Chronic Subdural Hematoma as a Potentially Reversible Cause of Cognitive and Gait Decline in Older Adults: Clinical Recognition, Treatment, and Functional Recovery

Chronic subdural hematoma (cSDH) is an increasingly common neurological disorder in older adults and may present with cognitive decline, gait instability, recurrent falls, and loss of independence rather than overt focal deficits. Because these symptoms overlap with dementia, delirium, parkinsonism, and frailty, diagnosis may be delayed despite the potential for meaningful recovery after treatment. This narrative review summarizes evidence on clinical recognition, treatment, early mobilization, rehabilitation, and patient-centered recovery in older adults with cSDH. A targeted search of PubMed/MEDLINE, Scopus, and Web of Science identified randomized trials, observational studies, systematic reviews, meta-analyses, guidelines, and consensus statements available through July 2026. Surgical decompression may improve cognition and mobility, but the magnitude and durability of recovery vary. Premorbid cognitive and functional status, frailty, malnutrition, postoperative delirium, and complications are associated with outcomes, although causal effects are incompletely established. Postoperative drainage reduces recurrence; selected randomized trials suggest that middle meningeal artery embolization reduces recurrence or treatment failure, whereas evidence for independent cognitive and gait benefits remains limited. Early mobilization may reduce medical complications. Evidence specific to cSDH remains insufficient to prescribe a standardized exercise dose or progression. Multidimensional follow-up and prospective trials using cognitive, gait, quality-of-life, and participation outcomes are needed to determine whether successful hematoma treatment translates into restored independence and meaningful daily function.