Risk of Alzheimer Disease and Vascular Dementia in Patients With Peripheral Vestibular Disorders: A Longitudinal Study of 140,726 Participants

Yun-Hsuan Lin, BS ; Mu-Hong Chen, MD, PhD ; Shun-Chieh Yu, MD ; Ya-Mei Bai, MD, PhD ; Tung-Ping Su, MD ; Tzeng-Ji Chen, MD, PhD ; Shih-Jen Tsai, MD

J Clin Psychiatry 2025;86(3):24m15699

Abstract

Objective: The associations between peripheral vestibular disorders (PVDs)—specifically Meniere’s disease, benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and unspecified PVD—and dementia risk are unclear.

Methods: By using data from the Taiwan National Health Insurance Research Database, this study included 70,363 patients aged ≥45 years with PVD between 1998 and 2011. An age-matched control group of 70,363 individuals without PVD was also established. All the included participants were followed up from the time of enrollment until the end of 2013 to assess the risk of dementia-related conditions, including Alzheimer’s disease (AD), vascular dementia, and unspecified dementia.

Results: Cox proportional hazards regression models, adjusted for demographic characteristics and psychiatric comorbidities, revealed that patients with PVD exhibited a significantly elevated risk of any form of dementia during the follow-up period (hazard ratio [HR] = 1.83, 95% CI, 1.69–1.97) compared with the control group. Notably, patients with BPPV exhibited the highest risk of AD (HR = 3.14, 95% CI, 2.35–4.19), followed by Meniere’s disease (HR= 2.79, 95% CI, 2.17–3.59) and vestibular neuritis (HR = 2.66, 95% CI, 2.11–3.35).

Conclusions: PVDs are a risk factor for dementia, regardless of psychiatric comorbidities. Further research is warranted to elucidate the pathophysiological mechanisms underlying the association between PVDs and dementia.

J Clin Psychiatry 2025;86(3):24m15699

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References (41)

