Ischemic stroke in the elderly: an overview of evidence

• Published in: Nature reviews. Neurology Vol. 6; no. 5; pp. 256 - 265
• Main Authors: Buchan, Alastair M, Balami, Joyce S, Esiri, Margaret M, Chen, Ruo-Li, Chen, Liang-Kung
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2010; Nature Publishing Group
• Subjects: 692/699/375/1370/534; 692/700/1518; Age; Age Factors; Aged; Aging; Animals; Antilipemic agents; Brain Ischemia - complications; Brain research; Cardiovascular disease; Clinical outcomes; Diagnosis; Disease Models, Animal; Geriatrics; Health aspects; Humans; Ischemia; Medical education; Medicine; Medicine & Public Health; Neurology; Older people; Patients; review-article; Risk Factors; Stroke; Stroke - etiology; United Kingdom; China; United Kingdom > UK
• ISSN: 1759-4758; 1759-4766
• DOI: 10.1038/nrneurol.2010.36

Most cases of stroke occur in the elderly, and stroke morbidity and mortality rates rise with increasing age. In this Review, Chen and colleagues examine the relationship between age and ischemic stroke, including discussion of the age-related changes that make elderly people particularly vulnerable to stroke and the factors that might be responsible for the poor outcomes observed in this patient group. Stroke mostly occurs in elderly people and patient outcomes after stroke are highly influenced by age. A better understanding of the causes of stroke in the elderly might have important practical implications not only for clinical management, but also for preventive strategies and future health-care policies. In this Review, we explore the evidence from both human and animal studies relating to the effect of old age—in terms of susceptibility, patient outcomes and response to treatment—on ischemic stroke. Several aging-related changes in the brain have been identified that are associated with an increase in vulnerability to ischemic stroke in the elderly. Furthermore, risk factor profiles for stroke and mechanisms of ischemic injury differ between young and elderly patients. Elderly patients with ischemic stroke often receive less-effective treatment and have poorer outcomes than younger individuals who develop this condition. Neuroprotective agents for ischemic stroke have been sought for decades but none has proved effective in humans. One contributing factor for this translational failure is that most preclinical studies have used young animals. Future research on ischemic stroke should consider age as a factor that influences stroke prevention and treatment, and should focus on the management of acute stroke in the elderly to reduce the incidence and improve outcomes in this vulnerable group. Key Points Over 80% of strokes occur in the elderly (people aged ≥65 years), and patient outcomes after stroke are highly influenced by age The increased vulnerability of elderly people to ischemic stroke is associated with several changes that occur in the aged brain Risk factor profiles and mechanisms of ischemic injury vary between young and old patients with stroke Elderly patients often receive less-effective treatment and have poorer outcomes following a stroke than younger individuals Most preclinical studies of neuroprotective agents have used young animals, which might partly explain the translational failure of these drugs in humans Future stroke research should place more focus on aged animals and the elderly