Neurologic diseases encountered in old age fall into three categories. First are those that occur nearly exclusively in the elderly–the degenerative and cerebrovascular disorders. Degenerative disorders encompass those in which the cause is unknown; some diseases (eg, familial Alzheimer’s disease) may be classified differently as more is learned about them. Second are disorders that occur at any age but have different implications, manifestations, treatment, and prognosis in the elderly. For example, seizures occurring for the first time in the elderly are more likely than those occurring in the young to be the result of some identifiable structural abnormality. Third are diseases that more typically occur in younger persons such as muscular dystrophy, demyelinating disease, and migraine. When they occur in late life, the cause may be unusual or the diagnosis may be incorrect.
Neurologic disorders are common in the elderly. The most serious, usually stroke or dementia, account for more than half of all disabilities requiring supervision in a nursing home. Acute conditions such as delirium are also common and serious, but they may be treatable. Yet, even less severe and potentially treatable neurologic conditions, such as movement disorders, are burdensome for the elderly and their caregivers. Neurologic diseases often rob elders of independence, productivity, drive, and personality.
New modes of therapy can successfully prevent or ameliorate some neurologic disorders. The incidence of cerebrovascular disease has decreased markedly in the USA, largely because of detection and treatment of hypertension. Advances in the treatment of Parkinson’s disease have helped tens of thousands of people. The second most common type of dementia in the elderly, vascular (multi-infarct) dementia, is now more easily detectable with new imaging techniques, and this dementia may be prevented or ameliorated with appropriate treatment of hypertension and diabetes.
Noninvasive means of visualizing the nervous system are providing more knowledge about many neurologic diseases, and advances in research techniques have been applied extensively to diseases of the nervous system. For example, advances in molecular biology have been used to identify sites on three chromosomes associated with familial Alzheimer’s disease. Genetic mutations that result in overproduction of amyloid, which may be a factor in Alzheimer’s disease, have also been identified. Other so-called degenerative diseases afflicting the elderly (eg, motor neuronal disorders, Huntington’s chorea, spinocerebellar degeneration) are now clearly established as genetic disorders.
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