Stroke In Elderly People Research Articles

Safety and efficacy of statin treatment in very elderly patients / Segurança e eficácia do tratamento com estatinas em pacientes muito idosos

Abstract
 Introduction and objectives: The treatment of dyslipidemia over 75 years old is not well elucidated, due to the non-inclusion in large randomized clinical trials. Elderly people develop atherosclerosis more often and the worldwide population shows greater longevity. To evaluate the efficacy and safety of statin in very elderly people. Methods: The patients were divided into two groups: over 75 years (very elderly) and up to 75 years (control group). We evaluated: coronary artery disease (CAD); stroke; clearance of creatinine; creatine phosphokinase (CPK) and transaminase (ALT, AST) levels; lipid profile; type, dosage, and time using a statin. Results: The sample of 120 patients, 53,2% male, age 74.1 (±11.1) years, 82.3 very elderly, and 64.9 years in the control group. The total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein (HDL-C) in very elderly and control were 162 and 166 (p=ns), 84 and 90 (p=ns), 52.5 and 47 mg/dL (p=0.07), respectively. CAD and stroke, respectively 52.5 and 78.8% (p=0.007), and 18.6 and 7.7% (p=0.09). The time using a statin and the number of drugs taken were the same in the groups. The CPK and ALT levels were 97 and 110 (p=ns) and 16.5 and 20 U/L (p=0.004), respectively. There was no statin dose reduction in the elderly group despite the higher proportion of clinical comorbidities or renal dysfunction. Conclusions: The statin treatment in very elderly patients is effective and safe. The increased risk of CAD and stroke in elderly people corroborate the importance of statin use in this age group.

Factors Associated with Independence for Elderly People in Their Activities of Daily Living

Background: Health in the elderly does not merely refer to a condition free from disease but should also have elements regarding functionality and independence. Purpose: This study aimed to measure Activities of Daily Living (ADLs) and to identify the factors affecting ADLs among the elderly population in Sleman District. Methods: A cross-sectional study was carried out using secondary data from the Multidimensional Elderly Care project, nested on the Health Demographic and Surveillance System in Sleman, involving 549 elderly participants. The independence of these elderly people was measured using an Activities of Daily Living Scale questionnaire. Factors measured were cognitive (using the Mini-Mental State Examination questionnaire), psychological (using the Geriatric Depression Scale or Cornell Scale for Depression in Dementia questionnaires), economic (using the Financial Management Behavior Scale questionnaire), and nutritional status (using the Mini Nutritional Assessment questionnaire). The data were analyzed using the chi-square test, Fisher test, and Poisson test for bivariate analysis, while multivariate analysis using a logistic regression test. Results: The prevalence of elderly dependence was 14.03%. Elderly dependence was significantly related to age, job, residence, financial management, dementia, depression, malnutrition, and stroke disease in the bivariate analysis. However, after multivariate analysis, only age (>86 years) (PR = 4.31; 95% CI = 1.91–9.72), malnutrition (PR = 6.62; 95% CI = 3.79–11.57), and stroke (PR = 3.06; 95% CI = 2.03–4.61) were still shown to be related to elderly dependence. Conclusion: Increasing age, malnutrition, and stroke in elderly people lead to higher dependency in their ADLs.

高齢者熱中症の最高気温別入院リスク調査と予防に関する費用便益分析(The evaluation of the admission risk according to the daily highest temperature and the cost–benefit analysis for prevention for heat stroke in elderly people)

要旨 近年，わが国における熱中症の発生は急増しており，特に高齢者の割合が多くなっている。高齢者の熱中症の特徴として，多くが自宅などの屋内で日常生活中に発症する非労作性であり，重症度も高い。しかしながら，高齢者は熱中症予防に効果的な冷房の使用をためらう傾向があるとされ，冷房使用で回避し得たはずの熱中症に罹患することが多く認められる。本研究では，都市部における高齢者世帯を対象とし，夏期1日の最高気温と熱中症入院件数との関係を調査した。また，対象地域の高齢者単独世帯のすべてが冷房を使用したことによる追加発電費用と，冷房稼働により減らしうる熱中症の医療費を便益として算出し，費用便益分析を行った。その結果，当日の最高気温が35℃を超える日は，そうでない日に比べて高齢者の熱中症入院件数が4倍近くになることが示された。また，2018年の熱中症救急搬送が最多であった日において，対象世帯全体の熱中症予防に必要な冷房稼働による追加発電分の総費用を，冷房をつけない傾向にあった高齢者の熱中症による期待医療費（便益）が上回り，高齢者単独世帯の冷房使用が費用便益分析上も合理的な予防方法であることが示された。このことより高齢者単独世帯に対して，冷房費用の社会的な補償などの施策が検討されるべきであることが示唆された。近年の熱中症の増加は既に社会的な災害規模にまで達しており，社会全体での対策が必要不可欠である。

