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Wu J, Chen M, Wang H, Zhu Y, Chen Y, Zhang S, Wang D. Comparison of Characteristics and Outcomes Between Acute Ischemic Stroke Patients with Different Types of Heart Failure. Int Heart J 2024; 65:94-99. [PMID: 38148008 DOI: 10.1536/ihj.22-717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Acute ischemic stroke (AIS) can be complicated by heart failure involving preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF), and whether or not the prognosis differs between the 2 types of patients remains unclear. We compared the clinical characteristics and outcomes of the 2 types of patients at 3 months after the stroke.We retrospectively analyzed patients who, between 1 January 2018 and 1 January 2021, experienced AIS that was complicated by HFrEF or HFpEF. All patients had been prospectively registered in the Chengdu Stroke Registry. Poor outcome was defined as a modified Rankin Scale (mRS) score of 2-6 at 3 months. Univariate and binary logistic regression was used to assess whether HFpEF was associated with a significantly worse prognosis than HFrEF.Among the final sample of 108 patients (60.2% men; mean age, 73.08 ± 10.82 years), 75 (69.4%) had HFpEF. Compared to HFrEF patients, those with HFpEF were older (P = 0.002), were more likely to have chronic kidney disease (P = 0.033), and were more likely to experience a poor outcome (P = 0.022). After adjustments, HFpEF was associated with significantly greater risk of poor outcome than HFrEF (OR 4.13, 95%CI 1.20-15.79, P = 0.029). However, rates of hemorrhagic transformation or mortality at 3 months after AIS did not differ significantly between the 2 types of heart failure (all P > 0.05).Patients with AIS involving HFpEF experience worse outcomes than those with HFrEF and therefore may require special monitoring and management. Our findings need to be verified in large prospective studies.
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Affiliation(s)
- Jiongxing Wu
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Mingxi Chen
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Huan Wang
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Yuyi Zhu
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Yaqi Chen
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Shihong Zhang
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
| | - Deren Wang
- Department of Neurology, West China Hospital, Sichuan University
- Center for Cerebrovascular Diseases, West China Hospital, Sichuan University
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Tuohy MC, Hillman EMC, Marshall R, Agalliu D. The age-dependent immune response to ischemic stroke. Curr Opin Neurobiol 2023; 78:102670. [PMID: 36586305 PMCID: PMC9845177 DOI: 10.1016/j.conb.2022.102670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
Stroke is a devastating cause of global morbidity and mortality. Ischemic brain injury triggers a profound local and systemic immune response that participates in stroke pathophysiology. In turn, this immune response has emerged as a potential therapeutic target. In order to maximize its therapeutic potential, it is critical to understand how the immune response to ischemic brain injury is affected by age - the strongest non-modifiable risk factor for stroke. The development of multi-omics and single-cell technologies has provided a more comprehensive characterization of transcriptional and cellular changes that occur during aging. In this review, we summarize recent advances in our understanding of how age-related immune alterations shape differential stroke outcomes in older versus younger organisms, highlighting studies in both experimental mouse models and patient cohorts. Wherever possible, we emphasize outstanding questions that present important avenues for future investigation with therapeutic value for the aging population.
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Affiliation(s)
- Mary Claire Tuohy
- Doctoral Program in Neurobiology and Behavior, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Zuckerman Mind Brain Behavior Institute and Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Elizabeth M C Hillman
- Zuckerman Mind Brain Behavior Institute and Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA. https://twitter.com/HillmanLab
| | - Randolph Marshall
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Dritan Agalliu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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3
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Sui H, Wu J, Zhou Q, Liu L, Lv Z, Zhang X, Yang H, Shen Y, Liao S, Shi F, Mo Z. Nomograms predict prognosis and hospitalization time using non-contrast CT and CT perfusion in patients with ischemic stroke. Front Neurosci 2022; 16:912287. [PMID: 35937898 PMCID: PMC9355636 DOI: 10.3389/fnins.2022.912287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Stroke is a major disease with high morbidity and mortality worldwide. Currently, there is no quantitative method to evaluate the short-term prognosis and length of hospitalization of patients. Purpose We aimed to develop nomograms as prognosis predictors based on imaging characteristics from non-contrast computed tomography (NCCT) and CT perfusion (CTP) and clinical characteristics for predicting activity of daily living (ADL) and hospitalization time of patients with ischemic stroke. Materials and methods A total of 476 patients were enrolled in the study and divided into the training set (n = 381) and testing set (n = 95). Each of them owned NCCT and CTP images. We propose to extract imaging features representing as the Alberta stroke program early CT score (ASPECTS) values from NCCT, ischemic lesion volumes from CBF, and TMAX maps from CTP. Based on imaging features and clinical characteristics, we addressed two main issues: (1) predicting prognosis according to the Barthel index (BI)–binary logistic regression analysis was employed for feature selection, and the resulting nomogram was assessed in terms of discrimination capability, calibration, and clinical utility and (2) predicting the hospitalization time of patients–the Cox proportional hazard model was used for this purpose. After feature selection, another specific nomogram was established with calibration curves and time-dependent ROC curves for evaluation. Results In the task of predicting binary prognosis outcome, a nomogram was constructed with the area under the curve (AUC) value of 0.883 (95% CI: 0.781–0.985), the accuracy of 0.853, and F1-scores of 0.909 in the testing set. We further tried to predict discharge BI into four classes. Similar performance was achieved as an AUC of 0.890 in the testing set. In the task of predicting hospitalization time, the Cox proportional hazard model was used. The concordance index of the model was 0.700 (SE = 0.019), and AUCs for predicting discharge at a specific week were higher than 0.80, which demonstrated the superior performance of the model. Conclusion The novel non-invasive NCCT- and CTP-based nomograms could predict short-term ADL and hospitalization time of patients with ischemic stroke, thus allowing a personalized clinical outcome prediction and showing great potential in improving clinical efficiency. Summary Combining NCCT- and CTP-based nomograms could accurately predict short-term outcomes of patients with ischemic stroke, including whose discharge BI and the length of hospital stay. Key Results Using a large dataset of 1,310 patients, we show a novel nomogram with a good performance in predicting discharge BI class of patients (AUCs > 0.850). The second nomogram owns an excellent ability to predict the length of hospital stay (AUCs > 0.800).
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Affiliation(s)
- He Sui
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiaojiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Qing Zhou
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Lin Liu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongwen Lv
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xintan Zhang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Haibo Yang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Yi Shen
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Shu Liao
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Zhanhao Mo
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Zhanhao Mo,
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Adcock AK, Schwamm LH, Smith EE, Fonarow GC, Reeves MJ, Xu H, Matsouaka RA, Xian Y, Saver JL. Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients. JAMA Netw Open 2022; 5:e2215869. [PMID: 35671055 PMCID: PMC9175073 DOI: 10.1001/jamanetworkopen.2022.15869] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Patients aged 80 years and older were often excluded or underrepresented in pivotal endovascular thrombectomy (EVT) trials. Accordingly, trends in frequency, outcomes, and disparities of EVT use merit close analysis. OBJECTIVE To delineate temporal trends in EVT use, outcomes, and disparities among patients with acute ischemic stroke aged 80 years and older vs those younger than 80 years. DESIGN, SETTING, AND PARTICIPANTS A US nationwide retrospective cohort study using prospectively collected data was conducted in patients admitted with a primary diagnosis of acute ischemic stroke between April 1, 2012, and June 30, 2019. Data were obtained from hospitals participating in the Get With the Guidelines-Stroke (GWTG-Stroke) program, which is a stroke quality improvement registry, with data collected prospectively, sponsored by the American Heart Association/American Stroke Association. Data analysis was conducted from November 2, 2020, to June 25, 2021. EXPOSURES Potentially eligible for EVT based on arrival within 6 hours and National Institutes of Health Stroke Scale score greater than or equal to 6. MAIN OUTCOMES AND MEASURES Efficacy outcomes included discharge to home, independent ambulation at discharge, and functional independence (modified Rankin Scale score 0-2) at discharge. Safety outcomes included in-hospital mortality, combined in-hospital mortality or discharge to hospice, and symptomatic intracranial hemorrhage. RESULTS Among 302 965 patients with ischemic stroke meeting study criteria as potentially eligible for EVT admitted to 614 GWTG-Stroke hospitals, 14.0% (42 422) received EVT (21 634 women [51.0%]), including 10.7% (12 768 of 119 453) of patients aged 80 years and older (median [IQR] age, 85 [82-89] years) and 16.2% (29 654 of 183 512) of patients younger than 80 years (median [IQR] age, 65 [56-73] years). Among patients aged 80 years and older, EVT rates increased substantially during the study period, from 3.3% in early 2012 to 20.8% in early 2019. By study end, the relative rate of EVT among eligible patients aged 80 years and older compared with those younger than 80 years increased from 0.49 (3.3% vs 6.7%) to 0.76 (20.8% vs 27.3%). Older patients had worse outcomes at discharge compared with younger patients, including discharge to home: 12.5% vs 31.1% (adjusted odds ratio [aOR], 0.43; 95% CI, 0.40-0.46), functional independence (modified Rankin Scale score 0-2): 10.9% vs 26.6% (aOR, 0.45; 95% CI, 0.41-0.49), and inpatient death or discharge to hospice, 34.5% vs 16.1% (aOR, 2.22; 95% CI, 2.09-2.36). Symptomatic intracranial hemorrhage rates did not differ significantly (6.9% vs 6.5%; aOR, 1.04; 95% CI, 0.94-1.14). CONCLUSIONS AND RELEVANCE In this cohort study, use of EVT among individuals aged 80 years and older increased substantially from 2012 to 2019, although the rate remained lower than in younger patients. Although favorable functional outcomes at discharge were lower and combined mortality or discharge to hospice was higher in the older patients, the risk of symptomatic intracranial hemorrhage was not increased.
