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Головокружение в пожилом возрасте: особенности течения и возможности реабилитации
Головокружение в пожилом возрасте: особенности течения и возможности реабилитации
Кунельская Н.Л., Гусева А.Л., Байбакова Е.В. и др. Головокружение в пожилом возрасте: особенности течения и возможности реабилитации. Consilium Medicum. 2017; 19 (2.1): 94–97.
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Аннотация
Жалобы на головокружение и нарушение равновесия часто встречаются у пожилых пациентов. В статье представлены возрастные особенности вестибулярных рецепторов лабиринта и вестибулярных центров центральной нервной системы, а также зрительной и проприоцептивной системы, участвующих в поддержании равновесия. Авторы приводят алгоритм клинического обследования пожилого пациента с головокружением с использованием как простых тестов, так и сложного диагностического оборудования. Рассмотрены наиболее часто встречаемые вестибулопатии, особенности их диагностики и принципы реабилитации в пожилом возрасте.
Ключевые слова: пожилые пациенты, вестибулопатия, вестибулярная реабилитация.
Key words: elderly patients, vestibulopathy, vestibular rehabilitation.
Ключевые слова: пожилые пациенты, вестибулопатия, вестибулярная реабилитация.
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Key words: elderly patients, vestibulopathy, vestibular rehabilitation.
Полный текст
Список литературы
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28. Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C et al. Benign paroxysmal positional vertigo in the elderly. Gerontology 2013; 59 (5): 408–12. DOI: 10.1159/000351204.
29. Johkura K, Momoo T, Kuroiwa Y. Positional nystagmus in patients with chronic dizziness. J Neurol Neurosurg Psychiatry 2008; 79 (12): 1324–6.
30. Кунельская Н.Л., Гусева А.Л., Байбакова Е.В. и др. Эффективный алгоритм диагностики и лечения доброкачественного пароксизмального позиционного головокружения. Вестн. оториноларингологии. 2015; 5: 19–22. / Kunel'skaya N.L., Guseva A.L., Baybakova E.V. i dr. Effektivnyy algoritm diagnostiki i lecheniya dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya. Vestn. otorinolaringologii. 2015; 5: 19–22. [in Russian]
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2. Jonsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 2004; 14 (1): 47–52.
3. Barin K1, Dodson EE. Dizziness in the elderly. Otolaryngol Clin North Am 2011; 44 (2): 437–54. DOI: 10.1016/j.otc.2011.01.013.
4. Nevitt MC, Commings SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J Am Geriatr Soc 1994; 42 (8): 909.
5. Mueller M, Strobl R, Jahn K et al. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study.Eur J Public Health 2014; 24 (5): 802–7. DOI: 10.1093/eurpub/ckt171.
6. Belal A, Glorig A. Dysequilibrium of ageing (presbyastasis). J Laryngol Otol 1986; 100 (9): 1037–41.
7. Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med 2000; 132 (5): 337–44.
8. Richter E. Quantitative study of human Scarpa's ganglion and vestibular sensory epithelia. Acta Otolaryngol 1980; 90 (3–4): 199–208.
9. Merchant SN, Velázquez-Villaseñor L, Tsuji K et al. Temporal bone studies of the human peripheral vestibular system. Normative vestibular hair cell data. Ann Otol Rhinol Laryngol (Suppl.) 2000; 181: 3–13.
10. Davalos-Bichara M, Agrawal Y. Normative results of healthy older adults on standard clinical vestibular tests. Otol Neurotol 2014; 35 (2): 297–300. DOI: 10.1097/MAO.0b013e3182a09ca8.
11. Li C, Layman AJ, Geary R et al. Epidemiology of vestibulo-ocular reflex function: data from the Baltimore Longitudinal Study of Aging. Otol Neurotol 2015; 36 (2): 267–72. DOI: 10.1097/MAO.0000000000000610.
12. Peterka RJ, Black FO, Schoenhoff MB. Age-related changes in human vestibulo-ocular reflexes: sinusoidal rotation and caloric tests. J Vestib Res 1990; 1 (1): 49–59.
13. Maleki M, Jafari Z, Zarrinkoob H, Akbarzadeh Baghban A. Effect of aging on saccular function. Med J Islam Repub Iran 2014; 28: 117.
14. Alvarez JC, Díaz C, Suárez C et al. Neuronal loss in human medial vestibular nucleus. Anat Rec 1998; 251 (4): 431–8.
15. Yesmin T, Ara S, Umar BU et al. Numbers of Purkinje cell with increasing age-a post mortem study. FMCJ 2011; 6 (2): 92–4. DOI: 10.3329/fmcj.v6i2.9209.
