Balance and mobility assessment for ruling-out the peripheral neuropathy of the lower limbs in older adults

- The peripheral neuropathy of the lower limbs (PNLL) is a common cause of balance and gait impairment in the elderly.
- The TUG, POMA and DEMMI are common tests for balance and mobility assessment.
- The CELSIUS scale was developed in this study for a selective evaluation of static balance.
- The CELSIUS, TUG and DEMMI have high sensitivity (but low specificity) for the PNLL.
- The CELSIUS, TUG and DEMMI can be used for ruling-out a significant large fibers PNLL in the older adult.

The peripheral neuropathy of the lower limbs (PNLL) is an important cause of balance and mobility impairment in older adults. The nerve conduction study (NCS) is the gold standard for PNLL diagnosis. Aim of this work is to establish the sensitivity (Sn) and the specificity (Sp) of the balance and mobility examination for the PNLL in older adults.This study consecutively recruited 72 participants (>65 years) who accessed to the clinical neurophysiology outpatient clinic for suspected PNLL. Participants were given the NCS and four clinical tests. Mobility was evaluated by the Timed Up and Go (TUG) test, the Performance Oriented Mobility Assessment (POMA) and the de Morton Mobility Index (DEMMI). In addition the Clinical Evaluation of Static Upright Stance (CELSIUS) scale was developed for a selective evaluation of static balance.Based on the NCS, 36% of participants had PNLL. The CELSIUS scale (cutoff: 19.5/24), the TUG test (cutoff: 9.6 s) and the DEMMI scale (cutoff: 17.5/19) have high Sn (0.92 ÷ 0.96), but low Sp (0.28 ÷ 0.43) for the PNLL in the older adult. POMA scale (cutoff: 14.5/16) has low Sn (0.73), but acceptable Sp (0.85). In addition, CELSIUS, DEMMI and TUG negative likelihood ratios are 0.13, 0.17 and 0.12, respectively.Balance and mobility examination have high sensitivity for PNLL. CELSIUS score > 19/24, DEMMI score > 17/19 or TUG time ≤ 9.6 s substantially reduce PNLL likelihood. These clinical measures are thus recommended for ruling-out PNLL in the older adult.