Temporal Trends in the Risk Factors and Clinical Characteristics of Ischemic Stroke in Young Adults

ObjectivesThis study aimed to analyze the risk factors of ischemic stroke in young adults of different ages; explore the changes in these risk factors with time; analyze the clinical characteristics of ischemic stroke in young adults; and assess how to better prevent ischemic stroke in young adults. MethodsAll patients with ischemic stroke who presented to the Department of Emergency Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School were enrolled. The data of patients aged 18–50 years were retrospectively evaluated for two periods, January–December 2008 and January–December 2018. Additionally, we collected the data of patients aged 51–90 years with ischemic stroke in the same ward in 2018. The subjects were divided into three groups: ischemic stroke in young people in 2008 (“Youth 2008”), ischemic stroke in young people in 2018 (“Youth 2018”), and ischemic stroke in elderly people in 2018 (“Senior 2018”). Risk factors, clinical characteristics and test indices were recorded and analyzed statistically. ResultsThe “Youth 2008” group included 28 patients—19 males (67.9%) and 9 females (31.2%) with a male-to-female ratio of 2.11:1. The “Youth 2018” group included 23 patients—20 males (87.0%) and 3 females (13.0%) with a male-to-female ratio of 6.67:1. The “Senior 2018” group included 210 patients—150 males (71.4%) and 60 females (28.6%) with a male-to-female ratio of 2.50:1. The risk factors in “Youth 2018” were higher than those in “Youth 2008” in terms of hypertension, hyperglycemia, and hypercholesterolemia without significant difference. Smoking and hypertrophic cardiomyopathy were significantly increased (P < 0.05) in this population. Smoking, hypercholesterolemia, and hypertrophic cardiomyopathy were more prevalent among the “Youth 2018” group than among the “Senior 2018” group, whereas carotid plaques, hypertension, and atrial fibrillation were less common in the younger group (P < 0.05). There was no significant difference between the younger and older groups in terms of thrombolysis rate, cerebral infarction type, and complications, except pulmonary infections (P < 0.05). ConclusionsThere was no significant change in the main risk factors of ischemic stroke in young adults during the 10-year period. Traditional risk factors—smoking and hypertrophic cardiomyopathy—were still common but with a significantly greater prevalence, whereas carotid plaques, hypertension, and atrial fibrillation had become less common. The clinical characteristics, other than pulmonary infection, were not significantly different between the younger and older patients with ischemic stroke.

Stroke. Support for IV tPA in ischaemic stroke in elderly people.

In Europe, use of intravenous tissue plasminogen activator (tPA) in patients older than 80 years is discouraged because these patients have been excluded from certain past clinical trials. A new retrospective, observational study shows that tPA can substantially improve functional outcome after ischaemic stroke in patients aged 80–89 years.

Lipid lowering drugs may lower risk of stroke in elderly people

Lipid lowering drugs may lower risk of stroke in elderly people

Associations Between Thrombin Generation and the Risk of Cardiovascular Disease in Elderly Patients: Results From the PROSPER Study.

