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Older people are over represented among pedestrian casualties, and cognitive decline is an often cited possible contributory factor. Cognitive decline and dementia are intimately associated, however the role dementia might play in older pedestrian crashes has received little attention. This study describes crash characteristics for 52 fatally injured older pedestrians in the Sydney metropolitan area. It investigates the relationship between the extent of neurofibrillary tangles (NFT), a hallmark of Alzheimer`s disease in the brain, and particular crash situations. The results demonstrate crash characteristics that are similar to that reported in other studies of older pedestrians. Furthermore, the results suggest that cognitive decline associated with dementia related neuropathology may be associated with specific crash situations. Compared to older pedestrians with no, or low NFT, those with moderate to high NFT were more likely to be: at least partially responsible for the incident; injured while in low complexity situations; involved in impacts with reversing vehicles; impacted in near lanes of traffic; and struck by a vehicle off road. While described as trends only (p less than or equal 0.2), these findings highlight areas of concern for older pedestrians and suggest potential targets for engineering and behaviour-based countermeasures aimed at reducing casualty numbers among older pedestrians. © 2007 Elsevier Ltd. All rights reserved.