What Causes Imbalance Issues And Frustration In An Elderly Person?

Posted on Wed, 14 Jan 2015

Question: Soon to be 87 year old male complains of feeling woozy. Has been to doctors including neurologist and they can not define anything specific. Does have change in white brain matter. He is wobbly and can lose his balance. Mentally he is pretty clear but gets frustrated with this feeling.

Answered by Dr. Pankaj Borade (2 hours later)

Brief Answer:
Early dementia

Detailed Answer:
Hi,
Well, as I can understand you have two major complaints
1) feeling dizzy
2) unsteady gait
If I am correct.

Considering your high age, changes in white matter is very likely. We have to rule out any degenerative disorder such as Alzheimer's or Parkinson's or any other dementing disorder.
I will require a detailed history regarding his complaints.
1) is he having any tremors while at rest.
2) Are his general body movements such as winging of hands, are slow?
3) Does his facial expression appears dull or flat than normal?
4) Does he has problem doing his routine activity?
5) Is he being irritable, sleep is reduced?

Answer to these question from you will make my job easy.
As your doctor have told you about the White matter changes, there is a high possibility of the dementing changes to have just begun and the full florid symptoms of any particular disorder is yet to develop.
It will be very kind to have your answers on above questions.

Thank you.

Regards,
Dr Pankaj Borade

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Pankaj Borade (1 hour later)

He is not having any tremors. His general movements do appear slower to me. His gait when he walks is more of a shuffle. My mom says his expression is more dull and he is starting to complain about routine activities such as taking care of the cat (wants to get rid of his cat). She also says he is irritable and that his sleep is not good. He has a mask for sleep apnea. My sister says his paler is not good...more grey.

Answered by Dr. Pankaj Borade (5 minutes later)

Brief Answer:
Few more information

Detailed Answer:
thank you,
Is he having problem in recalling events in recent past? navigating road? remembering daily tasks?
Any history of head injuries?
Spech difficulties?
urinary incontinence?

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Pankaj Borade (19 minutes later)

No problem that I can observe recalling recent events. Is navigating well although I will not let him drive at night. His speech is good. No incontinence no head injury that I can recall.

He has commented several times of people he grew up with now dieing.

Answered by Dr. Pankaj Borade (3 hours later)

Brief Answer:
An early stage Parkinson's disorder Is likely

Detailed Answer:
thank you.
well, your information rules out the possibility of Alzheimer's Disease. Therefore, now Parkinson's disorder is the most probable diagnosis that remains, that explains his symptoms. This could be the early stage of disorder.
I would suggest to look out for signs of tremors and increment in rigidity in future. Currently the slowing of movements and full face, unstable gait all suggest Parkinson's.
A proper neurological examination of motor system warrants here, therefore a consultation to neurologist is advisable. Consider adding dopamine reuptake inhibitor class of drugs to the prescribed medications.

welcome for futher opinion.
thank you

Regards,
Dr Pankaj Borade

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju