How do we distinguish loss of vibration sensation due to neuropathy from that due to ageing?

Abstract

The aim of this study was to determine whether loss of sensation in the feet due to diabetic neuropathy can be distinguished from age-related changes by testing sensation at more proximal sites. Vibration perception threshold (VPT) was tested using a biothesiometer at the feet, mid-tibia and knees on participants who had a VPT ≥50 volts. We studied: (i) diabetic patients with a history of neuropathic ulceration (N Ulcer +ve); (ii) elderly diabetic patients with no history of ulceration (E Ulcer -ve); and (iii) elderly non-diabetic controls. The VPT of the N Ulcer +ve group dropped significantly at the level of mid-tibia and knee and was significantly different from the E Ulcer -ve group at both sites and from the elderly controls at the knee (p<0.05). By contrast, the E Ulcer -ve group and the elderly controls tended to have poor vibration perception at all three sites. The results of this study suggest that diabetic neuropathy is a predominantly distal disease, whereas ageing is associated with a more generalised loss of sensation. This observation may be used to grade more precisely the risk of ulceration in elderly diabetic patients. Copyright © 2013 John Wiley & Sons.