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Affiliation(s)
- Amelia K. Adcock
- Department of Neurology, West Virginia University School of Medicine, Morgantown
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eric E. Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gregg C. Fonarow
- Division of Cardiology, University of California, Los Angeles
- Section Editor, Health Care Quality and Guidelines, JAMA Cardiology
| | - Mathew J. Reeves
- Department of Epidemiology, Michigan State University, East Lansing
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | | | - Ying Xian
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Ginex V, Viganò M, Gilardone G, Monti A, Gilardone M, Corbo M. Predicting home discharge after inpatient rehabilitation of stroke patients with aphasia. Neuropsychol Rehabil 2022; 33:393-408. [PMID: 37070855 DOI: 10.1080/09602011.2021.2021951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The early identification of the discharge setting from Inpatient Rehabilitation Facilities is a primary goal in stroke-related research because of its clinical and socio-economic relevance. Several features have been identified as significant predictors of the discharge setting. Within cognitive deficits, aphasia is known to be a common and disabling condition that could influence rehabilitation outcome. However, it is often set as an exclusion criterion in stroke research. This study aims to investigate the predictive power of clinical variables, in particular specific language disturbances and nonlinguistic cognitive deficits, for discharge setting in post-acute stroke patients with aphasia after intensive multidisciplinary rehabilitation. In a sample of 158 patients, demographic, motor, language, and nonverbal cognitive data were retrospectively considered for the prediction of the discharge to home vs. another institutional setting. Univariate analysis identified relevant differences between groups and the significant variables were included in a logistic regression model. The results showed that better functional motor status, absence of dysphagia and unimpaired nonlinguistic cognitive profile independently predict the discharge to home. In particular, nonverbal cognitive functioning seemed to be specifically relevant within the aphasic population. The findings could be helpful for setting up the rehabilitation priorities and an adequate discharge arrangement.
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Affiliation(s)
- Valeria Ginex
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Mauro Viganò
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Giulia Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Marco Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
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Salhadar N, Dibas M, Sarraj A, Tekle W, Hassan AE. The outcomes of mechanical thrombectomy in nonagenarians and octogenarians in a majority hispanic population. Clin Neurol Neurosurg 2021; 208:106872. [PMID: 34391086 DOI: 10.1016/j.clineuro.2021.106872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVE Elderly patients (≥ 80 years) were underrepresented in randomized trials that proved the efficacy and safety of mechanical thrombectomy (MT) in acute ischemic strokes (AIS) due to large vessel occlusion (LVO). Additionally, the impact of race and socioeconomics on AIS outcomes is well-reported. We sought to compare the MT clinical outcomes between octogenarians and nonagenarians, the majority of whom are Hispanic, in underserved border communities. METHODS This is a retrospective cohort study that was conducted in a comprehensive stroke center between 2012 and 2020. The baseline characteristics and outcomes were compared between the two groups. The primary measured outcome included a favorable outcome on the modified Rankin Scale (mRS) after three months (mRS ≤ 2). Secondary outcomes included mortality, symptomatic intracerebral hemorrhage (sICH), and an improvement in NIH Stroke Scale (NIHSS) score (≤4). RESULTS Of 215 included patients, 184 (85.6%) were octogenarians and 31 (14.4%) were nonagenarians. There were no significant differences between octogenarians and nonagenarians in terms of rates of favorable outcomes after three months (30.4% vs. 19.4%, p = 0.247), clinical improvement in discharge NIHSS (16.3% vs. 19.4%, p = 0.753), mortality (24.5% vs. 29.0%; p = 0.710) and sICH (6.5% vs. 3.2%, p = 0.780). Furthermore, Hispanic and non-Hispanic patients had similar outcomes. CONCLUSION There were no significant differences in the outcomes of MT between octogenarians and nonagenarians and between Hispanic and non-Hispanic patients. The similar clinical outcomes between both age groups in our study and the lower rates of sICH support the use of this treatment among people who are aged 80 or older.
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Affiliation(s)
- Nura Salhadar
- University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Mahmoud Dibas
- Sulaiman Al Rajhi University, College of Medicine, Qassim, Saudi Arabia.
| | - Amrou Sarraj
- Department of Neurology, University of Texas at Houston Stroke Center, USA
| | - Wondwossen Tekle
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA
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Adcock A. Reply Letter to Evolving the Proposed HEMS Stroke Triaging Tool. J Emerg Med 2021; 60:813-814. [PMID: 34147230 DOI: 10.1016/j.jemermed.2021.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
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8
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The association between telomere length and ischemic stroke risk and phenotype. Sci Rep 2021; 11:10967. [PMID: 34040069 PMCID: PMC8155040 DOI: 10.1038/s41598-021-90435-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
The chronological age of a person is a key determinant of etiology and prognosis in the setting of ischemic stroke. Telomere length, an indicator of biological aging, progressively shortens with every cell cycle. Herein, we determined telomere length from peripheral blood leukocytes by Southern blot analyses in a prospective cohort of ischemic stroke patients (n = 163) and equal number of non-stroke controls and evaluated its association with various ischemic stroke features including etiology, severity, and outcome. A shorter telomere length (i.e. lowest quartile; ≤ 5.5 kb) was significantly associated with ischemic stroke (OR 2.95, 95% CI 1.70–5.13). This significant relationship persisted for all stroke etiologies, except for other rare causes of stroke. No significant association was present between admission lesion volume and telomere length; however, patients with shorter telomeres had higher admission National Institutes of Health Stroke Scale scores when adjusted for chronological age, risk factors, etiology, and infarct volume (p = 0.046). On the other hand, chronological age, but not telomere length, was associated with unfavorable outcome (modified Rankin scale > 2) and mortality at 90 days follow-up. The association between shorter telomere length and more severe clinical phenotype at the time of admission, might reflect reduced resilience of cerebral tissue to ischemia as part of biological aging.
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Imura T, Inoue Y, Tanaka R, Matsuba J, Umayahara Y. Clinical Features for Identifying the Possibility of Toileting Independence after Convalescent Inpatient Rehabilitation in Severe Stroke Patients: A Decision Tree Analysis Based on a Nationwide Japan Rehabilitation Database. J Stroke Cerebrovasc Dis 2021; 30:105483. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 01/19/2023] Open
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Algeo C, Beh S, McDonald L, MacLeod AD, Reid JM. Examining Outcomes following Thrombolysis in An Increasingly Older and Dependent Stroke Population. J R Coll Physicians Edinb 2020; 50:372-378. [DOI: 10.4997/jrcpe.2020.405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Thrombolysis for acute ischaemic stroke (AIS) patients aged ≥80 years is evidence based, although its use in previously dependent patients is controversial. Methods Data from 831 thrombolysed AIS patients in our centre from 2009–2017 were used to compare demographic trends and outcomes (haemorrhage, mortality, three-month independence) in patients aged <80 and ≥80 years and with prior dependency. Comparison with UK and world registry data regarding age and pre-stroke dependency was made. Results The percentage of treated patients aged ≥80 years increased year-on-year, doubling from 25% to 50% (p<0.01), with increasing average age and pre-stroke dependency in world centres. Patients ≥80 years had higher (p<0.001) stroke severity, symptomatic intracerebral haemorrhage (5% vs. 1.5%), mortality (35% vs. 13%) and lower three month independent survival (24% vs. 60%). Patients with pre-stroke dependency had especially higher three month mortality (57–71%, OR 3.75 [95% CI 1.97–7.15]) in both age groups. Conclusion Patients aged ≥80 years and with dependency increasingly receive thrombolysis. Given poorer outcomes thrombolysis trials are needed in pre-stroke dependent patients.
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Affiliation(s)
- Charlotte Algeo
- Foundation Year 2 Doctor, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sean Beh
- Foundation Year 2 Doctor, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lindsey McDonald
- ST6 in Geriatric Medicine, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Angus D MacLeod
- Senior Clinical Lecturer in Neurology, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Consultant Neurologist, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - John M Reid
- Consultant Neurologist, Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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Abe T, Iwata K, Yoshimura Y, Shinoda T, Inagaki Y, Ohya S, Yamada K, Oyanagi K, Maekawa Y, Honda A, Kohara N, Tsubaki A. Low Muscle Mass is Associated with Walking Function in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:105259. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105259] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/11/2020] [Accepted: 08/16/2020] [Indexed: 12/18/2022] Open
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12
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Yüksel A, Kulan CA, Akçiçek F. The investigation of asymptomatic swallowing disorder through surface electromyography in the geriatric population. Aging Clin Exp Res 2020; 32:1567-1576. [PMID: 31538319 DOI: 10.1007/s40520-019-01349-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
AIM Swallowing is a vital activity. The difficulty while swallowing, referred to as swallowing disorder, is strongly associated with serious health problems in the elderly. The aim of this study is to enable early recognition of the swallowing function developing as an asymptomatic condition. METHOD Our study was conducted on elderly populations aged 65 years and over who met the exclusion criteria. Firstly, to be able to reach the number of sampling, "EAT-10 questionnaire", which also has a Turkish validation, was used to eliminate those with symptomatic swallowing disorders. The number of patients we reached was 320, but 7 dropped out of the study and therefore the study was carried out with a total of 313 [reached as 97.8% (up 95% G-power)]. RESULT We used validated sEMG test in the quantitative (objective) detection of asymptomatic swallowing disorder. In this method, asymptomatic swallowing disorder was detected in 39 cases (12.4%). CONCLUSION Swallowing disorder without symptoms is frequent and the sEMG test is useful in detecting it in the elderly population.
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Affiliation(s)
- Arif Yüksel
- Department of Internal Medicine, Izmir Bozyaka Health Research and Application Center, University of Health Sciences, Izmir, Turkey.
