Spatial navigation entropy suggests allocentric dysfunction in PPPD

IntroductionPersistent postural-perceptual dizziness (PPPD) is a common chronic dizziness disorder with an unclear pathophysiology. It is hypothesized that PPPD may involve functional dysfunction of the construction of inner cognitive maps, leading to disrupted spatial cognition processes as a core...

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Main Authors: Felipe Faúndez, Camilo Arévalo-Romero, Karen Villarroel, Claudio Lavín, Kevin Alarcón, Gustavo Vial, Francisco Artus, Pablo Billeke, Paul H. Delano, Hayo A. Breinbauer
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Neurology
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Online Access:https://www.frontiersin.org/articles/10.3389/fneur.2025.1599307/full
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author Felipe Faúndez
Camilo Arévalo-Romero
Karen Villarroel
Claudio Lavín
Kevin Alarcón
Kevin Alarcón
Gustavo Vial
Francisco Artus
Pablo Billeke
Paul H. Delano
Paul H. Delano
Paul H. Delano
Hayo A. Breinbauer
Hayo A. Breinbauer
author_facet Felipe Faúndez
Camilo Arévalo-Romero
Karen Villarroel
Claudio Lavín
Kevin Alarcón
Kevin Alarcón
Gustavo Vial
Francisco Artus
Pablo Billeke
Paul H. Delano
Paul H. Delano
Paul H. Delano
Hayo A. Breinbauer
Hayo A. Breinbauer
author_sort Felipe Faúndez
collection DOAJ
description IntroductionPersistent postural-perceptual dizziness (PPPD) is a common chronic dizziness disorder with an unclear pathophysiology. It is hypothesized that PPPD may involve functional dysfunction of the construction of inner cognitive maps, leading to disrupted spatial cognition processes as a core feature. The present studies attempt to unravel the neural mechanisms that underlie spatial navigation in PPPD.MethodsFifty-two participants completed the study: 19 PPPD patients, 20 control subjects with vestibular disorders but without PPPD (with comparable peripheral vestibular function to the PPPD group, and 13 healthy volunteers). All underwent a virtual Morris Water Maze (vMWM) task in both, non-immersive (NI) and virtual reality (VR) modalities, assessing spatial navigation performance, gaze behavior, and head kinematics.ResultsPPPD patients exhibited significantly worse navigation performance than both control groups across all metrics, with greater impairments in predominantly allocentric tasks. They also showed increased exploratory gaze behavior, unaffected by NI vs. VR modality or task condition. Head kinematics did not significantly differ between the three groups, though a non-significant trend indicated reduced head movement in both PPPD and vestibular controls. VR intolerance was highest in PPPD patients, followed by vestibular controls, with healthy volunteers showing the lowest discomfort.DiscussionOur findings suggest that PPPD involves deficits in allocentric spatial navigation, likely due to predictive coding errors and impaired internal model updating, rather than sensory input dysfunction. Increased gaze scanning may reflect compensatory mechanisms for spatial uncertainty. Notably, VR immersion did not alter navigation performance, suggesting visuo-vestibular conflict is not the primary driver of PPPD-related spatial deficits. These findings offer new insights into PPPD as a disorder of spatial cognition, opening avenues for novel diagnostic and therapeutic approaches.
