Dizziness in old age is one of the main geriatric problems and is more than just a condition. Therefore, it should be treated quickly and effectively to prevent falls and the increased risk of mortality that accompanies them. In addition to physiotherapy and cognitive training, pharmacological interventions include antivertiginosa.
When health declines occur in old age, they usually take place in the area of physical functions. Especially immobility, instability and incontinence are common. But changes can also be observed intellectually. In addition, there is isolation, iatrogenic drug effects, depression, and ultimately senile dementia. This is a limitation of spatial orientation, which is nowadays also called multimodal vertigo. This is usually due to impairments of both the central and peripheral nervous systems (Table 1).
In patients over 75 years of age, dizziness is the most common leading symptom of all. It leads to a loss of mobility and participation in age-appropriate activities and therefore significantly limits the quality of life. Furthermore, multimodal dizziness increases the risk of falls per se by a factor of 2.6. This in turn is associated with an increased mortality by a factor of 3. Therefore, the risk of falling should be reduced – also to avoid chronification by the “dizziness memory”.
Multimodal therapy reduces risk of falls
Effective therapy is multimodal in design and consists of activating physical therapy, mitigation of the living environment, critical indication for walking aids, avoidance of sedating medications, and use of nonsedating antivertiginous agents. The latter have a calming effect on the vomiting center in the brain and on the balance center. These include, among others, the combination of cinnarizine and dimenhydrinate, in addition to ginger, cocculus and betahistine. While ginger shows evidence of efficacy in hyperemesis gravidarum, betahistine is used primarily in Meniere’s disease. Cinnarizine and dimenhydrinate should be used as a fixed combination, as this can reduce dizziness better than the single substances. Cocculus is one of the natural medicines. All components (Anamirta cocculus, Ambra grisea, Conium maculatum and Petroleum rectificatum) strengthen the blood circulation of the vessels in the brain, improving the processing of sensory impressions responsible for a stable balance. Since the treatment is symptomatic and not curative, pharmacological intervention is usually used as a continuous therapy. Attention to possible interactions with other drugs is therefore indicated.
Vestibular, visual and propioceptive training are available for physical treatment. With Balanceboard, Health Games or MemoreBox, patients can exercise independently. A combination of physiotherapy and cognitive training (dual tasking) has proven to be effective.
Further reading:
- Jahn K, et al: Vertigo and gait unsteadiness in old age. Causes, diagnosis, and therapy. Dtsch Arztebl Int 2015; 112: 387-393.
- Jönsson R, et al: Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 2004; 14: 47-52.
- www.luks.ch/ihr-luks/wie-gefaehrlich-ist-schwindel-und-was-kann-man-dagegen-tun (last call on 11.03.2020)
InFo NEUROLOGY & PSYCHIATRY 2020; 18(2): 22.
