Wu Y H Andrew, He Jiahuan Helen, McDermott Katherine M, Wang Dan, Fang Michael, Windham B Gwen, Selvin Elizabeth, Hicks Caitlin W
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2025 Sep 1. doi: 10.1111/jgs.70041.
Emerging evidence suggests that peripheral neuropathy (PN), which has been associated with mortality, is more common in older adults than previously recognized. However, most studies define PN by loss of protective sensation alone, a late form of PN. We aimed to quantify the prevalence and risk factors of PN in very old community-dwelling adults regardless of diabetes using the Michigan Neuropathy Screening Instrument (MNSI), a validated screening tool.
We conducted a cross-sectional analysis of participants aged 78-100 years old in the Atherosclerosis Risk in Communities Study (2022-2023). PN was defined by a score > 2 on the MNSI physical examination or ≥ 7 on the MNSI questionnaire. We report the prevalence rates and age-, sex-, race-center-adjusted odds ratios (aOR) of PN-associated covariates using logistic regression.
Among 1068 participants (median age 84.1 years, SD 3.9; 40.0% male; 17.6% Black; 26.8% with diabetes), 62.4% had PN. MNSI-detected PN was present in 67.5% of participants with diabetes, 61.7% with prediabetes, and 60.2% without diabetes (p = 0.14). Covariates associated with PN included advanced age (≥ 90 years vs. 75-80 year: aOR 2.92), male sex vs. female sex: (aOR 2.38), taller height (height quartile 4 vs1: aOR 2.32), low short physical performance battery scores (vs. highest scores: aOR 2.35), hypertension (aOR 1.56), and lumbosacral stenosis (aOR 1.76). In a sensitivity analysis, PN prevalence was lower when using the monofilament test (38.9%) compared to the MNSI (p < 0.001). Diabetes was significantly associated with PN when assessed using monofilament testing for loss of protective sensation (aOR: 1.85; 95% CI: 1.31-2.61) compared to the MNSI (aOR: 1.42; 95% CI: 1.00-2.03).
PN detected by the MNSI is highly prevalent among very old adults, regardless of diabetes status. The MNSI detected a higher prevalence of PN in older adults compared to the monofilament test. Routine screening of high-risk adults using the MNSI may be warranted to facilitate early detection and management.
新出现的证据表明，与死亡率相关的周围神经病变（PN）在老年人中比以前认为的更为常见。然而，大多数研究仅通过保护性感觉丧失来定义PN，这是PN的一种晚期形式。我们旨在使用经过验证的筛查工具密歇根神经病变筛查工具（MNSI），对居住在社区的高龄成年人中PN的患病率和危险因素进行量化，无论其是否患有糖尿病。
我们对社区动脉粥样硬化风险研究（2022 - 2023年）中78 - 100岁的参与者进行了横断面分析。PN通过MNSI体格检查得分>2或MNSI问卷得分≥7来定义。我们使用逻辑回归报告PN相关协变量的患病率以及年龄、性别、种族中心调整后的优势比（aOR）。
在1068名参与者中（中位年龄84.1岁，标准差3.9；40.0%为男性；17.6%为黑人；26.8%患有糖尿病），62.4%患有PN。MNSI检测到的PN在67.5%的糖尿病参与者、61.7%的糖尿病前期参与者和60.2%的非糖尿病参与者中存在（p = 0.14）。与PN相关的协变量包括高龄（≥90岁与75 - 80岁相比：aOR 2.92）、男性与女性相比（aOR 2.38）、身高较高（身高四分位数4与1相比：aOR 2.32）、短身体性能测试得分较低（与最高得分相比：aOR 2.35）、高血压（aOR 1.56）和腰骶部狭窄（aOR 1.76）。在一项敏感性分析中，与MNSI相比，使用单丝试验时PN患病率较低（38.9%）（p < 0.001）。与MNSI（aOR：1.42；95%CI：1.00 - 2.03）相比，使用单丝试验评估保护性感觉丧失时，糖尿病与PN显著相关（aOR：1.85；95%CI：1.31 - 2.61）。
无论糖尿病状态如何，MNSI检测到的PN在高龄成年人中高度流行。与单丝试验相比，MNSI在老年人中检测到的PN患病率更高。使用MNSI对高危成年人进行常规筛查可能有助于早期发现和管理。
