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Influence of age on nerve conduction

Rivner et al. reported that the “percentage of normals who had no response increased with advancing age” in regard to nerve conduction studies. We find that statement to be largely erroneous. We draw the authors’ attention to our electrodiagnostic studies on the healthy elderly. The healthy elderly subjects were carefully screened. Any medical condition associated with a peripheral neuropathy or the use of any medication associated with a peripheral neuropathy led to the exclusion of the subjects, even if there were no symptoms or signs of a peripheral neuropathy. None of the included subjects resided in a nursing home because of the implication of some degree of chronic illness. A clinical history and physical examination was performed and any subject with symptoms or signs of neuromuscular impairment in any limb was also excluded. We found that sensory responses for the median, ulnar, and radial nerves were readily obtained in all subjects from 60–95 years of age. In the lower limbs, sural responses were obtained in all but two individuals, who were 79 and 85 years of age. A limitation of the study of Dr. Rivner and his colleagues is that the population was not normal. Their normative data were collected on referred patients—not selected healthy subjects—whose data were retrospectively analyzed. In other words, the patients presented seeking an answer to some neurologic symptom that led the referring physician to request an electrodiagnostic consultation. As such, it is strongly implied that some type of pathology was present in these patients. In addition, there may be some discrepancies and difficulties with the techniques applied in obtaining the sensory responses. In some cases, particularly in individuals over 80 years of age, averaging may be needed. We would welcome the opportunity to review more prospective studies on healthy elderly subjects. Based upon our experience, the absence of recordable sensory nerve action potentials in the upper limbs should clearly be considered abnormal, and the absence of recordable sensory nerve action potentials in the lower limbs of a symptomatic elderly subject is highly suspicious for the presence of significant pathology.