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*For medical professionals to read and help standardize the diagnosis and treatment of dizziness/vertigo 1 Definition of dizziness/vertigo in the elderly "Multidisciplinary Expert Consensus on Diagnosis and Treatment of Dizziness/Vertigo in the Elderly (2021)" Dizziness/vertigo in the elderly was defined as various vestibular symptoms in the elderly ≥60 years old, including dizziness, vertigo, vestibular-visual symptoms, and postural symptoms
.
2 Epidemiology The incidence of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo in the elderly was 36.
2%, 10.
0% and 14.
2%, respectively
.
At present, there is a lack of large-scale epidemiological data related to dizziness/vertigo in the elderly population
.
The epidemiological situation abroad is roughly as follows: 3 Pathophysiological characteristics of dizziness/vertigo in the elderly As the age increases, the vestibular sense, vision and proprioceptive systems of the elderly will age to varying degrees, and the compensatory ability exists to different degrees In addition, there are multiple drug use cases, and it is necessary to identify the possibility of adverse drug reactions
.
Therefore, the cause of dizziness/vertigo in the elderly is often the process of superimposing specific diseases in the normal aging physiological process.
The diagnosis and treatment of dizziness/vertigo in the elderly should focus on the combined effect of multiple factors
.
1.
Degeneration of vestibular system With the increase of age, the degeneration of otolith organs, degeneration of vestibular hair cells, decrease of peripheral vestibular afferent function and decrease of the number of vestibular nucleus cells lead to vestibular dysfunction
.
Vestibular dysfunction limits postural control, resulting in instability and postural symptoms
.
In addition, the calcium carbonate in the utricular cyst plaques in the elderly is easy to fall off, resulting in a high incidence of otolithiasis
.
2.
Degeneration of the visual system Due to the aging of the eye movement system, the saccade latency is prolonged, the eye tracking speed is slowed down, and the ability of visual accommodation and suppression of nystagmus through fixation is weakened
.
3.
Bone joint and muscle lesions In the bone joint and muscle system, the thresholds of vibration and touch and muscle strength also change with age
.
Peripheral neuropathy and osteoarthritis, which are common in older adults, are all causes of balance disorders
.
4.
Cardiovascular diseases increase.
Elderly people often use a combination of antihypertensive drugs and other drugs for reasons such as hypertension, myocardial ischemia or abnormal heart rhythm
.
At the same time, because vestibular autonomic reflexes decline with age, some abnormalities in blood pressure regulation, such as orthostatic hypotension, occur
.
According to statistics, 20% of the elderly over the age of 65 have orthostatic hypotension, 30% over the age of 75, and the incidence rate of the elderly in nursing homes can reach about 50%
.
5.
Decreased cognitive function White matter lesions and other causes can cause a decline in cognitive function (such as spatial memory), often with a decline in balance function and abnormal gait, accidents such as falls and even serious trauma, resulting in an increased risk of death for the elderly
.
6.
Mental and psychological disorders As the age increases, the incidence of anxiety and depression also gradually increases
.
Both anti-anxiety and sedative medications increase the incidence of dizziness and balance disturbances
.
At the same time, the elderly have different degrees of psychological phenomenon of fear of falling
.
7.
Other factors The decreased mineral density and 25-(OH) vitamin D level in the bones of middle-aged and elderly women may be the predisposing factors for the recurrence of BPPV
.
4 Common causes of dizziness/vertigo in the elderly Dizziness/vertigo is prevalent in the elderly population, but dizziness/vertigo is not an inevitable result of aging, but may originate from different single disease entities or joint effects, and the etiology may be vestibular system diseases, non- Vestibular disorders or comorbidities
.
Elderly people often have a variety of chronic diseases, such as vision and hearing impairment, balance disorders, abnormal gait, orthostatic hypotension, heart disease, cognitive impairment of varying degrees, anxiety and depression disorders, sleep disorders, and multiple medications that cause dizziness.
/Vertigo characteristics are different from young people
.
(1) Dizziness/vertigo caused by vestibular system diseases According to the type of attack, vestibular system dizziness/vertigo is divided into three types: first-episode acute persistent dizziness, recurrent episodes of dizziness/vertigo and chronic persistent dizziness
.
