Peripheral Neuropathy May Be the Major Cause of Imbalance in Older Patients
Akhand Pratap Singh1, Karen Stephenson1, Ahmed Alwahaidy1, Jennifer Cox1, Lixin Zhang1
1Dent Neurologic Institute
Objective:
To identify the common contributing factors to imbalance in patients 65 years or older.
Background:
In our dizziness and balance center, a subset of older patients present with complaints of imbalance with or without falls. Patients were assessed by an experienced neurotologist and underwent extensive vestibular testing, posturography, and imaging studies. For peripheral neuropathy, patients were tested for reduced or loss of vibration sense in the feet using a 128Hz tuning fork. Peripheral neuropathy is often underdiagnosed because most patients have no complaints related to their feet. We aim to identify the common contributing factors to imbalance in the 65 years or older population through review of these findings.
Design/Methods:
In this retrospective study, 661 patients who had a diagnosis of imbalance and a follow up visit between January 2015 and February 2020 were pulled from the clinical database. Out of which 191 patients were included in the study using the inclusion criteria of age ≥ 65, complaint of imbalance and exclusion criteria: complaints of vertigo, dementia, Parkinson’s disease, spinal stenosis, radiculopathy, and acute infarct. We analyzed clinical records, vestibular testing, posturography, and imaging of the eligible patients.
Results:

Out of the 191 patients (males=93, females=98), 70.7% (n= 135) had peripheral neuropathy as a contributory cause of imbalance, 44.5% (n=85) had vestibulopathy, 24.6% (n=47) had intracranial etiology, and 55.5% (n=106) had a combination of the above. Peripheral neuropathy was found to be more common among males (80.6%) compared with females (61.2%) (odds ratio 2.64, 95% CI: 1.4 – 5.1). Among the patients with two or more diagnoses, the most common combination was peripheral neuropathy and vestibulopathy.

Conclusions:
This study suggests that peripheral neuropathy may be one of the most common contributing factors to imbalance in the elderly.