Study - Subtle Neurological Changes May Predict Stroke and Death in Older Adults

Tremor, reduced reflexes, differences in hand strength and unstable posture have been found to predict the risk of stroke and death in otherwise healthy older individuals within 8 years, according to a study published in the June 23 issue of the Archives of Internal Medicine. The findings may be so subtle that they are not likely to be reported by patients.

Marco Inzitari, MD, from the University of Florence, in Italy, and colleagues examined 506 individuals with an average age of 72.5 years who had no neurological disease. Fourteen percent of the participants had 3 or more subtle neurological abnormalities. The incidence of death and stroke was recorded over eight years, and it was found that those with three or more subtle neurological abnormalities had a greater risk of dying or having a stroke over an eight year period. The researchers were able to conclude that "a simple neurological examination seems to be an additional prognosticator of hard outcomes, particularly death, above and beyond other measures used in clinical practice.” Furthermore, "These findings support the hypothesis that subtle neurologic abnormalities in elderly individuals are a manifestation of early brain damage," Understanding the nature of dysfunctions underlying the decline in physical performance and disability contributes to planning specific prevention initiatives."

What this Study Means to You

Healthy older adults should undergo routine neurological testing to identify the risk for future events that may lead to loss of activity and increased mortality. Preventative measures include enrolling active elders in prevention trials. Family physicians are urged to incorporate the Vulnerable Older Adult Scale into routine practice.

The usefulness of predicting health outcomes can help physicians, patients and families make necessary decisions about individualized patient care.

“In clinical settings, our index may be useful in identifying both high- and low-risk patients so that specific interventions can be targeted to each group. Because the benefits of cancer screening are not realized for 5 years, recent cancer screening guidelines call for targeting screening to individuals with a life expectancy of more than 5 years. Our index may be useful in identifying older low-risk patients who may benefit from screening as well as identifying younger high-risk patients for whom the benefits of screening are outweighed by the harms. For example, a 75-year-old male smoker with heart failure, difficulty bathing, walking, and managing finances may not be an appropriate candidate for colorectal cancer screening because his probability of 4-year mortality is greater than 64% (16 points). On the other hand, an 85-year-old woman with no major comorbid conditions and excellent functional status has a high probability of surviving 4 years and would be a good candidate for screening despite her advanced age. In addition, our index may be useful in identifying patients with whom advance directives would be especially important to discuss.”(1)

Quality of life is important. Decisions regarding medical interventions and independent living become more critical with aging. Defining the risks and benefits of surgery and invasive procedures can seem difficult. The information provided by this study can help everyone make informed decisions about living arrangements, medical testing and available treatment options for older adults. The findings here emphasize the fact that “one size (does not) fit all”.

Arch Intern Med 2008;168:1270-1276 Abstract

(1) Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults