Gufoni M, Guidetti G, Nuti D, Pagnini P, Vicini C, Tinelli C, Mira E
Ambulatorio Otorinolaringoiatria, Azienda Ospedaliera 6, Livorno.
Acta Otorhinolaryngol Ital. 2005 Jun;25(3 Suppl 79):12-21.
Balance and spatial orientation complaints, generically defined as "dizziness", are frequent in the elderly. They can cause a greater or lesser degree of handicap, and be associated with a greater or lesser degree of cognitive impairment and anxiety-depression symptoms. We examined 163 patients, referred for these complaints to the otoneurological outpatient services of 6 university hospital centres of the northern and central Italy, performing a bedside vestibular examination. The test allowed to distinguish between subjects with specific vestibular disorders (mainly BVP, Menière's disease and vestibular neuritis) and subjects in who the vestibular examination was not significant, and whose dizziness probably resulted from impairment or disease in multiple systems. The evaluation of the degree of handicap, using the Dizziness Handicap Inventory, showed that in the former group the physical parameters were significantly impaired with respect of a group of 81 age matched healthy controls, whereas the functional and emotional parameters were not. The evaluation of the degree of anxiety-depression, using the Hospital Anxiety Depression Scale, showed that all elderly people with balance and spatial orientation complaints present a degree of anxiety, but not of depression, greater than the controls, irrespective of the vestibular or extravestibular origin of the symptoms. The evaluation of the cognitive level, using the Mini Mental Test, showed that it is similar to the cognitive level in the controls when, according to the results of the otoneurological examination, the balance and spatial orientation complaints are due to vestibular disorders, but it is impaired when these symptoms are related to a dizziness of multifactorial aetiology. The presence of comorbidities is also higher in these patients. It is likely that in the elderly balance and spatial orientation complaints not caused by specific vestibular disorders are due to a dizziness of multifactorial origin, both organic and psychic, that can be classified as a geriatric syndrome.
平衡和空间定向障碍，一般定义为“头晕”，在老年人中很常见。它们可导致不同程度的残疾，并与不同程度的认知障碍和焦虑抑郁症状相关。我们检查了163例因这些症状转诊至意大利北部和中部6家大学医院中心耳神经科门诊的患者，并进行了床边前庭检查。该检查能够区分患有特定前庭疾病（主要是良性阵发性位置性眩晕、梅尼埃病和前庭神经炎）的患者和前庭检查无明显异常、其头晕可能由多个系统的损伤或疾病引起的患者。使用头晕残障量表评估残疾程度，结果显示，与81名年龄匹配的健康对照组相比，前一组的身体参数明显受损，而功能和情感参数则未受损。使用医院焦虑抑郁量表评估焦虑抑郁程度，结果显示，所有有平衡和空间定向障碍主诉的老年人，无论症状的前庭或前庭外起源如何，其焦虑程度均高于对照组，但抑郁程度则不然。使用简易精神状态检查表评估认知水平，结果显示，根据耳神经科检查结果，当平衡和空间定向障碍主诉由前庭疾病引起时，其认知水平与对照组相似，但当这些症状与多因素病因引起的头晕有关时，认知水平则受损。这些患者的合并症发生率也更高。在老年人中，非由特定前庭疾病引起的平衡和空间定向障碍主诉，很可能是由多因素起源的头晕所致，包括器质性和精神性因素，可归类为一种老年综合征。
