The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.
The clinical identification of peripheral neuropathy among older persons
Abstract
Objective To identify simple clinical rules for the detection of a diffuse peripheral neuropathy among older outpatients.Design Observational, blinded, controlled study.Setting A tertiary-care electrodiagnostic laboratory and biomechanics laboratory.Participants One hundred research subjects, 68 with electrodiagnostic evidence of peripheral neuropathy, between the ages of 50 and 80 years.Interventions Not applicable.Main outcome measurements One examiner, unaware of the results of electrodiagnostic testing, evaluated Achilles' and patellar reflexes, Romberg testing, semiquantified vibration, and position sense at the toe and ankle in all subjects, and unipedal stance time and the Michigan Diabetes Neuropathy Score in a subset of subjects.Results Significant group differences were present in all clinical measures tested. Three signs, Achilles' reflex (absent despite facilitation), vibration (128Hz tuning fork perceived for <10s), and position sense (<8/10 1-cm trials) at the toe, were the best predictors of peripheral neuropathy on both univariate and logistic regression (pseudo R(2)=.744) analyses. The presence of 2 or 3 signs versus 0 or 1 sign identified peripheral neuropathy with sensitivity, specificity, and positive and negative predictive values of 94.1%, 84.4%, 92.8%, and 87.1%, respectively. Values were similar among subgroups of subjects with and without diabetes mellitus. When other clinicians applied the technique to 12 more subjects, excellent interrater reliability regarding the presence of peripheral neuropathy (kappa=.833) and good to excellent interrater reliability for each sign (kappa range,.667-1.00) were shown.Conclusion Among older persons, the presence of 2 or 3 of the 3 clinical signs strongly suggested electrodiagnostic evidence of a peripheral neuropathy, regardless of etiology. Age-related decline in peripheral nerve function need not be a barrier to the clinical recognition of a diffuse peripheral neuropathy among older persons.
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“Conversely, even in patients suspected to have upper motor neuron disorders, PTR is not enhanced when peripheral neuropathic diseases, such as diabetes mellitus36, coexist.”
From Quantification of patellar tendon reflex using portable mechanomyography and electromyography devices (2021) · cites this paper as [36]
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The meaning of distal sensory loss and absent ankle reflexes in relation to age: A meta–analysis
Vrancken, A. F. J. E., Kalmijn, S., Brugman, F., Rinkel, G. J. E., & Notermans, N. C. (2006) · Journal of Neurology · doi:10.1007/s00415-005-0064-0 · Cited by 50
Tsuji, H., Misawa, H., Takigawa, T., Tetsunaga, T., Yamane, K., Oda, Y., & Ozaki, T. (2021) · Scientific Reports · doi:10.1038/s41598-021-81874-5 · Cited by 16
Metadata
- Authors
- Richardson, J. K.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Richardson, James K.
- ORCID
- Richardson, James K.
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2002-11
- Volume
- 83
- Issue
- 11
- Pages
- 1553-1558
- ISSN
- 0003-9993 (ISSN-L)
- OpenAlex
- W1996689993
- Cited by
- 95
- References
- 38
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 7 · 2019: 2 · 2018: 1 · 2017: 5 · 2016: 4 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 4
- FWCI
- 2.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1p30ag008808-01)
- National Institute on Aging (K23 AG 00989-01, 1P30AG08808, K23AG000989)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Peripheral Nerve Disorders
- Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Hereditary Neurological Disorders
- Keywords
- peripheral neuropathy, older adults, clinical screening, Achilles tendon reflex, vibration perception, position sense, Romberg test, patellar reflex, inter-rater reliability, diabetes mellitus, electrodiagnostic testing
- MeSH terms
- Achilles Tendon, Aged, Aging, Analysis of Variance, Clinical Protocols, Electrodiagnosis, Female, Humans, Male, Mass Screening, Neural Conduction, Neurologic Examination, Patella, Peripheral Nervous System Diseases, Proprioception, Reflex, Abnormal, Sensitivity and Specificity, Vibration, Observer Variation, Confounding Factors, Epidemiologic, Logistic Models, Case-Control Studies, Single-Blind Method, Diabetes Complications
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