The Soft Signs of Neurological Problems of Mobility

Abstract

“Soft signs” is clinical shorthand for early and subtle signs of disease. The term is often used as contrast with the phrase “hard signs” which implies unequivocal and pathognomonic signs of disease. It also implies debatable or at times rather indefinite clinical signs which often merge imperceptibly into the usual normal physical findings of a particular age group. Thus, before commenting on specific “soft signs” of neurological disease in patients above the age of 50 years, it would seem worthwhile to list the findings in the physical examination and fragments of the clinical history in the late middle-aged and the elderly which are not uncommon nor critical indicators of disease. These relatively common and normal variants are often mistaken as clinical signals of serious ongoing intracranial disease and are the subject of unnecessary consultations, laboratory work and admissions to hospital. Were they recognized for what they are, that is, the normal changes in the central and peripheral nervous systems occurring with age, a great deal of anxiety and fear in patients could be allayed and considerable money saved when unnecessary and often dangerous laboratory work is eliminated. The following list contains a number of these normal and common variants found in the examination of the late middle-aged and early:

• 1. Talkativeness and vagaries of speech.

• 2. Indistinct pronunciation to a modest degree.

• 3. A hesitant, staccato type of speech.

• 4. Some inattention and restlessness.

• 5. Poor vision and cataracts.

• 6. Moderate deafness, either unilateral or bilateral.

• 7. Unequal pupils, poorly reactive to light.

• 8. An absence of the convergence reflex.

• 9. Incomplete upward gaze.

• 10. Inadequate lateral gaze.