The neurology of ageing: what is normal?

13 June 2017

As with all aspects of human physiology, the nervous system alters with ageing. Even in the healthiest elderly, there is more neuronal loss, more vascular pathology and numerous changes at the cellular level compared with healthy younger adults. These changes have consequences, and all neurologists will recognise that when examining a patient, what can reasonably be determined to be ‘within normal limits’ for a healthy 70-year-old differs from that for a healthy 20-year-old. Inherent therefore when evaluating any patient is knowledge of what can reasonably be considered to be within the normal range in any given age group. While there is considerable dogma about what constitutes ‘normal’ neurological ageing — there can be few neurologists who will not recall being told that one can disregard absent ankle jerks or impaired distal vibration sense in somebody in their 70s or 80s — the evidence base for such assertions is rather less clear.

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