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Subtle Physical Signs Could Predict Decline in Elderly

Many elderly people live full, independent lives and don't need much help from family and friends. But sometimes, older people experience what seems to be a sudden decline in their ability to remain independent, even while they don't appear to have suffered strokes, or have a debilitating illness such as Parkinson's or heart disease. Rose Hoban reports on a simple technique that may predict these kinds of changes.

Doctor Marco Inzitari from the Autonomous University of Barcelona studies these sudden declines in older people. He says with a magnetic resonance imaging machine, or an MRI, doctors can see some changes in small blood vessels in the brain. "But it's very hard to use it [the MRI] in everyday practice and also to use it in very large studies, because these kinds of assessments are very expensive," he explains.

But often, doctors and family members start to notice small, subtle changes – a senior loses balance more easily, or becomes unable to pick up a grandchild. Inzitari was interested to see if these subtle signs could actually be a low-tech way to predict imminent decline in the elderly.

Inzitari was able to use data from a study begun in 1995 of elders in a rural village in his native Italy. The researchers did thorough evaluations of the people, and collected data on many functional systems, including the neurological system.

"We used a standard neurological exam, and... this includes different signs, such as for example, in paired muscle strength, or reduced reflexes, or postural instability, as a very simple balance test," Inzitari says. "These kinds of things… all the physicians studied in medical school and this is something that is standardized all over the world." The researchers excluded people from the study who already had a diagnosable neurological disease.

Sure enough, when looking at the data, Inzitari found that people who had several of these subtle neurological changes at the beginning of the study were more likely to have declined after four years.

"Participants who had three or more neurological abnormalities at baseline lost around one or more than one activities of daily living at follow up," he says. "So they really declined in the functional status." He also notes that people with more abnormalities at the beginning of the study were more than twice as likely to have died after eight years.

Inzitari says one of the advantages to a standard neurological assessment is that it's cheap and universally understood by doctors. He also says these subtle changes are the kinds of things that families notice and can bring up with doctors.

If further research shows that, indeed, these subtle signs are predictors of physical and mental decline, they could become ways to alert doctors and families to take action before seniors decline too far.

Inzitari's research is published in the Archives of Internal Medicine.