Brain fMRI study in elderly BPPV patients with comorbid anxiety and depression

A significant proportion of benign paroxysmal positional vertigo (BPPV) patients suffer from anxiety and depression, severely affecting their quality of life. Functional magnetic resonance imaging (fMRI), as a non-invasive technique, has been widely applied in exploring the pathophysiology of neuropsychiatric disorders. This study used fMRI-based Amplitude of low-frequency fluctuations (ALFF) analysis and seed-based functional connectivity (FC) mapping to investigate brain activity and connectivity changes in elderly BPPV patients, aiming to clarify functional brain alterations associated with anxiety and depression. Elderly BPPV patients with anxiety/depression (BPPV, n = 25) and age-matched healthy control subjects (HCs, n = 20) underwent resting-state fMRI scanning. The ALFF was calculated to observe the intrinsic brain activity across all brain voxels. Brain regions with altered ALFF were further selected as seeds for FC analysis. Correlation analysis was performed between ALFF/FC and clinical parameters in BPPV patients. Compared with HCs, BPPV patients exhibited significantly increased ALFF in the bilateral hippocampal regions and the left parahippocampal area. When the bilateral hippocampal regions and the left parahippocampal area were selected as seed regions, significantly decreased in FC were observed in the left cerebellar anterior lobe. In addition, the ALFF values in the bilateral hippocampal regions were positively correlated with the severity of anxiety, depression, and vertigo in BPPV patients. The ROC curves of the altered brain regions indicated great accuracy in distinguishing between BPPV patients and HCs. The hippocampal region, a critical area in regulating emotional and cognitive functions, exhibited increased neural activity and disrupted cerebellar connectivity, which may exacerbate anxiety and depression in elderly BPPV patients. This study provides preliminary insights into the potential neural mechanisms related to mood and cognitive dysfunctions in BPPV patients.