The characteristic morphologic changes frequently observed in the brain of an old adult include a decrease in weight and volume, a change in the pattern of cerebral cortical convolutions, and an increase in ventricular size. Cell loss varies from region to region in the brain, and may be intensified in Alzheimer's disease and other disorders associated with senile dementia. Among the neuroglial cells, the microglia undergo the most significant changes with age. Although senile brain disease previously has been regarded as secondary to atherosclerosis, recent neuropathologic studies indicate that only 30 to 40 percent of senile brain disease arises from cerebrovascular pathologic lesions. The dilemma remains, however, of how much of the deterioration observed in the aged is related to disease and how much to senescence. The interaction between gene expression and environmental conditions in aging is another important question for the geriatrician. Progress in the control and treatment of disorders associated with old age depends upon further research into the mechanisms that underlie the process of aging in the brain.