title: 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.
  
  
  METHODS
  Observational, blinded, controlled study.
  
  
  METHODS
  A tertiary-care electrodiagnostic laboratory and biomechanics laboratory.
  
  
  METHODS
  One hundred research subjects, 68 with electrodiagnostic evidence of peripheral neuropathy, between the ages of 50 and 80 years.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, MPB D5200, Ann Arbor, MI 48109-0718, USA. jkrich@umich.edu
authors.forename: James K
authors.initials: JK
authors.lastname: Richardson
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology; D000368:Aged; D000375:Aging / Q000502:physiology; D000704:Analysis of Variance; D016022:Case-Control Studies; D002985:Clinical Protocols / Q000592:standards; D015986:Confounding Factors, Epidemiologic; D048909:Diabetes Complications; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D009431:Neural Conduction; D009460:Neurologic Examination / Q000379:methods* / Q000592:standards; D015588:Observer Variation; D010329:Patella; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011434:Proprioception; D012021:Reflex, Abnormal; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014732:Vibration