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spelling doaj-art-5aa327fa4d2c406e9bf26aaffe2fae062025-08-20T01:50:59ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-05-011610.3389/fneur.2025.15993071599307Spatial navigation entropy suggests allocentric dysfunction in PPPDFelipe Faúndez0Camilo Arévalo-Romero1Karen Villarroel2Claudio Lavín3Kevin Alarcón4Kevin Alarcón5Gustavo Vial6Francisco Artus7Pablo Billeke8Paul H. Delano9Paul H. Delano10Paul H. Delano11Hayo A. Breinbauer12Hayo A. Breinbauer13Laboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileDepartamento de Psicología, Universidad Autónoma de Chile, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileServicio de Otorrinolaringología Hospital Clínico San Borja Arriarán, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileLaboratorio de Neurociencia Social y Neuromodulación, Centro de Investigación en Complejidad Social (neuroCICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileCentro Avanzado de Ingeniería Eléctrica y Electrónica, AC3E, Universidad Técnica Federico Santa María, Valparaíso, ChileServicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, ChileLaboratory for Clinical Neuro-otology and Balance-Neuroscience, Department of Neuroscience, Facultad de Medicina, Universidad de Chile, Santiago, ChileDepartment of Otolaryngology, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, ChileIntroductionPersistent postural-perceptual dizziness (PPPD) is a common chronic dizziness disorder with an unclear pathophysiology. It is hypothesized that PPPD may involve functional dysfunction of the construction of inner cognitive maps, leading to disrupted spatial cognition processes as a core feature. The present studies attempt to unravel the neural mechanisms that underlie spatial navigation in PPPD.MethodsFifty-two participants completed the study: 19 PPPD patients, 20 control subjects with vestibular disorders but without PPPD (with comparable peripheral vestibular function to the PPPD group, and 13 healthy volunteers). All underwent a virtual Morris Water Maze (vMWM) task in both, non-immersive (NI) and virtual reality (VR) modalities, assessing spatial navigation performance, gaze behavior, and head kinematics.ResultsPPPD patients exhibited significantly worse navigation performance than both control groups across all metrics, with greater impairments in predominantly allocentric tasks. They also showed increased exploratory gaze behavior, unaffected by NI vs. VR modality or task condition. Head kinematics did not significantly differ between the three groups, though a non-significant trend indicated reduced head movement in both PPPD and vestibular controls. VR intolerance was highest in PPPD patients, followed by vestibular controls, with healthy volunteers showing the lowest discomfort.DiscussionOur findings suggest that PPPD involves deficits in allocentric spatial navigation, likely due to predictive coding errors and impaired internal model updating, rather than sensory input dysfunction. Increased gaze scanning may reflect compensatory mechanisms for spatial uncertainty. Notably, VR immersion did not alter navigation performance, suggesting visuo-vestibular conflict is not the primary driver of PPPD-related spatial deficits. These findings offer new insights into PPPD as a disorder of spatial cognition, opening avenues for novel diagnostic and therapeutic approaches.https://www.frontiersin.org/articles/10.3389/fneur.2025.1599307/fullpersistent postural perceptual dizzinessfunctional dizzinessspatial navigationspatial cognitionfunctional neurological disorderchronic dizziness
spellingShingle Felipe Faúndez
Camilo Arévalo-Romero
Karen Villarroel
Claudio Lavín
Kevin Alarcón
Kevin Alarcón
Gustavo Vial
Francisco Artus
Pablo Billeke
Paul H. Delano
Paul H. Delano
Paul H. Delano
Hayo A. Breinbauer
Hayo A. Breinbauer
Spatial navigation entropy suggests allocentric dysfunction in PPPD
Frontiers in Neurology
persistent postural perceptual dizziness
functional dizziness
spatial navigation
spatial cognition
functional neurological disorder
chronic dizziness
title Spatial navigation entropy suggests allocentric dysfunction in PPPD
title_full Spatial navigation entropy suggests allocentric dysfunction in PPPD
title_fullStr Spatial navigation entropy suggests allocentric dysfunction in PPPD
title_full_unstemmed Spatial navigation entropy suggests allocentric dysfunction in PPPD
title_short Spatial navigation entropy suggests allocentric dysfunction in PPPD
title_sort spatial navigation entropy suggests allocentric dysfunction in pppd
topic persistent postural perceptual dizziness
functional dizziness
spatial navigation
spatial cognition
functional neurological disorder
chronic dizziness
url https://www.frontiersin.org/articles/10.3389/fneur.2025.1599307/full
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