Associations Between Cognitive Performance, Depression, Anxiety, and Stress in Patients With Chronic Vestibular Dysfunction: A Cross-Sectional Analysis

TL;DR

This study explores how cognitive performance and mental health are linked to vestibular function in patients with chronic balance issues.

Contribution

It identifies a significant correlation between cognitive function and right ocular VEMP amplitude in chronic vestibular dysfunction.

Findings

A statistically significant medium correlation was found between cognitive function (MoCA) and right ocular VEMP amplitude.

No significant correlations were found between vestibular potentials and depression, anxiety, or stress scores.

The study provides preliminary insights into the neurophysiological links between balance, cognition, and emotion.

Abstract

Background: The vestibular system is critical for sensorimotor function, balance control, and gaze stability. Recent research highlights its role in cognitive functions, including attention, memory, and visuospatial skills. The integration of this system is lateralized in the brain. These disorders represent a substantial burden on healthcare systems, and a negative impact on quality of life.

Objectives: Previous research has shown that increased cognitive load can alter vestibular evoked myogenic potentials (VEMPs), suggesting that vestibular function is influenced by cognitive demands. Therefore, this study aims to (1) examine the relationship between cognitive performance, as measured by the Montreal Cognitive Assessment (MoCA), and baseline vestibular function through cervical and ocular VEMPs (cVEMPs and oVEMPs), to determine whether vestibular dysfunction is associated with cognitive decline; (2) assess the association between depression, anxiety, and stress measured by the Depression, Anxiety, and Stress Scale (DASS-21) subscales, and VEMP parameters; and (3) explore the overall interaction between cognitive and affective domains in chronic vestibular dysfunction, providing insight into the neurophysiological links between balance, cognition, and emotion.

Methodology: Patient data was retrieved from the Otoneurology Service database at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, covering the period from January 2017 to December 2019. This study was conducted from 2022 to 2025. Data included: self-reported scores from the DASS-21 and results from the MoCA test. For data analysis, descriptive statistics, bivariate frequency tables, and the Shapiro-Wilks test, were used to characterize the variables. Spearman's correlation coefficients were then used to evaluate the relationship between MoCA scores, the scores from the DASS-21 scales (depression, anxiety, and stress), cVEMP, and oVEMP values, using a P value < 0.05 for statistical significance. Linear regression was subsequently performed to further analyze any relationships found to be statistically significant.

Results: In this study of 29 subjects, a demographic analysis revealed a slight female predominance, with 18 subjects (62.1%) female and 11 subjects (37.9%) male. The mean age was 49 years. The most prevalent diagnosis was right vestibular dysfunction, which affected 17 subjects (58.6%), with dizziness being the most common accompanying symptom, also reported by 17 subjects (58.6%). A subsequent Spearman correlation analysis revealed a positive and statistically significant (P=0.04), though medium, correlation between cognitive function (as measured by the MoCA) and the amplitude of the right ocular VEMP. This finding was further supported by a linear regression analysis, which also showed a statistically significant relationship between the variables (P=0.03).

Conclusions: A positive and statistically significant medium correlation was found, using both Spearman's correlation coefficient and linear regression, between cognitive function and amplitude of vestibular response in the right oVEMP. Conversely, this study found no significant correlation between vestibular evoked myogenic potentials, cervical or ocular, and the variables for the DASS-21. Though further research needs to be done to definitively determine the relationship between the vestibular system, cognition, and cognitive states, this study provides valuable preliminary insights.

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