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Persistent Postural-Perceptual Dizziness in Older Adults: Associations With Intrinsic Capacity Decline, Probable
Nagihan Sözen Gencer1, Sibel Cavdar2, Mehmet Fatih Özhan3
1Division of Geriatrics, Department of Internal Medicine, Balıkesir Atatürk City Hospital, Balıkesir, Turkiye.
Introduction:
Persistent postural-perceptual dizziness (PPPD) is a chronic dizziness disorder in older adults, characterized by persistent non-vertiginous dizziness and postural instability. This study aimed to investigate the associations of intrinsic capacity, sarcopenia and geriatric syndromes with PPPD in older adults.
Methods:
This cross-sectional study included 263 individuals aged over 65 years (128 with PPPD and 135 without PPPD) attending geriatric and otorhinolaryngology outpatient clinics. PPPD was diagnosed according to Bárány Society criteria. Comprehensive geriatric assessment included intrinsic capacity domains, frailty (FRAIL scale), handgrip strength (HGS), sarcopenia parameters and history of falls. Multiple logistic regression models were constructed to evaluate independent associations while avoiding collinearity between overlapping variables. Separate models were used to assess physical performance, intrinsic capacity, sarcopenia and geriatric syndromes.
Results:
Participants with PPPD had significantly lower intrinsic capacity, slower gait speed, lower handgrip strength, higher depressive symptoms, higher frailty and more frequent falls (all p ≤ 0.005). In locomotion-based models, slower gait speed (OR = 0.121, 95% CI: 0.031-0.474; p = 0.002), higher GDS-15 scores (OR = 1.131, 95% CI: 1.021-1.252; p = 0.018) and fall history (OR = 2.660, 95% CI: 1.502-4.711; p = 0.001) were independently associated with PPPD. In muscle strength models, lower handgrip strength was also associated with PPPD (OR = 0.927, 95% CI: 0.879-0.978; p = 0.006). Domain-based analysis showed that locomotor and psychological impairments were independently associated with PPPD. Lower intrinsic capacity was strongly associated with PPPD (OR = 0.497, 95% CI: 0.377-0.656; p < 0.001). In clinically oriented models, probable sarcopenia (OR = 2.185, 95% CI: 1.188-4.018; p = 0.012), frailty (OR = 2.381, 95% CI: 1.323-4.285; p = 0.004) and depression (OR = 2.558, 95% CI: 1.387-4.717; p = 0.003) were independently associated with PPPD, while malnutrition did not show a significant association.
Conclusion:
PPPD in older adults extends beyond a purely vestibular disorder, encompassing geriatric dimensions such as frailty, muscle weakness and depressive symptoms. An integrated otolaryngology-geriatrics care model is warranted, and longitudinal studies evaluating the impact of geriatric interventions on PPPD's natural history are needed.
