Risk of Death in Senior Citizens Indicated by Subtle
Nervous System Abnormalities
Slowed reflexes, sagging posture and other small
neurological problems need more attention in elderly patients
June
23, 2008 If you are elderly say 72 or so and show subtle signs of
reflexes that are not so quick, a posture that sags and maybe another
slight neurological problem or two, there is evidence from a new study
that you may be in danger of a stroke or death, even if you appear to be
otherwise healthy.
The authors of the report in the June 23 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals, say
that evidence of this study combines with others to strongly support
more simple neurological examinations with senior citizens.
Previous research has linked subtle neurological
abnormalities - which also include resting tremors and differences in
hand strength - to poor physical function and to falls.
In addition, other studies of apparently healthy
older individuals have shown that those with subclinical diseases of
different organs, such as subtle signs of heart trouble that have not
yet led to a heart disease diagnosis, are more likely to become
physically or mentally impaired.
Marco Inzitari, M.D., of the University of
Florence, Italy, and colleagues studied 506 individuals (average age
72.5) who did not have neurological disease beginning in 1995. A
neurological examination was administered then and again four years
later. Deaths and cerebrovascular events, such as stroke, were tracked
for an average of eight years.
At the beginning of the study, 59 percent of the
participants had at least one subtle neurological abnormality, with an
overall average of 1.1 per individual.
After adjusting for age and sex, an increasing
number of such abnormalities was associated with more severe
disabilities, more symptoms of depression and declining cognitive
(thinking, learning and memory) and functional status.
Compared with individuals who had fewer than three
subtle neurological abnormalities, those who had three or more subtle
neurological abnormalities were more likely to die or experience a
cerebrovascular event over eight years.
Based on these findings, a simple neurological
examination seems to be an additional prognosticator of hard outcomes,
particularly death, above and beyond other measures used in clinical
practice, which currently include other performance-based tests for
cognitive and physical function and depressive symptoms, the authors
write.
It is likely that the neurological examination
might capture additional information about the integrity of the nervous
system in apparently healthy older adults, say the researchers.
Our data support the hypothesis that subtle
neurological abnormalities in elderly individuals are a manifestation of
early brain damage, a finding that may have important implications in
research studies on the prevention of age-related cognitive and
functional decline.
Understanding the nature of dysfunctions
underlying the decline in physical performance and disability
contributes to planning specific preventive interventions, they
conclude.
Editor's Note: This work was supported by the
Italian Ministry of Scientific and Technological Research (National
Special Project on Heart Failure), by the government of Tuscany and by
the Azienda Ospedaliero-Universitaria Careggi-Firenze, Italy.
Editorial: Findings Useful For Research,
Clinical Practice
Combining the new findings with previous work about
life expectancy, a typical physician caring for a healthy older adult
could use a simple routine neurological examination to provide his or
her patients with valuable prognostic information, write Malaz Boustani,
M.D., M.P.H., and Michael D. Justiss, Ph.D., of the Regenstrief
Institute Inc., Indianapolis, and colleagues in an accompanying
editorial.
The scale could also be used to identify at-risk
older adults and enroll them in research studies of interventions to
prevent disability and eventually increase the active life expectancy of
the aging population, Drs. Boustani and Justiss note.
Keep up with the latest news for senior citizens, baby
boomers
June
23, 2008 If you are elderly say 72 or so and show subtle signs of
reflexes that are not so quick, a posture that sags and maybe another
slight neurological problem or two, there is evidence from a new study
that you may be in danger of a stroke or death, even if you appear to be
otherwise healthy.