16. Sun DQ, Zuniga MG, Davalos-Bichara M et al. Evaluation of a bedside test of utricular function – the bucket test – in older individuals. Acta Otolaryngol 2014; 134 (4): 382–9. DOI: 10.3109/00016489.2013.867456.
17. Tourtillott BM, Ferraro JA, Bani-Ahmed A et al. Age-related changes in vestibular evoked myogenic potentials using a modified blood pressure manometer feedback method. Am J Audiol 2010; 19 (2): 100–8. DOI: 10.1044/1059-0889(2010/10-0021).
18. Newman-Toker DE, Cannon LM, Stofferahn ME et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82 (11): 1329–40.
19. Tuunainen E, Poe D, Jäntti P et al. Presbyequilibrium in the oldest old, a combination of vestibular, oculomotor and postural deficits. Aging Clin Exp Res 2011; 23 (5–6): 364–71. DOI: 10.3275/7623.
20. Cohen HS, Mulavara AP, Peters BT et al. Standing balance tests for screening people with vestibular impairments. Laryngoscope 2014; 124 (2): 545–50. DOI: 10.1002/lary.24314.
21. Pal'chun V.T., Guseva A.L., Chistov S.D., Levina Yu.V. Otonevrologicheskoe obsledovanie patsienta s golovokruzheniem. Vestn. otorinolaringologii. 2015; 5: 60–6. [in Russian]
22. Soto-Varela A, Faraldo-García A, Rossi-Izquierdo M et al. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx 2015; 42 (1): 8–14. DOI: 10.1016/j.anl.2014.06.005.
23. Curthoys IS. The interpretation of clinical tests of peripheral vestibular function. Laryngoscope 2012; 122 (6): 1342–52. DOI: 10.1002/lary.23258.
24. Suvorov A.Yu., Samsygina O.M., Ivanova G.E., Efremova N.M. Organizatsionnye aspekty provedeniya reabilitatsionnykh meropriyatiy v ostreyshiy period tserebral'nogo insul'ta. Lechebnaya fizkul'tura i sportivnaya meditsina. 2009; 8: 45–9. [in Russian]
25. Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11): 3504–10. DOI: 10.1161/STROKEAHA.109.551234.
26. Zamergrad M.V. Kak raspoznat' insul't u bol'nogo s ostrym golovokruzheniem? Sovr. terapiya v psikhiatrii i nevrologii. 2016; 1: 8–12. [in Russian]
27. Katsarkas A. Dizziness in aging: a retrospective study of 1194 cases. Otolaryngol Head Neck Surg 1994; 110 (3): 296–301.
28. Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C et al. Benign paroxysmal positional vertigo in the elderly. Gerontology 2013; 59 (5): 408–12. DOI: 10.1159/000351204.
29. Johkura K, Momoo T, Kuroiwa Y. Positional nystagmus in patients with chronic dizziness. J Neurol Neurosurg Psychiatry 2008; 79 (12): 1324–6.
30. Kunel'skaya N.L., Guseva A.L., Baybakova E.V. i dr. Effektivnyy algoritm diagnostiki i lecheniya dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya. Vestn. otorinolaringologii. 2015; 5: 19–22. [in Russian]
31. Wladislavosky-Waserman P, Facer GW, Mokri B, Kurland LT. Meniere’s disease: a 30-year epidemiologic and clinical study in Rochester, Mn, 1951–1980. Laryngoscope 1984; 94 (8): 1098–102.
32. Levina Yu.V., Kunel'skaya N.L., Krasyuk A.A., Baush Ya.A. Epidemiologicheskaya kharakteristika bol'nykh, stradayushchikh kokhleovestibulyarnymi narusheniyami pri gidropse labirinta. Vestn. otorinolaringologii. 2011; 4: 40–2. [in Russian]
33. Kentala E, Havia M, Pyykkö I. Short-lasting drop attacks in Meniere's disease. Otolaryngol Head Neck Surg 2001; 124 (5): 526–30.
34. Godemann F, Siefert K, Hantschke-Bruggemann M et al. What accounts for vertigo one year after neuritis vestibularis – anxiety or a dysfunctional vestibular organ? J Psychiatr Res 2005; 39 (5): 529–34.
35. Howe TE, Rochester L, Neil F et al. Exercise for improving balance in older people. Cochrane Database Syst Rev 2011; 11: CD004963. DOI: 10.1002/14651858.CD004963.pub3.
