GB, Gresty MA, Nakamura T, Metcalfe TJO, Neurotology. Sensing and controlling rotational orientation in normal subjects and patients with loss of labyrinthine function. 1993;14(4):349-51.\u003c/li\u003e\n\u003cli\u003eEraslan Boz H, Kırkım G, Ko\u0026ccedil;oğlu K, \u0026Ccedil;akır \u0026Ccedil;etin A, Akkoyun M, G\u0026uuml;neri EA, et al. Cognitive function in Meniere\u0026rsquo;s disease. 2023;28(4):1076-86.\u003c/li\u003e\n\u003cli\u003eVetvik KG, MacGregor EAJTLN. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. 2017;16(1):76-87.\u003c/li\u003e\n\u003cli\u003eLiu YF, Locklear TD, Sharon JD, Lacroix E, Nguyen SA, Rizk HGJO, et al. Quantification of cognitive dysfunction in dizzy patients using the neuropsychological vertigo inventory. 2019;40(7):e723-e31.\u003c/li\u003e\n\u003cli\u003eBhattacharyya R, Barman A, Antony FJJoO. Influence of BPPV and Meniere\u0026apos;s disease on cognitive abilities: a questionnaire-based study. 2024;19(1):10-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vestibular migraine, Ménière’s disease, Benign paroxysmal positional vertigo, Neuropsychological Vertigo Inventory, Cognitive dysfunction","lastPublishedDoi":"10.21203/rs.3.rs-6542170/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6542170/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Purpose \u003c/strong\u003e\u003cem\u003eCognitive impairments are increasingly acknowledged in individuals affected by vestibular disorders, particularly those with peripheral etiologies such as benign paroxysmal positional vertigo (BPPV), Ménière’s disease, and vestibular migraine. This study aimed to compare the extent cognitive dysfunction among patients with these three common peripheral vestibular conditions using the Persian version of the Neuropsychological Vertigo Inventory (P-NVI).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e \u003cem\u003eA total of 133 patients aged 25–80 years diagnosed with BPPV, Ménière’s disease, or vestibular migraine completed the Persian version of the NVI. The NVI assesses cognitive function across seven domains: spatial perception, temporal perception, attention, memory, emotions, vision, and movement. Descriptive statistics, one-way ANOVA, two-way ANOVA, and Tukey’s test were used for statistical analysis.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e \u003cem\u003ePatients with vestibular migraine exhibited the highest mean P-NVI scores (M = 42.00), followed by Ménière’s disease (M = 27.82), and BPPV (M = 19.45). Significant differences were observed across disease groups in total and subscale P-NVI scores (p \u0026lt; 0.05). Age and gender interactions were also significant. Notably, patients with vestibular migraine demonstrated higher impairments in attention and visual processing.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e \u003cem\u003eThe Persian version of the NVI(P-NVI ) appears to be a reliable tool for assessing cognitive dysfunction in vestibular patients. Vestibular migraine is associated with more severe cognitive deficits compared to BPPV and Ménière’s disease. These findings highlighted the clinical value \u0026nbsp;of incorporating cognitive screening into vestibular evaluations to optimize \u0026nbsp;diagnosis and management.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Cognitive Dysfunction in Patients with Common Peripheral Vestibular Disorders: A Comparative Study Using the Persian Version of the Neuropsychological Vertigo Inventory","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 12:48:26","doi":"10.21203/rs.3.rs-6542170/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a2d1a680-4188-4cb6-be40-da965ff2f454","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T06:56:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-14 12:48:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6542170","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6542170","identity":"rs-6542170","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}