1.
For the elderly, with the increase of risk factors for cardiovascular and cerebrovascular diseases, the first acute persistent vertigo in the elderly should be the first to exclude stroke.
, first-episode Meniere's disease (MD), first-episode vestibular migraine (VM), demyelinating disease, and tumors are less common
.
2.
Recurrent dizziness/vertigo Common causes of recurrent dizziness/vertigo in the elderly include BPPV (primary or secondary), transient ischemic attack (TIA), and VM
.
Elderly BPPV patients often have abnormal walking instability and exercise intolerance, which complicates the diagnosis and differential diagnosis, and requires more patient consultation and careful physical examination
.
The elderly may be complicated by a variety of diseases, such as cervical and lumbar spondylosis, cognitive decline, cardiovascular and cerebrovascular diseases, etc.
, and attention should be paid to identifying potential risks during reduction and treatment
.
Although the position test of some elderly people turns negative after reduction treatment, they still have symptoms such as balance disorder, dizziness, dizziness, and even anxiety, which should be paid attention to and timely intervention
.
3.
Chronic persistent dizziness The causes of chronic persistent dizziness in the elderly include persistent postural-perceptual dizziness (PPPD), geriatric vestibulopathy and neurodegenerative diseases
.
Among them, neurodegenerative diseases such as PPPD, geriatric vestibulopathy and Parkinson's disease (PD) are common in the elderly
.
Geriatric vestibular disease and bilateral vestibular hypofunction are often overlooked
.
Vestibular disease in the elderly is a common cause of dizziness and gait instability in the elderly.
Its prominent symptoms are postural imbalance and gait instability, and the symptoms are aggravated when walking on dark environments and uneven ground; VOR) dysfunction with vibrophonia
.
Bilateral vestibular hypofunction is often associated with ototoxic drugs (eg, aminoglycosides) or with inner ear disease, polyneuropathy, and cerebellar disease
.
Neurodegenerative diseases include Parkinson's disease/syndrome, cerebellar ataxia, positive pressure hydrocephalus,
etc.
(2) Dizziness/vertigo caused by non-vestibular system dysfunction Non-vestibular system dysfunction also plays a role that cannot be ignored in causing dizziness and balance disorders in the elderly
.
Cardiovascular diseases such as arrhythmia, myocardial infarction, orthostatic hypotension, heart failure, etc.
, and some blood system diseases such as anemia can also cause dizziness and balance disorders
.
Mental disorders such as chronic anxiety and depression can also cause dizziness/vertigo and balance disorders in the elderly
.
Drugs such as anticholinergics, antihypertensives, antiepileptic drugs, anxiolytics, benzodiazepines, and drugs for the treatment of benign prostatic hyperplasia are widely used in the elderly.
Risk of falling
.
The sensory system, neuromuscular and skeletal joints and other structural functions of the elderly gradually decline, such as sensory loss, polyneuropathy, and decreased vision, which can lead to dizziness and gait instability
.
Compared with young adults, cervical spondylosis may also play a part in the etiology and mechanism of dizziness/vertigo in the elderly.
However, due to the lack of sufficient evidence on the relationship and formation mechanism of dizziness/vertigo and cervical spondylosis, the diagnosis still needs to be cautious
.
In conclusion, when analyzing the causes of dizziness/vertigo in the elderly, in addition to vestibular system diseases, mental disorders such as cardiovascular system, vision, musculoskeletal system diseases, proprioceptive and somatosensory loss or loss, anxiety and depression should also be considered.
A variety of adverse drug reactions and sleep apnea syndrome, etc.
, these factors may play different weights in the formation of dizziness/vertigo and balance disorders in the elderly
.
After learning the basic characteristics of dizziness/vertigo in the elderly in this issue, we will study the contents of diagnosis and treatment in the "Multidisciplinary Diagnosis and Treatment Consensus for Dizziness/Vertigo in the Elderly" together in the next issue
.
References: [1] Stroke and Vertigo Branch of Chinese Stroke Society, Vertigo Professional Committee of Neurology Branch of Chinese Medical Doctor Association, Ju Yi, et al.