- SBU Izmir Bozyaka Eğitim ve Araştırma Hastanesi, Saim Cıkrıkcı Cad., No:59 Karabaglar, Izmir, Turkey.
| | - Can Ahmet Kulan
- Department of Neurology, Izmir Bozyaka Health Research and Application Center, University of Health Sciences, Izmir, Turkey
| | - Fehmi Akçiçek
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
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Perin C, Bolis M, Limonta M, Meroni R, Ostasiewicz K, Cornaggia CM, Alouche SR, da Silva Matuti G, Cerri CG, Piscitelli D. Differences in Rehabilitation Needs after Stroke: A Similarity Analysis on the ICF Core Set for Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124291. [PMID: 32560129 PMCID: PMC7345505 DOI: 10.3390/ijerph17124291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O, >65 years old) and younger (Y, ≤65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales was translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y (n = 35, 46.17 ± 11.27 years old) and O (n = 35, 76.43 ± 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
- Correspondence: ; Tel.: +39-03-6298-6446; Fax: +39-03-6298-6439
| | - Marta Bolis
- Casa di cura Beato Palazzolo, 24122 Bergamo, Italy;
| | - Marco Limonta
- Istituti Clinici Zucchi, 20841 Carate Brianza, Italy;
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, 4671 Differdange, Luxembourg;
| | | | - Cesare Maria Cornaggia
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
| | - Sandra Regina Alouche
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil;
| | - Gabriela da Silva Matuti
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil;
- Associação de Assistência à Criança Deficiente (AACD), 04027-000 São Paulo, Brazil;
| | - Cesare Giuseppe Cerri
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
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14
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Groot AE, Treurniet KM, Jansen IG, Lingsma HF, Hinsenveld W, van de Graaf RA, Roozenbeek B, Willems HC, Schonewille WJ, Marquering HA, van den Berg R, Dippel DW, Majoie CB, Roos YB, Coutinho JM. Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry. Neurology 2020; 95:e131-e139. [DOI: 10.1212/wnl.0000000000009764] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/26/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo explore clinical outcomes in older adults with acute ischemic stroke treated with endovascular thrombectomy (EVT).MethodsWe included consecutive patients (2014–2016) with an anterior circulation occlusion undergoing EVT from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the effect of age (dichotomized at ≥80 years and as continuous variable) on the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage (sICH), and reperfusion rate. The association between age and mRS was assessed with multivariable ordinal logistic regression, and a multiplicative interaction term was added to the model to assess modification of reperfusion by age on outcome.ResultsOf the 1,526 patients, 380 (25%) were ≥80 years of age (referred to here as older adults). Older adults had a worse functional outcome than younger patients (adjusted common odds ratio [acOR] for an mRS score shift toward better outcome 0.31, 95% confidence interval [CI] 0.24–0.39). Mortality was also higher in older adults (51% vs 22%, adjusted odds ratio 3.12, 95% CI 2.33–4.19). There were no differences in proportion of patients with mRS scores of 4 to 5, sICH, or reperfusion rates. Successful reperfusion was more strongly associated with a shift toward good functional outcome in older adults than in younger patients (acOR 3.22, 95% CI 2.04–5.10 vs 2.00, 95% CI 1.56–2.57, pinteraction = 0.026).ConclusionOlder age is associated with an increased absolute risk of poor clinical outcome, while the relative benefit of successful reperfusion seems to be higher in these patients. These results should be taken into consideration in the selection of older adults for EVT.
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15
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Sharma A, Sharma VK, Ahmad A, Gupta D, Khan K, Shuaib A, Alexandrov AV, Saqqur M. Effect of Age on Arterial Recanalization and Clinical Outcome in Thrombolyzed Acute Ischemic Stroke in CLOTBUST Cohort. Ann Indian Acad Neurol 2020; 23:189-194. [PMID: 32189860 PMCID: PMC7061505 DOI: 10.4103/aian.aian_434_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background and Aims: Despite the evidence from randomized clinical trials, the effectiveness of intravenous tissue recombinant plasminogen activator (IV-tPA) for elderly patients (≥80 yrs) with acute ischemic stroke (AIS) is often an important consideration in clinical practice. We evaluated the effect of older age on arterial recanalization, timing of recanalization and outcome in thrombolysed AIS patients. Methods: Consecutive AIS patients treated with IV-tPA and transcranial Doppler (TCD) examination within 3 hours of symptom-onset were included. Thrombolysis in Brain Ischemia (TIBI) flow-grading system was used to interpret TCD findings of persistent occlusion, re-occlusion and complete recanalization within 2 hours of IV-tPA bolus. Poor functional outcome was defined by modified Rankin score of 3 or more. Univariate and multiple logistic regression analyses were performed to assess the effect of age on clinical and TCD outcome measures. Results: The study included 361 patients (elderly = 85, <80 yrs = 276). Median age was 68 years (range 18-91 years). Compared to the elderly, younger patients (<80 years) were more females (63.5% versus 41.3%), had higher baseline National Institute of Health Stroke Scale score (17.5 versus 16.0 points) and shorter time from symptom-onset to IV-tPA bolus (median 136.6 versus 139.7 minutes). No significant differences were noted between the site of arterial occlusion, TCD outcome measures or time of complete recanalization between the 2 groups. More patients aged < 80 years achieved good functional outcome (51.9% versus 31.8% in the older age group; P = 0.004). IV-tPA induced recanalization and symptomatic intracranial hemorrhage were similar in the 2 groups. Multivariate logistic regression showed elderly age as an independent predictor of poor outcome (adjusted OR 2.5, 95%CI 1.26-4.95; P = 0.008). Conclusion: Elderly AIS patients achieve relatively poor functional outcome after IV-tPA despite similar rates of arterial recanalization. However, there is no increase in the hemorrhagic risk. Perhaps, decision for IV thrombolysis in elderly patients should be made cautiously.
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Affiliation(s)
- Arvind Sharma
- Department of Neurology, Zydus Hospital and B J Medical College, Ahmedabad, Gujarat, India
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore
| | - Aftab Ahmad
- Division of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Deepak Gupta
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Khursheed Khan
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Maher Saqqur
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.,Department of Neurology, Hammad Medical Center, Doha, Qatar
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16
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Major S, Huo S, Lemale CL, Siebert E, Milakara D, Woitzik J, Gertz K, Dreier JP. Direct electrophysiological evidence that spreading depolarization-induced spreading depression is the pathophysiological correlate of the migraine aura and a review of the spreading depolarization continuum of acute neuronal mass injury. GeroScience 2020; 42:57-80. [PMID: 31820363 PMCID: PMC7031471 DOI: 10.1007/s11357-019-00142-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023] Open
Abstract
Spreading depolarization is observed as a large negative shift of the direct current potential, swelling of neuronal somas, and dendritic beading in the brain's gray matter and represents a state of a potentially reversible mass injury. Its hallmark is the abrupt, massive ion translocation between intraneuronal and extracellular compartment that causes water uptake (= cytotoxic edema) and massive glutamate release. Dependent on the tissue's energy status, spreading depolarization can co-occur with different depression or silencing patterns of spontaneous activity. In adequately supplied tissue, spreading depolarization induces spreading depression of activity. In severely ischemic tissue, nonspreading depression of activity precedes spreading depolarization. The depression pattern determines the neurological deficit which is either spreading such as in migraine aura or migraine stroke or nonspreading such as in transient ischemic attack or typical stroke. Although a clinical distinction between spreading and nonspreading focal neurological deficits is useful because they are associated with different probabilities of permanent damage, it is important to note that spreading depolarization, the neuronal injury potential, occurs in all of these conditions. Here, we first review the scientific basis of the continuum of spreading depolarizations. Second, we highlight the transition zone of the continuum from reversibility to irreversibility using clinical cases of aneurysmal subarachnoid hemorrhage and cerebral amyloid angiopathy. These illustrate how modern neuroimaging and neuromonitoring technologies increasingly bridge the gap between basic sciences and clinic. For example, we provide direct electrophysiological evidence for the first time that spreading depolarization-induced spreading depression is the pathophysiological correlate of the migraine aura.
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Affiliation(s)
- Sebastian Major
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Shufan Huo
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Coline L Lemale
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Denny Milakara
- Solution Centre for Image Guided Local Therapies (STIMULATE), Otto-von-Guericke-University, Magdeburg, Germany
| | - Johannes Woitzik
- Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Karen Gertz
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.
- Einstein Center for Neurosciences Berlin, Berlin, Germany.
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17
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Zhao W, Ma P, Zhang P, Yue X. Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis. Front Neurol 2020; 10:1355. [PMID: 32038452 PMCID: PMC6993560 DOI: 10.3389/fneur.2019.01355] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background and purpose: Multiple randomized trials have confirmed that mechanical thrombectomy (MT) is an effective treatment method for patients with acute ischemic stroke (AIS). However, evidence on the safety and efficacy of MT in elderly patients compared with younger patients is controversial. This meta-analysis is aimed to systematically compare the outcomes of elderly patients and younger patients after MT for AIS. Methods: A systematic literature search was conducted through the PubMed, EMBASE, and Cochrane Library database. The primary outcomes were favorable functional outcome at 90 days and mortality. The secondary outcomes were symptomatic intracerebral hemorrhage (sICH) and successful recanalization rate. Odds ratios (ORs) were estimated using a random effects model. Results: Sixteen studies published between 2014 and 2019 were included in this meta-analysis totally involving 3,954 patients. The pooled results showed that patients aged ≥80 years had worse functional outcome (OR = 0.40; 95% CI, 0.32–0.50; P < 0.001) and higher rates of mortality (OR = 2.26; 95% CI, 1.73–2.95; P < 0.001). There was a trend of higher rates of sICH in patients aged ≥80 years compared with patients aged <80 years, whereas this did not reach statistical significance (OR = 1.28; 95% CI, 0.89–1.84; P = 0.18). Furthermore, the frequency of successful recanalization was also lower in patients aged ≥80 years compared with patients aged <80 years (OR = 0.72; 95% CI, 0.55–0.95; P = 0.02). The subgroup analysis indicated that in comparison with those studies published between 2014 and 2016, elderly patients undergoing MT had better outcomes in studies published between 2017 and 2019. Conclusion: Elderly patients undergoing MT had higher risk of mortality and worse functional outcome. Meanwhile, there was a trend toward higher rates of sICH and lower probability of achieving successful recanalization in elderly patients. These findings emphasize the need for improving the rates of successful recanalization in elderly patients with AIS. In addition, advanced technology of endovascular intervention and peri-interventional management might be associated with the prognosis in elderly patients. However, more prospective or randomized studies should be conducted to further explore this issue.
