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Table of Contents
Vol. 39, No. 1, 2012
Issue release date: July 2012
Neuroepidemiology 2012;39:57–62
(DOI:10.1159/000339362)

Stroke in the Very Elderly: Characteristics and Outcome in Patients Aged ≥85 Years with a First-Ever Ischemic Stroke

Gur A.Y. · Tanne D. · Bornstein N.M. · Milo R. · Auriel E. · Shopin L. · Koton S. · on behalf of the NASIS Investigators
aDepartment of Neurology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, and Departments of Neurology, bSheba Medical Center, cTel-Aviv Sourasky Medical Center, and dThe Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Abstract

Background: Epidemiological and clinical features of very elderly patients with stroke are still uncertain. Our aim was to study the patient characteristics and outcomes in the very elderly (aged ≥85 years) with a first-ever ischemic stroke in the National Acute Stroke Israeli Survey (NASIS) registry. Methods: The NASIS registry is a nationwide prospective hospital-based study performed triennially (2004, 2007, 2010). Patients with ischemic stroke aged ≥85 years were compared with those 65–84 years old regarding their baseline characteristics, stroke severity, etiology of stroke and stroke outcomes. Logistic regression analyses were used to adjust for potential confounders. Stroke severity was determined according to the National Institute of Health Stroke Scale (NIHSS) score. Results: The proportion of very elderly (≥85 years) patients among the NASIS population increased from 18.3% in 2004 to 19.9% in 2007 and 24.5% in 2010 (p for trend = 0.005). The percentage of women was higher in patients aged ≥85 years (p < 0.0001). Atrial fibrillation, congestive heart disease and prior disability were significantly more common, while diabetes, current smoking and dyslipidemia were less frequent in the very elderly. The very elderly presented with more severe strokes: 36.3% of the ≥85-year-old patients had an NIHSS score ≥11 compared with 22.0% in the younger age group (p < 0.05). Conclusions: There is an increasing proportion of very elderly subjects, mostly women, among first-ever ischemic stroke patients. Current information on age-specific aspects of stroke in the very elderly is crucial to set up successful prevention pathways and implementing well-organized stroke care for this population.



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References

  1. Besdine RW: Stroke prevention in the elderly. Conn Med 1993;57:287–292.
  2. Shuaib A, Boyle C: Stroke in the elderly. Curr Opin Neurol 1994;7:41–47.
  3. Lee M, Huang WY, Weng HH, Lee JD, Lee TH: First-ever ischemic stroke in very old Asians: clinical features, stroke subtypes, risk factors and outcome. Eur Neurol 2007;58:44–48.
  4. Rojas JI, Zurrú MC, Romano M, Patrucco L, Cristiano E: Acute ischemic stroke and transient ischemic attack in the very old-risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years. Eur J Neurol 2007;14:895–899.
  5. Roijer A, Lindgren A, Rudling O, et al: Potential cardioembolic sources in an elderly population without stroke. A transthoracic and transoesophageal echocardiographic study in randomly selected volunteers. Eur Heart J 1996;17:1103–1011.
  6. Olindo S, Cabre P, Deschamps R, et al: Acute stroke in the very elderly: epidemiological features, stroke subtypes, management, and outcome in Martinique, French West Indies. Stroke 2003;34:1593–1597.
  7. Woo J, Lau E, Kay R: Elderly subjects aged 70 years and above have different risk factors for ischemic and hemorrhagic strokes compared to younger subjects. J Am Geriatr Soc 1992;40:124–129.
  8. Soares I, Abecasis P, Ferro JM: Outcome of first-ever ischemic stroke in the elderly. Arch Gerontol Geriatr 2011;53:81–87.
  9. Shimizu H, Kawarai T, Saji N, et al: Re-evaluation of clinical features and risk factors of acute ischemic stroke in Japanese longevity society. Kobe J Med Sci 2010;55:132–139.
  10. Shyu YI, Maa SH, Chen ST, Chen MC: Quality of life among older stroke patients in Taiwan during the first year after discharge. J Clin Nurs 2009;18:2320–2328.

    External Resources

  11. Lee YS, Chen DY, Chen YM, et al: First-ever ischemic stroke in Taiwanese elderly patients: predicting functional independence after a 6-month follow-up. Arch Gerontol Geriatr 2009;49(suppl 2):S26–S31.

    External Resources

  12. Wang D, Hao Z, Tao W, et al: Acute ischemic stroke in the very elderly Chinese: risk factors, hospital management and one-year outcome. Clin Neurol Neurosurg 2011;113:442–446.

    External Resources

  13. Griffiths D, Sturm J: Epidemiology and etiology of young stroke. Stroke Res Treat 2011, Epub ahead of print.
  14. Tanne D, Goldbourt U, Koton S, et al: National Acute Stroke Israeli Survey Group: a national survey of acute cerebrovascular disease in Israel: burden, management, outcome and adherence to guidelines. Isr Med Assoc J 2006;8:3–7.
  15. Wityk RJ, Pessin MS, Kaplan RF, Caplan LR: Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 1994;25:362–365.
  16. van Swieten JC, Koudstal PJ, Visser MC, Schouten HJ, van Gijn J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–607.
  17. Goldstein LB, Jones MR, Matchar DB, et al: Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke 2001;32:1091–1098.
  18. Roquer J, Campello AR, Gomis M: Sex differences in first-ever acute stroke. Stroke 2003;34:1581–1585.
  19. Marini C, Baldassarre M, Russo T, et al: Burden of first ever ischemic stroke in the oldest old. Neurology 2004;62:77–81.
  20. Arboix A, Miguel M, Císcar E, García-Eroles L, Massons J, Balcells M: Cardiovascular risk factors in patients aged 85 or older with ischemic stroke. Clin Neurol Neurosurg 2006;108:638–643.
  21. Hajat C, Dundas R, Stewart JA, et al: Cerebrovascular risk factors and stroke subtypes: differences between ethnic groups. Stroke 2001;32:37–42.
  22. Wolf PA, Abbott RD, Kannel WB: Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med 1987;147:1561–1564.
  23. Mayo NE, Nadeau L, Daskalopoulou SS, Cote R: The evolution of stroke in Quebec: a 15-year perspective. Neurology 2007;68:1122–1127.
  24. Saposnik G, Cote R, Phillips S, et al: Stroke outcome in those over 80: a multicenter cohort study across Canada. Stroke 2008;39:2310–2317.
  25. Shuaib A, Hachinski VC: Mechanisms and management of stroke in the elderly. CMAJ 1991;145:433–443.
  26. Shanmugasundaram M, Rough SJ, Alpert JS: Dyslipidemia in the elderly: should it be treated? Clin Cardiol 2010;33:4–9.

    External Resources

  27. Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S: Trends in hypertension prevalence, awareness, treatment, and control in older US adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc 2007;55:1056–1065.


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