Vestibular Pathology and Instability in the Elderly and its Relationship with Small Vessel Disease. Cross-Sectional Descriptive Study

Introduction and objective: The high prevalence of dizziness and instability in the elderly, its heterogeneous etiology, and its important consequences (falls and their subsequent lesions) imply a serious sanitary problem. The objective of the following study is to determine if there is any relation between those symptoms and the presence of small vessel disease. Second, we will try to describe the most frequent causes of dizziness and instability in the elderly. Method: A cross-sectional study was conducted on 214 patients over 70 years of age who had been referred for the assessment of vertigo, dizziness or instability. The most frequent diagnoses were evaluated, and three groups were compared: 1) peripheral vestibular disorders, 2) dizziness or instability of unknown etiology and 3) control group. To this end we used Fazekas scale, which determines the magnitude of white matter lesions using magnetic resonance imaging. Results: Benign paroxysmal positional vertigo was the most frequent diagnosis (17,3%), followed by Meniere's disease (15%). 20% of patients were classified like unknown or multifactorial etiology. Small vessel disease was more frequently found in the group with dizziness of unknown etiology (p=0,034). Conclusions: In the study we confirm the association between white matter lesions, suggestive of small vessel disease, and the more frequent appearance of dizziness and instability in the elderly, since the prevalence of the disease is significantly lower in the control group than in those with dizziness of unknown etiology. Futermore, we conclude that the benign paroxysmal positional vertigo is the most frequent diagnosis of dizziness and instability in the elderly, ahead of Meniere's disease.