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Affiliation(s)
- Weisong Zhao
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, China
| | - Pengju Ma
- Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Ping Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xuejing Yue
- School of Basic Medicine, Xinxiang Medical University, Xinxiang, China
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18
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Value of the Barthel scale in prognostic prediction for patients with cerebral infarction. BMC Cardiovasc Disord 2020; 20:14. [PMID: 31931720 PMCID: PMC6956477 DOI: 10.1186/s12872-019-01306-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to evaluate the ADL(activity of daily living) of patients with acute cerebral infarction through BI scoring, in order to observe its predictive value in the prognosis of these patients. Methods According to the inclusion and exclusion criteria, patients with acute anterior circulation cerebral infarction were included in the present study. Then, the BI scoring was analyzed through five grades, in order to further investigate the dose-response relationship between BI scoring and mortality risk in patients with cerebral infarction. The receiver operating characteristic (ROC) curves for BI-scored patients were drawn, and the predictive authenticity of the Barthel scale in prognostic prediction for patients with cerebral infarction was estimated. Results The difference in BI scores between the survival group and death group were statistically significant (t = 10.029, P < 0.05), in which the score was lower in the death group than in the survival group. According to the linear trend ×2-test, the decrease in BI score indicates an increase in mortality risk in patients with cerebral infarction. The area under the curve (AUC) of the ROC curve was 0.794 with a P–value of < 0.05. Conclusion BI scoring is a highly valuable scoring system for the prognostic prediction of patients with acute cerebral infarction.
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19
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DeMark L, Fox EJ, Spigel PM, Osborne J, Rose DK. Clinical application of backward walking training to improve walking function, balance, and fall-risk in acute stroke: a case series. Top Stroke Rehabil 2019; 26:497-502. [PMID: 31311448 DOI: 10.1080/10749357.2019.1641011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: With limited inpatient rehabilitation (IR) length of stays for patients post-stroke, it is critical to maximize the effectiveness of interventions to address their balance and gait speed deficits. Backward walking (BW) is an emerging training approach; however, its application to patient populations consistent with those in IR is limited. Objectives: To describe the effects of an additional BW training program to standard IR care on balance, walking ability and fall-risk in a heterogenic caseload of adults <2 weeks post-stroke with a broad range of lesion locations and physical sequelae. Methods: Eight patients with first-time stroke (5 male; average age 66.5 ± 11.7 years; average stroke onset 7.6 ± 1.6 days; 6 right hemiparesis) participated in 10-daily sessions that included 20 min of over ground BW training for each session, in addition to standard IR. Standard outcome measures were used to assess balance, walking ability and fall-risk at admission and post-intervention. Results: All eight patients demonstrated improvements in all outcomes with a clinically meaningful increase in forward walking speed, as measured by 10MWT. Four participants exceeded fall-risk cut-off scores for all balance-related outcome measures. Conclusions: In a diverse patient population early after stroke, individuals successfully participated in an additional BW training program. Despite the patients' acuity and severe impairments in walking, significant gains in balance and walking function were noted. This program may be useful in improving outcomes with patient characteristics commonly seen in IR.
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Affiliation(s)
- Louis DeMark
- Brooks Rehabilitation, Clinical Research Center , Jacksonville , FL , USA
| | - Emily J Fox
- Brooks Rehabilitation, Clinical Research Center , Jacksonville , FL , USA.,Department of Physical Therapy, University of Florida , Gainesville , FL , USA
| | - Pamela M Spigel
- Brooks Rehabilitation, Clinical Research Center , Jacksonville , FL , USA
| | - Jacqueline Osborne
- Brooks Rehabilitation, Clinical Research Center , Jacksonville , FL , USA
| | - Dorian K Rose
- Brooks Rehabilitation, Clinical Research Center , Jacksonville , FL , USA.,Department of Physical Therapy, University of Florida , Gainesville , FL , USA.,Malcolm Randall VA Medical Center, Brain Rehabilitation Research Center , Gainesville , FL , USA
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20
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Harada S, Inatomi Y, Nakajima M, Yonehara T, Ando Y. [Clinical characteristics of oldest-old patients with ischemic stroke]. Rinsho Shinkeigaku 2019; 59:125-132. [PMID: 30814450 DOI: 10.5692/clinicalneurol.cn-001262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We divided acute ischemic stroke patients into an oldest old group (≥90 years, n = 414) and an elderly group (75-89 years, n = 1,927), and compared the clinical characteristics between the two groups. Female sex, early admission, severe stroke on admission, atrial fibrillation, and cardioembolic stoke were significantly more frequent in the oldest-old group. On the other hand, risk factors associated with atherosclerosis were less frequent in the oldest-old group. There were no differences in hyper-acute recanalization therapy between the two groups, whereas antithrombotic therapy for secondary prevention at discharge was introduced less frequently in the oldest-old group than in the elderly group. Death prior to discharge from the acute care hospital , and death at 3 months were significantly more frequent in the oldest-old group. Moreover, in the oldest old group, severe stroke and atrial fibrillation were independent predictors for both death prior to discharge from the acute care hospital and at 3 months after onset. Oldest-old stroke patients had poor outcome, although they had received aggressive treatment as same as elderly patients. Therefore, as the number of oldest-old stroke patients is increasing, the demand for cooperation in the healthcare system is likely to grow, including acute care hospitals.
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Affiliation(s)
| | | | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | | | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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21
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Cocho D, Yarleque S, Boltes A, Espinosa J, Ciurans J, Pont-Sunyer C, Pons J. Clinical Outcome of Ischemic Stroke in Old Patients Versus Oldest-Old. J Stroke Cerebrovasc Dis 2018; 27:3657-3661. [PMID: 30279058 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/29/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is unclear whether very old patients benefit from stroke unit. The aim of our work was to compare the clinical outcome of patients with ischemic stroke aged either 70 or 80 (G 1) versus oldest-old greater than or equal to 81 years (G 2). METHODS Of 1187 patients admitted with stroke during 5 years in our stroke unit, we included 252 patients with independent functional status (modified Rankin scale, [mRS] ≤ 2) before the stroke. All patients underwent clinical examination, blood test, electrocardiography, brain imaging, and cerebrovascular ultrasound. Clinical outcome was assessed with the mRS and National Institutes of Health Stroke Scale (NIHSS) at discharge. We considered favorable outcome mRS 0-2 at discharge. RESULTS Of 252 patients included, 55% were male, 150 (59.5%) patients belonged to G1 and 102 (40.5%) G2. We detected a significant increase of atrial fibrillation, bronchoaspiration, mortality, higher NIHSS at admission, and worse functional status at discharge in G2. No significant differences in other demographic, vascular risk factors, hospital stay, NIHSS at discharge or subtype of stroke were found. NIHSS at discharge was the only independent predictor of good functional status (odds ratio 0.4; 95% confidence interval, 0.3-0.6; P < .001). CONCLUSIONS Oldest-old patients showed similar NIHSS at discharge than younger patients despite having higher neurological severity at admission. Our results support the hypothesis that oldest-old patients have good recovery potential, and should not be excluded from the stroke unit. The worse functional status detected at discharge in these patients could be attributed to others factors and not to neurological severity.
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Affiliation(s)
- Dolores Cocho
- Department of Neurology, Hospital General de Granollers, Barcelona, Spain.
| | - Sulema Yarleque
- Department of Geriatrics, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anuncia Boltes
- Department of Neurology, Hospital General de Granollers, Barcelona, Spain
| | - Jordi Espinosa
- Department of Neurology, Hospital General de Granollers, Barcelona, Spain
| | - Jordi Ciurans
- Department of Neurology, Hospital General de Granollers, Barcelona, Spain
| | | | - Jordi Pons
- Department of Neurology, Hospital General de Granollers, Barcelona, Spain
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22
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Zucchella C, Consilvio M, Iacoviello L, Intiso D, Tamburin S, Casale R, Bartolo M. Rehabilitation in oldest-old stroke patients: a comparison within over 65 population. Eur J Phys Rehabil Med 2018; 55:148-155. [PMID: 30160435 DOI: 10.23736/s1973-9087.18.05297-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Considering the demographic trend, characterized by a marked aging due to the increase in life expectancy and the improvement in medical care, in the next future elderly patients will represent the majority of stroke victims with a strong impact on rehabilitative services. AIM To investigate and characterize differences in functional outcome in elderly patients after stroke. DESIGN Observational study. SETTING Post-acute inpatient rehabilitation. POPULATION Subjects aged ≥65 years with acute (i.e. within 30 days from onset) ischemic or hemorrhagic stroke. METHODS At admission, all patients underwent neurological and clinical examination, functional evaluation and laboratory assessment. Comorbidities and clinical complications during hospital stay were recorded. Functional status was evaluated by means of the Functional Independence Measure (FIM) administered at admission and discharge. All patients underwent neuromotor rehabilitation, and speech therapy in case of aphasia, once a day, six days per week. RESULTS The study enrolled 402 patients, who were stratified in three groups according to age: 145 patients in Group 1, the young-old (65-74.9 years, G1), 206 in Group 2, the middle-old (75-84.9 years, G2) and 51 in Group 3, the oldest-old (≥85 years, G3). At discharge, FIM total scores increased significantly for all the groups (P<0.001); however FIM gains, as well as the efficiency parameters derived from FIM were significantly lower in G3 when compared with G1 and G2. G3 showed a significantly higher rate of comorbidities and a higher presence of pressure sores; infections occurred mainly in G2 and G3. Hospitalization was significantly longer for G1 and G2 with respect to G3, while mortality rates were significantly higher in G2 and G3 with respect to G1. The variables that predicted functional outcome were age, previous stroke, stroke severity and functional status at admission. CONCLUSIONS Despite advancing age seems to be associated with a reduced effectiveness of the rehabilitation process and a greater number of complications, intensive rehabilitation can produce significant functional gains for all stroke survivors, regardless of age. CLINICAL REHABILITATION IMPACT Understanding the specificity of this population will offer older subjects targeted interventions and, for health systems, better allocation of resources and the development of more effective approaches.
