Age-Related Changes in Neurologic Examination and Sensory Nerve Amplitude in the General Population: Aging of the Peripheral Nervous System
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Abstract
Background and Objectives: Chronic axonal polyneuropathy is a common disease of the peripheral nervous system with increasing prevalence with age. Typical neurological signs are present in patients with polyneuropathy, but may also occur in individuals without disease. Due to limited knowledge on normal aging of the peripheral nervous system, it can be difficult to distinguish peripheral nerve dysfunction due to disease from variations in normal aging. Therefore, we described the changes in neurological examination and nerve conduction studies that accompany aging in the general population.
Methods: In this cross-sectional population-based study, we screened participants for chronic polyneuropathy in a controlled environment using standardized methods including a symptom questionnaire, neurological examination and nerve conduction studies (NCS). Inclusion criteria were age ≥40 years old and living in a suburb of Rotterdam, the Netherlands. Participants not diagnosed with chronic polyneuropathy, based on the discussion of findings in the screening by an expert team, were included to determine the effect of age (range 41-96years) on features of neurological examination and NCS using frequency calculations and quantile regression analysis.
Results: In total, 4179 participants (mean age 64.5±12.7 years, 54.9% female) were included of whom 3780 (90.5%) did not fulfil the criteria for polyneuropathy. In the population without polyneuropathy, the frequency of normal features at neurological examination declined with age, most pronounced for vibration sense at the hallux (from 6.6 [sd±1.5] in 40-49 years old to 3.6 [sd±3.1] in ≥80 years old) and Achilles tendon reflexes (absent in 9% in 40-49 years old up to 33% in ≥80 years old). Superficial pain sensation and patellar tendon reflexes remained stable over time. Sural sensory nerve action potential (SNAP) amplitude declined with age from 11.2µV in 40-49years old to 3.3µV in ≥80 years old. Non-recordable SNAP amplitudes were found in 25.1% of the participants over 80 years old, more often in men (30.3%) than in women (21.0%).
Discussion: This study showed the effect of age on features of neurological examination and sural nerve amplitude in the general population. These findings are helpful to distinguish features suggesting polyneuropathy from variations of normal aging of the peripheral nervous system.
- Received January 27, 2023.
- Accepted in final form June 5, 2023.
- © 2023 American Academy of Neurology. Unauthorized reproduction of this article is prohibited
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