Abstract：
Benign paroxysmal positional vertigo (BPPV) is amongst the commonest causes of dizziness and falls in older adults. Diagnosing and treating BPPV can reduce falls, and thereby reduce fall-related morbidity and mortality. Recent World Falls Guidelines recommend formal assessment for BPPV in older adults at risk of falling, but only if they report vertigo. However, this recommendation ignores the data that (i) many older adults with BPPV experience dizziness as vague unsteadiness (rather than vertigo), and (ii) others may experience no symptoms of dizziness at all. BPPV without vertigo is due to an impaired vestibular perception of self-motion, termed \'vestibular agnosia\'. Vestibular agnosia is found in ageing, neurodegeneration and traumatic brain injury, and results in dramatically increased missed BPPV diagnoses. Patients with BPPV without vertigo are typically the most vulnerable for negative outcomes associated with this disorder. We thus recommend simplifying the World Falls Guidelines: all older adults (>60 years) with objective or subjective balance problems, irrespective of symptomatic complaint, should have positional testing to examine for BPPV.
摘要：
良性阵发性位置性眩晕（BPPV）是老年人头晕和跌倒的最常见原因之一。诊断和治疗BPPV可以减少跌倒，从而降低与跌倒相关的发病率和死亡率。最近的世界瀑布指南建议对有跌倒风险的老年人进行BPPV的正式评估，但前提是他们报告眩晕。然而,该建议忽略了以下数据：（i）许多患有BPPV的老年人将头晕视为模糊的不稳定（而不是眩晕），和(ii)其他人可能根本没有头晕症状。无眩晕的BPPV是由于前庭对自我运动的感知受损，称为“前庭失认症”。前庭失认症是在衰老中发现的，神经变性和创伤性脑损伤，并导致漏诊的BPPV显著增加。没有眩晕的BPPV患者通常最容易受到与该疾病相关的负面结果的影响。因此，我们建议简化世界瀑布指南：所有有客观或主观平衡问题的老年人（>60岁），不管有症状的投诉，应进行位置测试以检查BPPV。
