medigraphic.com
Colegio de Medicina Interna de México.

2025, Number 07

<< Back Next >>

Med Int Mex 2025; 41 (07)

Diagnosis and management of peripheral neuropathy in elderly adults

Prado F

Language: Spanish
References: 51
Page: 424-438
PDF size: 681.50 Kb.


ABSTRACT

Background: Peripheral neuropathy impacts functional capacity and interferes with healthy ageing in elderly adults. The high prevalence of idiopathic cases reduces the therapeutic options.
Objective: To summarize the key aspects of diagnosis and management of peripheral neuropathy in adults, sixty-four and older.
Methodology: Indexed, high quality scientific literature search.
Results: Physiologic changes in ageing increase the risk of developing peripheral neuropathy in elderly adults. Peripheral neuropathy may be classified in five clinical patterns. The onset, progression, type of nervous fiber damaged and clinical presentation help clinicians in the differential diagnosis workup. The most common causes of peripheral neuropathy in elderly adults are diabetes, nutritional deficiencies (either due to impairments of absorption or to urinary micronutrient loss), especially the related to vitamin B12 deficiency, neurotoxic medications or toxins. There are also cases of immune mediated peripheral neuropathy. Treatment includes prevention of neurologic damage, management of treatable causes and secondary prevention of related complications.
Conclusiones: Beyond symptomatic pain, peripheral neuropathy includes a broad spectrum of signs and symptoms, such as falls and fear of falling, gait and equilibrium disturbances, all of which affect functional capacity. Management depends largely on an accurate causal diagnosis. Prevention of neurological damage, and prompt treatment are clue to therapeutic success.


REFERENCES

  1. Giovannini S, Coraci D, Brau F, Galluzzo V, et al. Neuropathicpain in the elderly. Diagnostics 2021; 11: 613. https://doi.org/10.3390/diagnostics11040613

  2. Rudnicka E, Napierala P, Podfigurna A, Męczekalski B, etal. The World Health Organization (WHO) approach tohealthy ageing. Maturitas 2020; 139: 6-11. https://doi.org/10.1016/j.maturitas.2020.05.018

  3. Lehmann H, Wunderlich G, Fink G, Sommer C. Diagnosisof peripheral neuropathy. Neurol Res Pract 2020; 2: 20.https://doi.org/10.1186/s42466-020-00064-2

  4. Watson J. Peripheral neuropathy: A practical approachto diagnosis and symptom management. Mayo ClinProc 2015; 90 (7): 940-51. https://doi.org/10.1016/j.mayocp.2015.05.004

  5. Hicks CW, Wang D, Windham BG, Matsuhita K, Selvin E.Prevalence of peripheral neuropathy defined by monofilamentinsensitivity in middle-aged and older adults intwo US cohorts. Sci Rep 2021; 11: 19159. https://doi.org/10.1038/s41598-021-98565-w

  6. Bronge W, Lindholm B, Elmstahl S, Siennicki-Lantz A.Epidemiology and functional impact of early peripheralneuropathy signs in older adults from a generalpopulation. Gerontology 2024; 70: 257-268. https://doi.org/10.1159/000535620

  7. Motiwala R. A clinical approach to disease of peripheralnerve. Clin Geriatr Med 2021; 37: 197-208. https://doi.org/10.1016/j.cger.2021.01.009

  8. Norman K, Haß U, Pirlich M. Malnutrition in older adults- Recent advances and remaining challenges. Nutrients2021; 13: 2764. https://doi.org/10.3390/nu13082764

  9. Prado F. Diagnóstico y tratamiento de neuropatía periféricaen prediabetes y diabetes. Rev Mex Endocrinol Metab Nutr2025; 12: 15-29. https://doi.org/10.24875/RME.24000018

  10. Taams N, Drenthen J, Hanewinckel R, Ikram A, van Doorn P.Age-related changes in neurologic examination and sensorynerve amplitude in the general population. Neurology2023; 101 (13): e1351-e1358. https://doi.org/10.1212/wnl.0000000000207665

  11. Borzuola R, Giombini A, Torre G, Campi S, Albo E, Bravi M,et al. Central and peripheral neuromuscular adaptations toageing. J Clin Med 2020; 9: 741. https://doi.org/10.3390/jcm9030741

  12. Bouche P. Neuropathy of the elderly. Rev Neurol2020; 176 (9): 733-738. https://doi.org/10.1016/j.neurol.2019.11.007

  13. Verdú E, Ceballos D, Vilches J, Navarro X. Influence of agingon peripheral nerve function and regeneration. J PeripherNerv Syst 2008; 5: 191-208. https://doi.org/10.1046/j.1529-8027.2000.00026.x

