Prevalence of Vestibular Disorder in Older People Who Experience Dizziness

Abstract

Dizziness and imbalance are clinically poorly defined terms, which affect ~30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51–92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1–2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s2 to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of ~25%. Our results indicate that htDVA, sinusoidal (particularly 0.5–1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction.

Idiopathic benign paroxysmal positional vertigo in the elderly: a long-term follow-up study

“…A previous population-based clinical study in the United Kingdom reported that 30% of people older than 65 years have dizziness or vertigo [16]. Many previous studies demonstrated that peripheral vestibular dysfunction is the most frequent cause of dizziness in the elderly, and BPPV constitutes one of the most common peripheral vestibular disorders [5,7,17,18]. BPPV can arise in various etiological factors, but idiopathic occurrence is the most frequent cause and the incidence is increasing with aging [8,19,20].…”

“…Several studies have demonstrated that older patients with BPPV have a more protracted course and higher risk of recurrence, but the causes of recurrence are not well understood [2,[4][5][6][7][8]. There are reports that aging contributes to the fragmentation of otoconia, as idiopathic BPPV (iBPPV) is more common in older adults than in younger individuals [8,12].…”

“…Although the underlying causes of dizziness in older people are multifactorial, benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheraltype vertigo in elderly people [5,[7][8][9][10]. BPPV is characterized by short-standing episodes of vertigo which triggered by a change in head position [10][11][12].…”

“…The prevalence of this condition in patients older than 65 years is around 30%, and due to an aging world population, the number of patients is rapidly increasing [5,6].…”

Associations between Age-Related Changes in the Core Vestibular Projection Pathway and Balance Ability: A Diffusion Tensor Imaging Study

“…Balance ability involves the visual, vestibular, and somatosensory systems [7]. Recently, studies on the relation between balance and the vestibular system have described age-related changes [12][13][14], and several studies suggested that age-associated reductions in vestibular function are caused by loss of neurons and vestibular hair cells in vestibular nuclei and diminished vestibuloocular reflex gain [13,15]. The structures that mediate these vestibular functions are considered important, and structures of the central vestibular form are considered to be especially important [16].…”