Effect of peripheral and central vestibular dysfunction on sense of direction
Reviewed by Victor Osei-Lah

Sense of direction (SOD) is the ability to orientate ourselves and to determine the locus of objects in our environment. The vestibular system plays a key role in spatial orientation by encoding angular acceleration in the absence of visual cues but the role the vestibular system plays in SOD is not clear, hence this study. The primary aim was to assess the extent to which vestibular dysfunction impairs SOD ability. Secondary aims were to assess SOD ability between varying vestibular diagnoses, and to explore the interactions between symptomatic dizziness, psychological comorbidity and migraine factors with SOD ability. The authors recruited 87 adults with various vestibular disorders: 13 BPPV, 12 bilateral vestibular failure (BVF), 12 Ménière’s disease (MD), 20 vestibular migraine (VM), 30 persistent postural perceptual dizziness (PPPD) and 69 healthy controls. All participants completed questionnaires to evaluate dizziness disability, cognitive ability, psychological symptoms and sense of direction, namely, dizziness handicap inventory (DHI), visual vertigo analogue scale (VVS), HADS, Santa Barbara sense of direction scale (SBSOD), migraine screen (MSQ), spatial anxiety (SA) and objective perspective test (OPT). The key finding with respect to the primary aim was that SOD was affected by central (VM) and functional (PPPD) vestibular disorders, even though as a group patients fared worse than controls. SOD was not significantly different in patients with peripheral disorders compared to controls. The observation that patients with BVF do not show abnormal perceived sense of direction means normal peripheral function is not critical for SOD. Another finding was that spatial anxiety highly correlated with orientational abilities in patients and controls, in agreement with previous research that showed that heightened anxiety trait is associated with disruption of spatial working memory in healthy individuals and increased sensitivity of the vestibular system.

Sense of direction in vestibular disorders.
Moore AIG, Golding JF, Alenova A, et al.
J VESTIB RES
2024;34(2-3):113–23.