Only 20% of elder patients with abnormal peripheral nerve testing had Diabetes.

[Argirios Argiriou]

January 5, 2015

Abnormal Peripheral Nerve Function: A Problem in Elders.

Allan S. Brett, MD reviewing Ward RE et al. J Am Geriatr Soc 2014 Dec.

Motor or sensory abnormalities were associated with development of mobility impairment.

When older adults develop problems with mobility or balance, abnormal peripheral nerve function is a common contributing factor. In this prospective study of 2148 older adults (age range, 70–79) who had no mobility problems at baseline, researchers assessed associations between lower-leg nerve dysfunction and later development of mobility disability. At baseline, 55% of participants had at least one abnormality on motor testing (peroneal nerve conduction) or sensory testing (vibration detection threshold or monofilament sensitivity of the large toe).

During median follow-up of 8.5 years, 30% of participants developed mobility disability (difficulty walking one quarter of a mile or climbing a flight of stairs). Peripheral nerve impairment at baseline was associated with excess risk for mobility disability during follow-up: The greater the severity of nerve impairment, the greater the risk for incident mobility disability. Adjustment for various comorbidities attenuated these associations somewhat, but not entirely.

COMMENT

These findings should serve as a reminder to clinicians to perform careful peripheral nerve examinations in older patients who present with declining mobility or with disequilibrium. The study did not include systematic evaluation to find the cause of impaired nerve function, but only about 20% of patients with abnormal nerve testing had diabetes; some cases of nerve impairment probably were idiopathic or related to mechanical factors (e.g., spinal stenosis). Whether or not a treatable underlying cause of neuropathy is found, knowing that peripheral nerve dysfunction is contributing to mobility and balance problems can help physicians and physical therapists to individualize treatment.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Allan S. Brett, MD at time of publication
Nothing to disclose

CITATION(S):

Ward RE et al. Sensory and motor peripheral nerve function and incident mobility disability. J Am Geriatr Soc 2014 Dec; 62:2273. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος