Most important, the meaning of particular symptoms may change with age.

Question

Most important, the meaning of particular symptoms may change with age. For example, problems with early morning awakenings may indicate depression in a young adult but may simply be a result of normal aging in an older adult.I have seen the sentence and I was wondering if "Most important" is a right expression there or it should be Most importantly or here important itself can be used as an adverb?What do you native English speakers think? Thank you so much as usual in advance!

Michael Chambers Teaching English · Accepted Answer

As a phrase on its own, you need "most importantly".  Kind regards, Michael

Mister Micawber · Answer

Here's an interesting comment from StackExchange:

...I also think it's useful to note a related issue concerning the adverbial usage of the specific word importantly, especially in the phrases more importantlyand most importantly.

For some reason, importantly was (probably unjustly) targeted by style guides and usage experts in the mid-20th century. After having encountered a couple overzealous older editors who insisted on rephrasing almost any use of the word importantly, I'm somewhat heartened to read answers and comments here by people who seem not to even realize this was once a significant editorial issue.
There's a bit of the history of the controversy here:

In 1968, “Winners and Sinners,” a periodic bulletin published by the New York Times, noted that, at the head of a sentence, “the adverbial phrase ‘more importantly’ modifies nothing in the sentence. What is wanted in constructions of this kind is ‘more important,’ an ellipsis of the phrase ‘what is more important.’”
Other authorities felt the same way, including Strunk and White’s “The Elements of Style,” which categorized the sentence-modifying “more importantly” as a misuse and told writers to avoid it by replacing it with “more important” or some other term.
Strangely, this flurry of opposition to “more importantly” was concentrated mainly in the 1960s and ‘70s as people got to thinking about the term and decided that it didn’t make sense.

Usage guides in the past couple of decades generally tend to downplay this issue or state that it was always an imaginary problem. Bryan Garner in his Modern American Usage notes that this logic simply can't apply to many other sentence adverbs, like notably or interestingly (e.g., one generally wouldn't begin a sentence, "Most notable,..." but rather "Most notably,..."). He goes on to say:

The criticism of more importantly and most importantly has always been rather muted and obscure, and today it has dwindled to something less than muted and obscure. So writers needn't fear any criticism for using the -ly forms; if they encounter any, it's easily dismissed as picayunish pedantry.

Despite Garner's judgment, I have still in recent years encountered people who appear to adhere to Strunk & White's unjustified statement that the word importantly should always be rephrased. (Actually, in this case, this arbitrary pronouncement seems to originate with White; the rule did not appear in the original Strunk.)
Thus, while there is a distinction to be made between the adjective most important and the adverbmost importantly, writers should be aware that there are still those out there who think that even adverbial uses of most importantly are incorrect and should be changed to most important. (By the way, this modification is generally explained in older usage guides by some logic like: at the beginning of a sentence, what you should be saying is "What is most important..." and most important is an abbreviated version of that. Why the word important(ly) among sentence modifiers is singled out for this treatment is never explained.)

Most important, the meaning of particular symptoms may change with age.

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