Objective To retrospectively analyze the clinical characteristics of tuberculous meningitis (TBM) in the elderly, and improve the early diagnostic rate. Methods Clinical data of 60 patients with TBM admitted in our hospital from January 2008 to June 2013 were enrolled in this study. According to the patients’ age, they were divided into the aged group (n＝31) and the young and middle-aged group (n＝29). Clinical features, including major symptoms and signs, cerebrospinal fluid, brain CT and/or MRI results, misdiagnosis, treatment and prognosis were compared between the 2 groups. The results were analyzed by Student’s t-test, Chi-square test and rank sum test. Results The aged group had significantly lower intracranial pressure (P＝0.000) and lower white blood cell count in cerebrospinal fluid (P＝0.001) when compared with the young and middle-aged group. The incidence of cerebral infarction was significantly higher in the aged than in the young and middle-aged group (41.9% vs 17.2%, P＝0.037), and so was its diagnostic rate (51.6% vs 24.1%, P＝0.029), but the cure rate was remarkably lower in the former than in the latter group (54.8% vs 79.3%, P＝0.044). Conclusion The elderly with TBM have comparatively lower increased intracranial pressure and white blood cell count of cerebrospinal fluid, higher incidence and misdiagnostic rate of cerebral infarction, and lower cure rate than the young and aged patients, which deserves attention clinically.