THE CLINICAL-DIAGNOSIS OF SENSORY NEUROPATHY IN ELDERLY PEOPLE

Minor abnormalities in sensory perception are common in elderly people but the significance of these findings is uncertain. In order to defi ne the most relevant clinical tests for the diagnosis of significant n europathy in the elderly diabetic patient, quantified perception of vi bration, temperature, pain, and light touch was assessed in 200 (100 h ospitalized, 100 community) consecutive non-diabetic elderly subjects without apparent neurological disease, using an established scoring sy stem. The changes in sensory perception were similar in the two groups and data were pooled for further analysis. Progressive loss of periph eral sensation was apparent with increasing age (neuropathy deficit sc ore vs age: r = 0.4, p < 0.0001). Loss of vibration perception was par ticularly marked; deficit scores for vibration were significantly lowe r in the < 70 years age group than in all the older age groups (vibrat ion score: < 70 years vs 80-84 years mean (95 % CI) 0.89 (0.54) vs 3.0 2 (0.6), p < 0.0001). In contrast, perception of light touch and pain was relatively preserved in old age. Assessment of vibration perceptio n is of limited value in elderly people since the distinction between 'normal ageing' and significant neuropathy is unclear. Perception of l ight touch and pain are likely to be the most reliable clinical indica tors of significant neuropathy in an elderly diabetic population.