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Deutsches Arzteblatt International Jun 2015Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected... (Review)
Review
BACKGROUND
Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected persons, the factors leading to dizziness and gait impairment in old age are never identified, yet some of these factors can be specifically detected and treated.
METHODS
This review is based on publications (2005-2014) retrieved by a selective search in PubMed on the terms "aging," "dizziness," "elderly," "gait," "gait disorder," "geriatric," "locomotion," and "vertigo."
RESULTS
Dizziness interferes with the everyday activities of 30% of persons over age 70 and is so severe that it constitutes a reason for consulting a physician. The more common causes of dizziness and unsteady gait in old age are sensory deficits, such as bilateral vestibular failure, polyneuropathy, and impaired visual acuity; benign paroxysmal positioning vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and fear of falling. Many elderly persons have multiple factors at the same time. Benign paroxysmal positioning vertigo can be effectively treated with specific physical maneuvers. Sedating drugs are indicated only for the treatment of acute rotatory vertigo and are not suitable for long-term use. Sarcopenia can be treated with physical training.
CONCLUSION
If a specific cause can be identified, dizziness and gait unsteadiness in old age can often be successfully treated. The common causes can be revealed by systematic clinical examination. Controlled clinical trials on the efficacy of treatments for elderly persons are urgently needed.
Topics: Aged; Aged, 80 and over; Brain Diseases; Dizziness; Evidence-Based Medicine; Female; Gait Disorders, Neurologic; Geriatric Assessment; Humans; Male; Physical Therapy Modalities; Sensation Disorders; Treatment Outcome
PubMed: 26157011
DOI: 10.3238/arztebl.2015.0387 -
Journal of the Association For Research... Dec 2023
Topics: Humans; Dizziness; Vertigo
PubMed: 38117401
DOI: 10.1007/s10162-023-00921-2 -
South African Family Practice :... Apr 2023Dizziness is an extremely common, yet complex neurological symptom that reflects a disturbance of normal balance perception and spatial orientation. Dizziness is a...
Dizziness is an extremely common, yet complex neurological symptom that reflects a disturbance of normal balance perception and spatial orientation. Dizziness is a non-specific, catch-all term commonly used by patients to describe a wide array of symptoms, including a sensation of motion, weakness, light-headedness, unsteadiness, emotional upset and depression. The national 1-year prevalence of dizziness is around 50%, accounting for 4% of emergency department presentations and 1% of primary care consultations in South Africa. This article will focus on a diagnostic approach to the most common cause of dizziness (vertigo).
Topics: Humans; Dizziness; Vertigo; Space Perception; Orientation, Spatial; Primary Health Care
PubMed: 37132567
DOI: 10.4102/safp.v65i1.5712 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2021With the aging of population structure, the age-related balance dysfunction increases gradually, and the injuries related fall are increasing, which cause a serious... (Review)
Review
With the aging of population structure, the age-related balance dysfunction increases gradually, and the injuries related fall are increasing, which cause a serious social and economic burden. In addition, dizziness or vertigo is very common clinically, and these patients also have a higher risk of falling. In order to reduce the incidence of falls, targeted prevention measures are urgently needed. In this paper, the risk assessment, preventive measures and rehabilitation strategies of falls are systematically expounded, it is hoped that it will be helpful for the prevention and treatment of falls.
Topics: Accidental Falls; Aging; Dizziness; Humans; Postural Balance; Vertigo
PubMed: 33540989
DOI: 10.13201/j.issn.2096-7993.2021.02.004 -
NeuroImage. Clinical 2023Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal,...
INTRODUCTION
Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal, or palpitation as well as neurological symptoms like vertigo, stance and gait disorders. Furthermore, previous studies have shown a bidirectional link between vestibulo-spatial and anxiety neural networks. So far, there have been no neuroimaging-studies comparing these groups.
OBJECTIVES
The aim of this explorative study was to investigate differences and similarities of neural correlates between these two patient groups and to compare their findings with a healthy control group.
