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 define the most relevant clinical tests for the diagnosis of significant neuropathy in the elderly diabetic patient, quantified perception of vibration, temperature, pain, and light touch was assessed in 200 (100 hospitalized, 100 community) consecutive non-diabetic elderly subjects without apparent neurological disease, using an established scoring system. The changes in sensory perception were similar in the two groups and data were pooled for further analysis. Progressive loss of peripheral sensation was apparent with increasing age (neuropathy deficit score vs age: r = .04, p < 0.0001). Loss of vibration perception was particularly marked; deficit scores for vibration were significantly lower in the < 70 years age group than in all the older age groups (vibration score: < 70 years vs 80-84 years mean (95% CI) 0.89 (0.54) vs 3.02 (0.6), p < 0.0001). In contrast, perception of light touch and pain was relatively preserved in old age. Assessment of vibration perception is of limited value in elderly people since the distinction between 'normal ageing' and significant neuropathy is unclear. Perception of light touch and pain are likely to be the most reliable clinical indicators of significant neuropathy in an elderly diabetic population.