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Affiliation(s)
| | - Marco Consilvio
- Division of Neurologic, Cardiologic, and Pneumological Rehabilitation, European Institute of Rehabilitation, Isernia, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, NEUROMED Mediterranean Neurological Institute for Research and Care, Pozzilli, Isernia, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Domenico Intiso
- Unit of Physical Medicine and Neurorehabilitation, Casa Sollievo della Sofferenza Institute for Research and Care, San Giovanni Rotondo, Foggia, Italy
| | - Stefano Tamburin
- Unit of Neurology, University Hospital of Verona, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Casale
- Scientific Direction, HABILITA, Zingonia di Ciserano, Bergamo, Italy
| | - Michelangelo Bartolo
- Unit of Neurorehabilitation, Department of Rehabilitation, HABILITA, Zingonia di Ciserano, Bergamo, Italy -
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Roy-O’Reilly M, McCullough LD. Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocrinology 2018; 159:3120-3131. [PMID: 30010821 PMCID: PMC6963709 DOI: 10.1210/en.2018-00465] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023]
Abstract
Ischemic stroke is a devastating brain injury resulting in high mortality and substantial loss of function. Understanding the pathophysiology of ischemic stroke risk, mortality, and functional loss is critical to the development of new therapies. Age and sex have a complex and interactive effect on ischemic stroke risk and pathophysiology. Aging is the strongest nonmodifiable risk factor for ischemic stroke, and aged stroke patients have higher mortality and morbidity and poorer functional recovery than their young counterparts. Importantly, patient age modifies the influence of patient sex in ischemic stroke. Early in life, the burden of ischemic stroke is higher in men, but stroke becomes more common and debilitating for women in elderly populations. The profound effects of sex and age on clinical ischemic stroke are mirrored in the results of experimental in vivo and in vitro studies. Here, we review current knowledge on the influence of age and sex in the incidence, mortality, and functional outcome of ischemic stroke in clinical populations. We also discuss the experimental evidence for sex and age differences in stroke pathophysiology and how a better understanding of these biological variables can improve clinical care and enhance development of novel therapies.
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Affiliation(s)
- Meaghan Roy-O’Reilly
- Department of Neurology, University of Texas Health Science Center, Houston, Texas
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Science Center, Houston, Texas
- Correspondence: Louise D. McCullough, MD, PhD, Department of Neurology, University of Texas Health Science Center, 6431 Fannin Street, Houston, Texas 77030. E-mail:
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24
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Di Carlo A, Lamassa M, Franceschini M, Bovis F, Cecconi L, Pournajaf S, Paravati S, Biggeri A, Inzitari D, Ferro S. Impact of acute-phase complications and interventions on 6-month survival after stroke. A prospective observational study. PLoS One 2018; 13:e0194786. [PMID: 29570742 PMCID: PMC5865737 DOI: 10.1371/journal.pone.0194786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/10/2018] [Indexed: 11/25/2022] Open
Abstract
The outcome of stroke patients is complex and multidimensional. We evaluated the impact of acute-phase variables, including clinical state, complications, resource use and interventions, on 6-month survival after first-ever stroke, taking into account baseline conditions exerting a possible effect on outcome. As part of a National Research Program, we performed a prospective observational study of acute stroke patients in four Italian Regions. Consecutive patients admitted for a period of 3 months to the emergency rooms of participating hospitals were included. A total of 1030 patients were enrolled (median age 76.0 years, 52.1% males). At 6 months, 816 (79.2%) were alive, and 164 (15.9%) deceased. Survival status at the 6-month follow-up was missing for 50 (4.9%). Neurological state in the acute phase was significantly worse in patients deceased at 6 months, who showed also higher frequency of acute-phase complications. Cox regression analysis adjusted for demographics, pre-stroke function, baseline diseases and risk factors, indicated as significant predictors of 6-month death altered consciousness (HR, 1.70; 95% CI, 1.14–2.53), total anterior circulation infarct (HR, 2.13; 95% CI, 1.44–3.15), hyperthermia (HR, 1.70; 95% CI, 1.18–2.45), pneumonia (HR, 1.76; 95% CI, 1.18–2.61), heart failure (HR, 2.87; 95% CI, 1.34–6.13) and nasogastric feeding (HR, 2.35; 95% CI, 1.53–3.60), while antiplatelet therapy during acute phase (HR, 0.56; 95% CI, 0.39–0.79), and early mobilisation (HR, 0.55; 95% CI, 0.36–0.84) significantly increased 6-month survival. In a prospective observational study, stroke severity and some acute-phase complications, potentially modifiable, significantly increased the risk of 6-month death, independently of baseline variables. Early mobilisation positively affected survival, highlighting the role of early rehabilitation after stroke.
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Affiliation(s)
- Antonio Di Carlo
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- * E-mail:
| | - Maria Lamassa
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Marco Franceschini
- IRCCS San Raffaele Pisana, Rome, Italy
- San Raffaele University, Rome, Italy
| | - Francesca Bovis
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | | | | | | | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Salvatore Ferro
- Department of Hospital Services, Emilia-Romagna Region Health Authority, Bologna, Italy
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Pastuszak Ż, Koźniewska E, Stępień A, Piusińska-Macoch A, Czernicki Z, Koszewski W. Importance rating of risk factors of ischemic stroke in patients over 85 years old in the polish population. Neurol Neurochir Pol 2017; 52:88-93. [PMID: 29196059 DOI: 10.1016/j.pjnns.2017.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The European population is aging and the number of elderly patients suffering from ischemic brain stroke increases. A better knowledge of the correlation between the risk factors and the course of the disease in old people may be useful for planning medical care and prophylactic strategies. AIM This prospective study aimed to perform a demographic and clinical analysis of the etiology of ischemic stroke, survival rate and severity of post-stroke disability in patients who developed ischemic stroke at the age of over 85 years in the Polish population. METHOD The study group consisted of 159 patients over 85 years old with ischemic stroke. The prevalence of risk factors such as sex, hypertension, hyperlipidemia, atrial fibrillation, heart failure and diabetes was evaluated. The outcome was assessed using the Barthel scale and the National Institutes of Health Stroke Scale. RESULTS The most common risk factors of ischemic stroke were hypertension and atrial fibrillation. Patients with atrial fibrillation had a more severe course of ischemic stroke. CONCLUSION The course of brain stroke in the Polish population is more severe in patients over 85 years old than in younger ones. The key risk factor in this group is atrial fibrillation.
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Affiliation(s)
- Żanna Pastuszak
- Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, ul. Pawińskiego 5, 02-106 Warsaw, Poland.
| | - Ewa Koźniewska
- Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, ul. Pawińskiego 5, 02-106 Warsaw, Poland
| | - Adam Stępień
- Department of Neurology, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland
| | - Anna Piusińska-Macoch
- Department of Neurology, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland
| | - Zbigniew Czernicki
- Department of Neurosurgery, Second Faculty of the Medical University of Warsaw, ul. Cegłowska 80, 01-809 Warsaw, Poland
| | - Waldemar Koszewski
- Department of Neurosurgery, Second Faculty of the Medical University of Warsaw, ul. Cegłowska 80, 01-809 Warsaw, Poland
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Zou C, Wei C, Wang Z, Jin Y. Sex differences in outcomes and risk factors among elderly patients with ischemic stroke. Oncotarget 2017; 8:104582-104593. [PMID: 29262663 PMCID: PMC5732829 DOI: 10.18632/oncotarget.21967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 09/21/2017] [Indexed: 12/03/2022] Open
Abstract
We aimed to investigate the sex differences in the clinical characteristics and risk factors for adverse outcomes among elderly patients with atherosclerotic stroke. We recruited 942 consecutive patients with atherosclerotic stroke aged 75 years and older between January 2008 and December 2013 from Jiamusi University First Hospital, China. Stroke subtype, severity, risk factors, and outcomes (mortality, dependency, and recurrence) at 3 and 12 months after stroke were recorded and assessed. Mortality at 3 months after stroke was higher in men than in women. Stroke severity was an independent risk factor for mortality, dependency, and recurrence at 3 and 12 months after stroke in both men and women. However, the presence of total anterior circulation infarct and obesity protected against mortality at 3 months after stroke in men, while total anterior circulation infarct was a risk factor for dependency at 3 months after stroke in women. In women, positive associations were found between fasting plasma glucose level and mortality at 3 months after stroke and between hypertension, atrial fibrillation, and recurrence at 12 months after stroke. These findings suggest that it is crucial to control the primary risk factors individually by sex, especially regarding hypertension and atrial fibrillation management, to improve secondary prevention of stroke among the elderly and reduce the burden of stroke in China.
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Affiliation(s)
- Chunying Zou
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Heilongjiang, 154002, China
| | - Chunjie Wei
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Heilongjiang, 154002, China
| | - Zengmian Wang
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Heilongjiang, 154002, China
| | - Yuling Jin
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, Heilongjiang, 154002, China
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Jeon JP, Kim SE, Kim CH. Endovascular treatment of acute ischemic stroke in octogenarians: A meta-analysis of observational studies. Clin Neurol Neurosurg 2017; 161:70-77. [PMID: 28863285 DOI: 10.1016/j.clineuro.2017.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, South Korea
| | - Chul Ho Kim
- Department of Neurology, Hallym University College of Medicine, Chuncheon, South Korea.
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Ahmed N, Lees KR, Ringleb PA, Bladin C, Collas D, Toni D, Ford GA. Outcome after stroke thrombolysis in patients >80 years treated within 3 hours vs >3-4.5 hours. Neurology 2017; 89:1561-1568. [PMID: 28887377 DOI: 10.1212/wnl.0000000000004499] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/21/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine outcomes and risks of IV thrombolysis (IVT) in patients with acute ischemic stroke (AIS) >80 years of age within 3 hours compared to >3 to 4.5 hours recorded in the Safe Implementation of Treatment in Stroke (SITS) International Stroke Thrombolysis Registry. METHODS A total of 14,240 (year 2003-2015) patients >80 years of age with AIS were treated with IVT ≤4.5 hours of stroke onset (3,558 in >3-4.5 hours). Of these, 8,658 (2,157 in >3-4.5 hours) were treated otherwise according to the European Summary of Product Characteristics (EU SmPC) criteria for alteplase. Outcomes were 3-month functional independence (modified Rankin Scale score 0-2), mortality, and symptomatic intracerebral hemorrhage (SICH)/SITS. Results were compared between the groups treated in >3 to 4.5 and ≤3 hours. RESULTS Median age was 84 years; 61% were female in both groups. Median NIH Stroke Scale score was 12 vs 14 in the >3- to 4.5- and ≤3-hour group, respectively. Three-month functional independence was 34% vs 35% (adjusted odds ratio [aOR] 0.78, 95% confidence interval [CI] 0.69-0.89, p < 0.001); mortality was 31% vs 32% (aOR 1.10, 95% CI 0.97-1.25, p = 0.13); and SICH/SITS was 2.7% vs 1.6% (aOR 1.72, 95% CI 1.25-2.35, p = 0.001). In EU SmPC-compliant patients, 3-month functional independence was 36 vs 37% (aOR 0.79, 95% CI 0.68-0.92, p = 0.002), mortality was 29% vs 29.6% (aOR 1.10, 95% CI 0.95-1.28, p = 0.20), and SICH/SITS was 2.7% vs 1.6% (aOR 1.62, 95% CI 1.12-2.34, p = 0.01). CONCLUSIONS In this observational study, unselected patients >80 years of age treated with IVT after 3 hours vs earlier had a slightly higher rate of SICH and similar unadjusted functional outcome but poorer adjusted outcome. The absolute difference between the treatment groups is small, and elderly patients should not be denied IVT in the later time window solely because of age without other contraindications.
