老年人持续性姿势-知觉性头晕：与内在能力下降、可能肌少症及老年综合征的关联
Persistent Postural-Perceptual Dizziness in Older Adults: Associations With Intrinsic Capacity Decline, Probable Sarcopenia and Geriatric Syndromes.
文献信息
| PMID | 42764271 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Nagihan Sözen Gencer |
| 作者单位 | Division of Geriatrics, Department of Internal Medicine, Balıkesir Atatürk City Hospital, Balıkesir, Turkiye. |
| 期刊 | Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
引言： 持续性姿势-知觉性头晕（PPPD）是老年人中的一种慢性头晕障碍，以持续性非旋转性头晕和姿势不稳为特征。本研究旨在探讨老年人内在能力、肌少症和老年综合征与PPPD的关联。
方法： 这项横断面研究纳入了263名年龄超过65岁的个体（128例PPPD患者和135例非PPPD患者），他们就诊于老年科和耳鼻咽喉科门诊。PPPD根据Bárány学会标准诊断。综合老年评估包括内在能力各领域、衰弱（FRAIL量表）、握力（HGS）、肌少症参数和跌倒史。构建了多因素logistic回归模型以评估独立关联，同时避免重叠变量之间的共线性。使用单独的模型评估躯体功能、内在能力、肌少症和老年综合征。
结果： PPPD患者的内在能力显著较低、步速较慢、握力较低、抑郁症状较多、衰弱程度较高且跌倒更频繁（所有p ≤ 0.005）。在基于运动功能的模型中，步速较慢（OR = 0.121，95% CI：0.031-0.474；p = 0.002）、GDS-15评分较高（OR = 1.131，95% CI：1.021-1.252；p = 0.018）和跌倒史（OR = 2.660，95% CI：1.502-4.711；p = 0.001）与PPPD独立相关。在肌力模型中，握力较低也与PPPD相关（OR = 0.927，95% CI：0.879-0.978；p = 0.006）。基于领域的分析显示，运动功能和心理领域损害与PPPD独立相关。内在能力较低与PPPD强烈相关（OR = 0.497，95% CI：0.377-0.656；p < 0.001）。在临床导向的模型中，可能肌少症（OR = 2.185，95% CI：1.188-4.018；p = 0.012）、衰弱（OR = 2.381，95% CI：1.323-4.285；p = 0.004）和抑郁（OR = 2.558，95% CI：1.387-4.717；p = 0.003）与PPPD独立相关，而营养不良未显示显著关联。
结论： 老年人的PPPD超越了单纯的前庭障碍，涵盖了衰弱、肌无力和抑郁症状等老年医学维度。有必要建立耳鼻咽喉科-老年科整合照护模式，并需要开展纵向研究以评估老年医学干预对PPPD自然病程的影响。
英文摘要
INTRODUCTION: Persistent postural-perceptual dizziness (PPPD) is a chronic dizziness disorder in older adults, characterized by persistent non-vertiginous dizziness and postural instability. This study aimed to investigate the associations of intrinsic capacity, sarcopenia and geriatric syndromes with PPPD in older adults.
METHODS: This cross-sectional study included 263 individuals aged over 65 years (128 with PPPD and 135 without PPPD) attending geriatric and otorhinolaryngology outpatient clinics. PPPD was diagnosed according to Bárány Society criteria. Comprehensive geriatric assessment included intrinsic capacity domains, frailty (FRAIL scale), handgrip strength (HGS), sarcopenia parameters and history of falls. Multiple logistic regression models were constructed to evaluate independent associations while avoiding collinearity between overlapping variables. Separate models were used to assess physical performance, intrinsic capacity, sarcopenia and geriatric syndromes.
RESULTS: Participants with PPPD had significantly lower intrinsic capacity, slower gait speed, lower handgrip strength, higher depressive symptoms, higher frailty and more frequent falls (all p ≤ 0.005). In locomotion-based models, slower gait speed (OR = 0.121, 95% CI: 0.031-0.474; p = 0.002), higher GDS-15 scores (OR = 1.131, 95% CI: 1.021-1.252; p = 0.018) and fall history (OR = 2.660, 95% CI: 1.502-4.711; p = 0.001) were independently associated with PPPD. In muscle strength models, lower handgrip strength was also associated with PPPD (OR = 0.927, 95% CI: 0.879-0.978; p = 0.006). Domain-based analysis showed that locomotor and psychological impairments were independently associated with PPPD. Lower intrinsic capacity was strongly associated with PPPD (OR = 0.497, 95% CI: 0.377-0.656; p < 0.001). In clinically oriented models, probable sarcopenia (OR = 2.185, 95% CI: 1.188-4.018; p = 0.012), frailty (OR = 2.381, 95% CI: 1.323-4.285; p = 0.004) and depression (OR = 2.558, 95% CI: 1.387-4.717; p = 0.003) were independently associated with PPPD, while malnutrition did not show a significant association.
CONCLUSION: PPPD in older adults extends beyond a purely vestibular disorder, encompassing geriatric dimensions such as frailty, muscle weakness and depressive symptoms. An integrated otolaryngology-geriatrics care model is warranted, and longitudinal studies evaluating the impact of geriatric interventions on PPPD's natural history are needed.