Effects of Aging on Impairment Ratings: Part 3: Neurological and Associated Issues
Stephen L. Demeter
Search for other papers by Stephen L. Demeter in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

This article is the third in a series of four that explore the effects of age-related changes in impairments as defined by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions. Specifically, this article focuses on evaluation of disturbances of the nervous system, divided for discussion here into four parts—the central nervous system (CNS), the peripheral nervous system, vision, and hearing—and offers guidance in using the AMA Guides, Fifth and Sixth Editions, in a variety of specific disorders within each group. For example, the CNS discussions address disorders of consciousness and awareness; sleep and arousal disorders; alterations in metal status, cognition, and highest integrative function; aphasia or dysphagia; emotional or behavioral disorders resulting from CNS causation (fifth edition only); chronic pain; and others. One of the most challenging issues in evaluating peripheral neuropathy regards carpal tunnel syndrome, and rating physicians should provide references in their reports to justify their position. Rating visual problems usually requires attention to the medical records to document preinjury visual status. The AMA Guides, Fifth and Sixth Editions, do not use age-adjusted corrections in assessing age-related diminished hearing, but local jurisdictions and circumstances may apply apportionment. In apportioning impairment due to aging, the examiner must understand both the science and the specific legal processes involved.

  • 1.

    Cocchiarella L, Andersson GBJ, eds. Guides to the Evaluation of Permanent Impairment, 5th ed. Chicago: American Medical Association; 2001.

    • Search Google Scholar
    • Export Citation
  • 2.

    Rondinelli RD, ed. Guides to the Evaluation of Permanent Impairment, 6th ed. Chicago: American Medical Association; 2008.

  • 3.

    Taffet GE. Normal aging. Schmader KE, ed. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

  • 4.

    Caplan LR. Etiology, classification, and epidemiology of stroke. Kasner SE, ed. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 5.

    Ovbiagele B, Nguyen-Huynh MN. Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics. 2011; 8:319329.

    • Search Google Scholar
    • Export Citation
  • 6.

    Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011; 123:e18e209.

    • Search Google Scholar
    • Export Citation
  • 7.

    Kaufmann H. Mechanisms, causes, and evaluation of orthostatic hypotension. Aminoff MJ, ed. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 8.

    Edwards BA, O'Driscoll DM, Ali A, Jordan AS, Trinder J, Malhotra A. Aging and sleep: physiology and pathophysiology. Semin Respir Crit Care Med. 2010; 31:618633.

    • Search Google Scholar
    • Export Citation
  • 9.

    Orr JE, Malhotra A, Sands SA. Pathogenesis of central and complex sleep apnoea. Respirology. 2017; 22:4352.

  • 10.

    Strohl KP. Overview of obstructive sleep apnea in adults. Collop N, ed. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 11.

    Young T, Shahar E, Neito J, et al. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002; 162:893900.

    • Search Google Scholar
    • Export Citation
  • 12.

    Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing in cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163:1925.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mehra R. Obstructive sleep apnea and cardiovascular disease in adults. Collop N, ed. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 14.

    Mann NM, Lafreniere D. Anatomy and etiology of taste and smell disorders. Deschler DG, eds. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 15.

    Bajwa ZH, Ho CC, Khan SA. Trigeminal neuralgia. Shefner JM, Swanson JW, eds. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 16.

    Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017; 158:11661174.

  • 17.

    Winn FJ, Ptuz-Anderson V. Vibration thresholds as a function of age and diagnosis of carpal tunnel syndrome: a preliminary report. Exp Aging Res. 1990; 16:221224.

    • Search Google Scholar
    • Export Citation
  • 18.

    Baldereschi M, Inzitari M, Di Carlo A, et al. Epidemiology of distal symmetrical neuropathies in the Italian elderly. Neurology. 2007; 68:14601467.

    • Search Google Scholar
    • Export Citation
  • 19.

    Rivner MH, Swift TR, Malik K. Influence of age and height on nerve conduction. Muscle Nerve. 2001; 24:11341141.

  • 20.

    Melhorne JM, Martin D, Brooks CN, Seaman S. Upper limb. In: Melhorne JM, Talmage JB, Ackerman WE, Hyman MH, eds. AMA Guides to the Evaluation of Disease and Injury Causation. 2nd ed. Chicago: AMA Press; 2014;243355.

