In otherwise healthy older people, subtle nervous system problems may signal an increased risk of stroke and death, Italian researchers report.

The warning signs can include reduced reflexes, unstable posture, resting tremors and differences in hand strength, they noted.

Previous evidence has linked subtle neurological abnormalities in older adults to poor physical function and falls.

In this latest study, researchers from the University of Florence studied 506 people, average age 72.5, who had an initial neurological examination in 1995 and again four years later.

At the start of the study, 59 percent of the participants had at least one subtle neurological abnormality. After they adjusted for age and sex, the researchers found a higher number of such abnormalities was associated with more severe disabilities, more symptoms of depression, and declining cognitive and functional status.

In addition, people with three or more subtle neurological abnormalities were more likely than those with fewer than three of these abnormalities to die or suffer a stroke or other cerebrovascular event over eight years.

The findings indicate “a simple neurological examination seems to be an additional prognosticator of hard outcomes, particularly death, above and beyond other measures used in clinical practice,” which currently include other performance-based tests for cognitive and physical function and depression, the study authors wrote.

“It is likely that the neurological examination might capture additional information about the integrity of the nervous system in apparently healthy older adults,” they noted.

“Our data support the hypothesis that subtle neurological abnormalities in elderly individuals are a manifestation of early brain damage, a finding that may have important implications in research studies on the prevention of age-related cognitive and functional decline. Understanding the nature of dysfunctions underlying the decline in physical performance and disability contributes to planning specific preventive interventions,” the researchers concluded.

The study was published in the June 23 issue of the Archives of Internal Medicine.

Standard neurological examinations of older adults are good predictors of future brain health and quality of life and should become part of doctors’ routine check-up of older adults, says an accompanying editorial.

“The Italian study confirms that looking at subtle neurological abnormalities in healthy older adults gives the doctor an insight into factors that contribute to impairment of functional cognition which lead to disability and poor quality of life,” editorial co-author Dr. Malaz Boustani, an investigator at the Indiana University Center for Aging Research, said in a prepared statement.

“Until now, we haven’t had proof of value of the standard neurological exam. We now know that the test is a good value for older adults and could even be used as a ‘cheap biomarker’ of future cognitive decline, because it appears to have predictive value similar to biomarkers,” said Boustani, a research scientist at the Regenstrief Institute Inc.

(Source: JAMA/Archives journals and Indiana University, news releases, June 23, 2008)