Yagi Chihiro, Morita Yuka, Kitazawa Meiko, Yamagishi Tatsuya, Ohshima Shinsuke, Izumi Shuji, Takahashi Kuniyuki, Horii Arata
Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Front Neurol. 2021 Apr 16;12:652366. doi: 10.3389/fneur.2021.652366. eCollection 2021.
Persistent postural-perceptual dizziness (PPPD) is a persistent chronic vestibular syndrome exacerbated by upright posture/walking, active or passive motion, and exposure to moving or complex visual stimuli. PPPD has four precursors: phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness. These four diseases share clinical features that form the basis of the diagnostic criteria for PPPD. Semiological similarities do not necessarily mean that PPPD is a single entity. However, if PPPD is not a single disorder but just a composite of four precursors, it may be subdivided according to the characteristics of each precursor. To test whether PPPD is a single disorder, we attempted a subtyping of PPPD. One-hundred-eight untreated patients with PPPD were enrolled in the study, who filled out the Niigata PPPD Questionnaire (NPQ) that consists of 12 questions on exacerbating factors for PPPD. A factor analysis of the patients' answers to the NPQ and a subsequent cluster analysis of the patients with PPPD using factors revealed by the factor analysis were performed. To validate our cluster classification, cluster differences were assessed using analysis of variance. Multiple comparison analyses were performed on demographical data, precipitating diseases, the Dizziness Handicap Inventory, the Hospital Anxiety and Depression Scale, and several vestibular tests to characterize each cluster. Factor analysis revealed three underlying factors among the exacerbating factors in the NPQ. Exacerbation by visual stimuli (visual factor) accounted for 47.4% of total variance in the questionnaire. Exacerbation by walking/active motion (active-motion factor) and by passive motion/standing (passive-motion/standing factor) accounted for 12.0 and 7.67% of variance, respectively. Cluster analysis revealed three clusters: the visual-dominant subtype ( = 49); the active motion-dominant subtype ( = 20); and the mixed subtype ( = 39). The patients in the active motion-dominant subtype were significantly older than those in the visual-dominant subtype. There were no significant differences among the subtypes in other demographical data or conventional vestibular tests. The most common main exacerbating factor of PPPD was the visual factor. PPPD may be categorized into three subtypes. Conventional vestibular tests failed to point the characteristics of each subtype.
持续性姿势 - 感知性头晕（PPPD）是一种持续性慢性前庭综合征，直立姿势/行走、主动或被动运动以及暴露于移动或复杂视觉刺激会使其加重。PPPD有四个前驱疾病：恐惧性姿势性眩晕、空间 - 运动不适、视觉性眩晕和慢性主观性头晕。这四种疾病具有一些临床特征，这些特征构成了PPPD诊断标准的基础。症状学上的相似性并不一定意味着PPPD是一个单一的实体。然而，如果PPPD不是一种单一的疾病，而只是四种前驱疾病的组合，那么它可能会根据每种前驱疾病的特征进行细分。为了测试PPPD是否是一种单一的疾病，我们尝试对PPPD进行亚型分类。108名未经治疗的PPPD患者参与了这项研究，他们填写了新潟PPPD问卷（NPQ），该问卷由12个关于PPPD加重因素的问题组成。对患者对NPQ的回答进行因子分析，并对使用因子分析揭示的因子对PPPD患者进行后续聚类分析。为了验证我们的聚类分类，使用方差分析评估聚类差异。对人口统计学数据、诱发疾病、头晕残障量表、医院焦虑抑郁量表以及几项前庭测试进行多重比较分析，以描述每个聚类的特征。因子分析在NPQ的加重因素中揭示了三个潜在因子。视觉刺激加重（视觉因子）占问卷总方差的47.4%。行走/主动运动加重（主动运动因子）和被动运动/站立加重（被动运动/站立因子）分别占方差的12.0%和7.67%。聚类分析揭示了三个聚类：视觉主导亚型（n = 49）；主动运动主导亚型（n = 20）；和混合亚型（n = 39）。主动运动主导亚型的患者明显比视觉主导亚型的患者年龄大。在其他人口统计学数据或传统前庭测试中，各亚型之间没有显著差异。PPPD最常见的主要加重因素是视觉因子。PPPD可能可分为三种亚型。传统前庭测试未能指出每种亚型的特征。
