Influence of BPPV and Meniere's Disease on cognitive abilities: A Questionnaire-Based Study

Abstract

The vestibular system comprises peripheral and central connections that travel from the inner ear to the midbrain and subsequently to the subcortical structures. Any structural abnormality could lead to problems related to cognition. Recent clinical reports suggest that vertigo patients also frequently complain of associated cognitive symptoms, including attention, memory, spatial perception, navigation, mental rotation and mental representation of three-dimensional space, which are not necessarily related to any particular episode of vertigo (Guidetti et al., 2020). Meniere's Disease (MD) and Benign paroxysmal positional vertigo (BPPV) are the two most common causes of vestibular vertigo (Neuhauser, 2016). Although there is an increasing research interest in vestibular disorders and cognition, the relationship between specific vestibular disorders and cognition has been less explored. Thus, the study aimed to find if there is any cognitive problem associated with patients diagnosed with BPPV and MD and find a relation between them. A non-experimental standard group comparison research design was employed. A total of 107 subjects participated in the survey, out of which, Group-I had 29 subjects (Mean age = 53.96 years) who were clinically normal, Group II had 38 (Mean age = 50.71 years) subjects diagnosed with BPPV and Group III had 40 (Mean age = 54.55 years) subjects diagnosed with Meniere’s disease. The study was conducted in an online/tele-mode, where a google form was sent to the subjects via email/WhatsApp. A total of 10 questions related to cognition, primarily selected from the Neurobehavioral Cognitive Status Examination (NCSE), were present, along with demographic details, which the participants had to fill. For each response, the score of 0 for "Yes," 1 for "Sometimes," and 2 for "No" were assigned for the analysis. The overall score for each subject for all the ten questions was calculated with a maximum score of 20 and a minimum of 0. Shapiro-Wilk's test was done, and the data was found to be non-normally distributed. Kruskal-Wallis H test was conducted, and it was found that there was a significant difference in scores between Group I and Group II (p<0.05) and Group I and Group III (p<0.05). Chi-square tests were done for the ten cognition-related questions with respect to the overall scores assigned. It revealed that responses were dependent on the groups, i.e., for Group I number of people with cognitive problems was less (i.e., the overall scores were less), for Group II, it was more (i.e., overall scores were more). Mann-Whitney U test was conducted to check if the associated problems like hypertension, diabetes and hearing loss significantly affected the responses within the groups, and it revealed no significant difference (p>0.05). From the current study, it can be inferred that there is a significant relationship between cognitive problems in participants who have BPPV and MD. However, no association between cognitive problems between BPPV and MD was found. This agrees with the findings reported in studies on the vestibular system's contribution to cognitive function, which suggests vestibular disorder may lead to spatial memory deficits, attention problems, dyscalculia and other cognition-related difficulties (Gurvich et al., 2013a). By establishing a relationship between cognition and vestibular disorder, we can provide a better holistic diagnosis and rehabilitation services to improve the patients quality of life.