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September 26, 2023; 101 (13) Research Article

Age-Related Changes in Neurologic Examination and Sensory Nerve Amplitude in the General Population

Aging of the Peripheral Nervous System

View ORCID ProfileNoor E. Taams, Judith Drenthen, Rens Hanewinckel, M. Arfan Ikram, Pieter A. van Doorn
First published August 4, 2023, DOI: https://doi.org/10.1212/WNL.0000000000207665
Noor E. Taams
From the Departments of Epidemiology (N.E.T., M.A.I.) and Neurology (N.E.T., J.D., R.H., P.A.D.) and Clinical Neurophysiology (J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • ORCID record for Noor E. Taams
Judith Drenthen
From the Departments of Epidemiology (N.E.T., M.A.I.) and Neurology (N.E.T., J.D., R.H., P.A.D.) and Clinical Neurophysiology (J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands.
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Rens Hanewinckel
From the Departments of Epidemiology (N.E.T., M.A.I.) and Neurology (N.E.T., J.D., R.H., P.A.D.) and Clinical Neurophysiology (J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands.
MD, PhD
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M. Arfan Ikram
From the Departments of Epidemiology (N.E.T., M.A.I.) and Neurology (N.E.T., J.D., R.H., P.A.D.) and Clinical Neurophysiology (J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands.
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Pieter A. van Doorn
From the Departments of Epidemiology (N.E.T., M.A.I.) and Neurology (N.E.T., J.D., R.H., P.A.D.) and Clinical Neurophysiology (J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands.
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Age-Related Changes in Neurologic Examination and Sensory Nerve Amplitude in the General Population
Aging of the Peripheral Nervous System
Noor E. Taams, Judith Drenthen, Rens Hanewinckel, M. Arfan Ikram, Pieter A. van Doorn
Neurology Sep 2023, 101 (13) e1351-e1358; DOI: 10.1212/WNL.0000000000207665

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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 neurologic signs are present in patients with polyneuropathy but may also occur in individuals without disease. Owing 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 neurologic 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, neurologic examination, and nerve conduction studies (NCS). Inclusion criteria were 40 years or older 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 41–96 years) on features of neurologic examination and NCS using frequency calculations and quantile regression analysis.

Results In total, 4,179 participants (mean age 64.5 ± 12.7 years, 54.9% female) were included of whom 3,780 (90.5%) did not fulfil the criteria for polyneuropathy. In the population without polyneuropathy, the frequency of normal features at neurologic examination declined with age, most pronounced for vibration sense at the hallux (from 6.6 [SD ± 1.5] in 40–49 years to 3.6 [SD ± 3.1] in 80 years or older) and Achilles tendon reflexes (absent in 9% in 40–49 years up to 33% in 80 years or older). Superficial pain sensation and patellar tendon reflexes remained stable over time. Sural sensory nerve action potential (SNAP) amplitude declined with age from 11.2 μV in 40–49 years to 3.3 μV in 80 years or older. Nonrecordable SNAP amplitudes were found in 25.1% of the participants older than 80 years, more often in men (30.3%) than in women (21.0%).

Discussion This study showed the effect of age on features of neurologic 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.

Glossary

NCS=
nerve conduction studies;
SNAP=
sensory nerve action potentials

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Associate Editor Anthony Amato, MD, FAAN.

  • CME Course: NPub.org/cmelist

  • Received January 27, 2023.
  • Accepted in final form June 5, 2023.
  • © 2023 American Academy of Neurology
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