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It is becoming increasingly clear from a variety of clinical and laboratory approaches that the human vestibular system not only regulates autonomic activity but also influences higher level processes. To help understand the nature of these higher-level interactions, we investigated the prevalence of cognitive, psychiatric and fatigue disturbances in a sample of 100 patients with primary vestibular disorder. The nature of this relationship and the variables influencing it were also explored.A comprehensive neuropsychological assessment battery, including measures of depression, anxiety, depersonalization, fatigue, sleep, memory, attention and executive function was completed by patients at their initial neuro-otology appointment. Neurological questionnaires and balance function tests were also administered. Unexpectedly, nearly all patients showed evidence of clinical impairment on most tests. Symptoms of fatigue, anxiety and working memory impairment were especially prevalent in the sample (over 50% fell outside the normative cut-off). Age, visual dominance, and previous access of psychological support were all significant predictors of the presence of these comorbidities.These finding suggest that the vestibular system exerts a much wider influence on cognition and affect than previously indicated, and underlines the need for broader clinical diagnosis, assessment and management in patients who present with balance complaints.