The association between impaired perception of verticality and cerebral white matter lesions in the elderly patients with orthostatic hypotension

BACKGROUND: The morbidity of orthostatic hypotension (OH) increases with aging and the elderly often complain of dizziness associated with OH, which is implicated in white matter lesions (WMLs) on MRI. However little is known how WMLs are contributed to the development of dizziness in elderly patients. OBJECTIVE: We evaluated the involvement of cerebral WMLs in the vertical perception in the elderly with OH. METHODS: This study consisted of 71 dizzy patients who underwent the examinations including the Schellong orthostatic test and subjective visual vertical (SVV) test. RESULTS: The male patients aged >= 65 years with OH (1.9 +/- 0.9 degrees) showed a significantly higher magnitude of variance of SVV, which reflects an impaired vertical perception, in comparison with the male patients aged >= 65 years without OH and the male patients aged < 65 years with OH (1.0 +/- 0.4 degrees, 0.9 +/- 0.4 degrees, p < 0.05). The variance of SVV significantly correlated with the volume of WMLs in both sides on MRI in the male, but not female patients (p < 0.01). CONCLUSIONS: Our results suggest that severe WMLs in the elderly with OH are involved in impaired perception of verticality, resulting in inducing subjective dizziness.