Till Örebro universitet

Background: Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.

Aims: To report physical functioning, health-related aspects and gender differences in elderly persons with and without dizziness in a population-based sample of 75-year-olds.

Methods: A cross-sectional sample of 75-year-olds from Gothenburg, Sweden (n = 675, 398 women and 277 men) was examined by means of questionnaires and functional tests. The questions concerned dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication. The tests included were self-selected and maximum gait speed, stair climbing capacity, one leg stance and grip strength.

Results: More women than men reported dizziness/imbalance (40 vs 30 %, p < 0.001). Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level (summer: 62 vs 74 %, p < 0.001; winter: 41 vs 51 %, p < 0.001), less often took a daily walk (p < 0.05), had lower scores on the FES(S) (p < 0.001), more often reported general fatigue (p < 0.001), more often had fallen in the previous year (40 vs 23 %, p < 0.001) and had a higher intake of medical drugs (4.6 vs 3.3, p < 0.001). They also performed worse regarding gait speed, stair climbing and one leg stance (p < 0.001), but there was no difference in grip strength.

Conclusion: Older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.

Background and aims: Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table. The aims of this study were to investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and without BPPV.

Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons underwent side-lying, static balance and dynamic walking tests.

Results: Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when walking outdoors. A significant gender difference was found, with a higher prevalence in women (40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more common in women (p<0.01). Elderly individuals with BPPV also displayed significantly impaired balance in static and dynamic balance tests compared with persons without BPPV (p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared with persons without BPPV (p<0.001).

Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in the elderly.

Dizziness and balance problems are common symptoms at all ages. The aims were; to evaluate rehabilitation, static, dynamic balance and recovery in acute unilateral vestibular loss (AUVL), to evaluate the treatment of benign paroxysmal positional vertigo (BPPV) with assessment of static and dynamic balance and to evaluate the prevalence of dizziness and BPPV in a population of 75-year-olds.

Study 1: Twenty-seven patients (51years) with AUVL were included and the recovery was followed regarding vestibular function, dizziness, and sick-leave. The recovery was rapid, with disappearance of spontaneous nystagmus and rapid return to work.

Study II: Forty two patents (51 years) with AUVL were included and compared with a reference group. Static and dynamic balance were assessed after six months. Significant instability was found both in static and dynamic balance compared to a reference group.

Study III: Seventeen patients (52 years) with severe BPPV (> 3 months) were treated with Semonts´s manouver and/or Brandt-Daroff exercises. The recovery was evaluated by Dix-Hallpike test, subjective dizziness, unsteadiness and balance tests, after 1, 6 and 12 months. Semont´s maneouver resolved dizziness but the long term follow up showed impaired balance.

Study IV: A large cohort (675) of elderly was assessed regarding dizziness and BPPV. Side lying test and balance tests were applied. A high prevalence of dizziness (36%) and BPPV (11%) was found.

Conclusions: Patients with AUVL and BPPV have despite good symptomatic relief, still impaired static and dynamic balance at long term follow up. BPPV in elderly is common and should be examined since it can be treated.

The aim of this trial was to evaluate long-term (after six months) effects of successful vestibular rehabilitation in patients with acute unilateral vestibular loss (AUVL) in relation to static and dynamic balance, hypertension, headache, disturbed sleep and physical exercise habits. A group of 42 patients were included. For comparison, an age and gender matched healthy reference group was used, consisting of 56 subjects. The assessments were static and dynamic balance performances with the Romberg test, a sharpened Romberg test (SREC), standing on one leg with eyes open/closed (SOLEO/SOLEC) and a 10-m walking test, with and without head movements. A questionnaire concerning the occurrence of hypertension, headache, disturbed sleep and physical exercise habits was also administered. The AUVL group walked significantly slower and took shorter steps (p<0.001) compared to the subjects in the reference group. Significantly impaired performances were also found in the AUVL group in SREC (p<0.01) and SOLEC (p<0.05) compared to the reference group. A significantly larger proportion of patients with AUVL (26%) used anti-hypertensive medication compared to the reference group (4%) (p<0.01). This study demonstrated that AUVL patients, after vestibular rehabilitation and compensation, still have long-term static and dynamic balance problems. We have also found that patients who have suffered from AUVL have a higher prevalence of hypertension compared to a reference group.

