A study of age as a risk factor in ischemic stroke of elderly

Hari Priya Reddy, Jaganath A., Nagaraj N., Visweswara Reddy Y. J.


Background: The aim of the study was to determine the effect of age as a risk factor and a determinant of outcome in elderly ischemic stroke patients.

Methods: This is an observational study. One hundred, successive elderly patients aged 60 years and above, admitted with acute ischemic stroke in PESIMSR over a period of 18 months were prospectively studied. Patients with hemorrhagic stroke, neurological deficits following trauma or following infection were excluded. Demographics, risk factors, stroke severity at admission were estimated by NIHSS. Risk factors and clinical profile were noted and compared among male and female patients. Outcome at discharge was measured by-mRS-modified ranking score.

Results: Patients in age group 60-75 years presented with less severe stroke and better mRS when compared to >75 years age group. Complications were significantly higher among the older age group.

Conclusions: The risk factors identified for ischemic stroke in the present study are diabetes, hypertension, dyslipidaemia, obesity, smoking, and alcohol. Severity of stroke at presentation, clinical outcome and complication rate during the in-hospital stay were all significantly affected by the age, more so in ischemic stroke. Age specific factors of stroke prevention are crucial for successful prevention and implementation of well-organized stroke care.


Complications, Elderly, Ischemic stroke, Severity

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Hatano S. Experience from a multicentre stroke register: a preliminary report. Bulletin World Health Org. 1976;54(5):541.

Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet. 1997;349(9061):1269-76.

Lloyd-Jones. Heart disease and Stroke statistics-2009 update: A Report from the American heart association statistics committee and stroke statistics subcommittee. Circul. 2009;119(3):E182

Dávalos A. Thrombolysis in acute ischemic stroke: successes, failures, and new hopes. Cerebrovascular Dis. 2005;20(2):135-9.

Leys D, Deplanque D, Mackowiak-Cordoliani MA, Lucas C, Bordet R, Mounier-Vehier C. Stroke prevention: management of modifiable vascular risk factors. J Neurol. 2003;250(9):1125-6.

Kuller LH. Epidemiology and prevention of stroke, now and in the future. Epidemiol Reviews. 2000;22(1):14-7.

Sacco RL. American heart association prevention conference: IV. prevention and rehabilitation of stroke-risk factors. Stroke. 1997;28:1507-17.

Hu G, Sarti C, Jousilahti P, Peltonen M, Qiao Q, Antikainen R, et al. The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality. Stroke 2005;36: 25.

Raz N. In: New Frontiers in Cognitive Ageing. Dixon RA, Backman L, Nilsson LG, eds. Oxford University Press: Oxford. 2004: 115-134.

Esiri MM. Ageing and the brain. J Pathol Society Great Britain Ireland. 2007;211(2):181-7.

Anderson JM, Hubbard BM, Coghill GR, Slidders W. The effect of advanced old age on the neurone content of the cerebral cortex: Observations with an automatic image analyser point counting method. J Neurol Sci. 1983;58(2):235-46.

Pfefferbaum A, Mathalon DH, Sullivan EV, Rawles JM, Zipursky RB, Lim KO. A quantitative magnetic resonance imaging study of changes in brain morphology from infancy to late adulthood. Archives Neurol. 1994;51(9):874-87.

Breteler MM, Van Swieten JC, Bots ML, Grobbee DE, Claus JJ, Van Den Hout JH, et al. Cerebral white matter lesions, vascular risk factors, and cognitive function in a population‐based study: the Rotterdam study. Neurol. 1994;44(7):1246.

Fernando MS, Simpson JE, Matthews F, Brayne C, Lewis CE, Barber R, et al. White matter lesions in an unselected cohort of the elderly: molecular pathology suggests origin from chronic hypoperfusion injury. Stroke. 2006;37(6):1391-8.

Prins ND, van Dijk EJ, den Heijer T, Vermeer SE, Koudstaal PJ, Oudkerk M, et al. Cerebral white matter lesions and the risk of dementia. Archives Neurol. 2004;61(10):1531-4.

Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, et al. Changes in white matter as determinant of global functional decline in older independent outpatients: three-year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ. 2009;339:b2477.

Pantoni L, Garcia JH. Pathogenesis of leukoaraiosis: a review. Stroke. 1997;28(3):652-9.

Koton S, Schwammenthal Y, Merzeliak O, Philips T, Tsabari R, Orion D, et al. Cerebral leukoaraiosis in patients with stroke or TIA: clinical correlates and 1‐year outcome. European J Neurol. 2009;16(2):218-25.

Fu JH, Lu CZ, Hong Z, Dong Q, Luo Y, Wong KS. Extent of white matter lesions is related to acute subcortical infarcts and predicts further stroke risk in patients with first ever ischaemic stroke. J Neurol Neurosurg Psychiatry. 2005;76(6):793-6.

Farkas E, De Vos RA, Donka G, Steur EJ, Mihaly A, Luiten PG. Age-related microvascular degeneration in the human cerebral periventricular white matter. Acta Neuropathol. 2006;111(2):150-7.

Marstrand JR, Garde E, Rostrup E, Ring P, Rosenbaum S, Mortensen EL, et al. Cerebral perfusion and cerebrovascular reactivity are reduced in white matter hyperintensities. Stroke. 2002;33(4):972-6.

Bertsch K, Hagemann D, Hermes M, Walter C, Khan R, Naumann E. Resting cerebral blood flow, attention, and aging. Brain Res. 2009;1267:77-88.

Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Applied Physiol. 2008;105(5):1652-60.

Qin CC, Hui RT, Liu ZH. Aging-related cerebral microvascular degeneration is an important cause of essential hypertension. Med Hypotheses. 2008;70(3):643-5.

Ueno M, Tomimoto H, Akiguchi I, Wakita H, Sakamoto H. Blood brain barrier disruption in white matter lesions in a rat model of chronic cerebral hypoperfusion. J Cerebral Blood Flow Metabol. 2002;22(1):97-104.

Deng YX, Wang YL, Gao BQ, Wang CX, Zhao XQ, Liu LP, et al. Age differences in clinical characteristics, health care, and outcomes after ischemic stroke in China. CNS Neurosci Therapeutics. 2012;18(10):819-26.

Gur AY, Tanne D, Bornstein NM, Milo R, Auriel E, Shopin L, et al. Stroke in the very elderly: characteristics and outcome in patients aged≥ 85 years with a first-ever ischemic stroke. Neuroepidemiol. 2012;39(1):57-62.

Knoflach M, Matosevic B, Rücker M, Furtner M, Mair A, Wille G, et al. Functional recovery after ischemic stroke-a matter of age: data from the Austrian stroke unit registry. Neurol. 2012;78(4):279-85.

Chen CM, Hsu HC, Chang CH, Lin CH, Chen KH, Hsieh WC, et al. Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study. BMC Geriat. 2014;14(1):41.

Pandian JD, Kaur A, Jyotsna R, Sylaja PN, Vijaya P, Padma MV, et al. Complications in acute stroke in India (CAST-I): a multicenter study. J Stroke Cerebrovascular Dis. 2012;21(8):695-703.