Hypercoagulability may be an important contributor to the pathophysiology of atherosclerosis and atherothrombosis. As thrombin fulfills a central role in coagulation and links to several cellular mechanisms involved in arterial disease, we hypothesized that thrombin generation is associated with cardiovascular events in elderly patients. We studied the relationship between plasma thrombin generation and incident coronary heart disease (CHD) and stroke in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). From this multicenter prospective cohort, 4,932 samples of subjects (70-82 years) with pre-existing vascular disease or risk factors were available for thrombin generation measurements. Within the 3.2 years of follow-up incident stroke and CHD was observed in 227 and 545 subjects, respectively. Baseline thrombin generation was significantly decreased in subjects with incident stroke compared with subjects without: normalized peak height 71.1±40.8% versus 82.3±44.9%, p = .0002, and normalized endogenous thrombin potential 79.1±23.3% versus 87.0±24.8%, p < .0001 (mean and SDs). Thrombin generation was independently and inversely associated with stroke risk: hazard ratio 0.71 (95%CI: 0.60-0.85), 0.68 (95%CI: 0.58-0.79), for normalized peak height and normalized endogenous thrombin potential, respectively (all p < .001). In subjects with incident CHD, thrombin generation was comparable to subjects without a coronary event. Only an increased normalized peak height was significantly associated with incident CHD (hazard ratio 1.17 [95% CI: 1.06-1.28], p = .002). We demonstrate that a delayed and decreased thrombin generation is a strong and independent predictor for stroke in elderly people at increased risk of vascular disease. However, no convincing consistent association could be demonstrated between thrombin generation and incident CHD.

Secondary prevention of stroke in elderly people in Poland—Results of PolSenior study

Background and purposeThe purpose of the study was to evaluate the frequency of use of oral antiplatelet (OAP) and anticoagulant (OAC) drugs as secondary stroke prevention among older people in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. Material and methodsThe study group consisted of 426 subjects with a history of a previous stroke (mean age of 81.5±8.2 years), participants of multicentre, population-based PolSenior study. ResultsAmong the study group, 261 people (61.3%) used at least one drug as a secondary prevention. OAPs were regularly used by 237 people (55.6%), and OACs—by 25 people (5.9%). The most often used drug was acetylsalicylic acid. Ticlopidine was more frequently used than clopidogrel, and acenocoumarol was used more often than warfarin. Among all of the concomitant cardiovascular risk factors, congestive heart failure was mostly associated with OAP treatment, and a history of atrial fibrillation—with OAC treatment. Use of drugs did not depend on age, sex, place of residence (rural or urban), level of education and personal income, but it was associated with the region where the respondents lived. ConclusionsSecondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly.

Possible Paliperidone-Related Pons Infarction

Possible Paliperidone-Related Pons Infarction

Cognitive function and improvement of balance after stroke in elderly people: the Gothenburg Cognitive Stroke Study in the Elderly

Purpose. The ability to balance is no longer automatic after stroke in patients with motor impairment and needs to be relearned. Learning requires cognitive and executive abilities. It is well known that cognitive and executive impairments are common after stroke, but how these are related to balance has not yet been fully studied. We, therefore, wanted to explore the impact of pre-stroke cognitive impairment, global and selective cognitive and executive impairment in the early phase after stroke and at the 1-year follow-up on balance and on the improvement of balance during the first year after stroke.Method. Seventy-four patients were included consecutively on admission following stroke to a geriatric stroke unit and followed prospectively for 1 year. Balance was assessed using the Berg Balance Scale on admission, on discharge and 1 year after stroke.Results. Cognitive impairment before stroke, measured using the Cognitive Impairment Questionnaire, was found to lead to poor balance on discharge and 1 year after stroke. Patients with impaired logical deductive ability and executive function, measured using a neuropsychological test battery both in the early phase and 1 year after stroke, also had significantly poorer balance 1 year after stroke than patients with intact functions. Most importantly, only patients with intact cognitive function, before stroke, on admission and at the 1-year follow-up, significantly improved their balance after discharge.Conclusions. Our results show that cognitive status, both before and after stroke, is important for balance and improvement of balance after stroke.

The place of robotics in post-stroke rehabilitation

Reducing the impact of stroke on the independence of elderly patients during daily life is becoming a primary societal goal in developed countries owing to population aging and to the incidence of stroke in elderly people. Rehabilitation plays a fundamental role in reducing the residual motor deficits of stroke patients, both during hospitalization (acute/subacute phase, inpatient rehabilitation) and after discharge (chronic phase, ambulatory/home rehabilitation). Since 1995, when the first pioneering robotic system for rehabilitation was presented, the use of robotics in post-stroke rehabilitation has been investigated intensely, and positive, although not yet fully satisfactory, clinical results were obtained. This article presents the most recent developments in this young research field, outlining the state of the art and the prospective role of robotics in post-stroke rehabilitation.