  14. Gallo A, Pellegrino S, Pero E, Agnitelli M, et al. Maindisorders of gastrointestinal tract in older people: Anoverview. Gatrointest Disord 2024; 6: 31-336. https://doi.org/10.3390/

  15. Hammond N, Wang Y, Dimanchkie M, Barohn R. Nutritionalneuropathies. Neurol Clin 2013; 31 (2): 477-489. https://doi.org/10.1016/j.ncl.2013.02.002

  16. Pinzón - Espitia O. Malnutrición en el adulto mayor. RevCienc Salud 2023; 21 (2): 1-4. http://dx.doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.13492

  17. Domic J, Grootswagers P, van loon L, de Groot L. Perspective:Vegan diets for older adults? A perspective on thepotential impact on muscle mass and strength. Adv Nutr2022; 13: 712-725. https://doi.org/10.1093/advances/nmac009.

  18. Fang Y, Yuan X, Zhang Q, Liu J, et al. Causality betweensarcopenia and diabetic neuropathy. Front Endocrinol.2024; 15: 1428835. https://doi.org/10.3389/fendo.2024.1428835

  19. Beard J, Officer A, Araujo de Carvalho I, Sadana R, et al. TheWorld Report on ageing and Health: a policy frameworkfor healthy ageing. Lancet 2016; 10033 (387): 2145-2154.https://doi.org/10.1016/S0140-6736(15)00516-4

  20. Yang Q, Ni X, Zhang Y, Zhu B, et al. Sarcopenia is an independentrisk factor for all-cause mortality rate in patientswith diabetic foot ulcers. Front Nutr 2023; 10: 1097008.https://doi.org/10.3389/fnut.2023.1097008

  21. Teissier T, Boulanger E, Cox L. Interconnections betweeninflammageing and immunosenescence duringageing. Cells. 2022; 11 (3). https://doi.org/10.3390/cells11030359

  22. Castelli G, Desai KM, Cantone RE. Peripheral neuropathy:evaluation and differential diagnosis. Am Fam Phys 2020;102 (12).

  23. Beran R. Paraesthesia and peripheral neuropathy. AustFam Phys 2015; 44 (3): 92-5. https://pubmed.ncbi.nlm.nih.gov/25770571/

  24. Ginsberg L. Acute and chronic neuropathies. Medicine(Abingdon) 2020; 48 (9). https://doi.org/10.1016/j.mpmed.2020.06.009

  25. Chen Y, Tang X. Chronic demyelinating poliradiculoneuropathyin association with concomitant diseases: identificationand management. Front Immunol 2022; 13: 890142.https://doi.org/10.3389/fimmu.2022.890142

  26. Singh D, Gray J, Laura M, Reilly M. Charcot neuropathy inpatients with Charcot Marie Tooth disease. Foot AankleSurg 2021; 27 (8): 865-868. https://doi.org/10.1016/j.fas.2020.11.005

  27. Zhang Q, Zhou X, Yajun L, Yang X, Abassi Q. Clinical recognitionof sensory ataxia and cerebellar ataxia. Front HumNeuroxci 2021; 15: 639871. https://doi.org/10.3389/fnhum.2021.639871

  28. Chitimus D, Jurcut C, Pleșa CF. Peripheral neuropathy: Apractical guide for internists. Internal Med 2021; XVIII (5).https://doi.org/10.2478/inmed-2021-0182

  29. Niu J, Ganta C, Kim L. Peripheral neuropathy in older adults.J Electrodiagn Neuromuscul Dis 2023; 25 (3): 92-99. https://doi.org/10.18214/jend.2023.00115

  30. McDermott K, Fang M, Boulton A, Selvin E, Hicks C. Etiology,epidemiology, and disparities in the burden of diabetic footulcers. Diabetes Care 2023; 46 (1): 209-221. DOI: https://doi.org/10.2337/dci22-0043

  31. Yao Y, Chen L, Qian Y. Age characteristics of patients withtype 2 diabetic foot ulcers and predictive risk factors forlower limb amputation: A population-based retrospectivestudy. JDR 2024; 2024. https://doi.org/10.1155/jdr/2380337

  32. Anish L, Nagappa M, Mahadevan A, Taly A. Neuropathy inelderly: lessons learnt from nerve biopsy. Age Ageing 20015;44: 312-317. https://doi.org/10.1093/ageing/afu171

