The impaired subjective perception of verticality independent of peripheral vestibular function in dizzy elderly with orthostatic hypotension.

BACKGROUND

The elderly often complain of faintness, lightheadedness, dizziness, and unsteadiness, which may be associated with the orthostatic hypotension (OH), but most of them are subclinical. The pathogenic mechanism of subjective symptoms in the elderly with OH is controversial.

AIMS: The aim of this study was to assess the involvement of the irregularity of the vertical perception in the dizzy elderly with OH.

METHODS

This study consisted of 403 patients seeking treatment for dizziness in our hospital. The neurotological examinations include the subjective visual vertical (SVV) test and the bithermal caloric test. The self-perceived handicapping effects imposed by dizziness were assessed by the dizziness handicap inventory (DHI). The variability (standard deviation) and the average deviation of eight trials (four trials in each direction) were calculated. In addition, they underwent the orthostatic Schellong test for the diagnosis of the OH. They were separated into three groups, including patients aged ≥65 years, patients aged 50-64 years, and patients aged <50 years.

RESULTS

The variability of the SVV in the patients aged ≥65 years with OH was significantly larger than that in the patients aged ≥65 years without OH. There was no significant difference in the average deviation of the SVV, the canal paresis % by the bithermal caloric test, and the DHI score among groups.

CONCLUSIONS

The result suggests that the elderly patients with OH have subclinical impairment in the perception of the verticality independent of the peripheral vestibular function.