Cronin T, Arshad Q, Seemungal BM. Vestibular deficits in neurodegenerative disorders: balance, dizziness, and spatial disorientation. Front Neurol. 2017;8:538. PubMed CrossRef
Neuhauser HK, Lempert T. Vertigo: epidemiologic aspects. Semin Neurol. 2009;29(5):473–481. PubMed CrossRef
Strupp M, Mandalà M, López-Escámez JA. Peripheral vestibular disorders: an update. Curr Opin Neurol. 2019;32(1):165–173. PubMed
Hülse R, Biesdorf A, Hörmann K, et al. Peripheral vestibular disorders: an epidemiologic survey in 70 million individuals. .Otol Neurotol. 2019;40(1):88–95.
Hung S-H, Xirasagar S, Dang LH, et al. Trends in the incidence of peripheral vestibular disorders: a nationwide population-based study. Front Neurol. 2023;14:1322199. PubMed CrossRef
Hung SH, Xirasagar S, Dang LH, et al. Trends in the incidence of peripheral vestibular disorders: a Nationwide population-based study. Front Neurol. 2023;14:1322199. PubMed CrossRef
Aedo-Sanchez C, Riquelme-Contreras P, Henríquez F, et al. Vestibular dysfunction and its association with cognitive impairment and dementia. Front Neurosci. 2024;18:1304810. PubMed CrossRef
Pan S, Hu Y, Zhang H, et al. The current status and trends of research related to vestibular disorders, vertigo, and cognitive impairment in the elderly population: a bibliometric analysis. Ear Nose Throat J. 2024:1455613241257396. PubMed CrossRef
Bosmans J, Gommeren H, Gilles A, et al. Evidence of vestibular and balance dysfunction in patients with mild cognitive impairment and Alzheimer’s disease. Ear Hear. 2024;45(1):53–61. PubMed CrossRef
Hebert LE, Scherr PA, Bienias JL, et al. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60(8):1119–1122. PubMed CrossRef
Obermann M, Gebauer A, Arweiler-Harbeck D, et al. Cognitive deficits in patients with peripheral vestibular dysfunction. Eur J Neurol. 2025;32(1):e15907. PubMed CrossRef
Li J, Xu X, Deng X, et al. Association of vestibular disorders and cognitive function: a systematic review. Laryngoscope. 2024;134(12):4858–4872. PubMed CrossRef
Bigelow RT, Semenov YR, du Lac S, et al. Vestibular vertigo and comorbid cognitive and psychiatric impairment: the 2008 National Health Interview Survey. J Neurol Neurosurg Psychiatry. 2016;87(4):367–372. PubMed CrossRef
Lim SJ, Son S, Chung Y, et al. Relationship between vestibular loss and the risk of dementia using the 2002-2019 National Insurance Service Survey in South Korea. Sci Rep. 2023;13(1):16746. PubMed CrossRef
Hitier M, Besnard S, Smith PF. Vestibular pathways involved in cognition. Front Integr Neurosci. 2014;8:59. PubMed CrossRef
Wei EX, Oh ES, Harun A, et al. Vestibular loss predicts poorer spatial cognition in patients with Alzheimer’s disease. J Alzheimers Dis. 2018;61(3):995–1003. PubMed CrossRef
Lee IH, Yu H, Ha SS, et al. Association between late-onset Ménière’s disease and the risk of incident all-cause dementia. J Pers Med. 2021;12(1):19. PubMed CrossRef
Lo MH, Lin CL, Chuang E, et al. Association of dementia in patients with benign paroxysmal positional vertigo. Acta Neurol Scand. 2017;135(2):197–203. PubMed CrossRef
Kim SY, Yoo DM, Min C, et al. Increased risk of neurodegenerative dementia after benign paroxysmal positional vertigo. Int J Environ Res Public Health. 2021;18(19):10553. PubMed CrossRef
Hung SH, Chang AH, Cheng YF, et al. Association of young-onset dementia with pre-existing peripheral vestibular disorders. J Alzheimers Dis. 2024;101(2):603–610. PubMed CrossRef
Chen MH, Hsu JW, Huang KL, et al. Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study. Psychol Med. 2019;49(14):2397–2404. PubMed CrossRef
Chen MH, Lan WH, Hsu JW, et al. Risk of developing type 2 diabetes in adolescents and young adults with autism spectrum disorder: a nationwide longitudinal study. Diabetes Care. 2016;39(5):788–793. PubMed CrossRef
Cheng CM, Chang WH, Chen MH, et al. Co-aggregation of major psychiatric disorders in individuals with first-degree relatives with schizophrenia: a nationwide population-based study. Mol Psychiatry. 2018;23(8):1756–1763. PubMed CrossRef
Zhang B, Wang HE, Bai YM, et al. Inflammatory bowel disease is associated with higher dementia risk: a nationwide longitudinal study. Gut. 2021;70(1):85–91. PubMed CrossRef
Hassing LB, Dahl AK, Thorvaldsson V, et al. Overweight in midlife and risk of dementia: a 40-year follow-up study. Int J Obes. 2009;33(8):893–898. PubMed CrossRef
Vuoksimaa E, Rinne JO, Lindgren N, et al. Middle age self-report risk score predicts cognitive functioning and dementia in 20-40 years. Alzheimers Dement (Amst). 2016;4:118–125. PubMed CrossRef
Yang T-H, Xirasagar S, Cheng Y-F, et al. Peripheral vestibular disorders: nationwide evidence from Taiwan. Laryngoscope. 2021;131(3):639–643. PubMed CrossRef
Liu C-Y, Hung Y-T, Chuang Y-L, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag. 2006;4:1–22.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. PubMed CrossRef
Bigelow RT, Agrawal Y. Vestibular involvement in cognition: visuospatial ability, attention, executive function, and memory. J Vestib Res. 2015;25(2):73–89. PubMed CrossRef
Xie D, Welgampola MS, Miller LA, et al. Subjective cognitive dysfunction in patients with dizziness and vertigo. Audiol Neurootol. 2022;27(2):122–132. PubMed CrossRef
Gacek RR. Pathology of benign paroxysmal positional vertigo revisited. Ann Otol Rhinol Laryngol. 2003;112(7):574–582. PubMed CrossRef
Yang WS, Kim SH, Lee JD, et al. Clinical significance of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo. Otol Neurotol. 2008;29(8):1162–1166. PubMed CrossRef
Lyness SA, Zarow C, Chui HC. Neuron loss in key cholinergic and aminergic nuclei in Alzheimer disease: a meta-analysis. Neurobiol Aging. 2003;24:1–23. PubMed CrossRef
Bhattacharyya R, Barman A, Antony F. Influence of BPPV and Meniere’s disease on cognitive abilities: a questionnaire-based study. J Otol. 2024;19(1):10–18. PubMed CrossRef
Rizk HG, Sharon JD, Lee JA, et al. Cross-sectional analysis of cognitive dysfunction in patients with vestibular disorders. Ear Hear. 2020;41(4):1020–1027. PubMed CrossRef
Lupien SJ, de Leon M, de Santi S, et al. Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nat Neurosci. 1998;1:69–73. PubMed CrossRef
Seo YJ, Kim J, Kim SH. The change of hippocampal volume and its relevance with inner ear function in Meniere’s disease patients. Auris Nasus Larynx. 2016;43(6):620–625. PubMed CrossRef
Van Cruijsen N, Hiemstra WM, Meiners LC, et al. Hippocampal volume measurement in patients with Ménière’s disease: a pilot study. Acta Otolaryngol. 2007;127(10):1018–1023. PubMed CrossRef
Guo J, Wang J, Liang P, et al. Vestibular dysfunction leads to cognitive impairments: state of knowledge in the field and clinical perspectives (Review). Int J Mol Med. 2024;53(4):36. PubMed CrossRef
Harun A, Oh ES, Bigelow RT, et al. Vestibular impairment in dementia. Otol Neurotol. 2016;37(8):1137–1142. PubMed CrossRef