Persistent Dizziness in Older Adults: A Neurological Perspective

Mom is experiencing dizziness, but the cause cannot be identified?

Hello, doctor.
My mother's symptoms include dizziness, where her vision sways side to side as if experiencing an earthquake.
She feels unsteady whether standing or sitting, but the symptoms improve or disappear when lying down.
This has occurred twice.
The first episode lasted about a week and resolved on its own, during which she did not experience dizziness while sitting.
The second episode has persisted since December of last year, and now she experiences dizziness even while sitting.
The dizziness has not improved.
She has seen a neurologist who performed a brain CT and vascular ultrasound, both of which returned normal results.
She has also consulted an ENT specialist who ruled out benign paroxysmal positional vertigo (BPPV).
Her heart is healthy, and her blood pressure has been checked, ruling out orthostatic hypotension.
The prescribed anti-dizziness medication has had little effect.
She has visited 3 to 4 different doctors.
Sometimes, sitting in the waiting room is very uncomfortable, and eating while sitting is also distressing.
She can only rest in bed all day, and occasionally, when the dizziness lessens, she can walk a bit.
There are days when the dizziness suddenly intensifies, forcing her to lie down again.
My mother is now 70 years old.
Could the dizziness be related to organ aging? We are currently at a loss regarding the cause, which is very distressing.

Afu, 40~49 year old female. Ask Date: 2024/03/10

Dr. Jiang Junyi reply Neurology

Dear Mr.
Afu,
You mentioned that your mother experiences dizziness that feels like the ground is shaking, making it difficult for her to stand, and that she can only lie in bed all day, with occasional relief allowing her to walk.
The improvement when lying down suggests that we should first rule out symptoms caused by dehydration leading to insufficient cerebral circulation.
This can be addressed by replenishing fluids and electrolytes.
In addition to magnetic resonance imaging (MRI), blood tests can assist in evaluating the cause of dizziness.
These tests should include screening for potential complications such as anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders.
If multiple issues are present, I recommend changing physicians to gain a different perspective on treatment, and seeking a nearby hospital with an emergency department to consolidate medical information in one place.
It is also important to understand the purpose and timing of each medication prescribed.
From my clinical perspective, bodily ailments are dynamic and require adjustments in medical care as the body changes.
I suggest that you gather information and consult a neurologist to discuss further examinations and treatment options.
Thank you for your inquiry, and I welcome further discussion.
Wishing you and your mother good health, safety, and happiness.
Sincerely,
Dr.
Jiang, Department of Neurology, Taoyuan Hospital

Reply Date: 2024/03/10

More Info

Persistent dizziness in older adults can be a complex issue, often requiring a thorough evaluation to determine the underlying cause. Given your mother's symptoms of dizziness, which include a sensation of the environment swaying as if in an earthquake, and the fact that her dizziness improves when lying down, there are several potential neurological and non-neurological factors to consider.

Firstly, it is important to note that dizziness can be categorized into two main types: vertigo, which is a false sense of movement, and non-vertiginous dizziness, which may include lightheadedness or imbalance. The description of your mother's symptoms suggests that she may be experiencing a form of vertigo, although the improvement when lying down could indicate other underlying issues.

One common cause of dizziness in older adults is vestibular dysfunction, which affects the inner ear's ability to maintain balance. While you mentioned that an ENT specialist ruled out benign paroxysmal positional vertigo (BPPV), other vestibular disorders could still be at play. For instance, vestibular neuritis or labyrinthitis, which are often viral in nature, can lead to prolonged dizziness and imbalance.

Another possibility is that your mother may be experiencing a form of orthostatic hypotension, where blood pressure drops significantly upon standing, leading to dizziness. Although you indicated that her blood pressure has been checked, it may be worth re-evaluating this condition, especially in different positions (lying down, sitting, and standing) to see if there are any significant changes.

Additionally, neurological conditions such as transient ischemic attacks (TIAs) or even early signs of neurodegenerative diseases like Parkinson's disease or Alzheimer's disease can manifest as dizziness or balance issues. Given her age, it is essential to consider these possibilities, especially if there are any accompanying symptoms such as memory loss, changes in gait, or difficulty with coordination.

Furthermore, medication side effects can also contribute to dizziness. If your mother is taking multiple medications, it would be prudent to review them with her healthcare provider to identify any potential interactions or side effects that could be exacerbating her symptoms.

In terms of management, since the dizziness has persisted despite various evaluations and treatments, a multidisciplinary approach may be beneficial. This could include physical therapy focused on vestibular rehabilitation, which can help improve balance and reduce dizziness. Additionally, lifestyle modifications such as hydration, gradual changes in position, and avoiding sudden movements may also help alleviate symptoms.

Lastly, considering your mother's age and the complexity of her symptoms, it may be worthwhile to seek a second opinion from a neurologist who specializes in geriatric medicine or dizziness disorders. They may recommend further diagnostic tests, such as MRI or specialized vestibular testing, to uncover any underlying issues that have not yet been identified.

In conclusion, persistent dizziness in older adults can stem from a variety of causes, including vestibular disorders, neurological conditions, medication side effects, and orthostatic hypotension. A comprehensive evaluation and a multidisciplinary approach to management are essential in addressing this challenging symptom. It is crucial to continue advocating for your mother's health and seeking appropriate care until a definitive cause is identified and effectively managed.

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