Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK.
Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA.
Age Ageing. 2023 Nov 2;52(11). doi: 10.1093/ageing/afad206.
Benign paroxysmal positional vertigo (BPPV) is amongst the commonest causes of dizziness and falls in older adults. Diagnosing and treating BPPV can reduce falls, and thereby reduce fall-related morbidity and mortality. Recent World Falls Guidelines recommend formal assessment for BPPV in older adults at risk of falling, but only if they report vertigo. However, this recommendation ignores the data that (i) many older adults with BPPV experience dizziness as vague unsteadiness (rather than vertigo), and (ii) others may experience no symptoms of dizziness at all. BPPV without vertigo is due to an impaired vestibular perception of self-motion, termed 'vestibular agnosia'. Vestibular agnosia is found in ageing, neurodegeneration and traumatic brain injury, and results in dramatically increased missed BPPV diagnoses. Patients with BPPV without vertigo are typically the most vulnerable for negative outcomes associated with this disorder. We thus recommend simplifying the World Falls Guidelines: all older adults (>60 years) with objective or subjective balance problems, irrespective of symptomatic complaint, should have positional testing to examine for BPPV.
良性阵发性位置性眩晕（BPPV）是老年人头晕和跌倒的常见原因之一。诊断和治疗 BPPV 可以减少跌倒，从而降低与跌倒相关的发病率和死亡率。最近的世界跌倒指南建议对有跌倒风险的老年人进行 BPPV 的正式评估，但前提是他们报告有眩晕。然而，这一建议忽略了以下数据：（i）许多患有 BPPV 的老年人将头晕描述为模糊的不稳定感（而非眩晕），以及（ii）其他人可能根本没有头晕症状。没有眩晕的 BPPV 是由于对自身运动的前庭感知受损，称为“前庭认知障碍”。前庭认知障碍在衰老、神经退行性变和创伤性脑损伤中存在，导致 BPPV 诊断明显漏诊。没有眩晕的 BPPV 患者通常是与这种疾病相关的负面后果最易受影响的人群。因此，我们建议简化世界跌倒指南：所有有客观或主观平衡问题的老年人（>60 岁），无论症状如何，都应进行位置测试以检查 BPPV。