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Affiliation(s)
- Niaz Ahmed
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK.
| | - Kennedy R Lees
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK
| | - Peter A Ringleb
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK
| | - Christopher Bladin
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK
| | - David Collas
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK
| | - Danilo Toni
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK
| | - Gary A Ford
- From the Department of Clinical Neuroscience (N.A.), Karolinska Institutet; Department of Neurology (N.A.), Karolinska University Hospital, Stockholm, Sweden; Institute of Cardiovascular & Medical Sciences (K.R.L.), University of Glasgow, UK; Department of Neurology (P.A.R.), University Hospital Heidelberg, Germany; Department Neurosciences (Eastern Health) (C.B.), Box Hill Hospital, Monash University, Melbourne, Australia; Department of Medicine (D.C.), West Hertfordshire Hospitals NHS Trust, Watford, UK; Hospital Policlinico Umberto I (D.T.), Deptartment of Neurology and Psychiatry, "Sapienza" University Viale del Policlinico, Rome, Italy; Oxford University Hospitals NHS Foundation Trust (G.A.F.); and Radcliffe Department of Medicine (G.A.F.), Oxford University, UK
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Stroke characterization in Sun Saharan Africa: Congolese population. Int J Cardiol 2017; 240:392-397. [DOI: 10.1016/j.ijcard.2017.04.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/26/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
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Stroke in Frail Older People. Geriatrics (Basel) 2017; 2:geriatrics2030024. [PMID: 31011034 PMCID: PMC6371123 DOI: 10.3390/geriatrics2030024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023] Open
Abstract
The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but at the same time they suffer increased mortality. Their outcome following stroke and intervention is more often predicted by the presence of frailty rather than age alone. Intervention both in primary prevention and hyperacute stroke management needs to allow for preexisting morbidity and frailty in deciding what is and what is not appropriate, rather than an arbitrary decision on age. Frail older people are more likely to develop delirium and dysphagia combined with poor mouthcare and die, yet all of these issues are managed badly. An increased awareness of these complications of stroke in the frail older person is necessary.
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Baştan B, Günaydin S, Balci FB, Acar H, Mutlu A, Özer F, Çokar Ö. Ischemic Stroke in the Elderly: Septuagenarians Versus Octogenarians. Noro Psikiyatr Ars 2017; 53:334-337. [PMID: 28360808 DOI: 10.5152/npa.2016.15923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/26/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Stroke prevalence is known to increase with age. Approximately 50% of acute ischemic stroke patients are aged between 70 and 89 years. METHODS In this study, records of 770 ischemic stroke patients who were 70-89 years old were retrospectively examined (407 septuagenarians and 363 octogenarians). The demographics, comorbid conditions, ischemic stroke type, and stroke outcome for the two age groups were analyzed. RESULTS Comorbid hypertension, diabetes mellitus, and HbA1c levels of ≥6.5% more frequently occurred in septuagenarians than in octogenarians (80.6% versus 70.8%, p=0.002; 32.2% versus 21.8%, p=0.001; and 35% versus 23.2%, p=0.003, respectively), whereas atrial fibrillation was significantly higher in octogenarians (49.3% versus 41.5%, p=0.03). Hypercholesterolemia, previous stroke history, and antiaggregant and/or anticoagulant use were not significantly different between the two age groups. Based on the Oxfordshire Community Stroke Project classification, the most common stroke subtype in the septuagenarian group was a lacunar infarction and in the octogenarian group, it was a partial anterior circulation infarct. According to the Modified Ranking Score, the number of patients living independently was higher for septuagenarians (42.8% versus 27.8%, p<0.001). CONCLUSION The present findings indicate that the clinical characteristics of ischemic stroke differed between septuagenarians and octogenarians. Therefore, elderly stroke patients cannot be accepted as a homogeneous group. Because this is a hospital-based study, our findings need to be tested via additional epidemiological studies.
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Affiliation(s)
- Birgül Baştan
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Sefer Günaydin
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Fatma Belgin Balci
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Hürtan Acar
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Aytül Mutlu
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Feriha Özer
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Özlem Çokar
- Clinic of Neurology, Haseki Training and Research Hospital, İstanbul, Turkey
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Timsit S, Bailly P, Nowak E, Merrien FM, Hervé D, Viakhireva-Dovganyuk I, Jourdain A, Thomas E, Goas P, Rouhart F. Cryptogenic mechanism in ischaemic stroke patients is a predictor of 5-year survival: A population-based study. Eur Stroke J 2016; 1:279-287. [PMID: 31008289 DOI: 10.1177/2396987316669216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction The present study sought to identify factors affecting mortality beyond 28 days in ischaemic stroke patients with whatever ischaemic mechanism. Patients and methods A prospective population-based registry was set up in Brest County, Brittany, France. Demographic data, clinical presentation, vascular risk factors and mortality were collected from January 2008 to December 2012. At "home without help" was used as a surrogate marker for low Rankin (0-1) at discharge from the hospital. IS was classified on the TOAST classification. Overall mortality was calculated using the Kaplan-Meier method. Multivariate analysis of mortality beyond 28 days was implemented, using a Cox model, on significant risk factors identified on univariate analysis. Results About 3024 IS cases were followed up beyond 28 days. Overall mortality beyond 28 days was 38.49% at 60 months. On multivariate analysis, age (10 years: HR = 1.84; [1.66-2.02]), coronary artery disease (HR = 1.28; [1.05-1.56]), cardiac arrhythmia (HR = 1.36; [1.11-1.67]), peripheral artery disease (HR = 1.66 [1.29-2.13]) and incomplete assessment (HR = 1.39; [1.12-1.74]) were associated with higher mortality risk, whereas female gender (HR = 0.80; [0.68-0.94]), high Glasgow Coma Scale score (GCS > 12) (HR = 0.58; [0.45-0.76]), lacunar syndrome (HR = 0.82; [0.68-0.99], being 'at home without help' (HR = 0.50; [0.41-0.59]) and negative assessment (HR = 0.75; [0.58-0.97], compared to cardioembolism) were associated with better survival probability. Discussion Initial clinical status, prior cardiovascular diseases and age was associated with more risk of death: an increment of 10 years almost doubled mortality. Women had more survival probability than men, controlling for age. Ischaemic stroke mechanisms were predictors of late 5-year mortality. Conclusion Patients with negative assessment, i.e. representing truly cryptogenic ischaemic stroke, had the best survival probability probably due to fewer atherosclerotic markers.
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Affiliation(s)
- S Timsit
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - P Bailly
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - E Nowak
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | - F M Merrien
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - D Hervé
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | | | - A Jourdain
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - E Thomas
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - P Goas
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - F Rouhart
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
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Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke. J Stroke Cerebrovasc Dis 2016; 25:3005-3012. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/07/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2022] Open
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Möhlenbruch M, Pfaff J, Schönenberger S, Nagel S, Bösel J, Herweh C, Ringleb P, Bendszus M, Stampfl S. Endovascular Stroke Treatment of Nonagenarians. AJNR Am J Neuroradiol 2016; 38:299-303. [PMID: 27789451 DOI: 10.3174/ajnr.a4976] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although endovascular treatment has become a standard therapy in patients with acute stroke, the benefit for very old patients remains uncertain. The purpose of this study was the evaluation of procedural and outcome data of patients ≥90 years undergoing endovascular stroke treatment. MATERIALS AND METHODS We retrospectively analyzed prospectively collected data of patients ≥90 years in whom endovascular stroke treatment was performed between January 2011 and January 2016. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS, prestroke mRS), at discharge (NIHSS), and after 3 months (mRS). RESULTS Twenty-nine patients met the inclusion criteria for this analysis. The median prestroke mRS was 2. Successful recanalization (TICI ≥ 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0-2 or exhibited prestroke mRS, and 24.1% achieved mRS 0-3. Mortality rate was 44.8%. There was only 1 minor procedure-related complication (small SAH without clinical sequelae). CONCLUSIONS Despite high mortality rates and only moderate overall outcome, 17.2% of the patients achieved mRS 0-2 or prestroke mRS, and no serious procedure-related complications occurred. Therefore, very high age should not per se be an exclusion criterion for endovascular stroke treatment.