    • Search Google Scholar
    • Export Citation
  • 21.

    Becker J, Scalco RS, Pietroski F, Celli LF, Gomes I. Is carpal tunnel syndrome a slow, chronic, progressive nerve entrapment? Clin Neurophysiol. 2014; 125:642646.

    • Search Google Scholar
    • Export Citation
  • 22.

    Kommalage M, Parthirana KD. Influence of age and the severity of median nerve compression on forearm median motor conduction velocity in carpal tunnel syndrome. J Clin Neurophysiol. 2011; 28:642646.

    • Search Google Scholar
    • Export Citation
  • 23.

    Povlsen B. High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome. Am R Coll Surg Engl. 2010; 92:403405.

    • Search Google Scholar
    • Export Citation
  • 24.

    Kouyoumdjian JA, Zaanetta DM, Moria MP. Evaluation of age, body mass index, and wrist index as risk factors for carpal tunnel syndrome severity. Muscle Nerve. 2002; 25:9397.

    • Search Google Scholar
    • Export Citation
  • 25.

    Grant KA, Congleton JJ, Koppa RJ. Age and weight effects on motor nerve conduction time measurements and asymptomatic industrial population. J Occup Rehabil. 1992; 2:175182.

    • Search Google Scholar
    • Export Citation
  • 29.

    Mirza R, Kirchner DB, Dobie RA, et al. Occupational noise-induced hearing loss: ACOEM Task Force on Occupational Hearing Loss. JOEM. 2018; 60:e498e501.

    • Search Google Scholar
    • Export Citation
  • 31.

    Chen YC, Feng Y, Xu JJ, et al. Disrupted brain functional network architecture in chronic tinnitus patients. Front Aging Neurosci. 2016; 8:174.

    • Search Google Scholar
    • Export Citation
  • 32.

    Yoo HB, De Ridder D, Vanneste S. The importance of aging in gray matter changes within tinnitus patients shown in cortical thickness, surface area and volume. Brain Topogr. 2016; 29:885896.

    • Search Google Scholar
    • Export Citation
  • 33.

    Yoo HB, De Ridder D, Vanneste S. White matter changes in tinnitus: is it all age and hearing loss? Brain Connectivity. 2016; 6; 8493.

    • Search Google Scholar
    • Export Citation
  • 34.

    Atik A. Pathophysiology and treatment of tinnitus: an elusive disease. Indian J Otolaryngol Head Neck Surg. 2014; 66(Suppl 1):S1S5.

  • 35.

    Knipper M, Van Dijk P, Nunes I, Ruttiger L, Zimmermann U. Advances in the neurobiology of hearing disorders: recent developments regarding the basis of tinnitus and hyperacusis. Progress Neurobiology. 2013; 111:1733.

    • Search Google Scholar
    • Export Citation
  • 36.

    Hazell J. Tinnitus and disability with aging: adaptation and management. Acta Otolaryngol Suppl. 1990; 476:202208.

  • 37.

    Furman JM. Causes of vertigo. Aminoff MJ, Deschler DG, eds. UpToDate; Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 02, 2017.)

    • Search Google Scholar
    • Export Citation
  • 38.

    Balatsouras DG, Koukoutsis G, Fassolis A, Moulos A, Apris A. Benign paroxysmal vertigo in the elderly: current insights. Clin Interv Aging. 2018; 13:22512266.

    • Search Google Scholar
    • Export Citation
  • 39.

    Fujimoto C, Kawahara T, Kinoshita M et al. Aging is a risk factor for utricular dysfunction in idiopathic benign paroxysmal positional vertigo. Front Neurol. 2018; 9:1049.

    • Search Google Scholar
    • Export Citation
  • 40.

    Liu DH, Kuo CH, Wang CT, et al. Age-related increases in benign paroxysmal positional vertigo are reversed in women taking estrogen replacement therapy: a population-based study in Taiwan. Front Aging Neurosci. 2017; 9:404.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2187 2187 307
Full Text Views 33 33 0
PDF Downloads 0 0 0
Save