Neurological Assessment and Neurocognitive Evaluation of the Elderly

Abstract

A formal neurological examination is necessary within the perisurgical period and in case of geriatric syndrome like repeated falls, cognitive complaint, atypical pain, or mood disorder. The neurological examination should be structured and hierarchized as a function of complaints and symptoms. Asymmetry of findings represents a good predictive value of neurological abnormalities, as opposed to mild symmetrical signs like distal lower limb hypoesthesia or reflex abolition. After an interview of the patient and possibly a caregiver, an organized and thorough examination will determine whether neurological dysfunction exists. Antecedents and comorbidities should be formally collected, as well as full drug prescription. Any medical history should be deeply explored. Simply observing the patient during the course of the usual history and physical behaviors like watching the patient walk and get up and down from the exam table is the first step of examination. Then, as in adult, a formal examination will help to identify which components of the neurological system are affected (e.g., motor, sensory, cranial nerves, or possibly several systems simultaneously) and to determine the precise location of the problem, e.g., peripheral versus central nervous system.