Old Age Is a Too-Easy Culprit for Sudden Decline (Johns Hopkins Medical School)

Ahmet Hoke

Looking back to events that began two years ago, Emilie Daly can now recognize the subtle signs that her health was not right. It began, she now realizes, with an 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,” says Daly.

As her health declined, Daly’s son and daughter-in-law, Ned and Kitty Daly, took her to several doctors, and eventually, she was admitted to the hospital. But the doctors found nothing wrong that could account for Daly’s symptoms beyond “old age,” and they referred her to a rehabilitation facility, where she remained for several months.

By then, Daly had started to wonder whether her advancing years could really account for her condition. “I couldn’t even lift a pencil,” she says. Such frailty is not a normal consequence of aging. Kitty Daly, too, had not given up hope. She continued to seek the advice of various health professionals. Eventually, she spoke to a neurologist who suggested that Daly might have a condition called chronic inflammatory demyelinating polyneuropathy, or CIDP, and referred her to Johns Hopkins.

After examining Daly and reviewing her medical history, neurologist Ahmet Hoke agreed with her referring physician that she almost certainly had CIDP. The disease occurs when the immune system attacks the myelin sheath, the fatty covering that coats and protects nerve cells. 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, the tingling and numbness in her fingers and toes—technically called paresthesias—were not normal symptoms of “old age,” says Hoke. Another clue was the fact that her weakness began in her feet and legs and ascended upward, “textbook classic” of CIDP, says Hoke. To confirm his diagnosis, Hoke also performed a nerve conduction study, a test used to evaluate how well nerves conduct electrical signals. The test showed that Daly did indeed have CIDP.

Hoke prescribed a series of intravenous immunoglobulin treatments—basically, large doses of antibodies intended to reboot the immune system. After two rounds of the therapy, Daly says, her health had returned.

Daly has since 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.”

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