Summary

Neurological abnormalities, like hand tremor and reduced grip strength, may not be merely insignificant signs of aging. Researchers in Florence have carried out a study of older people, recording the number of such signs and then assessing cognitive status and disability four years on, as well as deaths and strokes occurring over eight years. The more neurological abnormalities found at the start, the worse the outcome during follow up.

Introduction

Apparently healthy older people dwelling in the community could be showing sub-clinical signs of disease. And these signs may be predictive of health problems to come. Previous research has shown that subtle - but detectable - neurological abnormalities (SNAs) are linked to poorer physical performance and increased risk of falls. And those with fewer signs of subclinical heart disease are more likely to age successfully - which means they have more years lived without physical or mental impairment or without overt disease such as heart disease or cancer. Marco Inzitari, MD, and colleagues at the University of Florence, Italy, have carried out a new study to see if SNAs are actually an independent risk factor for poor health outcomes in older people.

What was done

The researchers studied 506 individuals of average age 72.5 living in the community and without neurological disease. They had a simple, but thorough, neurological test at the start of the study and again four years later. The 15 SNAs measured included reflexes, handgrip strength, balance and manual dexterity. The number of SNAs was recorded and each individual given a score. At four years, physical and mental performance was also assessed with standard tests. The participants were also followed up for eight years with all instances of death or stroke being recorded.

What was found

Of the 15 SNAs measured, five were linked only to physical performance, one with only mental performance, and five with both. Reduced Achilles reflex and postural instability were the most common SNAs noted. The greatest number of SNAs noted in participants was 8, out of a possible total of 19. The older the patient, the greater the number of SNAs. At the start of the study, 59 per cent of the group had at least one SNA and the average number was just over one per person for the whole group. There was a strong link between the number of SNAs and physical and cognitive performance. This number predicted both decline over four years, and the risk of death or stroke over eight years.

What this study means

The study highlights the importance of SNAs as a predictive factor in older people. They appear to indicate early brain damage which could lead to increased risk of stroke. Therefore, a simple neurological exam may be important to pinpoint those at risk, even though they may appear healthy. It may thereby be possible to intervene to reduce the risk of stroke in these individuals.