Presbyvestibulopathy
Age-related decline of the vestibular system. Mild, symmetric, slow, and unmistakably real — the older patient's chair report is rarely entirely normal.
Clinical picture
The Bárány Society defines presbyvestibulopathy as a chronic vestibular syndrome in older adults (typically ≥ 60 years) with symptoms of postural imbalance or fall(s), and mild bilateral peripheral vestibular dysfunction documented on testingAgrawal Y 2019. Symptoms are slow, symmetrical, and non-episodic.
Pathophysiology
Type I hair-cell loss accelerates after age 60, and afferent nerve-fibre counts decline; the cupula stiffens slightly. The net effect is a low-frequency reduction in VOR drive, with the highest frequencies preserved.
RCT pattern
| Step Tc | 14.0 s |
|---|---|
| Step gain | 0.65 |
The earliest change is reduced gain at the lowest SHA frequencies (0.01–0.04 Hz), with progressively spared gain through 0.16–0.64 Hz Wang Y 2022. The post-rotational Tc drifts downward before the per-rotational. Phase and symmetry are usually preserved until very late.
Diagnosis & differential
- RCT consistent with the age-related pattern above.
- vHIT showing borderline gains, often with covert saccades.
- cVEMP and oVEMP frequently reduced bilaterally.
- Distinguish from frank bilateral vestibulopathy (gain < 0.1 criterion) and from cerebellar ataxia in the older patient.