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Physician Update - Old Age Is a Too-Easy Culprit for Sudden Decline

Physician Update Winter 2010

Old Age Is a Too-Easy Culprit for Sudden Decline

Date: January 31, 2010

Looking back, Emilie Daly can now recognize the subtle signs that her health was not right. It began with occasional tingling in her feet. Sometimes her legs felt weak. Then she started having trouble opening jars and turning the faucet.

At first, Daly didn’t pay much attention. She was 86, after all. “That’s just what happens when you get old,” she told herself. But over the next few months, her entire body grew weaker. “I couldn’t feed myself, write, stand, dress myself,” she says.

Daly’s son and daughter-in-law took her to several doctors, and eventually she was admitted to the hospital. But nothing could account for her symptoms beyond “old age,” and she was referred to a rehabilitation facility for several months. By then, Daly says, “I couldn’t even lift a pencil.”

Her daughter-in-law eventually spoke to a neurologist who suggested that Daly might have chronic inflammatory demyelinating polyneuropathy, or CIDP, and referred her to Johns Hopkins.

After examining Daly and reviewing her medical history, neurologist Ahmet Hoke agreed that she almost certainly had CIDP. The disease occurs when the immune system attacks nerve cells’ myelin sheath. As the damage progresses, nerve function declines, and the muscles stimulated by those nerves weaken. Daly’s symptoms, Hoke concluded, were strong signs that her body was experiencing such a reaction.

First, Hoke says, Daly’s paresthesias were not normal symptoms of old age. Second, her weakness began in her feet and ascended upward, “textbook classic” of CIDP, says Hoke. To confirm his diagnosis, he performed a nerve conduction study.

Hoke prescribed intravenous immunoglobulin treatments to reboot Daly’s immune system. After two rounds of the therapy, Daly says, her health had returned. She has resumed the active life she led before the onset of her illness, driving herself to the grocery store, playing duplicate bridge, and going to the fitness center three times a week.

“We often attribute weakness and frailty in older people to old age,” says Hoke. “But if these conditions develop rapidly, we should suspect something else. Just because somebody is elderly, you shouldn’t stop thinking about treatable causes.”

Call 410-955-9441 to refer a patient.