36. Kunel'skaya N.L., Baybakova E.V., Chugunova M.A., Guseva A.L. Ispol'zovanie metodov vestibulyarnoy reabilitatsii v kompleksnoy terapii vestibulyarnykh narusheniy razlichnogo geneza. Lechebnoe delo. 2015; 2: 52–5. [in Russian]
2. Jonsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 2004; 14 (1): 47–52.
3. Barin K1, Dodson EE. Dizziness in the elderly. Otolaryngol Clin North Am 2011; 44 (2): 437–54. DOI: 10.1016/j.otc.2011.01.013.
4. Nevitt MC, Commings SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J Am Geriatr Soc 1994; 42 (8): 909.
5. Mueller M, Strobl R, Jahn K et al. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study.Eur J Public Health 2014; 24 (5): 802–7. DOI: 10.1093/eurpub/ckt171.
6. Belal A, Glorig A. Dysequilibrium of ageing (presbyastasis). J Laryngol Otol 1986; 100 (9): 1037–41.
7. Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med 2000; 132 (5): 337–44.
8. Richter E. Quantitative study of human Scarpa's ganglion and vestibular sensory epithelia. Acta Otolaryngol 1980; 90 (3–4): 199–208.
9. Merchant SN, Velázquez-Villaseñor L, Tsuji K et al. Temporal bone studies of the human peripheral vestibular system. Normative vestibular hair cell data. Ann Otol Rhinol Laryngol (Suppl.) 2000; 181: 3–13.
10. Davalos-Bichara M, Agrawal Y. Normative results of healthy older adults on standard clinical vestibular tests. Otol Neurotol 2014; 35 (2): 297–300. DOI: 10.1097/MAO.0b013e3182a09ca8.
11. Li C, Layman AJ, Geary R et al. Epidemiology of vestibulo-ocular reflex function: data from the Baltimore Longitudinal Study of Aging. Otol Neurotol 2015; 36 (2): 267–72. DOI: 10.1097/MAO.0000000000000610.
12. Peterka RJ, Black FO, Schoenhoff MB. Age-related changes in human vestibulo-ocular reflexes: sinusoidal rotation and caloric tests. J Vestib Res 1990; 1 (1): 49–59.
13. Maleki M, Jafari Z, Zarrinkoob H, Akbarzadeh Baghban A. Effect of aging on saccular function. Med J Islam Repub Iran 2014; 28: 117.
14. Alvarez JC, Díaz C, Suárez C et al. Neuronal loss in human medial vestibular nucleus. Anat Rec 1998; 251 (4): 431–8.
15. Yesmin T, Ara S, Umar BU et al. Numbers of Purkinje cell with increasing age-a post mortem study. FMCJ 2011; 6 (2): 92–4. DOI: 10.3329/fmcj.v6i2.9209.
16. Sun DQ, Zuniga MG, Davalos-Bichara M et al. Evaluation of a bedside test of utricular function – the bucket test – in older individuals. Acta Otolaryngol 2014; 134 (4): 382–9. DOI: 10.3109/00016489.2013.867456.
17. Tourtillott BM, Ferraro JA, Bani-Ahmed A et al. Age-related changes in vestibular evoked myogenic potentials using a modified blood pressure manometer feedback method. Am J Audiol 2010; 19 (2): 100–8. DOI: 10.1044/1059-0889(2010/10-0021).
18. Newman-Toker DE, Cannon LM, Stofferahn ME et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007; 82 (11): 1329–40.
19. Tuunainen E, Poe D, Jäntti P et al. Presbyequilibrium in the oldest old, a combination of vestibular, oculomotor and postural deficits. Aging Clin Exp Res 2011; 23 (5–6): 364–71. DOI: 10.3275/7623.
20. Cohen HS, Mulavara AP, Peters BT et al. Standing balance tests for screening people with vestibular impairments. Laryngoscope 2014; 124 (2): 545–50. DOI: 10.1002/lary.24314.
21. Пальчун В.Т., Гусева А.Л., Чистов С.Д., Левина Ю.В. Отоневрологическое обследование пациента с головокружением. Вестн. оториноларингологии. 2015; 5: 60–6. / Pal'chun V.T., Guseva A.L., Chistov S.D., Levina Yu.V. Otonevrologicheskoe obsledovanie patsienta s golovokruzheniem. Vestn. otorinolaringologii. 2015; 5: 60–6. [in Russian]
22. Soto-Varela A, Faraldo-García A, Rossi-Izquierdo M et al. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx 2015; 42 (1): 8–14. DOI: 10.1016/j.anl.2014.06.005.
