Persistent postural-perceptual dizziness: subjective-objective dissociation and response to neurologist-led multimodal therapy

10/06/2026

AI Summary

High psychiatric comorbidity present in 88% of patients, most commonly combined anxiety and depression.
Characteristic subjective-objective dissociation: moderate to severe reported disability despite largely normal objective balance measures.
Structured neurologist-led multimodal therapy with explanation, vestibular rehabilitation, CBT and selective low-dose antidepressants led to significant 3-month improvement.

TL;DR (AI Generated)

This study evaluated clinical characteristics, psychiatric comorbidity, objective balance findings, and treatment response in patients with PPPD, with emphasis on neurologist-delivered diagnostic explanation within a multimodal treatment framework.

Despite moderate to severe subjective disability, objective balance measures were largely normal, demonstrating a characteristic subjective-objective dissociation.

Basic summary

J Neurol. 2026 Jun 10;273(7):386. doi: 10.1007/s00415-026-13927-6.

ABSTRACT

BACKGROUND AND OBJECTIVES: Persistent postural-perceptual dizziness (PPPD) is characterized by maladaptive central sensory processing and frequent psychiatric comorbidity. Prospective outcome data, particularly from low- and middle-income settings, remain limited. This study evaluated clinical characteristics, psychiatric comorbidity, objective balance findings, and treatment response in patients with PPPD, with emphasis on neurologist-delivered diagnostic explanation within a multimodal treatment framework.

METHODS: Seventy-five consecutive patients fulfilling Bárány Society criteria for PPPD were prospectively assessed using the Dizziness Handicap Inventory (DHI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Balance Rehabilitation Unit posturography. All patients received structured, neurologist-delivered diagnostic explanation and education. Treatment consisted of vestibular rehabilitation and cognitive behavioral therapy for all patients, with low-dose antidepressant therapy prescribed when PHQ-9 or GAD-7 scores were ≥ 5. Outcomes were reassessed at 3 months.

RESULTS: Psychiatric comorbidity was present in 88% of patients, most commonly combined anxiety and depression. Despite moderate to severe subjective disability, objective balance measures were largely normal, demonstrating a characteristic subjective-objective dissociation. Following treatment, median DHI scores improved from 40.4 to 8.0, PHQ-9 from 8.0 to 0.0, and GAD-7 from 8.0 to 0.0 (all p < 0.001).

CONCLUSIONS: PPPD is associated with high psychiatric comorbidity and marked subjective-objective dissociation yet shows substantial 3-month clinical improvement with a structured multimodal treatment approach. Structured diagnostic explanation and education may facilitate treatment engagement and recovery.

PMID:42268441 | DOI:10.1007/s00415-026-13927-6

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