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Affiliation(s)
- M Möhlenbruch
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - J Pfaff
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - S Schönenberger
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - S Nagel
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - J Bösel
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - C Herweh
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - P Ringleb
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - M Bendszus
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - S Stampfl
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
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Luebke T, Brunkwall J. Development of a Microsimulation Model to Predict Stroke and Long-Term Mortality in Adherent and Nonadherent Medically Managed and Surgically Treated Octogenarians with Asymptomatic Significant Carotid Artery Stenosis. World Neurosurg 2016; 92:513-520.e2. [DOI: 10.1016/j.wneu.2016.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
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Long X, Lou Y, Gu H, Guo X, Wang T, Zhu Y, Zhao W, Ning X, Li B, Wang J, An Z. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients. Front Aging Neurosci 2016; 8:142. [PMID: 27378914 PMCID: PMC4909745 DOI: 10.3389/fnagi.2016.00142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/30/2016] [Indexed: 02/01/2023] Open
Abstract
Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age <75 years) and elderly (age ≥75 years) patients. The elderly group included 692 patients (19.1%) overall. Elderly patients were more likely than younger patients to have a Trial of Org 10172 in Acute Stroke Treatment classification of stroke due to cardioembolism, moderate and severe stroke, and atrial fibrillation, but less likely to have hypertension and dyslipidemia, current smokers, and alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P < 0.05). Corresponding rates at 36 months after stroke were 35.4, 78.7, and 53.8% in the elderly group and 13.7, 61.7, and 43.0% in the younger group, respectively (all P < 0.001). The mortality, dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64-2.89) and 3.10 (2.35-4.08), respectively, for mortality, all P < 0.001; 1.81 (1.49-2.20) and 2.04 (1.57-2.34), respectively, for dependency, all P < 0.001; and 1.37 (1.06-1.76) and 1.40 (1.07-1.85), respectively, for recurrence, P = 0.016. The findings from this study suggest that management and secondary prevention should be emphasized in elderly patients with diabetes in China to reduce mortality, recurrence, and dependency after stroke.
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Affiliation(s)
- Xue Long
- Department of Neurology, Tianjin Haibin People's HospitalTianjin, China; The Graduate School, Tianjin University of Traditional Chinese MedicineTianjin, China
| | - Yongzhong Lou
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Xiaofei Guo
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Tao Wang
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Yanxia Zhu
- Department of Neurology, Tianjin Haibin People's Hospital Tianjin, China
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General HospitalTianjin, China; Department of Epidemiology, Tianjin Neurological InstituteTianjin, China
| | - Bin Li
- Department of Neurology, Tianjin Haibin People's HospitalTianjin, China; The Graduate School, Tianjin University of Traditional Chinese MedicineTianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General HospitalTianjin, China; Department of Epidemiology, Tianjin Neurological InstituteTianjin, China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital Tianjin, China
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Tanaka K, Yamada T, Torii T, Matsumoto S, Yoshimura T, Takase KI, Wakata Y, Nakashima N, Kira JI, Murai H. Clinical characteristics of atrial fibrillation-related cardioembolic stroke in patients aged 80 years or older. Geriatr Gerontol Int 2016; 17:708-713. [DOI: 10.1111/ggi.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/02/2016] [Accepted: 02/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takeshi Yamada
- Department of Neurology; Saiseikai Fukuoka General Hospital; Fukuoka Japan
| | - Takako Torii
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
- National Cerebral and Cardiovascular Center; Suita, Osaka Japan
| | - Shoji Matsumoto
- Department of Neurology; Kokura Memorial Hospital; Kitakyushu Japan
| | - Takeo Yoshimura
- Department of Neurology; Fukuoka City Hospital; Fukuoka Japan
| | | | - Yoshifumi Wakata
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
| | - Naoki Nakashima
- Medical Information Center; Kyushu University Hospital; Fukuoka Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Hiroyuki Murai
- Department of Neurological Therapeutics, Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Siegler JE, Swaminathan B, Giruparajah M, Bosch J, Perera KS, Hart RG, Kasner SE. Age disparity in diagnostic evaluation of stroke patients: Embolic Stroke of Undetermined Source Global Registry Project. Eur Stroke J 2016; 1:130-138. [PMID: 31008275 DOI: 10.1177/2396987316652265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/09/2016] [Indexed: 01/04/2023] Open
Abstract
Introduction: Incomplete evaluation of stroke patients may result in an unclear diagnosis. Our objective was to determine if older stroke patients more often undergo incomplete diagnostic evaluations versus younger patients in an international cohort. Patients and methods: The Embolic Stroke of Undetermined Source Global Registry was a retrospective cohort of consecutive stroke patients evaluated at 19 stroke centers in 19 countries. Diagnostic evaluation was considered as complete if the patient had, at a minimum, brain computed tomography or magnetic resonance imaging with evidence of infarction, extracranial and intracranial vascular imaging, electrocardiography, ≥24 h of cardiac rhythm monitoring, and echocardiography. Patients were diagnosed with Embolic Stroke of Undetermined Source if brain imaging confirmed a nonlacunar infarction and no stroke etiology was determined after complete evaluation. Completeness of evaluation was compared between patients ≥75 versus <75 years old. Results: The registry included 2132 patients with recent ischemic stroke during 2013-2014, of which 349 were diagnosed with Embolic Stroke of Undetermined Source. Embolic Stroke of Undetermined Source patients ≥75 years were less likely to undergo brain magnetic resonance imaging (74% versus 89%, p = 0.001), transesophageal echocardiography (22% versus 39%, p = 0.005), and combination transthoracic and transesophageal echocardiography (16% versus 32%, p = 0.005) compared with Embolic Stroke of Undetermined Source patients <75 years. Discussion: Our study has identified an international age disparity in fundamental diagnostic testing for older patients with stroke of unknown etiology. Some testing biases were affected by geographic location (e.g., brain MRI was less frequently used in European ESUS patients), whereas other testing was implemented less frequently in the elderly regardless of location (e.g., transesophageal echocardiogram). Conclusion: Older patients in this international cohort had less sophisticated diagnostic testing for stroke, despite advanced age being well established as an independent risk factor for recurrent stroke. This was a global problem and further investigations are warranted to explore the cause.
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Affiliation(s)
- James E Siegler
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | | | - Mohana Giruparajah
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Kanjana S Perera
- Department of Medicine, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Robert G Hart
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
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Kleine JF, Boeckh-Behrens T, Prothmann S, Zimmer C, Liebig T. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J Neurointerv Surg 2015; 8:671-6. [DOI: 10.1136/neurintsurg-2015-011702] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/11/2015] [Indexed: 11/03/2022]
Abstract
BackgroundStroke in aged patients has a relatively poor prognosis, even after recanalizing therapy. Potential reasons include mechanisms that relate directly to the extent of brain tissue damage, but also age-dependent factors which are not, or only indirectly, stroke-related, such as pre-existing functional deficits, comorbidities, and post-stroke complications (eg, infections).ObjectiveTo compare early neurological course with subsequent functional outcome in older (≥80 years) and younger stroke patients in order to estimate the relative impact of these factors. Specifically, to examine if the strong age-dependency of modified Rankin Scale (mRS) outcome scores in stroke patients after mechanical thrombectomy is paralleled by a similar age dependency of early postinterventional National Institute of Health Stroke Scale (NIHSS) scores—a more specific measure of stroke-induced brain damage.MethodsWe evaluated technical results, pre- and postinterventional NIHSS scores, mid-term mRS scores and early and overall mortality and their relation to age in 125 patients, 40 of them ≥80 years, with acute middle cerebral artery occlusion, treated by mechanical thrombectomy.ResultsTechnical success, pre- and postinterventional NIHSS scores and early mortality were age-independent. Early neurological improvement depended on successful recanalization, but not on age. Nevertheless, good mRS outcome (mRS 0–2) was much rarer, and overall mortality almost threefold higher in aged patients.ConclusionsOlder patients exhibit a similar early neurological course and responsiveness to mechanical thrombectomy as younger patients, but this is not reflected in mid-term functional outcome scores. This indicates that post-stroke complications and other factors that are not, or only indirectly, related to the brain tissue damage induced by the incident stroke have a dominant role in their poor prognosis.
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Ahn SY, Cho KH, Beom J, Park DJ, Jee S, Nam JH. Reliability of ultrasound evaluation of hyoid-larynx approximation with positional change. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1221-1225. [PMID: 25616584 DOI: 10.1016/j.ultrasmedbio.2014.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
We evaluated the reliability of ultrasound evaluation of hyoid-larynx approximation with positional change. Twenty healthy volunteers (10 men, 10 women) participated in this study. The distance between the hyoid bone and thyroid cartilage was measured by ultrasound in both the sitting and supine positions. Hyoid-larynx approximation was defined as the shortest distance between the lower tip of the hyoid bone and the upper end of the thyroid cartilage during swallowing. The transducer was placed in a longitudinal position above the midline of the larynx, which allowed visualization of the hyoid bone and thyroid cartilage. Patients were given 5 mL of water and swallowed. The measurement was repeated three times to enable averaging in each position. Using the mean distance at rest and the shortest distance during swallowing, we calculated relative laryngeal elevation. There was no significant difference in resting distance between the hyoid bone and thyroid cartilage with positional change or gender, with identical relative laryngeal elevation. However, there was a negative correlation between the resting and approximation distance and body mass index. In conclusion, ultrasound evaluation in healthy volunteers revealed no difference in hyoid-laryngeal approximation on swallowing in either the supine or sitting position. This finding is likely to be of value in the investigation of dysphagia.
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Affiliation(s)
- So Young Ahn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Dong Jun Park
- Korean Food Research Institue, 516 Baekhyun-Dong, Bundang-Ku, Songnam-Si, Kyunggi-Do 463-746, Republic of Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, South Korea.
| | - Jin Hee Nam
- Department of Rehabilitation Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, South Korea
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Danière F, Lobotesis K, Machi P, Eker O, Mourand I, Riquelme C, Ayrignac X, Vendrell JF, Gascou G, Fendeleur J, Dargazanli C, Schaub R, Brunel H, Arquizan C, Bonafé A, Costalat V. Patient selection for stroke endovascular therapy--DWI-ASPECTS thresholds should vary among age groups: insights from the RECOST study. AJNR Am J Neuroradiol 2015; 36:32-9. [PMID: 25273535 DOI: 10.3174/ajnr.a4104] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the benefits of endovascular intervention in large-vessel occlusion strokes, depending on age class. MATERIALS AND METHODS A clinical management protocol including intravenous treatment and mechanical thrombectomy was instigated in our center in 2009 (Prognostic Factors Related to Clinical Outcome Following Thrombectomy in Ischemic Stroke [RECOST] study). All patients with acute ischemic stroke with an anterior circulation major-vessel occlusion who presented within 6 hours were evaluated with an initial MR imaging examination and were analyzed according to age subgroups (younger than 50 years, 50-59 years, 60-69 years, 70-79 years; 80 years or older). The mRS score at 3 months was the study end point. RESULTS One hundred sixty-five patients were included in the analysis. The mean age was 67.4 years (range, 29-90 years). The mean baseline NIHSS score was 17.24 (range, 3-27). The mean DWI-derived ASPECTS was 6.4. Recanalization of TICI 2b/3 was achieved in 80%. At 3 months, 41.72% of patients had a good outcome, with a gradation of prognosis depending on the age subgroup and a clear cutoff at 70 years. Only 19% of patients older than 80 years had a good outcome at 3 months (mean ASPECTS = 7.4) with 28% for 70-79 years (mean ASPECTS = 6.8), but 58% for 60-69 years (mean ASPECTS = 6), 52% for 50-59 years (mean ASPECTS = 5.91), and 72% for younger than 50 years (mean ASPECTS = 6.31). In contrast, the mortality rate was 35% for 80 years and older, and 26% for 70-79 versus 5%-9% for younger than 70 years. CONCLUSIONS The elderly may benefit from thrombectomy when their ischemic core volume is low in comparison with younger patients who still benefit from acute recanalization despite larger infarcts. Stroke volume thresholds should, therefore, be related and adjusted to the patient's age group.
