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Examining the nervous system of an older patient 

Examining the nervous system of an older patient
Examining the nervous system of an older patient

Henry J. Woodford

and James George



New information on technological developments in nervous system examination

New references added throughout

Updated on 29 July 2020. The previous version of this content can be found here.
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date: 26 May 2022

Ageing is associated with changes in the nervous system, especially the accumulation of neurodegenerative and white matter lesions within the brain. Abnormalities are commonly found when examining older people and some of these are associated with functional impairment and a higher risk of death. In order to reliably interpret examination findings it is important to assess cognition, hearing, vision, and speech first. Clarity of instruction is key. Interpretation of findings must take into account common age-related changes. For example, genuine increased tone should be distinguished from paratonia. Power testing should look for asymmetry within the individual, rather than compare to the strength of the examiner. Parkinsonism should be looked for and gait should be observed. Neurological assessment can incorporate a range of cortical abilities and tests of autonomic function, but the extent of these assessments is likely to be determined by the clinical situation and time available.

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