Multidisciplinary Expert Consensus on Diagnosis and Treatment of Dizziness/Vertigo in the Elderly (2021) [J].
Chinese Geriatrics Journal, 2021, 40(10):13.
.
2 Epidemiology The incidence of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo in the elderly was 36.
2%, 10.
0% and 14.
2%, respectively
.
At present, there is a lack of large-scale epidemiological data related to dizziness/vertigo in the elderly population
.
The epidemiological situation abroad is roughly as follows: 3 Pathophysiological characteristics of dizziness/vertigo in the elderly As the age increases, the vestibular sense, vision and proprioceptive systems of the elderly will age to varying degrees, and the compensatory ability exists to different degrees In addition, there are multiple drug use cases, and it is necessary to identify the possibility of adverse drug reactions
.
Therefore, the cause of dizziness/vertigo in the elderly is often the process of superimposing specific diseases in the normal aging physiological process.
The diagnosis and treatment of dizziness/vertigo in the elderly should focus on the combined effect of multiple factors
.
1.
Degeneration of vestibular system With the increase of age, the degeneration of otolith organs, degeneration of vestibular hair cells, decrease of peripheral vestibular afferent function and decrease of the number of vestibular nucleus cells lead to vestibular dysfunction
.
Vestibular dysfunction limits postural control, resulting in instability and postural symptoms
.
In addition, the calcium carbonate in the utricular cyst plaques in the elderly is easy to fall off, resulting in a high incidence of otolithiasis
.
2.
Degeneration of the visual system Due to the aging of the eye movement system, the saccade latency is prolonged, the eye tracking speed is slowed down, and the ability of visual accommodation and suppression of nystagmus through fixation is weakened
.
3.
Bone joint and muscle lesions In the bone joint and muscle system, the thresholds of vibration and touch and muscle strength also change with age
.
Peripheral neuropathy and osteoarthritis, which are common in older adults, are all causes of balance disorders
.
4.
Cardiovascular diseases increase.
Elderly people often use a combination of antihypertensive drugs and other drugs for reasons such as hypertension, myocardial ischemia or abnormal heart rhythm
.
At the same time, because vestibular autonomic reflexes decline with age, some abnormalities in blood pressure regulation, such as orthostatic hypotension, occur
.
According to statistics, 20% of the elderly over the age of 65 have orthostatic hypotension, 30% over the age of 75, and the incidence rate of the elderly in nursing homes can reach about 50%
.
5.
Decreased cognitive function White matter lesions and other causes can cause a decline in cognitive function (such as spatial memory), often with a decline in balance function and abnormal gait, accidents such as falls and even serious trauma, resulting in an increased risk of death for the elderly
.
6.
Mental and psychological disorders As the age increases, the incidence of anxiety and depression also gradually increases
.
Both anti-anxiety and sedative medications increase the incidence of dizziness and balance disturbances
.
At the same time, the elderly have different degrees of psychological phenomenon of fear of falling
.
7.
Other factors The decreased mineral density and 25-(OH) vitamin D level in the bones of middle-aged and elderly women may be the predisposing factors for the recurrence of BPPV
.
4 Common causes of dizziness/vertigo in the elderly Dizziness/vertigo is prevalent in the elderly population, but dizziness/vertigo is not an inevitable result of aging, but may originate from different single disease entities or joint effects, and the etiology may be vestibular system diseases, non- Vestibular disorders or comorbidities
.
Elderly people often have a variety of chronic diseases, such as vision and hearing impairment, balance disorders, abnormal gait, orthostatic hypotension, heart disease, cognitive impairment of varying degrees, anxiety and depression disorders, sleep disorders, and multiple medications that cause dizziness.
/Vertigo characteristics are different from young people
.
(1) Dizziness/vertigo caused by vestibular system diseases According to the type of attack, vestibular system dizziness/vertigo is divided into three types: first-episode acute persistent dizziness, recurrent episodes of dizziness/vertigo and chronic persistent dizziness
.
1.
For the elderly, with the increase of risk factors for cardiovascular and cerebrovascular diseases, the first acute persistent vertigo in the elderly should be the first to exclude stroke.
