title: The meaning of distal sensory loss and absent ankle reflexes in relation to age: a meta-analysis.
abstract: BACKGROUND
  Polyneuropathy is a common disease and is more prevalent (at least 3 %) in elderly people. However, routine neurological examination of healthy elderly people may show distal sensory loss and absent tendon reflexes, which can obscure the distinction from polyneuropathy.
  
  
  OBJECTIVE
  To investigate the relation between age and the prevalence of distal sensory loss, absent tendon reflexes, or muscle weakness, and to ascertain above which age these neurological signs could be considered as normal in ageing.
  
  
  METHODS
  PubMed, Embase, the Cochrane Library, and Current Contents from 1960 until 2004. Reference lists of relevant studies were searched for additional studies, reviews or textbooks.
  
  
  METHODS
  Studies reporting on neurological signs upon routine neurological examination in generally healthy adult persons were considered for inclusion. Two reviewers independently assessed study eligibility and performed study inclusion. Of 629 studies initially identified, 50 (8 %) met the inclusion criteria.
  
  
  METHODS
  Two reviewers independently performed data extraction and assessed study quality based on study design and the rigour by which confounding co-morbidity was excluded.
  
  
  RESULTS
  The 50 included studies comprised a total of 9,996 adult persons. Assuming heterogeneity between studies, the prevalence data from different studies were pooled for separate age groups with a random-effects model. In healthy persons older than 60 years the prevalence of absent vibration sense at the big toes (29 % [95 % CI 18 % to 38%]) or ankles (15 % [95 % CI 11 % to 20%]), and absent ankle reflexes (23 % [95 % CI 16 % to 30 %]) was increased.
  
  
  CONCLUSIONS
  Self-declared healthy adult persons younger than 60 years do not have neurological signs. After the age of 60 absent vibration sense at the big toes or ankles, and absent ankle reflexes are more prevalent, although the majority does not have these neurological signs. It seems more appropriate to apply different diagnostic criteria for polyneuropathy in adult persons younger and older than 60 years.
authors.affiliation: Rudolf Magnus Institute of Neuroscience, Department of Neurology C03.236, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.f.j.e.vrancken@umcutrecht.nl
authors.forename: Alexander F J E
authors.initials: AF
authors.lastname: Vrancken
authors.forename: Sandra
authors.initials: S
authors.lastname: Kalmijn
authors.forename: Frans
authors.initials: F
authors.lastname: Brugman
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Nicolette C
authors.initials: NC
authors.lastname: Notermans
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000842:Ankle / Q000502:physiology*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D039781:PubMed / Q000706:statistics & numerical data; D012021:Reflex, Abnormal / Q000502:physiology*