The meaning of distal sensory loss and absent ankle reflexes in relation to age - A meta-analysis

Utrecht University, Utrecht, Utrecht, Netherlands
Journal of Neurology (Impact Factor: 3.38). 06/2006; 253(5):578-89. DOI: 10.1007/s00415-005-0064-0
Source: PubMed


Polyneuropathy is a common disease and is more prevalent (at least 3 %) in elderly people. However, routine neurological examination of healthy elderly people may show distal sensory loss and absent tendon reflexes, which can obscure the distinction from polyneuropathy.
To investigate the relation between age and the prevalence of distal sensory loss, absent tendon reflexes, or muscle weakness, and to ascertain above which age these neurological signs could be considered as normal in ageing.
PubMed, Embase, the Cochrane Library, and Current Contents from 1960 until 2004. Reference lists of relevant studies were searched for additional studies, reviews or textbooks.
Studies reporting on neurological signs upon routine neurological examination in generally healthy adult persons were considered for inclusion. Two reviewers independently assessed study eligibility and performed study inclusion. Of 629 studies initially identified, 50 (8 %) met the inclusion criteria.
Two reviewers independently performed data extraction and assessed study quality based on study design and the rigour by which confounding co-morbidity was excluded.
The 50 included studies comprised a total of 9,996 adult persons. Assuming heterogeneity between studies, the prevalence data from different studies were pooled for separate age groups with a random-effects model. In healthy persons older than 60 years the prevalence of absent vibration sense at the big toes (29 % [95 % CI 18 % to 38%]) or ankles (15 % [95 % CI 11 % to 20%]), and absent ankle reflexes (23 % [95 % CI 16 % to 30 %]) was increased.
Self-declared healthy adult persons younger than 60 years do not have neurological signs. After the age of 60 absent vibration sense at the big toes or ankles, and absent ankle reflexes are more prevalent, although the majority does not have these neurological signs. It seems more appropriate to apply different diagnostic criteria for polyneuropathy in adult persons younger and older than 60 years.

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Available from: Frans Brugman, Aug 18, 2014
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    ABSTRACT: Acknowledgement of the age effects on postural control and balance is essential to differentiate between physiological changes and actual pathological alterations of the elderly. The aim of this study is to establish the age-related postural changes recorded by the Computerized Dynamic Posturography. 70 healthy individuals (35 males and 35 females) with an average age of 44.9 years, evenly distributed in seven age groups. We carried out a Sensory Organization Test and Limits of Stability with the Neurocom Smart Balance Master(®) posturography platform. Statistical analysis was undertaken using ANOVA (p<0.05). Increased age-related balance percentage for Condition 4 (p=0.022), reduced usage rate of ankle-strategy for Conditions 3 (p=0.027) and 4 (p=0.05) for the higher age groups were reported. Regarding limits of stability, the following were the results: age-related differences at an early stage, reaction time from 40 to 49 years, velocity of movement, excursion and directional control from 50 to 59 years. Age only affects the balance rate under more complex sensory conditions. For healthy people, ankle strategy is more frequently used than hip strategy; however, the use of hip strategy increases under more difficult sensory conditions. Limits of stability get worse with age, namely after the age of 40-50 years. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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    • "A number of peripheral nerve changes documented with aging are also present in CIAP. In a meta-analysis of 50 studies, comprising nearly 10,000 patients, Vrancken and colleagues observed that absent vibration sense at the great toes, as well as absent ankle reflexes, was identified in nearly one-quarter of self-reported healthy individuals >60 years old, but only rarely in healthy younger patients (Vrancken et al., 2006). Corresponding results were obtained from an analysis of nerve conduction studies on 3,969 patients determined by neurologists to have a normal neurologic examination: some 24% of individuals aged 70–79 years had absent sural sensory responses, whereas the sural response was absent in fewer than 1% of normal subjects younger than 50 years of age (Rivner et al., 2001). "
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