[Vestibular disorders in old age]

The elderly show a general reduction of their bodily and mental reactions. They become slower to react and their sensory ability decreases, e.g. hearing, vision, smell and taste. With increasing age, disturbances of the balance system are found more frequently, resulting in dysequilibrium, vertigo, lightheadedness and falling. We investigated the physiological changes in the vestibular system associated with the ageing processes. We selected 470 patients aged from 1-90 years from 1500 routine neurological patients. All of these patients underwent a routine neuro-otological test battery including vestibular-spinal, caloric, rotatory and optokinetic tests with electronystagmographic recording. Vestibular ocular reactions change markedly over nine decades. The nystagmus reactions, expressed by frequency, amplitude and maximal slow phase velocity of children differ from those of adults and even more from those of the elderly. The quantitative nystagmus dynamics after caloric and rotatory stimulation are accompanied by qualitative changes of the nystagmus signal. With increasing age destructive signs appear which may produce unreadable electronystagmograms. The standing and moving pattern of the elderly patient is characterized by instability, slowness, tremor and ataxia. The results of the Romberg test show an increase of instability and unsteadiness in older patients. The Unterberger test, recorded by craniocorpography, demonstrates an increase of atactic patterns with increasing age. These changes are the result of age-related physiological changes in the sensory, cerebral, peripheral nervous and muscular systems.