Presbyvestibulopathy: Diagnostic criteria Consensus document of the classification committee of the Bárány Society

Abstract

This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and thresholds established for bilateral vestibulopathy. The diagnosis of PVP is based on the patient history, bedside examination and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with the video-HIT (vHIT); for the middle frequency range with rotary chair testing; and for the low frequency range with caloric testing. For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < 0.8 and > 0.6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25 • /s and > 6 • /s, and/or the horizontal angular VOR gain should be > 0.1 and < 0.3 upon sinusoidal stimulation on a rotatory chair. PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar and extrapyramidal function which also contribute and might even be required for the manifestation of the symptoms of unsteadiness, gait disturbance, and falls. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults.

Vestibular rehabilitation in Europe: a survey of clinical and research practice

“…Vestibular disorders are very frequent and problematic in older individuals [1]. Presbyvestibulopathy [27], recently defined by the Bárány Society as a chronic vestibular syndrome with mild bilateral vestibular deficits, is likely to be ameliorated with VR. It was encouraging to see that VR is emerging as a treatment within this setting.…”

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

“…Mixed results were found: A signi cant bene t of +9 points (p = < .05) on BBS, +4 points (p = < .05) in DGI and +27. 5 When comparing classical physiotherapy (described as "individually tailored and including exibility, strengthening, posture, breathing balance, walking exercises, and other functional activities") with additional sensorimotor integration training versus classical physiotherapy (n = 30 participants with Parkinson´s Disease Hoehn and Yahr stages 2-3, no primary outcome stated), mixed results were found in a RCT. Effects in favour of intervention were found in the 5 th position (+24.16, p = .027) and composite (+12.8, p = .042) of Computerized Dynamic Posturography -Sensory Organization Test (CDP-SOT) and…”

“…Furthermore, sensorimotor de cits due to aging and a signi cantly increasing incidence of neurodegenerative conditions such Parkinson´s disease starting at the age of > 60 years lead to less proprioceptive input and neuromuscular control and therefore promote imbalance [17,18]. The Bárány Society considered it necessary to attend to the phenomena of presbyvestibulopathy and developed diagnostic criteria for the manifestation of unsteadiness, gait disturbance, and falls [5].…”

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

“…Vertigo, dizziness and balance disorders (VDB) are the most relevant factors influencing the burden of disability among older adults [1] and are associated with immobility, limitations in activities of daily living (ADL) and decreased participation [2,3]. VDB are frequent complaints of older people [4][5][6][7] with a reported prevalence up to 50% [8,9], and the prevalence tends to increase with age [10].…”

“…Furthermore, somatosensory deficits because of conditions such as diabetic neuropathy lead to less proprioceptive input and promote imbalance [17]. The Bárány Society considered it necessary to attend to the phenomena of presbyvestibulopathy and developed diagnostic criteria for the manifestation of unsteadiness, gait disturbance, and falls [5].…”