Presbyvestibulopathy: an uncommon cause of dizziness in the elderly

Dizziness is common in older adults, and often presents a diagnostic challenge. Vestibular function declines with age, but the prevalence and diagnostic explanatory value of mild vestibular loss in isolation (i.e., the clinical diagnosis of "presbyvestibulopathy") remains uncertain.

We retrospectively analyzed consecutive patients aged ≥ 60 years in a subspecialty dizziness clinic who underwent clinical assessment (history, exam, videonystagmography) and horizontal canal video head impulse testing. We examined (i) the prevalence of vestibular loss (by laterality/degree of loss), including across age groups, and (ii) the distribution of primary diagnoses and proportion attributable to presbyvestibulopathy.

Of the 102 included patients (72% female, mean age 72.8 years), 70 (68.6%) had normal vestibular function. Seven (6.9%) had mild bilateral vestibular hypofunction (vestibulo-ocular reflex [VOR] gain of 0.6-0.8 bilaterally). A smaller number had more severe degrees of bilateral hypofunction: severe (n = 6), and asymmetric (n = 4). Right-sided VOR gain was highest in those aged 60-69 years (0.96), intermediate in those aged 70-79 years (0.89), and lowest in patients aged ≥ 80 years (0.77; p < 0.001). Presbyvestibulopathy was uncommon as a final diagnosis across all age groups, with a total prevalence of 2.9% (n = 3). All three of these patients had treatable comorbidities (e.g., anxiety).

VOR gain by vHIT declines with age in patients with symptomatic dizziness; however, most patients aged ≥ 60 still demonstrate normal VOR gains. The diagnosis of presbyvestibulopathy is uncommon in older adults with dizziness; a more specific vestibular diagnosis is often more appropriate. Even in those with presbyvestibulopathy, treatment of comorbidities can improve symptoms and function.