  33. Briani C, Dalla Torre C, Citton V, et al. Cobalamin deficiency:Clinical picture and radiological findings. Nutrients 2013; 5:4521-4539. https://doi.org/10.3390/nu5114521

  34. Muñoz-Chiamil S. Imaging evaluation of peripheral nerves.Austral J Imaging (Eng ed). 2024; 30 (4): 185-200. http://dx.doi.org/10.24875/AJI.23000085

  35. Kostick N, Chen E, Eckert T, Sirotkin I, et al. Clinical presentationof subacute combined degeneration in a patient withchronic B12 deficiency. Fed Pract 2022; 39 (3): 142-146.https://doi.org/10.12788/fp.0228

  36. Pitarokoili K, Gold R, Fisse A. Nerve ultrasound for thediagnosis and follow-up of peripheral neuropathies. CurrOpin Neurol 2023; 36: 373-381. https://doi.org/10.1097/wco.0000000000001183

  37. Huynh W, Kiernan M. Nerve conduction studies. Austr FamPhys 2011; 40 (9): 693 -697.

  38. Soury M, Fornasari B, Carta G, Zen F, et al. The role of dietarynutrients in peripheral nerve regeneration. Int J MolSci 2021; 22: 7417. https://doi.org/10.3390/ijms22147417

  39. Fei S, Fan J, Cao J, Chen H, et al. Vitamin D deficiency increasesthe risk of diabetic peripheral neuropathy in elderlytype 2 diabetes mellitus patients by predominantly increasinglarge-fiber lesions. Diabetes Res Clin Pract 2024; 2009:111585. https://doi.org/10.1016/j.diabres.2024.111585

  40. Mouchaileh N. Vitamin B12 deficiency in older people:A practical approach to recognition and management.J Pharm Pract Res 2023; 53: 350-358. https://doi.org/10.1002/jppr.1897

  41. Elangovan R, Baruteau J. Inherited and acquired vitaminB12 deficiencies: Which administration route to choosefor supplementation? Front Pharmacol 2022; 13: 972468.https://doi.org/10.3389/fphar.2022.972468

  42. Lyon P, Strippoli V, Fang B, Cimmino L. B vitamins and One-Carbon metabolism: Implications in human health and disease.Nutrients 2020; 12: 2867. https://doi.org/10.3390/nu12092867

  43. Loda I, D'Angelo E, Marzetti E, Kerminen H. Prevention, assessment,and management of malnutrition in older adultswith early stages of cognitive disorders. Nutrients 2024; 16:1566. https://doi.org/10.3390/nu16111566

  44. Wu H, McDonnel T, Chinnadurai R. Physiological associationbetween vitamin B deficiency and diabetic kidney disease.Biomedicines 2023; 11: 1153. https://doi.org/10.3390/biomedicines11041153

  45. Koike H, Takahashi M, Ohyama K, Hashimoto R, et al.Clinicopathologic features of folate - deficiency neuropathy.Neurology 2015; 84 (10): 1026-1033. https://doi.org/10.1212/WNL.0000000000001343

  46. Wald N, Morris J, Blakemore C. Public health failure in theprevention of neural tube defects: time to abandon thetolerable upper intake level of folate. Public Health Rev2018; 39: 2. https://doi.org/10.1186/s40985-018-0079-6

  47. Wu Z, Song X, Wang G, Wang B. U-shaped nonlinearrelation between dietary copper intake and peripheralneuropathy. Sci Rep 2024; 14: 25263. https://www.nature.com/articles/s41598-024-76159-6

  48. Rahaman K, Remli R, Tan H, Mustafa N, et al. The associationof vitamin D level with diabetic peripheral neuropathy:A comparative cross- sectional study. Neurology Asia 2023;28 (3): 663-671. https://doi.org/10.54029/2023eww

  49. Wakeman M. A literature review of the potential impactof medication on vitamin D status. Risk Manag HealthcPolicy 2021; 14: 3357-3381. https://doi.org/10.2147/RMHP.S316897

  50. Pedowitz E, Abrams R, Simpson D. Management ofneuropathic pain in the geriatric population. Clin GeriatrMed 2021; 37: 361-376. https://doi.org/10.1016/j.cger.2021.01.008

  51. Prado F. Neuropatía periférica y vitaminas del complejoB: revisión y algoritmo terapéutico. Rev MexEndocrinol Metab Nutr 2023; 10: 128-143. 10.24875/RME.23000012




2020     |     www.medigraphic.com