METHODS
63 participants, divided in two patient groups (ANX = 20 and PPPD = 14) and two sex and age matched healthy control groups (HC-A = 16, HC-P = 13) were included. Anxiety and dizziness related pictures were shown during fMRI-measurements in a block-design in order to induce emotional responses. All subjects filled in questionnaires regarding vertigo (VSS, VHQ), anxiety (STAI), depression (BDI-II), alexithymia (TAS), and illness-perception (IPQ). After modelling the BOLD response with a standard canonical HRF, voxel-wise t-tests between conditions (emotional-negative vs neutral stimuli) were used to generate statistical contrast maps and identify relevant brain areas (pFDR < 0.05, cluster size >30 voxels). ROI-analyses were performed for amygdala, cingulate gyrus, hippocampus, inferior frontal gyrus, insula, supramarginal gyrus and thalamus (p ≤ 0.05).
RESULTS
Patient groups differed from both HC groups regarding anxiety, dizziness, depression and alexithymia scores; ratings of the PPPD group and the ANX group did differ significantly only in the VSS subscale 'vertigo and related symptoms' (VSS-VER). The PPPD group showed increased neural responses in the vestibulo-spatial network, especially in the supramarginal gyrus (SMG), and superior temporal gyrus (STG), compared to ANX and HC-P group. The PPPD group showed increased neural responses compared to the HC-P group in the anxiety network including amygdala, insula, lentiform gyrus, hippocampus, inferior frontal gyrus (IFG) and brainstem. Neuronal responses were enhanced in visual structures, e.g. fusiform gyrus, middle occipital gyrus, and in the medial orbitofrontal cortex (mOFC) in healthy controls compared to patients with ANX and PPPD, and in the ANX group compared to the PPPD group.
CONCLUSIONS
These findings indicate that neuronal responses to emotional information in the PPPD and the ANX group are comparable in anxiety networks but not in vestibulo-spatial networks. Patients with PPPD revealed a stronger neuronal response especially in SMG and STG compared to the ANX and the HC group. These results might suggest higher sensitivity and poorer adaptation processes in the PPPD group to anxiety and dizziness related pictures. Stronger activation in visual processing areas in HC subjects might be due to less emotional and more visual processing strategies.
Topics: Humans; Dizziness; Vertigo; Brain; Anxiety Disorders; Cerebral Cortex; Anxiety
PubMed: 36696807
DOI: 10.1016/j.nicl.2023.103330 -
Nigerian Journal of Clinical Practice Sep 2023Patients with benign paroxysmal positional vertigo (BPPV) may experience significant deterioration in their quality of life due to dizziness and anxiety symptoms.
BACKGROUND
Patients with benign paroxysmal positional vertigo (BPPV) may experience significant deterioration in their quality of life due to dizziness and anxiety symptoms.
AIM
To evaluate the effect of betahistine add-on therapy on dizziness and anxiety symptoms of BPPV patients.
MATERIALS AND METHODS
Eighty-four patients who were diagnosed as having posterior canal BPPV were included in the study. Patients were divided into two groups according to the treatment regimen: Group 1 included 42 subjects who were treated with the Epley maneuver alone and Group 2 included 42 subjects who received betahistine 48 mg/day for ten days with the Epley maneuver. Dizziness handicap inventory (DHI) and Beck anxiety inventory (BAI) were evaluated at the time of diagnosis and at the control examination on the tenth day.
RESULTS
The mean before and after treatment DHI scores were 38.8 ± 14.6 and 5.47 ± 6.4 for Group 1 (P < 0.001), and 45.8 ± 21.1 and 10.3 ± 12.9 for Group 2 (P < 0.001). The mean before and after treatment BAI scores were 11.8 ± 6 and 1.33 ± 1.8 for Group 1 (P < 0.001), and 13.6 ± 8.3 and 2.9 ± 3.8 for Group 2 (P < 0.001). There was no significant difference between the before and after treatment DHI and BAI score differences of the two groups (P = 0.27, P = 0.43).
CONCLUSION
Canalith repositioning maneuvers (CRMs) should be the main treatment modality in the management of BPPV patients and adding on betahistine treatment to CRMs have no impact in the relieving of dizziness and anxiety symptoms.
