Stroke In Old Age Research Articles

Prevention of ischemic stroke in old age

Stroke is one of the main causes of permanent disability and death and the risk increases with age. Primary and secondary prevention therefore have a high priority. The treatment of risk factors, such as high blood pressure, diabetes mellitus and hyperlipidemia is just as important as anticoagulation in atrial fibrillation, in addition to optimization of lifestyle and diet. Platelet function inhibitors play arole in the prophylaxis of recurrence, carotid surgery and stenting are used in selected patients. There is little study evidence for old people, individualized treatment planning takes functional status and comorbidities into account.

Effect of advanced maternal age on ischemic stroke vulnerability in aged rats: Investigating on blood-brain barrier permeability and gene expression

BackgroundAdvanced maternal age (AMA), commonly defined as pregnancy at or above 35 years old. Based on the evidence, this trend has raised concerns about potential health consequences for mothers, particularly in relation to ischemic stroke. Studies suggest that AMA may be associated with a higher risk of ischemic stroke in women due to physiological changes that impact vascular health and increase cardiovascular risk factors. The aim of this study was to investigate the effect of AMA on the extent of damage after ischemic stroke in aged rats. MethodsFemale rats that gave birth at an old age (10 months) and at a young age (4 months) were subjected to ischemic stroke in old age (20 months) and subsequently compared.We assessed neurological deficits, infarct volume, blood–brain barrier (BBB) permeability, TNF-alpha levels, total oxidant capacity, and gene expressions that play a role in BBB integrity (VEGF, Occludin, and MMP-9) following ischemic stroke. ResultsThere were significantly elevated levels of MMP-9 expression and reduced levels of occludin in AMA rats. Additionally, AMA rats had significantly higher levels of TNF-alpha and total oxidant capacity after experiencing an ischemic stroke. AMA rats showed significantly higher brain water content (BBB permeability), infarct volume, and neurological deficits compared to young-aged pregnancies. DiscussionComplex relationship between pregnancy-related physiological changes, aging, vascular gene expression, and inflammatory factors may play a role in the increased vulnerability observed in older pregnant rats. The similarities between pregnancy-related alterations and aging highlight the influence of advanced maternal age on susceptibility to ischemic stroke.

Adult offspring and their socioeconomic resources for development and survival of stroke: A Swedish and Danish nationwide register-based study.

To explore the relationships between adult offspring's socioeconomic resources and the development of stroke and survival after stroke among older adults in Denmark and Sweden. The study included 1,464,740 Swedes and 835,488 Danes who had turned 65 years old between 2000 and 2015. Multivariable Cox proportional hazard regression models were used to analyse incident stroke and survival after stroke until 2020. Lower level of offspring's education, occupation and income were associated with higher hazards of stroke among both men and women in Sweden and Denmark. Associations with offspring's education, occupation and income were most consistent for death after the acute phase and for educational level. From one to five years after stroke and compared with a high educational level of offspring, low and medium educational level were associated with 1.34 (95% confidence interval (CI): 1.11; 1.62) and 1.18 (95% CI: 1.10; 1.27) as well as 1.26 (95% CI: 1.06; 1.48) and 1.14 (1.07; 1.21) times higher hazard of death in Swedish women and men, respectively. The corresponding estimates in the Danish population were 1.36 (1.20; 1.53) and 1.10 (1.01; 1.20) for women and 1.23 (95% CI: 1.11; 1.32) and 1.13 (95% CI: 1.05; 1.21) for men. Adult offspring socioeconomic resources are, independently of how we measure them and of individual socioeconomic characteristics, associated with development of stroke in old age in both Denmark and Sweden. The relationships between offspring socioeconomic resources and death after stroke are present especially after the acute phase and most pronounced for educational level as a measure of offspring socioeconomic resources.

Quality of Life After Stroke in Old Age: Comparison of Persons Living in Nursing Home and Those Living in Their Own Home

To determine the differences in subjective quality of life between elderly people living in a nursing home and those living in their own homes after brain stroke, and to determine the contribution of demographic variables and different quality of life domains to the explanation of self-assessed quality of life. The study included 60 elderly men and women, 30 living in their own homes (median age, 81; range, 72-90) and 30 living in a nursing home (median age, 81; range, 72-86). Both groups received care (stationary or ambulatory) from the same nursing home. World Health Organization Quality of Life Questionnaire-short version, self-assessed quality of life questionnaire, and demographic questionnaire were used to collect data on subjective quality of life. The participants completed self-report questionnaires individually. Quality of life scores were significantly higher in the elderly living in a nursing home than in the elderly living in their own home (mean +/- standard deviation, 78.7 +/- 12.8 vs 59.3 +/- 17.3 out of maximum 100, P < 0.001). Also, the elderly living in the nursing home scored significantly higher than those living in their own home on all 4 quality of life domains (maximum 100 for each domain): physical (28.5 +/- 3.3 vs 17.2 +/- 5.0), psychological (22.3 +/- 3.7 vs 16.3 +/- 5.0), social relationships (11.4 +/- 1.6 vs 8.3 +/- 1.7), and environment (32.8 +/- 4.6 vs 24.0 +/- 6.1) domain (P < 0.001 for all). All predictive variables together explained 51.9% of quality of life variance, with self-assessed health being the most significant predictor. Quality of life of the elderly in a nursing home was significantly higher than that of their peers living in their own home, which may be related to better care in specially organized settings.

