Editor:
We agree with the authors of this wide and accurate review that persons while they grow old have anatomic and physiological changes in central and peripheral nervous systems, as well as, in cognitive domain expressing in the interview and physical exam of the elderly. But, frequently, the doctors have difficulties to determine where and when the physiological end and the pathological begin in a proper older adult.

We know today that neurological and cognitive changes are included in the clinical features of frailty, conceptualized as a physiological syndrome characterized by decreased reserve and reduced resistance to stressors, resulting from cumulative decline across physiological systems resulting in 'vulnerability to adverse outcomes.'(1).

These bad results are the followings: increased risk for acute diseases (in particular, infections), falls and its consequences (damage, fractures), hospitalization, institutionalization, disability, dependence and death (2, 3).

Sarcopenia (loss of skeletal muscle mass) constitutes one determinant of frailty syndrome. The observed age-related decrease in muscle cross- sectional area seems to be the result of a decrease in the size of type 2 muscle fibers compared with that of type 1 muscle fibers and also from loss of muscle fiber number. This process is believed to be consistent with a progressive denervation and reinnervation process secondary to a chronic neuropathic process (4).

Furthermore, many authors consider that cognitive impairment is one of the most important components of frailty, and also, that mild cognitive impairment, named as "benign forgetfulness", is not as benign as it seems, because many older adults with this condition develop Alzheimer's Disease in the course of years (5).

Thus, we consider that neurological and cognitive changes detected in the elderly cannot be taken lightly, we must be aware for its further evolution and not resignation to assume to ageing per se.
Sincerely,
Julio C. Romero, Angel J. Romero

References:
1. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD. Interventions on Frailty Working Group. Designing randomized, cotrolled trials aimed at preventing or delaying functional decline and disability in frail older persons: a consensus report. J Am Geriatr Soc 2004; 52(4): 625-34.
2. Daniels R, Van Rassum E, De Witle L, Van der Hervel W. Frailty in older age: concepts and relevance for occupational and physical therapy. Phys Occup Ther Geriatr 2008; 27(2): 81-95.
3. Romero AJ. Frailty: and emerging geriatric syndrome. Medisur 2010; 8(6): 81-90.
4. Thomas DR. Sarcopenia. Clin Geriatr Med 2010; 26: 331-346.
5. Mayeux R. Early Alzheimer Disease. N Engl J Med 2010; 362: 2194-201.

Conflict of Interest:

None declared