Introduction: Dizziness is one of the most common symptoms in elderly patients. In this study, we investigated changes in white matter fiber bundles in elderly patients with chronic dizziness using Automated Fiber Quantification (AFQ) to explore correlations with clinical manifestations and to provide novel insights for diagnosis. Methods: This prospective study consecutively enrolled patients aged ≥60 years with varying degrees of white matter hyperintensities (WMH) on cranial MRI from May 2023 to October 2024. Participants were divided into a dizziness group and a non-dizziness group. Clinical data were collected for both cohorts. WMH severity and distribution were graded using the Fazekas scale, while AFQ tracked 18 cerebral white matter tracts. Between-group differences in fractional anisotropy (FA) and mean diffusivity (MD) were analyzed using independent samples t-tests. Results: A total of 42 elderly patients were enrolled, including 24 in the dizziness group (mean age: 65.71 ± 5.46 years; 12 males, 50.0%) and 18 in the non-dizziness group (mean age: 65.56 ± 4.49 years; 7 males, 38.9%). Multivariate logistic regression revealed a significant association between deep white matter hyperintensities (DWMH) and chronic unexplained dizziness (OR = 8.285, 95% CI = 1.355–50.636, p = 0.022). AFQ demonstrated significantly reduced FA in the dizziness group within the left corticospinal tract, the greater occipital fasciculus, the left inferior fronto- occipital fasciculus, and the left arcuate fasciculus (p < 0.01). Conversely, MD was elevated in the left corticospinal tract, the large callosal clamp, the left and right inferior fronto-occipital fasciculi, the left superior longitudinal fasciculus, and the right arcuate fasciculus (p < 0.01). Discussion: Our findings highlight that DWMH are closely linked to chronic dizziness in the elderly, and AFQ enables precise localization of microstructural damage in specific white matter tracts. These neuroimaging findings provide novel insights into the pathological mechanisms underlying chronic dizziness and offer potential imaging markers for clinical diagnosis. However, the cross-sectional design and single-center sample limit the generalization of the results, emphasizing the need for further multicenter longitudinal studies. Conclusion: DWMH correlates with chronic dizziness in elderly patients. AFQ can identify the degree and location of white matter microstructural damage, providing new insights for clinical diagnosis and treatment.
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