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


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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    • "Belal and Glorig (1986) used the term presbystasis to describe this type of age-related problem that cannot be attributed to any known diagnosis [17]. On the other hand, other studies assigned multiple diagnoses in 18% to 85% of older people with dizziness [8] [15] [18]. Tinetti et al. (2000) proposed that dizziness in the elderly should be considered as a multifactorial geriatric syndrome involving many different symptoms and originating from many different causes, including cardiovascular, neurologic, sensory, psychological and medication-related problems [1]. "
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    ABSTRACT: Dizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. Although the causes of dizziness in older people are multifactorial, peripheral vestibular dysfunction is one of the most frequent causes. Benign paroxysmal positional vertigo is the most frequent form of vestibular dysfunction in the elderly, followed by Meniere's disease. Every factor associated with the maintenance of postural stability deteriorates during aging. Age-related deterioration of peripheral vestibular function has been demonstrated through quantitative measurements of the vestibulo-ocular reflex with rotational testing and of the vestibulo-collic reflex with testing of vestibular evoked myogenic potentials. Age-related decline of vestibular function has been shown to correlate with the age-related decrease in the number of vestibular hair cells and neurons. The mechanism of age-related cellular loss in the vestibular endorgan is unclear, but it is thought that genetic predisposition and cumulative effect of oxidative stress may both play an important role. Since the causes of dizziness in older people are multi-factorial, management of this disease should be customized according to the etiologies of each individual. Vestibular rehabilitation is found to be effective in treating both unilateral and bilateral vestibular dysfunction. Various prosthetic devices have also been developed to improve postural balance in older people. Although there have been no medical treatments improving age-related vestibular dysfunction, new medical treatments such as mitochondrial antioxidants or caloric restriction, which have been effective in preventing age-related hearing loss, should be ienvestigated in the future.
    Aging and Disease 02/2015; 6(1):38-47. DOI:10.14336/AD.2014.0128 · 3.07 Impact Factor
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    • "Dizziness is more common in women [2,5]. It is associated with other psychological and physical comorbidities [6,7]. Dizziness can refer to vertigo, presyncope, disequilibrium, or to non-specific feelings such as giddiness or foolishness [8]. "
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    ABSTRACT: Background: Dizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown. Methods: The cross-sectional study evaluated the HRQoL in 203 patients suffering from dizziness, using the Medical Outcomes Studies 36-Item Short-Form Health-Survey (SF-36). The results were correlated with the severity of dizziness, using the Dizziness Handicap-Inventory (DHI), with emotional distress, using the Hospital Anxiety and Depression-Scale (HADS) and with further clinical symptoms and psychosocial parameters. In a multivariate hierarchical regression analysis associated variables which explain significant variance of the mental and physical HRQoL (MCS-36, PCS-36) were identified. Results: Patients suffering from dizziness showed a markedly reduced mental and physical HRQoL. Higher DHI and HADS scores were correlated with lower MCS-36 and PCS-36 scores. Taken together DHI and vertigo characteristics of dizziness explained 38% of the variance of PCS-36. Overall explained variance of PCS-36 was 45%. HADS and living with a significant other explained 66% of the variance of MCS-36 (overall variance explained: 69%). Conclusion: Both the physical and mental HRQoL are significantly impaired in patients with dizziness. While the impairment in PCS-36 can be explained by clinical symptoms of the dizziness, MCS-36 impairment is largely associated with psychosocial factors. To improve the patient’s overall well-being significantly and permanently doctors have to keep in mind both, the clinical symptoms and the psychosocial factors. Therefore, in addition to the physical examination doctors should integrate a basic psychological examination into the daily routine with dizziness patients.
    BMC Health Services Research 08/2014; 2014(14):317. DOI:10.1186/1472-6963-14-317 · 1.71 Impact Factor
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    • "Dizziness can be produced by peripheral vestibular disorders, central nervous system disorders, or combined lesions, as well as other conditions [2]. Treatment typically consists of reassurance and antivertiginous and antiemetic drugs to relieve symptoms [6-9]. However, several reviews of the management of dizziness have concluded that no medication in current use has well-established curative or prophylactic value or is suitable for long-term palliative use [10]. "
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    ABSTRACT: Dizziness is one of the most challenging symptoms in medicine. No medication for dizziness in current use has well-established curative or prophylactic value or is suitable for long-term palliative use. Unconventional remedies,such as acupuncture, should be considered and scientifically evaluated. However, there has been relatively little evidence in randomized controlled clinical trials on acupuncture to treat chronic dizziness. The aim of our study is to evaluate the efficacy and safety of acupuncture in patients with dizziness.Methods/design: This trial is a randomized, single-blind, controlled study. A total of 80 participants will be randomly assigned to two treatment groups receiving acupuncture and sham acupuncture treatment, respectively, for 4 weeks. The primary outcome measures are theDizziness Handicap Inventory (DHI) andtheVertigo Symptom Scale (VSS). Treatment will be conducted over a period of 4 weeks, at a frequency of two sessions per week. The assessment is at baseline (before treatment initiation), 4 weeks after the first acupuncture session, and 8 weeks after the first acupuncture session. The results from this study will provide clinical evidence on the efficacy and safety of acupuncture in patients with chronic dizziness.Trial registration: International Standard Randomized Controlled Trial Number Register: ISRCTN52695239.
    Trials 12/2013; 14(1):429. DOI:10.1186/1745-6215-14-429 · 1.73 Impact Factor
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