Prevalence and causes of locomotor disability in the community staying near the rural health center in Goa: A community-based study

Sir, Musculoskeletal conditions are widely prevalent and their impact is even pervasive. In one major study the prevalence of locomotor disability was 21.9% for men and 36.0% for women.(1) The exact prevalence of this disability in a rural Indian population is unknown. The descriptive, cross-sectional study was conducted to study the prevalence and causes of locomotor disability in the community at the five sub-centers of RHTC Mandur. All the five sub-centers were studied. 500 people participated in the pilot study. The prevalence of locomotor disability was found to be 7.6%. Accordingly, the sample size for the main study was calculated with the formula,(2) P=7.6=the crude prevalence, q=100-7.6=100-p L=10% of P= allowable error= 10% of p. So N=4863 was obtained. This was chosen from all the five sub-centers of RHTC Mandur. The population was chosen as fixed proportion to the population of the village. Systematic random sampling with one stage cluster sampling of the families (examination of all the family members) was done. This was done as the sampling of single person was difficult. Sampling frame was obtained from the Anganwadi workers’ register. Each Anganwadi covers 1645 people in the area. The average family size was 5.35 persons per family. The total population of RHTC Mandur is 36180. Sub-center 1 is located 4 km away from RHTC Mandur. It has three Anganwadis and nine areas. The population is 6400. So to obtain the representative sample, every sixth family was interviewed. Sub-center 2 is located 10 km away from RHTC Mandur. It has four Anganwadis and 11 areas. The population is 7017. So to obtain the representative sample, every seventh family was interviewed. Sub-center 3 has four Anganwadis and five areas. The population is 6500. So to obtain the representative sample, every fifth family was interviewed. Sub-center 4 is located 6 km away from RHTC Mandur. It has five Anganwadis and 15 areas. The population is 11231. So to obtain the representative sample, every eleventh family was interviewed. Sub-center 5 is located 4 km away from RHTC Mandur on the other side. It has five Anganwadis and 10 areas. The population is 5032. So to obtain the representative sample, every fifth family was interviewed. Total population of 4868 was studied. Locomotor disability(3) was defined as a person’s inability to execute distinctive activities associated with moving both himself and objects, from place to place, and such inability resulting from affliction of musculoskeletal and, or nervous system. The person was assessed for locomotor disability using the detailed goniometric evaluation technique if: difficulty or loss of any locomotor function loss of limb or part of a limb The detailed goniometric assessment was done by referring the patient to a specialist and Official Gazette(4) was followed for the same. Milestone delay was used to assess for disability if any relevant history was obtained from the head of the family. Prevalence of locomotor disability was 0.92%. There is a statistically significant association between age (χ2=0.528 P=0.46, df=2), educational status (χ2=13.96, P=0.00093, df=2), socio-economic class (χ2= 6.092, df= 4, P<0.01) and locomotor disability prevalence. Maximum prevalence of 1.58% was found in the socio-economic class IV. It was observed that majority of the cases of locomotor disability were due to fractures in young and stroke in elderly people. Most of the fractures in young were due to road traffic accidents. Osteomyelitis, dislocation, osteoarthritis, rheumatoid arthritis, and cerebral palsy were the main causes. The study clearly states the need to involve Anganwadi workers in data collection and also goniometry as a tool to assess exact prevalence of locomotor disability in the field. Reducing road traffic accidents by road safety programs is also needed.

Timing of stroke in elderly people exposed to typical and atypical antipsychotics: a replication cohort study after the paper of Kleijer, et al.

Timing of stroke in elderly people exposed to typical and atypical antipsychotics: a replication cohort study after the paper of Kleijer, et al.

The Neuroprotective Effect of Olanzapine

The Neuroprotective Effect of Olanzapine

Impaired glucose tolerance as a risk factor for stroke in a cohort of non-institutionalised people aged 70 years

