Vertigo is one of the most common complaints in the elderly and can significantly affect quality of life perceptions and fall risk. In order to offer patients adequate treatment options, it is important to determine the underlying causes of the dizziness. A recent review article has analyzed large data sets on this.
Secondary analysis published in the Journal of Clinical Medicine in 2023 identified audio-vestibular disorders as the most common cause of dizziness in the elderly [1]. In total, data from 2148 vertigo patients in the age group 60-90 years were included from five publications selected according to PRISMA guidelines [2–6].
Audio-vestibular, cardiovascular and neurological causes most common
Audio-vestibular disorders led the ranking of causes with 28.4%, followed by cardiovascular disease (20.4%) and neurological pathologies (15.1%) [1]. Psychiatric disorders were diagnosed in 9.1% of patients, while ophthalmological diagnoses accounted for 7.5% of cases and musculoskeletal disorders for 6.3%. In some cases, adverse effects of medications and metabolic diseases were identified as the cause, and in 3.4% of cases, the etiology remained unclear.
Among audio-vestibular disorders, benign paroxysmal positional vertigo (BPLS) was found to be the most common cause of vertigo symptoms (Fig. 1) [1]. Numerous studies suggest that the incidence of BPLS increases with age, possibly due to aging of the inner ear and otoconia detached from the utricular macula.
Cardiovascular disorders were included only if they were reported as the primary cause of dizziness. Blood pressure dysregulation (especially hypertension, but also orthostatic dysregulation) was identified as the main cause of vertigo in 34.5% of cardiovascular diagnoses, followed by ischemic heart disease, arrhythmias, and valvular heart disease [1].
Among neurological disorders, vestibular migraine had the highest prevalence at 28.5%, followed by cerebrovascular disorders (25.8%) and polyneuropathy (14.8%) [1]. Degenerative disorders (9.9%) included Parkinson’s disease, Alzheimer’s disease, and multisystem atrophy. Unspecified cerebellar syndromes, CANVAS (Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome), and down-beating nystagmus were grouped into the “cerebellar disorders” subgroup, which accounted for 5.2% of neurologic diagnoses. Vestibular schwannomas, glomus tympanicum, meningiomas, and ependymomas were represented among the tumors.
Among psychiatric disorders, anxiety was the most frequently reported diagnosis, accounting for 61% of cases, followed by depressive episodes [1]. In 3% of cases, the category of psychiatric diagnosis was not reported [7–9,11].
Finally, ophthalmologic and musculoskeletal disorders were reported in 7.5% and 6.3% of cases, respectively [1]. Adverse drug reactions and metabolic diseases were also cited as causes. In 3.4% of cases, the etiology remained unclear [1].
Literature:
- Fancello V, et al.: Vertigo in the Elderly: A Systematic Literature Review. Journal of Clinical Medicine. 2023; 12(6): 2182.
- Müller KJ, et al.: Chronic vestibular syndromes in the elderly: Presbyvestibulopathy – An isolated clinical entity? Eur J Neurol 2022; 29: 1825–1835.
- Van Vugt VA, et al.: Prognosis and Survival of Older Patients with Dizziness in Primary Care: A 10-Year Prospective Cohort Study. Ann Fam Med 2020; 18: 100–109.
- Pan Q, et al.: Diagnosis of Vertigo and Dizziness Syndromes in a Neurological Outpatient Clinic. Eur Neurol 2018; 79: 287–294.
- Albernaz PLM: Vertigo in Elderly Patients: A Review of 164 Cases in Brazil. Ear Nose Throat J 2014; 93: 322–330.
- van Leeuwen RB, Bruintjes TD: Dizziness in the elderly: Diagnosing its causes in a multidisciplinary dizziness unit. Ear Nose Throat J 2014; 93: 162–167.
InFo NEUROLOGIE & PSYCHIATRIE 2023; 21(2): 34
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