Prevalence of Peripheral Neuropathy Among Very Old Adults: Evidence From the Michigan Neuropathy Screening Instrument.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.