, first-episode Meniere's disease (MD), first-episode vestibular migraine (VM), demyelinating disease, and tumors are less common
.
2.
Recurrent dizziness/vertigo Common causes of recurrent dizziness/vertigo in the elderly include BPPV (primary or secondary), transient ischemic attack (TIA), and VM
.
Elderly BPPV patients often have abnormal walking instability and exercise intolerance, which complicates the diagnosis and differential diagnosis, and requires more patient consultation and careful physical examination
.
The elderly may be complicated by a variety of diseases, such as cervical and lumbar spondylosis, cognitive decline, cardiovascular and cerebrovascular diseases, etc.
, and attention should be paid to identifying potential risks during reduction and treatment
.
Although the position test of some elderly people turns negative after reduction treatment, they still have symptoms such as balance disorder, dizziness, dizziness, and even anxiety, which should be paid attention to and timely intervention
.
3.
Chronic persistent dizziness The causes of chronic persistent dizziness in the elderly include persistent postural-perceptual dizziness (PPPD), geriatric vestibulopathy and neurodegenerative diseases
.
Among them, neurodegenerative diseases such as PPPD, geriatric vestibulopathy and Parkinson's disease (PD) are common in the elderly
.
Geriatric vestibular disease and bilateral vestibular hypofunction are often overlooked
.
Vestibular disease in the elderly is a common cause of dizziness and gait instability in the elderly.
Its prominent symptoms are postural imbalance and gait instability, and the symptoms are aggravated when walking on dark environments and uneven ground; VOR) dysfunction with vibrophonia
.
Bilateral vestibular hypofunction is often associated with ototoxic drugs (eg, aminoglycosides) or with inner ear disease, polyneuropathy, and cerebellar disease
.
Neurodegenerative diseases include Parkinson's disease/syndrome, cerebellar ataxia, positive pressure hydrocephalus,
etc.
(2) Dizziness/vertigo caused by non-vestibular system dysfunction Non-vestibular system dysfunction also plays a role that cannot be ignored in causing dizziness and balance disorders in the elderly
.
Cardiovascular diseases such as arrhythmia, myocardial infarction, orthostatic hypotension, heart failure, etc.
, and some blood system diseases such as anemia can also cause dizziness and balance disorders
.
Mental disorders such as chronic anxiety and depression can also cause dizziness/vertigo and balance disorders in the elderly
.
Drugs such as anticholinergics, antihypertensives, antiepileptic drugs, anxiolytics, benzodiazepines, and drugs for the treatment of benign prostatic hyperplasia are widely used in the elderly.
Risk of falling
.
The sensory system, neuromuscular and skeletal joints and other structural functions of the elderly gradually decline, such as sensory loss, polyneuropathy, and decreased vision, which can lead to dizziness and gait instability
.
Compared with young adults, cervical spondylosis may also play a part in the etiology and mechanism of dizziness/vertigo in the elderly.
However, due to the lack of sufficient evidence on the relationship and formation mechanism of dizziness/vertigo and cervical spondylosis, the diagnosis still needs to be cautious
.
In conclusion, when analyzing the causes of dizziness/vertigo in the elderly, in addition to vestibular system diseases, mental disorders such as cardiovascular system, vision, musculoskeletal system diseases, proprioceptive and somatosensory loss or loss, anxiety and depression should also be considered.
A variety of adverse drug reactions and sleep apnea syndrome, etc.
, these factors may play different weights in the formation of dizziness/vertigo and balance disorders in the elderly
.
After learning the basic characteristics of dizziness/vertigo in the elderly in this issue, we will study the contents of diagnosis and treatment in the "Multidisciplinary Diagnosis and Treatment Consensus for Dizziness/Vertigo in the Elderly" together in the next issue
.
References: [1] Stroke and Vertigo Branch of Chinese Stroke Society, Vertigo Professional Committee of Neurology Branch of Chinese Medical Doctor Association, Ju Yi, et al.
Multidisciplinary Expert Consensus on Diagnosis and Treatment of Dizziness/Vertigo in the Elderly (2021) [J].
Chinese Geriatrics Journal, 2021, 40(10):13.