Plasma Levels of Apolipoprotein E and Risk of Stroke in Old Age

Recently, high plasma apoE levels have been shown to be related to increased cardiovascular mortality, independent of APOE genotype. Here we studied the association of plasma apoE levels with risk of stroke. Within the Leiden 85-plus Study, a prospective population-based study of 561 subjects aged 85 years, we measured plasma apoE level and determined APOE genotype at base line. The presence of stroke in the medical history and the incidence of stroke during a 5-year follow-up period were assessed by interviewing treating physicians. At base line, an increase of one standard deviation (SD) of plasma apoE level associated with a 1.47-fold higher risk of a history of stroke (P = 0.025). During follow-up, an increase of one SD of plasma apoE level associated with an increased risk of stroke (risk of stroke: 1.58, P = 0.010). This association was also observed in epsilon3epsilon3- (1.95, P = 0.002) and epsilon3epsilon4 carriers (3.01, P = 0.008), but not in epsilon2epsilon3 carriers (0.62, P = 0.440). In conclusion, in old age, except for epsilon2-allele carriers, high plasma apoE levels are associated with a higher risk of stroke, independent of APOE genotype, plasma levels of lipids, and other cardiovascular risk factors.

High-density vs low-density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age.

A high total serum cholesterol level does not carry a risk of cardiovascular mortality among people 85 years and older and is related to decreased all-cause mortality. At this old age, there are few data on fractionated lipoprotein levels in the determination of cardiovascular disease risk. The aim of this study was to evaluate the relationships between low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels and mortality from specific causes among people in the oldest age categories. Between September 1, 1997, and September 1, 1999, a total of 705 inhabitants in the community of Leiden, the Netherlands, reached the age of 85 years. Among these old people, we initiated a prospective follow-up study to investigate determinants of successful aging. A total of 599 subjects participated (response rate, 87%) and all were followed up to September 2001. Serum levels of total, LDL, and HDL cholesterol were assessed at baseline along with detailed information on comorbid conditions. The main outcome measure was all-cause and specific mortality risk. During 4 years of follow-up, 152 subjects died. The leading cause of death was cardiovascular disease, with similar mortality risks in all tertiles of LDL cholesterol level. In contrast, low HDL cholesterol level was associated with a 2.0-fold higher risk of fatal cardiovascular disease (95% confidence interval [CI], 1.2-3.2). The mortality risk of coronary artery disease was 2.0 (95% CI, 1.0-3.9) and for stroke it was 2.6 (95% CI, 1.0-6.6). Both low LDL cholesterol and low HDL cholesterol concentrations were associated with an increased mortality risk of infection: 2.7 (95% CI, 1.2-6.2) and 2.4 (95% CI, 1.1-5.6), respectively. The risks were unaffected by comorbidity. In contrast to high LDL cholesterol level, low HDL cholesterol level is a risk factor for mortality from coronary artery disease and stroke in old age.

Managing an Uncertain Illness Trajectory in Old Age: Patients' and Physicians' Views of Stroke

Uncertainty is a central feature of a chronic illness trajectory, resulting from questions about the effects of the illness on daily life, what symptoms mean, and what the future holds. When chronic illness occurs late in life, uncertainty is magnified, and serious questions arise about whether the individual will be able to weather the disruption and go on with daily life. This article examines illness trajectories from two vantage points, that of older persons who have had a stroke and that of physicians who care for stroke patients, by means of interviews with 36 persons who had strokes and with 20 physicians. Physicians' views of stroke were informed not only by knowledge of physiological processes but also by biomedical ideologies and cultural meanings associated with their patients' ages and impairments. People who had strokes focused on recovery; they assumed the trajectory was open to manipulation if they worked hard enough. The vague medical response to uncertainty affected patients' interpretations; what they were not told shaped their expectations about recovery as much as what they were told. The uncertain trajectory of stroke in old age is one example of how illness experience is affected by cultural attitudes about age, biomedical ideologies, the provision of health care services, and economically driven health policies. The anticipation of recovery by persons who have had strokes and the letdown when recovery does not occur reflect critical dilemmas in biomedicine and in society itself that have implications for health policy.

Stroke care in the next decades: a projection derived from a community-based study in Umbria, Italy.

Recently published data show that stroke incidence is not longer declining, while case fatality rates has had a less pronounced fall in recent years than in the past. Projections of the increasing number of elderly people, combined with the greater risk of stroke in old age, suggest that in the forthcoming decades we will be faced with an increased request of health resources for patients with stroke. We have therefore used data from a community-based study on stroke incidence and outcome to project the number of first ever strokes, death from stroke and handicap from stroke in Italy, up to the year 2016. Results show that incidence will increase by 22.2%, and death at 6 months from first ever stroke by 29%. However, since patients already handicapped for other reasons are more likely to die from their stroke, the net number of newly handicapped persons will only increased by 5%. These results suggest that in the next decades the major increase in request of health care resources will result from the acute event and the immediate post-ictal phase, and not from the management of chronic handicap after a stroke.