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Essay 9: Critically evaluate the role of neural and cognitive factors in the development
of dizziness
Persistent Postural Perceptual Dizziness (PPPD) is a newly defined functional balance
disorder that unifies and reconciles three decades of research on previously described
psychosomatic balance disorders including phobic postural vertigo, space-motion discomfort,
visual-vertigo and chronic subjective dizziness. Clinically, patients with PPPD present with
two key fluctuating or continuous symptoms; a) a dizzy, not-truly-vertiginous sensation, with
patients reporting that their head is swimming and/or b) unsteadiness, such that patients report
swaying, rocking or jelly legs. Symptoms can be exacerbated in visually complex
environments, during upright posture and head movements. Typically, PPPD is triggered by
an acute disruption to normal balance function; however, the development of PPPD is not
attributable to the degree of balance-organ dysfunction or failed ear recovery. That is, recent
studies have illustrated that psychological and cognitive factors including anxiety, personality
traits and shifts in psycho-physical functioning (space-motion perceptual style and visual
dependence) seem to be strong predictive factors for determining which patients will develop
PPPD following the development of a balance disorder. Furthermore, such changes have
been linked to altered neural processing.
In this essay, critically evaluate the interplay between the psychological and cognitive risk
factors implicated in the development of chronic dizziness, and link these factors to alterations
in brain function and cognition.
Popkirov, S., Staab, J.P., & Stone, J. (2018). Persistent postural-perceptual dizziness (PPPD):
a common, characteristic and treatable cause of chronic dizziness. Practical
Neurology. 18(1):5-13. doi: 10.1136/practneurol-2017-001809.
Brandt, T. (1996). Phobic postural vertigo. Neurology, 46(6):1515-1519.
Dieterich, M., & Staab, J. P. (2017). Functional dizziness: from phobic postural vertigo and
chronic subjective dizziness to persistent postural-perceptual dizziness. Current
Opinion in Neurology, 30(1):107 doi 10.1097/WCO.0000000000000417.
Lopez, C., & Elzière, M. (2018). Out-of-body experience in vestibular disorders - A prospective
study of 210 patients with dizziness. Cortex, 104, 193-206. doi:
10.1016/j.cortex.2017.05.026.
Kolev, O. I., Georgieva-Zhostova, S. O., & Berthoz, A. (2014). Anxiety changes
depersonalization and derealization symptoms in vestibular patients.. Behavioral
Neurology, 2014,847054. doi: 10.1155/2014/847054.
Li, K., Si, L., Cui, B., Ling, X., Shen, B., & Yang, X. (2019). Altered spontaneous functional
activity of the right precuneus and cuneus in patients with persistent posturalperceptual dizziness. Brain Imaging Behavior, 16. doi: 10.1007/s11682-019-00168-7
Staab, J.P. (2019). Psychiatric considerations in the management of dizzy patients. Advances
in Otorhinolaryngology, 82, 170-179. doi: 10.1159/000490286. 

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