Головокружения и расстройства равновесия не только являются одними из самых частых причин обращения пожилых людей за медицинской помощью, но и способны существенно снижать качество жизни пожилых пациентов и значительно повышать риск падений и травм. Наиболее распространенными причинами вестибулярного головокружения в пожилом возрасте бывают доброкачественное пароксизмальное позиционное головокружение, болезнь Меньера и инсульт или транзиторные ишемические атаки. Среди причин расстройств равновесия в пожилом возрасте чаще всего встречаются сенсорные нарушения с синдромом сенситивной атаксии, заболевания с поражением мозжечка, а также неврологические расстройства, проявляющиеся лобной дисбазией. В статье обсуждаются клинические особенности этих заболеваний у пожилых пациентов, а также основные способы их коррекции.
Dizziness and balance disorders are not only one of the most frequent reasons for elderly people to seek medical help, but they can significantly reduce the quality of life of elderly patients and significantly increase the risk of falls and injuries. The most common causes of vestibular vertigo in old age are benign paroxysmal positional vertigo, Meniere's disease and stroke or transient ischemic attacks. Among the causes of equilibrium disorders in old age, most often there are sensory disorders with a syndrome of sensory ataxia, diseases with cerebellar lesions, as well as neurological disorders manifested by frontal dysbasia. The article discusses the clinical features of these diseases in elderly patients, as well as the main methods of their correction.
Key words: dizziness in old age, benign paroxysmal positional vertigo, Meniere's disease, equilibrium disorders.
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15. Kerber KA. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37: 2484–7.
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17. Sherrington C, Whitney JC, Lord SR et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56 (12): 2234–43.
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1. Neuhauser HK, von Brevern M, Radtke A et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005; 65 (6): 898–904.
2. Agrawal Y, Carey JP, della Santina CC et al. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Arch Int Med 2009; 169: 938–44.
3. Katsarkas A. Dizziness in aging: a retrospective study of 1194 cases. Otolaryngol Head Neck Surg 1994; 110 (3): 296–301.
4. Davis LE. Dizziness in elderly men. J Am Geriatr Soc 1994; 42 (11): 1184–8.
5. Zamergrad M.V. Vozrastnye aspekty golovokruzhenii. Nevrol. zhurn. 2014; 19 (3): 21–8. [in Russian]
6. Von Brevern M, Radtke A, Lezius F et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78: 710–5.
7. Johkura K, Momoo T, Kuroiwa Y. Positional nystagmus in patients with chronic dizziness. J Neurol Neurosurg Psychiatry 2008; 79 (12): 1324–6.
8. Da Costa SS, de Sousa LC, Piza MR. Meniere's disease: overview, epidemiology, and natural history. Otolaryngol Clin North Am 2002; 35 (3): 455–95.
9. Ballester M, Liard P, Vibert D, Hausler R. Meniere's disease in the elderly. Otol Neurotol 2002; 23 (1): 73–8.
10. Sagalovich B.M., Pal'chun V.T. Bolezn' Men'era. M.: MIA, 1999. [in Russian]
11. Strupp M, Kremmyda O, Brandt T. Pharmacotherapy of vestibular disorders and nystagmus. Semin Neurol 2013; 33 (3): 286–96.
12. Patel M, Agarwal K, Arshad Q et al. Intratympanic methylprednisolone versus gentamicin in patients with unilateral Ménière's disease: a randomised, double-blind, comparative effectiveness trial. Lancet 2016; 388 (10061): 2753–62.
13. Cutler AR, Kaloostian SW, Ishiyama A, Frazee JG. Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature. J Neurosurg 2012; 117 (30): 507–13.
14. Baptista MV, van Melle G, Bogousslavsky J. Prediction of in-hospital mortality after first-ever stroke: the Lausanne Stroke Registry. J Neurol Sci 1999; 166: 107–14.
15. Kerber KA. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37: 2484–7.
16. Jahn K, Kressig RW, Bridenbaugh SA et al. Dizziness and Unstable Gait in Old Age: Etiology, Diagnosis and Treatment. Dtsch Arztebl Int 2015; 112 (23): 387–93.
17. Sherrington C, Whitney JC, Lord SR et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56 (12): 2234–43.
Авторы
М.В.Замерград*1,2, О.Н.Ткачева2, Э.А.Мхитарян2,3
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
3 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119992, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*zamergrad@gmail.com
1 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;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1;
3 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*zamergrad@gmail.com