Evaluation of orthostatic dizziness and lightheadedness in older adults: symptoms not to be taken lightly.

Orthostatic dizziness and lightheadedness are frequent complaints in patients age 60 and above, whereas various common and uncommon etiologies need to be considered, including medication side effects, cardiovascular and metabolic causes and neurologic disorders. Autonomic dysfunction is a common etiology that warrants comprehensive medical and neurologic evaluations for identification of neurogenic orthostatic hypotension, prodromal Parkinson's disease, Lew body dementia, pure autonomic failure and others. In this article, key historical details, physical exam findings and diagnostic investigations for orthostatic dizziness are discussed. Patients' report of chronic and persistent orthostatic intolerance, even in the absence of objective orthostatic hypotension, should serve as a reliable and sufficient key feature should prompt an evaluation for autonomic and neurodegenerative disorders.