Persistent Dizziness in Elderly: Exploring Unresolved Neurological Issues

An 88-year-old elderly person is experiencing dizziness?

Hello, doctor.
My grandmother has been experiencing dizziness for many years.
She has undergone examinations by an otolaryngologist with no issues found, and the cardiologist also reported no problems.
She has visited various major hospitals in Taichung for neurology consultations, but the cause of her dizziness remains undetermined.
Her dizziness is not characterized by vertigo; it is simply a feeling of lightheadedness.
What other tests can we consider, or which other specialties should we consult?

Zhang Xiaojie, 30~39 year old female. Ask Date: 2015/09/08

Dr. Gao Chunde reply Neurology

Dizziness can have many causes, and not all of them can be detected through instruments or tests.
Both physiological and pathological dizziness should be considered, and if no results are found, psychological causes must also be taken into account.
Generally, neurologists, cardiologists, and otolaryngologists have extensive experience in this area, and if the dizziness is not physiological, they are aware of the need to consider psychological issues.
If necessary, patients may be referred to a psychiatrist for further evaluation and treatment.
However, elderly individuals often experience issues with incomplete or uncoordinated signals due to central or peripheral nerve degeneration, which can manifest as dizziness.

Reply Date: 2015/09/08

More Info

Persistent dizziness in the elderly can be a complex issue, especially when multiple specialists have ruled out common causes. Given your grandmother's ongoing symptoms, it’s essential to consider a comprehensive approach to her condition.

Firstly, it’s important to understand that dizziness can arise from various sources, and it may not always be linked to a single identifiable cause. In older adults, dizziness can be multifactorial, involving a combination of vestibular, cardiovascular, neurological, and even psychological factors. Since your grandmother has already been evaluated by ENT, cardiology, and neurology without a definitive diagnosis, it may be beneficial to explore some additional avenues.

1. Vestibular Disorders: While ENT specialists typically evaluate vestibular function, some conditions may not be easily diagnosed through standard tests. Consider seeking a referral to a vestibular rehabilitation specialist or an audiologist who specializes in vestibular disorders. They can conduct more specific tests, such as videonystagmography (VNG) or vestibular evoked myogenic potentials (VEMP), to assess inner ear function more thoroughly.

2. Medication Review: Older adults often take multiple medications, which can lead to side effects, including dizziness. A comprehensive medication review by a geriatrician or a pharmacist specializing in geriatric care might reveal potential interactions or side effects contributing to her symptoms.
3. Orthostatic Hypotension: This condition, characterized by a significant drop in blood pressure upon standing, can cause dizziness. It may not always be detected during routine evaluations. A tilt table test or monitoring blood pressure in different positions (lying down, sitting, and standing) can help diagnose this issue.

4. Cognitive Assessment: Sometimes, dizziness can be related to cognitive issues or anxiety, particularly in older adults. A neuropsychological evaluation might be warranted to assess for any underlying cognitive decline or anxiety disorders that could be contributing to her symptoms.

5. Blood Tests: Comprehensive blood work can help rule out metabolic or endocrine issues, such as thyroid dysfunction, vitamin deficiencies (like B12), or anemia, which can also lead to dizziness.

6. Physical Therapy: If her dizziness is related to balance issues, a referral to a physical therapist specializing in balance and vestibular rehabilitation could be beneficial. They can provide exercises to improve stability and reduce the sensation of dizziness.

7. Alternative Approaches: If conventional medical evaluations do not yield results, some patients find relief through alternative therapies such as acupuncture or chiropractic care. While these should be approached cautiously and discussed with her primary care provider, they may offer some benefit.

8. Follow-Up with a Geriatrician: Given your grandmother's age and the complexity of her symptoms, a geriatrician can provide a holistic assessment and coordinate care among various specialists. They can help ensure that all potential causes are explored and that her overall health is managed effectively.

In conclusion, persistent dizziness in the elderly can be challenging to diagnose and treat. It often requires a multidisciplinary approach to identify the underlying causes. Encourage your grandmother to continue seeking care and to advocate for thorough evaluations. Keeping a detailed diary of her symptoms, including when they occur and any associated factors, can also be helpful for her healthcare providers in determining the best course of action.

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