Background: This study aims to investigate the metabolic characteristics of radiotherapy-induced temporal lobe injury in elderly patients with nasopharyngeal carcinoma using ¹H-magnetic resonance spectroscopy (MRS). Materials and Methods: Data were collected from 21 elderly patients and 33 young patients before and during therapy with different radiation dosages (20, 40, and 60 Gy). The Student’s t-test was used to compare the 1H-MRS-based N-acetyl aspartate /Creatine (NAA/Cr), Choline/Creatine (Cho/Cr), and NAA/Cho ratios in the temporal lobes. Results: Statistically significant differences in the NAA/Cr and NAA/Cho ratios was found between the two groups (P < 0.05) at 20, 40, and 60 Gy. The Cho/Cr ratios (20/40/60 Gy) were 1.82 ± 0.16/1.61 ± 0.29/1.37 ± 0.13 and 1.77 ± 0.19/1.48 ± 0.17/1.06 ± 0.14 in the elderly and young patients, respectively. We found significant differences between the two groups at the dosages of 40 and 60 Gy (P<0.05). The decrease in the NAA/Cr and NAA/Cho ratios in the elderly group was significantly higher than that in the young patients with dosages of 20, 40, and 60 Gy. The decrease in the Cho/Cr ratio in the elderly group (2.15%/11.29%/12.90%) was significantly lower than that in the young patients (3.30%/15.93%/17.58%). Conclusion: Under the same radiotherapy pattern and radiation dosage, the injury to the neurons in the temporal lobes was significantly greater in elderly patients than that in young patients. The intervention conducted in elderly patients at a dosage of 20 Gy might help minimize the injury to the neurons.