23. Curthoys IS. The interpretation of clinical tests of peripheral vestibular function. Laryngoscope 2012; 122 (6): 1342–52. DOI: 10.1002/lary.23258.
24. Суворов А.Ю., Самсыгина О.М., Иванова Г.Е., Ефремова Н.М. Организационные аспекты проведения реабилитационных мероприятий в острейший период церебрального инсульта. Лечебная физкультура и спортивная медицина. 2009; 8: 45–9. / Suvorov A.Yu., Samsygina O.M., Ivanova G.E., Efremova N.M. Organizatsionnye aspekty provedeniya reabilitatsionnykh meropriyatiy v ostreyshiy period tserebral'nogo insul'ta. Lechebnaya fizkul'tura i sportivnaya meditsina. 2009; 8: 45–9. [in Russian]
25. Kattah JC, Talkad AV, Wang DZ et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11): 3504–10. DOI: 10.1161/STROKEAHA.109.551234.
26. Замерград М.В. Как распознать инсульт у больного с острым головокружением? Совр. терапия в психиатрии и неврологии. 2016; 1: 8–12. / Zamergrad M.V. Kak raspoznat' insul't u bol'nogo s ostrym golovokruzheniem? Sovr. terapiya v psikhiatrii i nevrologii. 2016; 1: 8–12. [in Russian]
27. Katsarkas A. Dizziness in aging: a retrospective study of 1194 cases. Otolaryngol Head Neck Surg 1994; 110 (3): 296–301.
28. Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C et al. Benign paroxysmal positional vertigo in the elderly. Gerontology 2013; 59 (5): 408–12. DOI: 10.1159/000351204.
29. Johkura K, Momoo T, Kuroiwa Y. Positional nystagmus in patients with chronic dizziness. J Neurol Neurosurg Psychiatry 2008; 79 (12): 1324–6.
30. Кунельская Н.Л., Гусева А.Л., Байбакова Е.В. и др. Эффективный алгоритм диагностики и лечения доброкачественного пароксизмального позиционного головокружения. Вестн. оториноларингологии. 2015; 5: 19–22. / Kunel'skaya N.L., Guseva A.L., Baybakova E.V. i dr. Effektivnyy algoritm diagnostiki i lecheniya dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya. Vestn. otorinolaringologii. 2015; 5: 19–22. [in Russian]
31. Wladislavosky-Waserman P, Facer GW, Mokri B, Kurland LT. Meniere’s disease: a 30-year epidemiologic and clinical study in Rochester, Mn, 1951–1980. Laryngoscope 1984; 94 (8): 1098–102.
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32. Levina Yu.V., Kunel'skaya N.L., Krasyuk A.A., Baush Ya.A. Epidemiologicheskaya kharakteristika bol'nykh, stradayushchikh kokhleovestibulyarnymi narusheniyami pri gidropse labirinta. Vestn. otorinolaringologii. 2011; 4: 40–2. [in Russian]
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35. Howe TE, Rochester L, Neil F et al. Exercise for improving balance in older people. Cochrane Database Syst Rev 2011; 11: CD004963. DOI: 10.1002/14651858.CD004963.pub3.
36. Kunel'skaya N.L., Baybakova E.V., Chugunova M.A., Guseva A.L. Ispol'zovanie metodov vestibulyarnoy reabilitatsii v kompleksnoy terapii vestibulyarnykh narusheniy razlichnogo geneza. Lechebnoe delo. 2015; 2: 52–5. [in Russian]
Авторы
Н.Л.Кунельская*1,2, А.Л.Гусева2, Е.В.Байбакова1, Ю.В.Левина2, А.А.Макоева2
1 ГБУЗ «Научно-исследовательский клинический институт оториноларингологии им. Л.И.Свержевского» Департамента здравоохранения г. Москвы. 117152, Россия, Москва, Загородное ш., д. 18а, стр. 2;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*nlkun@mail.ru
1 L.I.Sverzhevskiy Otorhinolaryngology Healthcare Research Institute. 117152, Russian Federation, Moscow, Zagorodnoe sh., d. 18a, str. 2;
2 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*nlkun@mail.ru
1 ГБУЗ «Научно-исследовательский клинический институт оториноларингологии им. Л.И.Свержевского» Департамента здравоохранения г. Москвы. 117152, Россия, Москва, Загородное ш., д. 18а, стр. 2;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*nlkun@mail.ru
________________________________________________
1 L.I.Sverzhevskiy Otorhinolaryngology Healthcare Research Institute. 117152, Russian Federation, Moscow, Zagorodnoe sh., d. 18a, str. 2;
2 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*nlkun@mail.ru
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