Objective: Individuals aged 85 years or older (the ''oldest old'') are
the fastest-growing age group in the United States. Because there is
little information characterizing expected neurologic function in this
group, our goal was to determine clinical neurologic traits character
istic of the optimally healthy oldest old. Design: Standardized neurol
ogic evaluation findings of optimally healthy persons older than 84 ye
ars compared with those of equally healthy control subjects aged 65 to
74 years. Setting: Community-based, longitudinal aging study. Partici
pants: Community-residing, consecutively recruited volunteers who were
screened for the absence of chronic disease or medication use. Main O
utcome Measure: Standardized neurologic examination coded into ordinal
or interval variables. Results: Significant between-group differences
were greatest for tests of mental status, sensory function (ie, smell
, hearing, vibratory discrimination, and stereognosis), oculomotor fun
ction, distal movement speed, and balance. Discriminant function analy
sis suggests that of these changes, membership in the oldest group is
best predicted by poor performance on clinical tests of balance (heel-
toe walking and one-leg balancing with eyes closed), smell, and visual
pursuit. Conclusions: Many neurologic signs appear with aging that ca
nnot be attributed to disease, even in the very old. Deficits in balan
ce, olfaction, and visual pursuit discriminate best between the aging
changes of the healthy very old and changes seen in younger elderly pe
rsons.