Juliana Maria Gazzola

Versão brasileira do Dizziness Handicap Inventory

Background: impact of dizziness on life quality (LQ). Aim: to adapt the Dizziness Handicap Inventory (DHI) for application in the Brazilian population; to assess its reproducibility; and to describe the results obtained in patients with chronic dizziness. Method: The DHI was initially applied in 45 patients with chronic dizziness and with a clinical diagnosis of vestibular syndrome. The application followed the stages of translation - from English to Portuguese - and linguistic adaptation, grammatical and idiomatic equivalence review and evaluation of its intra and inter-researchers reproducibility. Reproducibility was assessed by using the Wilcoxon Test for two dependent samples, P < 0.05. The questionnaire was applied on 250 patients with chronic vestibular syndrome in order to evaluate the impact of dizziness on LQ. Results: The Brazilian version of the DHI (Brazilian DHI) was well comprehended by the studied population and no statistically significant difference was found in the inter-researcher (P = 0.418) and intra-researcher (P = 0.244) reproducibility. All of the studied patients presented a loss in LQ due to dizziness. Aspects which were most affected were the physical ones, followed by, in a decreasing order, the functional and the emotional ones. Functional aspects were more compromised in older individuals. No association was verified between gender and the overall mean scores of the DHI and between gender and the mean scores of each aspect assessed by the DHI. Conclusion: the DHI was culturally adapted for application in the Brazilian population (Brazilian DHI). This instrument was considered to be a reliable tool to evaluate the impact of dizziness on LQ. Patients with chronic dizziness and with clinical diagnosis of vestibular syndrome presented a loss in LQ, due to this symptom. This loss was verified by the application of the Brazilian DHI. Physical aspects were the most compromised.

Fatores associados ao equilíbrio funcional em idosos com disfunção vestibular crônica

Daily activities can be challenging for the elderly. AIM: To study the association between functional balance, evaluated by the Berg Balance Scale (BBS), sociodemographics, clinical and mobilility (Timed up and go test - TUGT, Dynamic Gait Index - DGI) variables in the elderly with chronic vestibular disorder. MATERIALS AND METHODS: A series study with one hundred and twenty elderly with chronic vestibular disorder. We performed the Mann-Whitney test, the Kruskal-Wallis test followed by Dunn test and the Spearman Coefficient (). RESULTS: Statistically significant associations and correlations were observed between total BBS score and age (=-0.354; p<0.001), age group (p<0.001), number off illnesses (p=0.030), number of illnesses (=-0.287; p=0.001), number of medications (p=0.014), number of medications (=-0.274; p=0.002), recurrent falls (p=0.010), tendency to fall (p=0.002), topographic diagnosis of central vestibular disorder (p<0.001) and periodicity of dizziness (p=0.039), TUGT (=-0.709; p<0.001) and DGI (=-0.748; p<0.001). CONCLUSIONS: Functional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central vestibular syndromes, daily dizziness, mobility and gait impairments.

Cuidando do paciente com Alzheimer: o impacto da doença no cuidador

Abstract Objective: To evaluate the subjective impact ofAlzheimer’s Disease (AD) on the lives of the primaryfamily caregivers of patients suffering from saiddisease. Method: A cross analysis has been carried outamong 29 caregivers of patients assisted. The usedtools were the CBS , and a questionnaire to carry on asocial survey on the caregivers and a formulary toperform an analysis on profile of the patient. Simpledescriptive statistics, Pearson’s Correlation Coeffi-cient (r), T Test for independent samples and ANOVAwere performed, followed by the Bonferroni method,a d” 0.05. Results: Most of caregivers were women(89.7%) average age 58, 55.2% elderly’s children, 27.6%couples, most of them havin g studied for over 8 years(55.2%), and 86.2% living with the elderly. The globalaverage impact score on the subjective impactcalculated by the CBS was 2.18. The total score averageof the CBS is higher in caregivers of bed-restrictedpatients (p=0.020). Caregivers with a lower educa-tional level had a higher total score in the

Quedas em idosos com Vertigem Posicional Paroxística Benigna

UNLABELLED Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. AIM to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). MATERIALS AND METHODS retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxons test was performed to compare the number of fall(s) before and after 12 months of the PRM. RESULTS One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). CONCLUSION BPPV elderly patients had indeed a reduction on the number of falls after the PRM.

