Reduced Risk of Benign Paroxysmal Positional Vertigo in Patients with Parkinson’s Disease: A Nationwide Korean Cohort Study

<b>Background/Objectives</b>: Parkinson's disease (PD) and benign paroxysmal positional vertigo (BPPV) are both prevalent in the geriatric population. While dizziness is a common non-motor symptom in PD, the relationship between PD and incident BPPV remains unclear. Limited data suggest potential shared mechanisms, including mitochondrial dysfunction and oxidative stress, but large-scale epidemiological evidence is lacking. This investigation focused on assessing the incidence of BPPV in patients with PD compared to matched controls using a nationwide cohort. <b>Methods</b>: Data from the Korean National Health Insurance Service-Health Screening Cohort were used to perform a retrospective cohort analysis. We identified 8232 newly diagnosed PD patients and matched them 1:4 with 32,928 controls based on age, sex, income, and residential region. Stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident BPPV. Subgroup and Kaplan-Meier analyses were also performed. <b>Results</b>: Over 220,151 person-years of follow-up revealed a lower incidence of BPPV in the PD group relative to the control group (4.98 vs. 5.95 per 1000 person-years); the corresponding adjusted HR was 0.77 (95% CI: 0.66-0.90; <i>p</i> = 0.001), indicating a 23% reduced risk. The inverse association remained consistent across most subgroups, including older adults and rural residents. Kaplan-Meier analysis further illustrated a significant decline in the cumulative incidence of BPPV in PD patients (<i>p</i> = 0.007). <b>Conclusions:</b> PD may contribute to a lower incidence of BPPV, which could be explained by reduced mobility, altered vestibular function, or diagnostic challenges. Clinicians should consider BPPV in PD patients presenting with dizziness.