Characteristics of 478 very old neurologic outpatients evaluated over 20 years in Guayaquil, Ecuador

There is scarce information on the diseases affecting very old neurologic outpatients in the developing world. We evaluated 478 neurologic outpatients aged 80 years or more over a 20-year period, to analyze data concerning reason for consultation, diagnosis and follow-up. The mean age was 83.9 ± 3.8 years, and 59% were women. Most common reasons for consultation were cognitive decline (24.7%), focal deficits (22.8%) and movement disorders (19.7%). Common categories of neurologic diseases included cerebrovascular (27.4%), degenerative (27.2%) and diseases of uncertain/unknown etiology (20.5%). We found significant variations in the reasons for consultation and in the prevalence of some neurologic diseases according to the year in which patients were evaluated. During the past few years, cognitive decline outnumbered patients with focal neurologic deficits and movement disorders. From 1990 to 1994, degenerative diseases accounted for only 14.5% of our patients, but from 2005 on, these conditions were responsible for 33.9% of the cases. When analyzing pre-existing conditions and diseases occurring at follow-up, we identified a subset of older patients who developed stroke and Alzheimer’s disease/mild cognitive impairment. There was a dynamic pattern of neurologic diseases over the years, with significant variations in the reason for consultation and the category of disease. Nowadays, distribution of neurologic symptoms and diseases in our population of very old neurologic patients is more similar to that reported from the developed world than it was 20 years ago.