Caracterização clínica de idosos com disfunção vestibular crônica

Dizziness is common among the elderly. AIM: To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. METHOD: A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. RESULTS: Most of the patients were female (68.3%) with a mean age of 73.40±5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83±1.84; the patients were taking on average 3.86±2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. CONCLUSIONS: Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

Circunstâncias e conseqüências de quedas em idosos com vestibulopatia crônica

AIM: To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). METHOD: Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Qui-Square test (<0.05). RESULTS: The sample was constituted by a female majority (76.6%) with a mean age of 73.62±5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). CONCLUSION: Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).

Circumstances and consequences of falls in elderly people with vestibular disorder

AIM To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). METHOD Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Chi-Square test (x2<0.05). RESULTS The sample was constituted by a female majority (76.6%) with a mean age of 73.62+/-5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). CONCLUSION Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).

Clinical evaluation of elderly people with chronic vestibular disorder

UNLABELLED Dizziness is common among the elderly. AIM To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. METHOD A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. RESULTS Most of the patients were female (68.3%) with a mean age of 73.40+/-5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83+/-1.84; the patients were taking on average 3.86+/-2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. CONCLUSIONS Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

Functional balance associated factors in the elderly with chronic vestibular disorder

UNLABELLED Daily activities can be challenging for the elderly. AIM To study the association between functional balance, evaluated by the Berg Balance Scale (BBS), sociodemographics, clinical and mobilility (Timed up and go test-TUGT, Dynamic Gait Index-DGI) variables in the elderly with chronic vestibular disorder. MATERIALS AND METHODS A series study with one hundred and twenty elderly with chronic vestibular disorder. We performed the Mann-Whitney test, the Kruskal-Wallis test followed by Dunn test and the Spearman Coefficient ([FORMULA: SEE TEXT]). RESULTS Statistically significant associations and correlations were observed between total BBS score and age ([FORMULA: SEE TEXT]=-0.354; p<0.001), age group (p<0.001), number off illnesses (p=0.030), number of illnesses ([FORMULA: SEE TEXT]=-0.287; p=0.001), number of medications (p=0.014), number of medications ([FORMULA: SEE TEXT]=-0.274; p=0.002), recurrent falls (p=0.010), tendency to fall (p=0.002), topographic diagnosis of central vestibular disorder (p<0.001) and periodicity of dizziness (p=0.039), TUGT ([FORMULA: SEE TEXT]=-0.709; p<0.001) and DGI ([FORMULA: SEE TEXT]=-0.748; p<0.001). CONCLUSIONS Functional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central vestibular syndromes, daily dizziness, mobility and gait impairments.

Resultados do Balance Rehabilitation Unit na Vertigem Posicional Paroxística Benigna

UNLABELLED Posturography is a useful new tool to study the influence of vestibular diseases on balance. AIM to compare the results from the Balance Rehabilitation Unit (BRU) static posturography in elderly patients with Benign Paroxysmal Positional Vertigo (BPPV), before and after Epleys maneuver. MATERIALS AND METHODS a prospective study of 20 elderly patients with a diagnosis of BPPV. The patients underwent static posturography and the limit of stability (LE) and ellipse area were measured. We also applied the Dizziness Handicap Inventory (DHI) questionnaire to study treatment effectiveness. RESULTS 80% were females, with a mean age of 68.15 years. After the maneuver, the LE increased significantly (p=0.001). The elliptical area of somatosensory, visual and vestibular conflicts (2,7,8,9 situations) in BRU and the DHI scores decreased significantly (p<0.05) after treatment. CONCLUSION the study suggests that elderly patients with BPPV may present static postural control impairment and that the maneuver is effective for the remission of symptoms, to increase in the stability and improvement in postural control in situations of visual, somatosensory and vestibular conflicts.