Frontiers in neurology · 2026
Presbyvestibulopathy: an uncommon cause of dizziness in the elderly.
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Chang Tzu-Pu, Kuo Yu-Hung, Bery Anand K
Аннотация
BACKGROUND: Dizziness is common in older adults, and often presents a diagnostic challenge. Vestibular function declines with age, but the prevalence and diagnostic explanatory value of mild vestibular loss in isolation (i.e., the clinical diagnosis of "presbyvestibulopathy") remains uncertain.
METHODS: We retrospectively analyzed consecutive patients aged ≥ 60 years in a subspecialty dizziness clinic who underwent clinical assessment (history, exam, videonystagmography) and horizontal canal video head impulse testing. We examined (i) the prevalence of vestibular loss (by laterality/degree of loss), including across age groups, and (ii) the distribution of primary diagnoses and proportion attributable to presbyvestibulopathy.
RESULTS: Of the 102 included patients (72% female, mean age 72.8 years), 70 (68.6%) had normal vestibular function. Seven (6.9%) had mild bilateral vestibular hypofunction (vestibulo-ocular reflex [VOR] gain of 0.6-0.8 bilaterally). A smaller number had more severe degrees of bilateral hypofunction: severe (n = 6), and asymmetric (n = 4). Right-sided VOR gain was highest in those aged 60-69 years (0.96), intermediate in those aged 70-79 years (0.89), and lowest in patients aged ≥ 80 years (0.77; p < 0.001). Presbyvestibulopathy was uncommon as a final diagnosis across all age groups, with a total prevalence of 2.9% (n = 3). All three of these patients had treatable comorbidities (e.g., anxiety).
CONCLUSION: VOR gain by vHIT declines with age in patients with symptomatic dizziness; however, most patients aged ≥ 60 still demonstrate normal VOR gains. The diagnosis of presbyvestibulopathy is uncommon in older adults with dizziness; a more specific vestibular diagnosis is often more appropriate. Even in those with presbyvestibulopathy, treatment of comorbidities can improve symptoms and function.
METHODS: We retrospectively analyzed consecutive patients aged ≥ 60 years in a subspecialty dizziness clinic who underwent clinical assessment (history, exam, videonystagmography) and horizontal canal video head impulse testing. We examined (i) the prevalence of vestibular loss (by laterality/degree of loss), including across age groups, and (ii) the distribution of primary diagnoses and proportion attributable to presbyvestibulopathy.
RESULTS: Of the 102 included patients (72% female, mean age 72.8 years), 70 (68.6%) had normal vestibular function. Seven (6.9%) had mild bilateral vestibular hypofunction (vestibulo-ocular reflex [VOR] gain of 0.6-0.8 bilaterally). A smaller number had more severe degrees of bilateral hypofunction: severe (n = 6), and asymmetric (n = 4). Right-sided VOR gain was highest in those aged 60-69 years (0.96), intermediate in those aged 70-79 years (0.89), and lowest in patients aged ≥ 80 years (0.77; p < 0.001). Presbyvestibulopathy was uncommon as a final diagnosis across all age groups, with a total prevalence of 2.9% (n = 3). All three of these patients had treatable comorbidities (e.g., anxiety).
CONCLUSION: VOR gain by vHIT declines with age in patients with symptomatic dizziness; however, most patients aged ≥ 60 still demonstrate normal VOR gains. The diagnosis of presbyvestibulopathy is uncommon in older adults with dizziness; a more specific vestibular diagnosis is often more appropriate. Even in those with presbyvestibulopathy, treatment of comorbidities can improve symptoms and function.