Age-Associated Characteristics of Patients With Chronic Dizziness and Vertigo.

OBJECTIVE: The incidence of dizziness and vertigo is increasing with age, and symptoms lead to significant limitations in daily living and to disability in older patients. METHOD: Data of 1,752 patients with chronic dizziness/vertigo subjected to a tertiary care, specialized interdisciplinary vertigo center were analyzed. Age, gender, symptoms, medical diagnosis, and Dizziness Handicap Inventory (DHI) were collected based on a questionnaire and analysis of associated patient records. The patients were assigned to 3 age groups (< 41, 41-65, and > 65 years). RESULTS: 33.7% of the patients were older than 65 years. Frequency of symptoms and DHI score increased with age. Older patients reported less frequently about coexisting symptoms such as nausea, headache, tinnitus, ear pressure, and visual impairment. Multisensory deficit, central vertigo, bilateral vestibulopathy, and benign paroxysmal positional vertigo were diagnosed increasingly with age, while persistent postural-perceptual dizziness and vestibular migraine were diagnosed in the younger age groups. CONCLUSION: In the diagnostic work-up of older patients age-specific characteristics of dizziness/vertigo have to be considered. The older patient generally is more impaired by the symptoms but possibly will not report typical diagnosis-defining symptoms.

Impact of Common Dizziness Associated Symptoms on Dizziness Handicap in Older Adults.

Background: A cross-sectional observational study was designed to determine the impact of dizziness associated symptoms on the dizziness handicap inventory (DHI) in older adults (≥60 years). Methods: In total, 785 individuals referred to a multidisciplinary dizziness unit were assessed. Participants completed self-report questionnaires with general questions about symptoms of dizziness as well as the DHI. The DHI subscores (physical, functional, emotional) were calculated. Medical diagnoses were collected from the medical records of the patients. One-way MANOVA and networking analysis were used to analyze the impact of dizziness associated symptoms on dizziness handicap. Results: Most patients reported swaying dizziness (60.6%) and feeling of unsteadiness (59.8%) with substantial overlap between the types of dizziness. Most frequent dizziness associated symptoms were ear noise/tinnitus, visual problems, and nausea/vomiting. Network analysis revealed that visual disturbances, headache, and hearing impairment were associated with higher DHI and explained 12% of the DHI variance in the linear regression. In the one-way MANOVA visual problems and headache had an effect on all three DHI subscores, while hearing impairment was associated with the functional and emotional subscores of DHI. Conclusion: Distinct dizziness associated symptoms have substantial impact on dizziness handicap in older adults. A multifactorial assessment including these symptoms may assist in tailoring therapies to alleviate dizziness handicap in this group.

Multimodal treatment of persistent postural-perceptual dizziness.

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic disorder with fluctuating symptoms of dizziness, unsteadiness, or vertigo for at least three months. Its pathophysiological mechanisms give theoretical support for the use of multimodal treatment. However, there are different therapeutic programs and principles available, and their clinical effectiveness remains elusive. METHODS: A database of patients who participated in a day care multimodal treatment program was analyzed regarding the therapeutic effects on PPPD. Vertigo Severity Scale (VSS) and Hospital Anxiety and Depression Scale (HADS) were assessed before and 6 months after therapy. RESULTS: Of a total of 657 patients treated with a tertiary care multimodal treatment program, 46.4% met the criteria for PPPD. PPPD patients were younger than patients with somatic diagnoses and complained more distress due to dizziness. 63.6% completed the follow-up questionnaire. All patients showed significant changes in VSS and HADS anxiety, but the PPPD patients generally showed a tendency to improve more than the patients with somatic diagnoses. The change in the autonomic-anxiety subscore of VSS only reached statistical significance when comparing PPPD with somatic diagnoses (p = .002). CONCLUSIONS: Therapeutic principles comprise cognitive-behavioral therapy, vestibular rehabilitation exercises, and serotonergic medication. However, large-scale, randomized, controlled trials are still missing. Follow-up observations after multimodal interdisciplinary therapy reveal an improvement in symptoms in most patients with chronic dizziness. The study was not designed to detect diagnosis-specific effects, but patients with PPPD and patients with other vestibular disorders benefit from multimodal therapies.