REVIEW ARTICLE Neurological Dysfunction in the Elderly Prone to Fall

While impaired joint function and general debility are relevant to function, we propose that abnormalities within the motor system controlling gait and postural reflexes are major causes of impaired mobility and falls in older individuals. Neu-rologic disease impairs this system at different foci, producing characteristic defi-cits. Thus, bilateral frontal lobe disease produces a characteristic gait and balance dysfunction along with a mild dementia and incontinence, whereas Parkinson’s disease produces a different set of motor abnormalities. Other loci of involvement include spinal cord, peripheral nerve, and muscle. Recently, we observed that lesions within the subcortical white matter (presumably ischemic in origin) may be an important factor in gait and balance dysfunction in older individuals without other defined neurologic disease. Key Words: Falls—Aging—Neurologic dis-ease—Diagnosis. It is increasingly common for neurologists to evalu-ate elderly individuals with impaired mobility who may have had multiple falls. The first step in such a