Imbalance and vertigo: the aging human vestibular periphery

Dizziness, vertigo, and imbalance are likely the most common presenting complaints among patients 75 years and older in office practices. Although the cause of falls among the aging population is multifactorial, several studies have implicated senescence of the vestibular periphery. It is imperative that clinicians correctly diagnose and treat dizziness and vertigo in the geriatric population, as vestibular impairment is quite responsive to specifically designed rehabilitation. One of the most common causes of vertigo in older adults is benign positional vertigo. The aging otolithic membrane, alterations in calcium metabolism, and microvascular ischemia may all play a role. An age-related deterioration of vestibular function on quantitative testing has been documented, and the age of onset correlates with the age-related cellular loss in the vestibular periphery. Furthermore, longitudinal tests of decline in vestibular function correlate with decline in gait and balance on testing. It is likely that senescence of both the central and peripheral vestibular pathways plays a role in age-related decline in balance. Vestibular disorders in the older patient are associated with a diminished level of independent activities, an increased incidence of falls, and possibly also clinical depression. The author's laboratory is delineating the immunohistochemical expression of proteins in the basement membrane of the vestibular system in older adults as a potential cause of the age-related decline in sensory cell and neuronal number.