03/18/2022    Leonard A. Levy, DPM, MPH

Detecting Peripheral Neuropathy as Well as Alzheimer’s Disease: The Podiatric Physician's Role

In 380 BCE, the great philosopher Plato wrote in a
play (i.e., Charmides), “As you ought not to
attempt to cure the eyes without the head, or the
head without the body, so neither ought you to
attempt to cure the body without the Soul. And
this ….is the reason why the cure of many diseases
is unknown to the physicians of Hellas (i.e.,
Greece), because they disregard the whole, which
ought to be studied also, for the part can never
be well unless the whole is well.”

A recent publication regarding peripheral
neuropathy being tied to a higher risk of
subsequent dementia graphically demonstrates
Plato’s statement and its relationship to
podiatric medicine and its importance not only to
the foot but also to its implications to the total
health of the body. Sensory nerve impairments
alone were associated with a 1.4 times higher
dementia risk, reports Brenowitz WD, et al. (1)

The study is the first to show a connection
between peripheral nerve function and central
nerve function which could be due to shared
genetics or pathways that affect both the
peripheral and central nervous system. For
clinicians which also includes podiatric
physicians, it suggests that older adults with
peripheral neuropathy should be monitored more
closely for dementia. The study included data on
2,174 people who were 70-79 years old who were
dementia-free when they enrolled, about half of
whom were women and 35% Black.

In an editorial by Shuman-Paretsky of the Icahn
School of Medicine at Mount Sinai in New York City
and Gustavo-Roman of Houston Methodist Hospital in
Texas noted that slow walking speed and poor gait
can predict dementia, in addition to motor and
sensory impairments being linked to Alzheimer’s
disease. (2) They further indicated that the
mechanisms linking the peripheral nervous system
to dementia are unclear but pathogenic factors
support the relationship.

Also pointed out is the typical pattern in the
elderly of peripheral neuropathy sensory loss,
which is distal, bilateral, and symmetrical are
thought to be due to loss of energy production in
the cell bodies in the dorsal root ganglia because
of metabolic (e.g., diabetes), toxic, and
neurogenic etiologies. It is reminded that
neurogenerative proteins have been found in the
dorsal root ganglia. This suggests that the same
process that occurs in brain neurons in the
central nervous system is also occurring in the
peripheral nervous system.

Recommended is the use of the Semmes-Weinstein
monofilament test and the 128 Hz tuning fork in
the lower extremity not only to detect peripheral
neuropathy but to help identify individuals in the
early stages of cognitive decline before dementia
begins or progresses. The role of podiatric
physicians being part of this diagnostic process
cannot be underestimated.

References

Brenowitz, WD, et al Associations of lower
extremity peripheral nerve impairment and risk of
dementia in Black and white older adults”
Neurology, March 9, 2022; DOI:
10.1212/WNL.0000000000200185.
Shuman-Paretsky M, Roman G “Association of lower
extremity peripheral nerve impairment and the risk
of dementia: bringing the peripheral nerve system
closer to the center “Neurology, March 9, 2022;
DOI: 10,1212/WNL. 0000000000200300.

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