We spend a lot of time looking at abnormal or pathological neurologic systems and symptoms. Doing so makes it easy to lose our mooring to the normal neurologic system. A wrench gets thrown into this system though, in the form of age; so many of the typical neurologic pathologies are most common in the elderly or are more likely to show themselves as we age. That leaves the quandary: what does the normal aged neurologic system look like?
Normal deficits associated with age:
— Distal vibration loss
— Absent ankle jerk reflex
— Progressive slowing of pupillary responses to light
— Impaired ability for the eyeballs to move together upward.
— Hearing loss at higher frequencies
— Declining senses of smell and taste
— Declining gait speed
— Parkinsonian like symptoms including axial bradykinesia, postural instability
— Tremor in small amount of people
— Progressive decline in thinking speed, reasoning, spatial skills, episodic memory
As one of my patients told me, “don’t get old.” All of these things begin to happen at varying ages, so check out the article to see those specifics.
A few things to keep in mind:
— Methods to illicit these items vary and can skew results.
— Elderly almost always come with loads of comorbidities that muddy the clinical picture.
— Generational lifestyle differences will effect these results as well, so what is true about the elderly we’re seeing today may not be true about the elderly we see in a decade or two.
— Generalizations are not always applicable to an individual, so it’s important to use the individual as their own ‘normal’; so make sure you’re asking about their premorbid status to get an accurate picture of the problem.
— “Abnormal” doesn’t necessiarily mean symptomatic.
— Are the signs you’re seeing occurring in isolation or in a group that might lead to a clinical diagnosis?
— Is there a biomarker test available and if so, what are the results?
— If you give a diagnostic name to the pathology you’re seeing, does it matter in the grand scope of things? Could this be treated to optimize a person’s experience of their life or would it just make them run home and Google themselves into an early grave with worry over nothing?
Now that we’re securely docked on ‘normal,’ we can continue looking at pathological neurologic systems accurately.