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The prognosis is good, usually with spontaneous remission within three months, but symptoms may last. Patients were consecutively evaluated before and 1, 6 and 12 months after treatment, to evaluate the long-term effects of the Semont manoeuvre and Brandt & Daroff exercises. The subjects were 17 patients (13 women and four men, mean age 52 years) who had suffered from BPPV for more than three months. The Semont manoeuvre was performed. Patients with vertigo after two Semont manoeuvres were instructed to perform Brandt & Daroff exercises. Follow-up was done by the Dix–Hallpike test, measurement of static/dynamic balance and a health questionnaire; for the vertigo, a visual analogue scale (VAS) was used. Three of 17 patients still suffered from vertigo after 12 months but the nystagmus during the Dix–Hallpike test was significantly decreased. At the end of the study, nine of 17 patients still experienced unsteadiness during standing and walking. It is of importance to perform not only manoeuvres and Brandt & Daroff exercises but also to instruct the patient in vestibular rehabilitation including static/dynamic balance exercises in order to reduce unsteadiness.

The aims of this study were to follow the recovery process, and explore the disease impact on sick leave in patients with acute unilateral vestibular loss (AUVL). Another aim was to investigate whether initial signs of nystagmus, caloric response, and subjective symptoms of vertigo could predict the return to work. Recovery was followed through the reduction in spontaneous and head-shaking nystagmus, evaluated by Video-Frenzel examination, and by caloric response/asymmetry and spontaneous nystagmus, evaluated by bithermal binaural caloric testing. Information regarding employment, sick leave and subjective symptoms of vertigo was collected using a questionnaire. Twenty-seven patients with AUVL participated in a physiotherapy training programme, starting within 48 h of disease onset. Four assessments were performed: at disease onset, in the acute stage, and after one and six months. In most patients a very rapid cessation of spontaneous nystagmus could be observed (14/27 at a median time of two days after disease onset, a further 10 patients after one month and the remaining three patients after six months). A more prolonged persistence of head shaking nystagmus was observed (24/27, 14/27 and 5/21 of the patients showed head-shaking nystagmus at the three assessments). Caloric asymmetry was normalized after six months in 11/27 patients. A positive and significant correlation was observed between long-lasting sick leave and caloric asymmetry, sense of unsteadiness when standing and walking and older age. Unsteadiness when standing and walking, as well as existence of spontaneous nystagmus, were also positively and significantly correlated with the degree of caloric asymmetry. Spontaneous or head-shaking nystagmus, caloric asymmetry and subjective vertigo at disease onset did not, however, predict sick leave after one or six months. Recovery was excellent in most of the patients.

Background and aims: Dizziness is a common problem among the elderly. Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly Benign Paroxysmal Positional Vertigo (BPPV). The diagnosis of BPPV is made by history and findings in the Dix-Hallpike test. It can be difficult to perform the Dix-Hallpike test in elderly persons due to limited range of motion when extending the neck. In this study we used a side-lying test to stimulate the posterior semicircular canal while the head and neck were fully supported on the examination table. The aims were to investigate the prevalence of dizziness or impaired balance and BPPV in a 75-year old population. Methods: A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons performed side-lying, static balance and dynamic walking tests.

Results: Subjective dizziness and/or impaired balance was found in 36% especially when walking outdoors. A significant gender difference was found with a higher prevalence in women (40%) compared to men (30%) (p<0.01). BPPV was found in 11%. This was significantly more common in women compared to men (p<0.01). Elderly persons with BPPV also showed significantly impaired balance ability in static and dynamic balance tests compared to age matched persons without BPPV(p<0.01). Persons with BPPV reported significantly more subjective problems with dizziness and balance compared to persons without BPPV (p<0.001).

Conclusions: Subjective and objective unsteadiness, dizziness and BPPV are common in elderly. The side-lying test is a good screening test for BPPV.