Colledeg NR, Barr-Hamilton RM, Lewis SJ, et al. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study

Department of Medicine, University of Edinburgh.
BMJ Clinical Research (Impact Factor: 14.09). 10/1996; 313(7060):788-92. DOI: 10.1136/bmj.313.7060.788
Source: PubMed

ABSTRACT To compare the findings in dizzy elderly people with those in controls of a similar age to identify which investigations differentiate dizzy from non-dizzy patients and to design an investigational algorithm.
Community based study of clinical and laboratory findings in dizzy and control elderly people.
Research outpatient clinic at a teaching hospital.
149 dizzy and 97 control subjects aged over 65 years recruited from a community survey and articles in the local press.
Findings on physical examination, blood testing, electrocardiography (at rest and over 24 hours), electronystagmography, posturography, and magnetic resonance imaging of head and neck (125 (84%) dizzy subjects and 86 (89%) controls); hospital anxiety and depression score; responses to hyperventilation, carotid sinus massage, and the Hallpike manoeuvre.
Blood profile, electrocardiography, electronystagmography, and magnetic resonance imaging failed to distinguish dizzy from control subjects because of the frequency of asymptomatic abnormalities in controls. Posturography and clinical assessment (physical examination, dizziness provocation, and psychological assessment) showed significant differences between the groups. A cause of the dizziness was identified from clinical diagnostic criteria based on accepted definitions in 143 subjects, with 126 having more than one cause. The most common diagnoses were central vascular disease (105) and cervical spondylosis (98), often accompanied by poor vision and anxiety.
Expensive investigations are rarely helpful in dizzy elderly people. The cause of the dizziness can be diagnosed in most cases on the basis of a thorough clinical examination without recourse to hospital referral.

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Available from: Robin J Sellar, Sep 19, 2014
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    • "Dizziness is a common presenting problem in clinical practice (Luxon, 1984; Kroenke and Mangelsdorff, 1989; Shumway-Cook and Horak, 1989; Kroenke et al., 1992; Colledge et al., 1996; Furman and Whitney, 2000) and is particularly prevalent in the elderly (Luxon, 1984; Colledge et al., 1996). Dizziness has substantial physical, social and emotional effects as well as financial consequences on individuals and the community (Yardley et al., 1992). "
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    ABSTRACT: <Cervicogenic dizziness is dizziness described as imbalance occurring together with cervical pain or headache. This study aimed to determine the efficacy of sustained natural apophyseal glides (SNAGs) in the treatment of this condition. A double-blind randomised controlled clinical trial was undertaken. Thirty-four participants with cervicogenic dizziness were randomised to receive four to six treatments of SNAGs (n=17) or a placebo of detuned laser (n=17). Participants were assessed by a blinded assistant before treatment, after the final treatment and at 6- and 12-week follow-ups. The primary outcome measures were severity of dizziness, disability, frequency of dizziness, severity of cervical pain, and global perceived effect; balance and cervical range of motion were secondary measures. At post-treatment, 6- and 12-week follow-ups compared to pre-treatment, the SNAG group had less (P<0.05) dizziness, lower (P<0.05) scores on the Dizziness Handicap Inventory (DHI), decreased (P<0.05) frequency of dizziness, and less (P<0.05) cervical pain. The placebo group had significant (P<0.05) changes only at the 12-week follow-up in three outcome measures: severity of dizziness, DHI, and severity of cervical pain. Compared to the placebo group at post-treatment and 6-week follow-up, the SNAG group had less (P<0.05) dizziness, lower (P < or =0.05) scores on DHI, and less (P<0.05) cervical pain. Balance with the neck in extension improved (P < or =0.05) and extension range of motion increased (P<0.05) in the SNAG group. No improvements in balance or range of motion were observed in the placebo group. The SNAG treatment had an immediate clinically and statistically significant sustained effect in reducing dizziness, cervical pain and disability caused by cervical dysfunction.
    Manual therapy 08/2008; 13(4):357-66. DOI:10.1016/j.math.2007.03.006 · 1.76 Impact Factor
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    • "Dizziness accounts for eight million primary care visits to doctors in the United States each year and is the most common presenting complaint in patients over 75 years (Colledge et al., 1996). It is reported in 30% of people over 65 years and 39% of these people fall because of their dizziness (Colledge et al., 1996). It is particularly relevant to note that out of 18,263 patients presenting to The National Institute of Physical Therapy in the Netherlands for manual therapy from 1972–1992, 18% suffered from vertigo (Oostendorp et al., 1992b). "
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    Manual Therapy 03/2005; 10(1):4-13. DOI:10.1016/j.math.2004.03.006 · 1.76 Impact Factor
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    • "Dizziness increases with advancing age and is more common in women than men [6]. Furthermore , dizziness often represents a chronic illness and is associated with physical and psychological morbidities [4] [7] [8]. Several researchers [4,9 Á/11] have reported the detrimental influence of chronic dizziness on functional and psychological outcomes and quality of life in the elderly. "
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    ABSTRACT: Elderly patients with chronic dizziness had a poor HRQoL, which could be successfully assessed using the SF-36, a generic health-status instrument. The frequency of dizziness and comorbid psychological distress were predictive of impairment in QoL. To evaluate health-related quality of life (HRQoL) and its relationship to characteristics of dizziness in elderly persons with chronic dizziness. A standardized dizziness questionnaire was used to evaluate characteristics of dizziness as well as medical, functional and demographic data in 197 consecutive patients with chronic dizziness aged > or =60 years. HRQoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Compared with normative data, results from patients with dizziness indicated a pervasive multidimensional decline in SF-36 scores. This decline was most notable in terms of role limitations in the physical and emotional dimensions. The frequency of attacks of dizziness correlated with perceived disability. Patients with chronic dizziness also had great psychological distress, as measured by the HADS score, which had a detrimental influence on their QoL.
    Acta Oto-Laryngologica 01/2005; 125(1):55-9. DOI:10.1080/00016480410017512 · 0.99 Impact Factor
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