Neurological Abnormalities Linked To Increase Risk Of Death And Stroke In Seniors

Editor's Choice
Main Category: Seniors / Aging
Also Included In: Neurology / Neuroscience;  Stroke
Article Date: 24 Jun 2008 - 0:00 PDT

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An article published in the June 23 issue of Archives of Internal Medicine finds that in healthy older adults, subtle (but noticeable) neurological abnormalities like reduced reflexes and unstable posture may be linked to the risk of death and stroke.

The study, conducted by Marco Inzitari, M.D. (University of Florence, Italy) and colleagues, was designed to clarify existing research that has linked subtle neurological abnormalities to poor physical function and falls. These neurological abnormalities also include resting tremors and differences in hand strength. Previous studies have demonstrated that the likelihood of physical or mental impairment is increased in seemingly healthy older adults who have subclinical diseases of different organs - i.e. subtle signs of heart trouble but no clinical heart disease diagnosis.

Inzitari and colleagues analyzed 506 individuals (72.5 years old, on average) who were not diagnosed with a neurological disease as of 1995. The participants received a neurological examination upon entering the study and also four years later. Over an eight year period, the researchers tracked deaths and cerebrovascular events such as stroke.

One neurological abnormality was found in 59% of the patients at the study's onset, and the participants had about 1.1 abnormalities per individual. Statistically controlling for age and sex revealed that a higher number of abnormalities was linked to more severe disabilities. In addition, those who had more neurological abnormalities were more likely to express symptoms of depression and to show a reduction in cognitive (thinking, learning and memory) and functional abilities. Patients with three or more subtle neurological abnormalities were more likely to experience death or a cerebrovascular event during the eight years of follow up than their counterparts with fewer than three abnormalities.

"A simple neurological examination seems to be an additional prognosticator of hard outcomes, particularly death, above and beyond other measures used in clinical practice," according to the authors. These additional measures include performance-based tests for cognitive and physical function and depressive symptoms. They add: "It is likely that the neurological examination might capture additional information about the integrity of the nervous system in apparently healthy older adults."

They conclude that, "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."

An accompanying editorial, written by Malaz Boustani, M.D., M.P.H. and Michael D. Justiss, Ph.D. (Regenstrief Institute Inc., Indianapolis) and colleagues, comments that, "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." Combining these results with other studies could help identify at-risk older adults for enrollment in intervention studies concerning disability prevention. This could have an effect of increasing life expectancy for this aging group, conclude the authors.

Subtle Neurological Abnormalities as Risk Factors for Cognitive and Functional Decline, Cerebrovascular Events, and Mortality in Older Community-Dwelling Adults
Marco Inzitari; Claudia Pozzi; Luigi Ferrucci; Daniela Chiarantini; Lucio A. Rinaldi; Marco Baccini; Riccardo Pini; Giulio Masotti; Niccolò Marchionni; Mauro Di Bari
Archives of Internal Medicine (2008). 168[12]: pp. 1270 - 1276.
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Written by: Peter M Crosta
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