Comparative cognitive performance in benign paroxysmal positional vertigo and vestibular migraine

Benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM) represent two common clinical episodic vestibular syndrome (EVS). Nonetheless, the differences in cognitive function between the two disorders are not well understood. This study aims to compare cognitive performance between BPPV and VM patients and to evaluate whether anti-saccade parameters may serve as potential objective markers associated with cognitive performance differences in EVS. General cognitive function and domain-specific cognitive performance were assessed using the MMSE, MoCA, and RBANS scales in 55 VM and 53 BPPV patients. All patients subsequently underwent anti-saccade testing. Compared with BPPV, VM patients demonstrated significantly lower scores in general cognition (MoCA: 25.7 ± 2.2 vs. 27.0 ± 2.2, p < 0.01), immediate memory, language, attention, and delayed memory, as well as longer processing speed and executive function durations (all p < 0.01). Anti-saccade latency ( p < 0.05) and frequency of direction errors ( p < 0.01) were also significantly higher in the VM group. Partial correlation analysis revealed that anti-saccade latency and frequency of direction errors were significantly negatively correlated with cognitive function. Furthermore, ROC analysis suggested that anti-saccade error frequency showed potential discriminative ability for distinguishing cognitive performance differences between the two groups. VM patients demonstrated relatively lower cognitive performance compared with BPPV patients across multiple domains. Anti-saccade parameters, particularly direction error frequency, may serve as a preliminary objective marker associated with cognitive performance differences in EVS, warranting further validation in prospective studies.