Clinical neurology is evolving in response to major changes in demography and prevalence rates of diseases associated with advanced age. Neurologic conditions, especially dementia and stroke, are leading causes of disability and institutionalization in the elderly. These and other common age-associated conditions are readily identified in current clinical practice. But as our patients age, numerous issues become evident that do not lend themselves readily to traditional models of practice in neurology. Whereas the fields of geriatric medicine and geriatric psychiatry have been formally recognized, the development of geriatric neurology has lagged behind. And yet, neurologic disorders account for about half of those patients older than 65 who are incapacitated and for more than 90% of those whose incapacities are severe.<sup>1Akhtar A.J., Broe G.A., Crombie A., e al. Disability and dependence in the elderly at home Age Ageing 1973 ;  2 : 102-111

Cliccare qui per andare alla sezione Riferimenti, 12Kurtzke J.F. The current neurologic burden of illness and injury in the United States Neurology 1982 ;  321 : 1207-1214

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The aging nervous system offers challenges in terms of placing disease and treatment in the context of predicted aging changes in neurochemistry, neurohistology, neuroanatomy, neurophysiology, and neuroimmunology. Treatments must be selected based on understanding aging changes in absorption, lean/fat body tissue ratios, hepatic metabolism, and renal clearance, as well as the interactions of multiple diseases and medications. In addition, consideration must be given to the behavioral consequences, functional demands, and social setting of the individual.

The concept of looking for one disease to explain a constellation of signs and symptoms is not particularly useful in older patients. A patient older than 65 is likely to take more than three medications and have at least as many medical diagnoses of significance.<sup>9Guralnik JM, LaCroix AZ, Everett DF: Aging in the eighties: The prevalence of comorbidity and its association with disability. Advance Data from the Vital and Health Statistics of the National Center for Health Statistics, Number 170, May 26, 1989

Cliccare qui per andare alla sezione Riferimenti</sup> They are a highly heterogeneous population who are likely to differ dramatically from one another in fitness levels and pathologies. Their presenting complaints tend to be quite atypical from what we have learned to expect of specific disorders. In fact, the elderly often present with “nonfocal” neurologic dysfunctions such as confusion, urinary incontinence, insomnia, and gait disturbances and falls as the earliest indicators for many nonneurologic disorders including myocardial infarction, pulmonary embolism, urinary tract infection, pneumonia, or fecal impaction.

The functional abilities, competency, and social support systems of the patient dictate the interventions more than diagnoses or age per se. This article lays the conceptual ground work for the fundamental issues inherent to geriatric neurology that require special attention in training our residents, practitioners, and specialists.