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We acquired resting\u2010state functional MRI (rs\u2010fMRI) in 52 patients with PPPD and 50 age\u2010 and sex\u2010matched healthy controls (HCs) and analyzed the data using a three\u2010tier approach: (i) functional network connectivity (FNC) of independent component analysis (ICA\u2010FNC), (ii) voxel\u2010wise measures of spontaneous amplitude of low\u2010frequency fluctuations (ALFF) and fractional ALFF (fALFF), and (iii) seed\u2010based connectivity using a priori vestibular and subcortical regions of interest (ROIs; e.g., cerebellar (CB) nodulus, parafascicular thalamus, and caudate). Integrating these analytic tiers, we observed a coherent pattern: broadly increased connectivity of CB and primary visual (VIS) networks together with selective hypoconnectivity between a brainstem\u2013cerebellar (BSC) component and the multimodal vestibular cortex (MVC), oculomotor (frontal eye field [FEF]), and default\u2010mode networks (DMN). Voxel metrics revealed decreased ALFF in parietal and frontal opercular cortices\u2014key vestibular integration regions\u2014contrasting with increased fALFF in mid\u2010cingulate, lateral occipital, and premotor areas. Seed\u2010based mapping identified strengthened thalamo\u2010VIS, striato\u2010limbic, and nodulus\u2010hippocampal connectivity. Importantly, increased BSC\u2010to\u2010VIS coupling correlated positively with depressive symptom severity and state anxiety, but negatively with balance confidence and psychological resilience, linking network imbalance to the biopsychosocial phenotype of PPPD. These findings support a multiscale signature of vestibular cortical disengagement accompanied by maladaptive VIS\u2010CB reinforcement and motivate multicenter validation of network\u2010level markers as adjuncts to symptom\u2010based diagnosis.<\/jats:p>","DOI":"10.1155\/np\/9968808","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T07:04:32Z","timestamp":1775631872000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Vestibular\u2010Visual Reweighting in Persistent Postural\u2010Perceptual Dizziness: A Multilevel Resting\u2010State fMRI Study"],"prefix":"10.1155","volume":"2026","author":[{"given":"Jin-Ju","family":"Kang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongseon","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Yeon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohui","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3598-376X","authenticated-orcid":false,"given":"Jong-Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3174-1680","authenticated-orcid":false,"given":"Sun-Young","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.3233\/VES-170622"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2017-001809"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000417"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.6.1515"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e318151a4dd"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002010"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-329321"},{"key":"e_1_2_10_8_2","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1055\/s-0039-3402736","article-title":"Persistent Postural-Perceptual Dizziness","volume":"40","author":"Staab J. 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