Ikeda Katsuhisa, Tanaka Kumiko, Tajima Shori, Takakura Tomokazu, Sugihara Masami, Ono Koichi
Department of Otorhinolaryngology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan.
Department of Rehabilitation, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo, 136-0075, Japan.
BMC Geriatr. 2024 Dec 27;24(1):1042. doi: 10.1186/s12877-024-05620-y.
Dizziness and unstable gait with resultant falls are common symptoms among the older adults. Most of studies have focused on statistical analysis regarding single factor related to dizziness and unstable gait. On the other hand, there are very few comprehensive studies using a large number of patients except several review papers.
We retrospectively analyzed a total of 164 aged patients with dizziness and unstable gait. The patients underwent description of the Japanese version of the Dizziness Handicap Inventory (DHI), measurements of vestibular function, handgrip muscle strength, physical performance, height-adjusted appendicular skeletal muscle mass, and vitamin B1 and B12, a full-night polysomnography study, cognition test and visual test.
Average age was 80.5 ± 6.1 years and ranged from 59 to 91 years. Forty-eight were males and 116 females. Three causative factors, namely vestibular hypofunction, muscle dysfunction and sleep disturbance, were independently and combinedly associated with dizziness and unstable gait in over 93% of the patients. Patients with higher scores defined by these three causative factors had higher scores of DHI. 23% of the patients showed vitamin B1 and/or B12 deficiency, which was highly associated with sarcopenia/frailty. Cognitive and visual impairment were recognized in 4.9% and 5.0%, respectively.
Dizziness and unstable gait were mainly associated with vestibular hypofunction, muscle dysfunction and sleep disturbance. In addition, vitamin B1 and B12 deficiency, and cognitive and visual impairment secondarily contribute to dizziness and unstable gait. Appropriate selection of treatment according to the underlying causes would prevent accidental falls among the older adults.
头晕和步态不稳导致跌倒在老年人中是常见症状。大多数研究集中于对与头晕和步态不稳相关的单一因素进行统计分析。另一方面，除了几篇综述文章外，很少有使用大量患者的综合性研究。
我们回顾性分析了总共164例有头晕和步态不稳的老年患者。这些患者接受了日语版头晕残障量表（DHI）的描述、前庭功能测量、握力、身体性能、身高调整后的四肢骨骼肌质量以及维生素B1和B12检测、整夜多导睡眠图研究、认知测试和视力测试。
平均年龄为80.5±6.1岁，范围从59岁至91岁。男性48例，女性116例。三个致病因素，即前庭功能减退、肌肉功能障碍和睡眠障碍，在超过93%的患者中与头晕和步态不稳独立且合并相关。由这三个致病因素定义的得分较高的患者DHI得分也较高。23%的患者显示维生素B1和/或B12缺乏，这与肌肉减少症/虚弱高度相关。认知障碍和视力障碍分别在4.9%和5.0%的患者中被识别出。
头晕和步态不稳主要与前庭功能减退、肌肉功能障碍和睡眠障碍相关。此外，维生素B1和B12缺乏以及认知和视力障碍继发导致头晕和步态不稳。根据潜在病因适当选择治疗方法可预防老年人意外跌倒。
