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Neuropathies in the Older Patients - Essay Example

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Neuropathies in the older patient Peripheral neuropathy is a term used to describe disorders of the peripheral nervous system. The disorders have an impact on the axon and/or myelin sheath1, whose key function is increasing the speed of transmission of nerve impulses…
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Neuropathies in the Older Patients

Download file to see previous pages... Hence, any injury to or disease of the peripheral nervous system could result in demyelination or axonal degeneration leading to disruption of the sensory and/or motor function of the affected nerve2. Peripheral neuropathy manifests most commonly as numbness, tingling and pain in feet and hands due to nerve damage. More severe symptoms include burning pain, muscle wasting, anomalies in organ and gland function, and paralysis2. Difficulty in food digestion, erratic maintenance of blood pressure levels, abnormal sweating and sexual dysfunction are other symptoms of peripheral neuropathy2. This objective of this paper is to discuss in detail the types of peripheral neuropathy observed in the older patients, their causes and diagnoses. Peripheral neurologic deficits especially losses of vibratory sensation and ankle reflexes are frequently observed in older patients during physical examination3. Epidemiologists believe that nearly 8% of people above 60 years of age are likely to have peripheral neuropathy4. Moreover, the incidence of peripheral neuropathy increases with advancing age1. Sensory changes including visual impairment, changes in hearing, smell, taste and peripheral sensation may be related to the aging process itself 3,1. Besides, in patients of advanced age, increased incidence of chronic systemic diseases triggering neuropathy, and the use of medications causing neurotoxic effects are also factors leading to the development of peripheral neuropathy1. The frequency of age-related neuropathy is constantly rising in the developed world as a result of improved longevity among the people1. According to Rajabally1, peripheral neuropathy in more than 50% of the elderly is caused by impaired glucose metabolism. So also, with increasing age, cases of cryptogenic neuropathy, that is, neuropathy with no clearly identifiable cause are more common1. Over-weight persons are prone to have diabetes and are, therefore, more likely to have neuropathy3. In the absence of any systemic diseases in the older patients, and when symptoms are relatively minor and mostly non-disabling, there is a tendency among caregivers to give less attention than required to neuropathy. However, studies have found strong evidence of a link between peripheral neuropathy and functional disability including impaired balance resulting in falls, deformities of the joints, leg cramps and muscular weakness1. Symptomatic manifestations and diagnosis of peripheral neuropathy in the older patients Idiopathic or age-related sensory neuropathy is often asymptomatic. Some changes in peripheral nerve function are increasingly observed clinically in older adults who show no overt symptoms. Achilles areflexia was observed in 25% of the subjects over the age of 60 who were part of a large meta-analysis while more than 33% of the subjects had reduced vibration sense at the big toes and absent ankle reflexes5. Clinical manifestations of neuropathic symptoms are highly variable and depend on the type and cause of neuropathy. Hence, taking an extensive patient history is required. According to NINDS Fact Sheet2, when damage to only one nerve is involved, it is known as mononeuropathy. When multiple nerves are damaged and affect all limbs, it is referred to as polyneuropathy. Involvement of two or more nerves in different parts of the body are involved, known as mono-neuritis multiplex, it may cause deep pain. The very frequently ...Download file to see next pagesRead More
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