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Background: Over the past few decades, advances in the neurology of aging have been considerable and have led to a better understanding of the science of age-related neurological disorders. Likewise, it changed the perception of classical neurology practice, research, and the way of looking at age-related conditions. Neurological disorders are the most frequent cause of major disability in the elderly and account for almost half of the incapacitation occurring beyond age 65 and more than 90% of serious dependency. However, a number of neurological changes occur also in the absence of a specific disease, making the assessment and management of neurological complaints and findings a specific expertise. Summary: Maximizing success in clinical care of the elderly requires expertise in geriatric neurology, which includes an understanding of current research regarding aging and age-related neurological dysfunctions, and the ability to work with other geriatric healthcare providers. Although current therapies for neurodegenerative diseases mainly offer symptomatic relief without slowing progression, the landscape is evolving. Biomarkers of pathology and neuroimaging have continued to develop, with a significant impact on diagnosis and treatment. These advances have not only helped to improve our knowledge of disease pathophysiology but also disease stages, guiding symptomatic monitoring, and possible therapeutic options at a pre-symptomatic stage. Key Messages: Neurological disorders are a leading cause of major disability and dependency in the elderly, underscoring the need for expertise in geriatric neurology for effective clinical care of this population. Although current therapies for neurodegenerative diseases primarily provide symptomatic relief without slowing disease progression, advancements in biomarkers and neuroimaging are significantly evolving. These advancements enhance our understanding of disease pathophysiology and stages, guiding symptomatic monitoring and potential therapeutic options at a pre-symptomatic stage. As knowledge about age-associated conditions is steadily rising and geriatric medicine gains further recognition, this article argues for a new focus on the role of neurologists in geriatric medicine, emphasizing the importance of integrating current research and collaborative care approaches in the management of elderly patients. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to establish whether advanced workup including long‐term electroencephalography (LT‐EEG) and brain magnetic resonance imaging (MRI) provides an additional yield for the diagnosis of new onset epilepsy (NOE) in patients presenting with a first seizure event (FSE). Methods: In this population‐based study, all adult (≥16 years) patients presenting with FSE in the emergency department (ED) between March 1, 2010 and March 1, 2017 were assessed. Patients with obvious nonepileptic or acute symptomatic seizures were excluded. Routine EEG, LT‐EEG, brain computed tomography (CT), and brain MRI were performed as part of the initial workup. These examinations' sensitivity and specificity were calculated on the basis of the final diagnosis after 2 years, along with the added value of advanced workup (MRI and LT‐EEG) over routine workup (routine EEG and CT). Results: Of the 1010 patients presenting with FSE in the ED, a definite diagnosis of NOE was obtained for 501 patients (49.6%). Sensitivity of LT‐EEG was higher than that of routine EEG (54.39% vs. 25.5%, p <.001). Similarly, sensitivity of MRI was higher than that of CT (67.98% vs. 54.72%, p =.009). Brain MRI showed epileptogenic lesions in an additional 32% compared to brain CT. If only MRI and LT‐EEG were considered, five would have been incorrectly diagnosed as nonepileptic (5/100, 5%) compared to patients with routine EEG and MRI (25/100, 25%, p =.0001). In patients with all four examinations, advanced workup provided an overall additional yield of 50% compared to routine workup. Significance: Our results demonstrate the remarkable added value of the advanced workup launched already in the ED for the diagnosis of NOE versus nonepileptic causes of seizure mimickers. Our findings suggest the benefit of first‐seizure tracks or even units with overnight EEG, similar to stroke units, activated upon admission in the ED. [ABSTRACT FROM AUTHOR]

Lewy body dementia (LBD) is the second most common neurodegenerative disorder after Alzheimer's disease. Cognitive fluctuations, visual hallucinations, parkinsonian signs, and rapid eye movement sleep behavior disorder (RBD) are diagnostic criteria. However, the diverse clinical presentations complicate diagnosis and management, as the disease may begin with psychiatric symptoms, confusion, sleep disturbances, and/or autonomic dysfunction. Its progression often leads to neuropsychiatric and behavioral symptoms that can overshadow cognitive impairments. Diagnosing LBD is crucial to avoid first iatrogenic effects (e.g., neuroleptics), and then facilitate a personalized approach to address cognitive and neuropsychiatric management, while considering comorbidities., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Dementia with Lewy bodies (DLB) is one of the most common causes of dementia, after Alzheimer's disease (AD) and vascular dementia. Its diagnosis remains a challenge for the clinician because of the variety of clinical presentations and comorbidities. The diagnosis is based on clinical criteria such as cognitive fluctuations, visual hallucinations, progressive cognitive impairment, Parkinsonian signs and REM sleep behavioral disorder. Although not specific, biomarkers are helpful for increasing the likelihood of LBD diagnosis and for differentiating LBD from other differential diagnoses such as Parkinson's disease with dementia and Alzheimer's disease. Clinicians should be aware of LBD clinical features and actively look for them in patients with cognitive symptoms, take into consideration the often-associated co-pathologies and to optimize patient's management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Cerebral amyloid angiopathy (CAA) is a common and well-defined small vessel disease characterized by the deposition of amyloid β in the vascular wall. CAA causes devastating outcomes related to intracerebral hemorrhage and cognitive decline in older adults. The shared pathogenic pathway between CAA and Alzheimer's disease, co-occuring frequently in the same subject, has important implications for cognitive outcomes and novel anti-amyloid-β immunotherapies. In this review, we present the epidemiology, pathophysiology, current diagnostic criteria of CAA, and future developments in the field., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Acute encephalopathy is one of the most frequent neurological complication in patients hospitalized for COVID-19. Electrolyte imbalance, drugs, and hypoxemia can all affect brain homeostasis, leading to acute cognitive dysfunction and direct implications of the SARS-CoV-2 are not completely understood. Neurological complications of SARS-CoV-2 infection are poorly understood: an inflammatory insult to the endothelium affecting the blood-brain barrier may explain the clinical presentation, but other hypotheses including direct viral damage or an immune-mediated reaction are also suggested. Among these various potential mechanisms, often combined, the controversy remains., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.