General Medical Information

Dysequilibrium And Ataxia Of The Elderly

Byron J. Bailey

Presbyastasis is the term for the dysequilibrium that results from aging. This condition is the functional outcome of degenerative changes such as vacuolization of the sensory epithelium of the semicircular canal ampullae plus fragmentation of the otoconia, along with morphologic changes in the vestibular nerves, Scarpa ganglion, and the cerebellum. Affected persons exhibit a progressive decline in their ability to perform eye tracking tests. Some studies show a decrease in the number of Purkinje cells in the cerebellum. The ability to maintain normal posture may decrease severely.

With the advancing age, the decline in sensory input along with decreased integrating ability and weakened muscular function produce balance problems in our patients. Common disease processes and various medications lead to further functional degradation. Prevention of falls, treatment, and rehabilitation strategies fall within the responsibility of the otolaryngologist in many instances.

Konrad pointed out in an excellent review that as we grow older, we lose balance function through loss of sensory elements, the ability to integrate information and send motor commands, and because we lose musculoskeletal function. Older patients are also subject to the common balance disorders of younger patients and require the same management in addition to placing more emphasis on prevention and rehabilitation.