Topics: Humans; Benign Paroxysmal Positional Vertigo; Dizziness; Betahistine; Quality of Life; Treatment Outcome
PubMed: 37794554
DOI: 10.4103/njcp.njcp_305_23 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2024Semicircular canal occlusion(SCO) is a surgical technique widely used for treating vertigo symptoms. It is primarily aimed at treating benign paroxysmal positional... (Review)
Review
Semicircular canal occlusion(SCO) is a surgical technique widely used for treating vertigo symptoms. It is primarily aimed at treating benign paroxysmal positional vertigo(BPPV), Ménière's disease(MD), labyrinthine fistula, and superior semicircular canal dehiscence syndrome, among others. This review aims to comprehensively summarize the development, evolution, relevant basic research, and clinical applications of semicircular canal occlusion, especially the application of endoscopic technology in recent years, and explore its practical value in the field of surgical treatment for vertigo.
Topics: Humans; Benign Paroxysmal Positional Vertigo; Meniere Disease; Semicircular Canals; Dizziness
PubMed: 38297865
DOI: 10.13201/j.issn.2096-7993.2024.02.008 -
Ugeskrift For Laeger Mar 2021Many medical, neurologic and psychiatric conditions as well as drugs can give chronic dizziness, and a systematic diagnostic workup is essential. Chronic vestibular... (Review)
Review
Many medical, neurologic and psychiatric conditions as well as drugs can give chronic dizziness, and a systematic diagnostic workup is essential. Chronic vestibular syndrome is a clinical syndrome of chronic vertigo, dizziness or unsteadiness lasting months to years. There is generally a persistent unilateral or bilateral vestibular loss. Treatment depends on the aetiology, but in general, treatment with vestibular rehabilitation is effective, which is summarised in this review. Betahistin or other anti-vertigo-drugs are not indicated in the treatment of chronic vertigo.
Topics: Dizziness; Humans; Vertigo; Vestibular Diseases
PubMed: 33829994
DOI: No ID Found -
Ear, Nose, & Throat Journal Nov 2022Psoriasis is an inflammatory skin disease that is characterized by T-cell-mediated hyperproliferation of the keratinocytes. It develops through immune-mediated...
INTRODUCTION
Psoriasis is an inflammatory skin disease that is characterized by T-cell-mediated hyperproliferation of the keratinocytes. It develops through immune-mediated mechanisms and is defined as an immune-mediated inflammatory disease. The inner ear is susceptible to inflammatory attacks, and vertigo and dizziness can occur as a complication. There is little information about psoriasis and the vestibular system.
OBJECTIVE
This study aimed to investigate the cervical vestibular-evoked myogenic potential (cVEMP) results of psoriasis patients and the effect of psoriasis on the vestibular system.
MATERIALS AND METHODS
Randomly selected and included in the study were patients who had been admitted to the Dermatology Outpatient Clinic of the Afyon Kocatepe University Medical Faculty, between November 15, 2017, and March 15, 2018, with the diagnosis of psoriasis, in addition to a healthy control group. This research was designed as cross-sectional study. Ethics committee permission was received. Both cVEMP and distortion product otoacoustic emission (DPOAE) tests were administered to all of the participants. Values were compared between the control group and psoriasis patients.
RESULTS
The study included 43 psoriasis patients and 40 controls. The duration of treatment of the patients and the drugs that they were using were noted. The psoriasis patients had lower p13-n23 amplitude differences in their cVEMP tests ( < .05). These patients also had lower signal to noise ratio values, at 4 and 6 kHz, on their DPOAE tests ( < .05).
CONCLUSION
Psoriasis is an immune-mediated inflammatory disease that can be associated with vestibulocochlear dysfunction.
Topics: Cross-Sectional Studies; Dizziness; Humans; Psoriasis; Vertigo; Vestibular Evoked Myogenic Potentials
PubMed: 33213202
DOI: 10.1177/0145561320970683 -
Brazilian Journal of Otorhinolaryngology 2021Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical...
INTRODUCTION
Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement.
OBJECTIVE
To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations.
METHODS
This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life.
RESULTS
When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors.
CONCLUSION
In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.
Topics: Aged; Dizziness; Humans; Physical Therapy Modalities; Postural Balance; Vertigo; Vestibular Diseases
PubMed: 32035856
DOI: 10.1016/j.bjorl.2019.12.003