to determine whether impaired glucose tolerance (IGT) is associated with an increased likelihood for ischaemic stroke. prospective cohort study. a sample of 1,032 non-institutionalised people aged 70 years in the Turku Elderly Study, Turku, Finland. the association between IGT (defined as plasma glucose level between 7.80 and 11.09 mmol/l 2 h after administration of 75 g of an oral glucose load) and diabetes mellitus (DM) (defined as the current use of insulin or an oral hypoglycaemic medication, a fasting plasma glucose level of >/=7 mmol/l or a plasma glucose level of >/=11.1 mmol/l 2 h after administration of an oral glucose load) with 12-year follow-up for the development of ischaemic stroke. a total of 742 (71.9%) subjects had normal glucose tolerance, 127 (12.3%) subjects had IGT and 163 (15.8%) had DM. Patients were examined in the year 1990 and followed up for stroke occurrence until death or until the end of 2002. Mean follow-up time was 9.6 years (SD +/-3.3 years). In total, 119 patients (11.5%) suffered a stroke during the follow-up. In logistic regression model, previous stroke, previous TIA, DM and atrial fibrillation were risk factors for stroke occurrence. stroke tended to happen more often in the IGT group than in the normal group, but the difference was not statistically significant. Statistically significant risk factors for stroke in elderly people are previous TIA or stroke, DM and atrial fibrillation.

Aggressive lowering of blood pressure

Aggressive lowering of blood pressure is being advocated by guidelines for controlling hypertension.1–3 For decades, clinicians focused on lowering diastolic blood pressure notwithstanding observational data, which emphasised the greater importance of systolic blood pressure in mediating cardiovascular disease risk. An unjustifiable early fear was that antihypertensive treatment of isolated systolic hypertension in elderly people would produce intolerable side-effects, and could be dangerous.4 Discounting these fears and faced with accumulating epidemiological evidence that isolated systolic hypertension was not an innocuous accompaniment of ageing, investigators started randomised trials in the USA and elsewhere to determine the efficacy of treating isolated systolic hypertension for the prevention of stroke in elderly people.

Pathophysiology and treatment of cardioembolic stroke

To elucidate the pathophysiologic mechanism of cardioembolic stroke in elderly people and to devise therapeutic strategies for it, was analyzed 120 consecutive patients (77 men and 43 women aged 65 +/- 13 years) with acute cardioembolic stroke who were admitted within 7 days of the stroke onset. We compared underlying heart diseases. NIH stroke scale on admission, lesion size on computed tomography (CT), the relation between anticoagulant therapy and recurrence, complications during admission. ADL at discharge, recurrence, and death during the follow up period in three groups: patients aged less than 65 years (the young group), those aged from 65 to 74 years (the "non-old" group), and those aged more than 75 years (the "old old" group). In the "old old" group, non valvular atrial fibrillation (75.8%) was the most common underlying heart disease and so was rheumatic heart disease (33.3%) in the "non-old" group. NIH stroke scale score (median, 11) and the proportion of patients with a large lesion (> 3 cm) of CT were higher in the "old old" group than in the other two groups. Immediate anticoagulation (A/C) within 14 days of onset was performed in more than 70% of the "non-old" and the "young old" groups but in only 57.6% of the "old old" group. Stroke recurred more often in 34 patients who did not receive immediate A/C than in the 86 who did (11.8% v.s. 2.3%. Chi square test, p = 0.053). Hemorrhage during immediate A/C and other complications (infection and pulmonary embolism) were seen in 2 and 14 patients, respectively, in both the "young old" groups, but not in the "non-old" group. Good outcomes (able to walk with or without cane) were more common in the "non-old" group (78.9%) than the other groups (57.1%, Chi square test, p < (0.01). A/C after the acute stage was done in more than 80% of those in the "non-old" and the "young old" groups, but in less than 30% of those in the "old old" group (Chi square test, p = 0.0514). Survival without recurrence during the observation period (605 +/- 550 days) was significantly lower in the "old old" group than in the other two groups (log-rank test, p = 0.0091). Cardioembolic stroke in the elderly may be characterized as follows: (1) non valvular atrial fibrillation is the most common, (2) severe neurologic deficits on admission and large lesions on CT are noted, (3) complications (infection and pulmonary embolism) often occur, (4) A/C in both acute and chronic stages are done infrequently. Therefore, the indication and intensity of A/C for primary and secondary prevention and prevention of complications are important in management of cardioembolic stroke in the elderly.

Embolic thrombus on mitral anulus calcification

Embolic thrombus on mitral anulus calcification (MAC) was demonstrated in an 83-year-old woman with retinal embolism. Mitral anulus calcification has been associated with a significant increase of stroke in elderly people. Atrial fibrillation and calcific emboli have been reported, and embolic thrombus by MAC may be another potential cause.