Small but clinically detectable neurological abnormalities, such as slower reflexes and tremors, are linked with an increased risk of stroke and death in healthy older adults, a new study says.
Italian researchers found that subjects who had three or more neurological abnormalities -- but did not have a specific neurological disease -- had a two-fold greater risk of stroke and death compared to subjects who had fewer than three abnormalities.
"Our data support the hypothesis that subtle neurological abnormalities in elderly individuals are a manifestation of early brain damage, a finding that may have important implications in research studies on the prevention of age-related cognitive and functional decline," the authors wrote.
"Understanding the nature of dysfunctions underlying the decline in physical performance and disability contributes to planning specific preventive interventions."
The study followed more than 500 adults with an average age of 72.5. The findings were published in the June 23 issue of Archives of Internal Medicine.
Study subjects underwent a neurological examination in 1995 and then another one four years later. Incidences of stroke and death were tracked for eight years.
In 1995, 59 per cent of subjects had at least one neurological abnormality. The researchers found that having more abnormalities was linked to an increase in symptoms of depression, decreasing memory and poor body functioning.
The study adds to previous research that showed that neurological abnormalities can lead to falls and overall poor physical function.
The researchers suggested that regular neurological examinations be given to healthy older adults to "capture additional information about the integrity of the nervous system."
Abstract:
Subtle Neurological Abnormalities as Risk Factors for Cognitive and Functional Decline, Cerebrovascular Events, and Mortality in Older Community-Dwelling Adults
Marco Inzitari, MD; Claudia Pozzi, MD; Luigi Ferrucci, MD, PhD; Daniela Chiarantini, MD; Lucio A. Rinaldi, PT; Marco Baccini, PT; Riccardo Pini, MD; Giulio Masotti, MD; Niccol锟� Marchionni, MD; Mauro Di Bari, MD, PhD
Background: Subtle, but clinically detectable, neurological abnormalities (SNAs) are associated with impaired physical performance in elderly persons without overt neurological diseases.Weinvestigated whether SNAs were prospectively associated with cognitive and functional status, death, and cerebrovascular events (CVEs) in older community-dwelling individuals.
Methods: In participants without history of stroke, parkinsonism and dementia, or cognitive impairment, a score (NSNA) was obtained by summing SNAs detected with a simple neurological examination. Cognitive status and disability were reassessed 4 years later, and deaths and CVEs were documented over 8 years.
Results: Of 506 participants free of neurological diseases (mean [SEM] age, 71.9[0.3] years; 42% were men), 59% had an NSNA of 1 or more (mean [SEM], 1.1[0.06]; range, 0-8). At baseline, the NSNA increased with age and with declining cognitive and physical performance, depressive symptoms, and disability, after adjusting for several covariates, but did not increase with falls and urinary incontinence. The NSNA prospectively predicted worsening cognitive status and disability, adjusting for demographics and for baseline comorbidity and cognitive and physical performance. The mortality rates were 22.6, 23.3, 23.9, 58.6, and 91.9 per 1000 person-years in participants with an NSNA of 0, 1, 2, 3, and 4 or higher, respectively. Compared with an NSNA of less than 3, having an NSNA of 3 or higher was associated with an increased adjusted risk of death (hazard ratio, 1.77; 95% confidence interval [CI], 1.25-2.74) and of CVE (hazard ratio, 1.94; 95% CI, 1.07-3.54) over 8 years.
Conclusion: In this sample of older community dwelling persons without overt neurological diseases, multiple SNAs were associated with cognitive and functional decline and independently predicted mortality and CVEs.
