The elderly are affected by many neurological symptoms as they age, which often have an impact on their health, ability to function, and overall quality of life. This chapter will examine some of the most common complaints and symptoms encountered by the primary care provider. The main goal is to distinguish the cause(s) and to determine the best course of action. Many of these symptoms can be evaluated and treated by the patient's primary care provider, whereas some may require consulting with a neurologist. This chapter will discuss the following topics: gait dysfunction, sensory loss, seizures, headaches, weakness, tremor, and parkinsonism.

GAIT DISORDERS

General Concepts

Gait impairment is a significant cause of morbidity and mortality in the elderly. As many as 15%–20% of patients older than 65 years will suffer from gait impairment, often requiring an assistive device. This percentage increases with age, with an estimated 40%–50% of those older than 85 years, and up to 70% in those older than 90 years.

Gait impairment leading to falls in the elderly represents the most common cause of injury. Some 30% of all elderly will fall at least once annually, with the risk as high as 50% of those older than 80 years. In addition, 50% of long-term care residents will fall at least once annually. One-half of all falls are related to gait impairment and another one-third to balance impairment or postural instability.

Normal locomotion depends on intact motor and sensory systems to maintain equilibrium and balance.