The "2024 Academic Annual Meeting of the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and the 5th China Vertigo Medicine Forum" was held in Zhuhai, Guangdong Province from May 10 to 12, sponsored by the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and undertaken by Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine and Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology. This conference invited a number of experts from all over the country to conduct in-depth discussions on new concepts, new technologies and new products in the field of vertigo medicine, bringing a feast of academic gluttony with various forms and rich contents. At this conference, Professor Zhuang Jianhua from Changzheng Hospital of Naval Medical University gave a wonderful sharing on the theme of "Vestibular Compensation and Rehabilitation Principles".
The author of this article is the report team of the Yimaitong Vertigo Conference
Yimaitong collated the report, please do not reprint without authorization.
The incidence of dizziness/vertigo is high in the elderly, and it can seriously affect life. A study conducted by Harrison W et al. found that 7 million (19.6%) of the 37 million older adults (> 65 years) experienced dizziness/imbalance in 1 year, of which 27.4% were because dizziness interfered with daily life, including exercise (61.2%), driving (47.1%), social activities (45.8%), and work (37.7%).
Characteristics of the elderly
1. 80% of the elderly have at least one chronic disease, such as diabetes, hypertension, cardiovascular and cerebrovascular diseases, etc., and the proportion of these elderly patients pre-syncope increases.
2. 50% of the elderly take more than 5 kinds of drugs, and the proportion of dizziness/vertigo caused by drug factors increases. The mechanism involves central sedation; orthostatic hypotension; slow sensory feedback, negative muscle strength; specific lesions to vestibular endings; Affects the vestibular center and visuomotor pathways. Both prescription and over-the-counter (OTC) drugs can cause dizziness, such as:
- Antibiotics: aminoglycosides
- Antidepressants: SSRI, tricycline
- Diuretics: furosemide, diuretic acid
- Salicylic acids
- Anticonvulsants: phenytoin, carbamazepine
- Sedatives, hypnotics: Valium, clonazepam
- Antihypertensive drugs: betalux, compound antihypertensive tablets, etc
- Vasodilators: nitroglycerin
- Alcoholism, chemotherapy drugs, etc
3. The elderly often have decreased functions such as vision, proprioception, muscle strength and cognition, as well as degeneration of the central control balance structure, so the elderly have increased the manifestations of multiple sensory impairment and instability; Poor compensation, slower recovery, more persistent and more prone to falls.
Dizziness and dizziness in the elderly
1. Be as clear as possible about the characteristics of the halo
Different complaints represent different causes:
Consultation content: six questions
- Nature: Vertigo? Dizziness/dizziness? Imbalance? Syncope?
- Duration: Seconds? Minute? Hour? Sky?
- Predisposing factors: Positional changes? Pressure changes?
- Number of episodes: single (persistent) or recurrent?
- Accompanying symptoms: tinnitus, deafness? Freemasonry, muscle strength?
- Anamnesis: ear disease, hypertension, diabetes, etc.; Other medical history: migraine history, infection history, medication history, etc
2. Physical examination
General examination: nutritional status (obesity); blood pressure in the upright position; Vision; Rhythm; Joint; Depression, anxiety assessment, etc.
Neurological examination: cognitive; cranial nerves (especially eye movements, various optic movements); muscle strength; muscle tone; Freemasonry, Romber; lower extremity vibration sensation, ankle reflex; Gait: start, stride length, stride base, turn.
Neuro-otological examination: hearing; spontaneous nystagmus; head shake test; position test; Shake head test.
3. Auxiliary examination
The auxiliary examination should be selected according to the examination and physical examination, and the interpretation of the examination results should be cautious.
May be merely age-related, nonspecific changes that are more suggestive of the patient's underlying condition.
4. Diagnosis and treatment
➤ Vertigo: Stratified diagnosis of vertigo according to the International Classification of Vestibular Disorders (ICVD).
Key points in the diagnosis and treatment of different vertigo syndromes:
- Positional vertigo syndrome: nystagmus features/reduction effect
- Acute vestibular syndrome: excludes stroke/focal symptoms
- Episodic vestibular syndrome: hearing/ladder therapy
- Chronic vestibular syndrome: degree of vestibular decline
➤ Syncope: transient hypoperfusion of the whole brain
(1) Neurally mediated (reflex) syncope: vasovagal syncope, situational syncope (coughing, sneezing, urination), carotid sinus syndrome, etc
(2) Orthostatic hypotensive syncope: orthostatic hypotension/intolerance, orthostatic tachycardia
(3) Cardiogenic syncope: various arrhythmias, various structural heart diseases
Pay attention to the hazard stratification diagnosis!
➤ Instability: Peripheral/central nervous system
Others can observe it, and it is easy to fall
(1) Peripheral nervous system: diabetes, severe alcohol, nutritional deficiencies, etc
(2) Central nervous system: cerebellar ataxia, extrapyramidal diseases, post-stroke, positive pressure hydrocephalus, etc
➤ Dizziness/drowsiness: often unable to speak
It is often difficult to identify without a clear history
- Mood disorders (depression, anxiety, etc.)
- Non-specific side effects of medications
- Endocrine and metabolic diseases (thyroid)
- Obstructive sleep apnea syndrome (OSAS)
- Leukoencephalopathy (diffuse)
- cognitive impairment, etc
Other Processing
- Rehabilitation: especially strength training
- Fall prevention measures: a lot of details (shoes, crutches, toilet configuration, night lighting, care, etc.)
Finally, Professor Zhuang Jianhua emphasized that due to the fact that elderly patients often have multiple risk factors, such as decreased vision and muscle strength, there may be many causes of dizziness/vertigo, so it is often a syndrome of multiple sensory impairment. More consideration is required in the diagnosis and management of dizziness/vertigo in older patients than in younger patients.
A special report on the 2024 Academic Annual Meeting of the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and the 5th China Vertigo Medicine Forum
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