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Affiliation(s)
- F Danière
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - K Lobotesis
- Imaging Department (K.L.), Imperial College Healthcare National Health Service Trust, Charing Cross Hospital, London, United Kingdom
| | - P Machi
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - O Eker
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | | | - C Riquelme
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | | | - J F Vendrell
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - G Gascou
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - J Fendeleur
- Anesthesiology (J.F.), CHU Montpellier, Montpellier, France
| | - C Dargazanli
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - R Schaub
- Department of Medical Statistics (R.S.), CHU Montpellier, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France
| | - H Brunel
- Department of Neuroradiology (H.B.), CHU Marseille, Hôpital La Timone, Marseille, France
| | | | - A Bonafé
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
| | - V Costalat
- From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.)
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Cha JK, Lim JH, Kim DH, Nah HW, Park HS, Choi JH, Suh HK, Huh JT. Prognostic factors for long-term poor outcomes after acute ischemic stroke in very old age (>80 years) patients: Total cholesterol level might differently influence long-term outcomes after acute ischemic stroke at ages above 80 years. Geriatr Gerontol Int 2014; 15:1227-33. [PMID: 25496005 DOI: 10.1111/ggi.12419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Abstract
AIM We investigated the differences in determinant factors for functional outcomes between patients aged >80 years and those aged <80 years after acute ischemic stroke (AIS). In particular, we would like to know the differential impacts of initial total cholesterol (TC) levels between the two groups. METHODS We defined a poor outcome as 3-6 modified Rankin Scale 90 days after AIS. RESULTS In the present study, 2772 participants were enrolled. Among them, 374 patients (13.5%) were aged >80 years, and 1061 patients had a poor outcome 90 days after AIS. The proportion was significantly higher in patients aged >80 years than in those aged <80 years after AIS. Regarding factors relating to poor outcomes, previous history of stroke, stroke severity and stroke subtypes of ischemic stroke were independent factors in patients aged <80 years, and the stroke severity and initial TC level independently influenced the outcome for patients aged >80 years. In particular, risk of poor outcome adjusted for age, stroke severity and subtypes of ischemic stroke for patients (OR [95% CI]) in the first quartile range (≤157 mg%) were 2.21 (1.06-4.62), in the third quartile range (184-210 mg%) 2.76 (1.27-6.01) and in the fourth quartile range (≥211 mg%) 2.75 (1.21-6.24) compared with those in the second quartile range (158-183 mg%) in patients aged >80 years. CONCLUSIONS There were also some differences in related factors regarding occurrences of poor outcome between the two groups. In particular, the initial TC level might play a crucial role for the outcome after AIS in the very old population.
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Affiliation(s)
- Jae-Kwan Cha
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Jun-Ho Lim
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Hyun-Wook Nah
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | | | | | - Hyun-Kyung Suh
- Department of Visual Optics, KyungWoon University, Gumi, Korea
| | - Jae-Taeck Huh
- Stroke Center, Dong-A University Hospital, Busan, Korea
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Wing JJ, Baek J, Sánchez BN, Lisabeth LD, Smith MA, Morgenstern LB, Zahuranec DB. Differences in initial stroke severity between Mexican Americans and non-Hispanic whites vary by age: the Brain Attack Surveillance in Corpus Christi (BASIC) project. Cerebrovasc Dis 2014; 38:362-9. [PMID: 25427748 DOI: 10.1159/000366468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/05/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A wide variety of racial and ethnic disparities in stroke epidemiology and treatment have been reported. Race-ethnic differences in initial stroke severity may be one important determinant of differences in the outcome after stroke. The overall goal of this study was to move beyond ethnic comparisons in the mean or median severity, and instead investigate ethnic differences in the entire distribution of initial stroke severity. Additionally, we investigated whether age modifies the relationship between ethnicity and initial stroke severity as this may be an important determinant of racial differences in the outcome after stroke. METHODS Ischemic stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project. National Institutes of Health Stroke Scale (NIHSS) was determined from the medical record or abstracted from the chart. Ethnicity was reported as Mexican American (MA) or non-Hispanic white (NHW). Quantile regression was used to model the distribution of NIHSS score by age category (45-59, 60-74, 75+) to test whether ethnic differences exist over different quantiles of NIHSS (5 percentile increments). Crude models examined the interaction between age category and ethnicity; models were then adjusted for history of stroke/transient ischemic attack, hypertension, atrial fibrillation, coronary artery disease, and diabetes. RESULTS were adjusted for multiple comparisons. RESULTS There were 4,366 ischemic strokes, with median age 72 (IQR: 61-81), 55% MA, and median NIHSS of 4 (IQR: 2-8). MAs were younger, more likely to have a history of hypertension and diabetes, but less likely to have atrial fibrillation compared to NHWs. In the crude model, the ethnicity-age interaction was not statistically significant. After adjustment, the ethnicity-age interaction became significant at the 85th and 95th percentiles of NIHSS distribution. MAs in the younger age category (45-59) were significantly less severe by 3 and 6 points on the initial NIHSS than NHWs, at the 85th and 95th percentiles, respectively. However, in the older age category (75+), there was a reversal of this pattern; MAs had more severe strokes than NHWs by about 2 points, though not reaching statistical significance. CONCLUSIONS There was no overall ethnic difference in stroke severity by age in our crude model. However, several potentially important ethnic differences among individuals with the most severe strokes were seen in younger and older stroke patients that were not explained by traditional risk factors. Age should be considered in future studies when looking at the complex distributional relationship between ethnicity and stroke severity.
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Affiliation(s)
- Jeffrey J Wing
- Department of Epidemiology, University of Michigan, Ann Arbor, Mich., USA
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Johnson JN, Haussen DC, Elhammady MS, Pao CL, Yavagal DR, Aziz-Sultan MA. Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke. Clin Neurol Neurosurg 2014; 123:136-41. [DOI: 10.1016/j.clineuro.2014.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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TAKAYANAGI S, OCHI T, HANAKITA S, SUZUKI Y, MAEDA K. The safety and effectiveness of low-dose recombinant tissue plasminogen activator (0.6 mg/kg) therapy for elderly acute ischemic stroke patients (≥ 80 years old) in the pre-endovascular era. Neurol Med Chir (Tokyo) 2014; 54:435-40. [PMID: 24670312 PMCID: PMC4533450 DOI: 10.2176/nmc.oa.2013-0264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/16/2013] [Indexed: 01/19/2023] Open
Abstract
There are still few studies of low-dose recombinant tissue plasminogen activator (rtPA) therapy (0.6 mg/kg) for acute ischemic stroke (AIS) patients ≥ 80 years old, though most strokes occur in elderly people. The safety and effectiveness of this form of thrombolysis without endovascular therapy were evaluated in AIS patients ≥ 80 years old at our hospital. The data were collected from August 2006 to April 2010, before approval of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retriever in Japan. Intravenous rtPA was administered to patients within 3 hours of stroke onset. The incidence of intracerebral hemorrhage (ICH), the recanalization rate of the occluded artery, and the modified Rankin Scale (mRS) score 3 months after stroke were examined. The patients who received rtPA therapy were stratified into two age groups: a younger group (< 80 years) and an older group (≥ 80 years). Of the 87 patients who received rtPA therapy, 17 (19.5%) were ≥ 80 years old. The incidence of symptomatic ICH was not significantly different between the younger (4.3%) and older (0%) groups (p = 0.61). The recanalization rate of the occluded artery was not significantly different between the younger (54%) and older (50%) groups (p = 0.78). The rate of an mRS score of 0-2, 3 months after stroke was significantly higher in the younger (44.3%) than in the older group (11.8%) (p = 0.013). Low-dose rtPA therapy appears to be as safe and feasible for AIS patients ≥ 80 years old as it is for younger people. This therapy should not be withheld because of age.
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Affiliation(s)
| | - Takashi OCHI
- Department of Neurosurgery, Aizu Chuo Hospital, Aizuwakamatsu, Fukushima
| | - Shunya HANAKITA
- Department of Neurosurgery, Aizu Chuo Hospital, Aizuwakamatsu, Fukushima
| | - Yasutaka SUZUKI
- Department of Neurosurgery, Aizu Chuo Hospital, Aizuwakamatsu, Fukushima
| | - Keiichiro MAEDA
- Department of Neurosurgery, Aizu Chuo Hospital, Aizuwakamatsu, Fukushima
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Naess H, Gjerde G, Waje-Andreassen U. Ischemic stroke in patients older and younger than 80 years. Acta Neurol Scand 2014; 129:399-404. [PMID: 24256324 DOI: 10.1111/ane.12199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare short-term outcome and long-term mortality in old and younger patients with ischemic stroke. We hypothesized that short-term outcomes in patients≥80 and <80 years with no neurological worsening are similar. METHODS The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity. Short-term outcome was determined by the NIHSS score 7 days after stroke onset. Neurological worsening was defined as NIHSS score worsening >3 points. Risk factors, prior diseases, complications, and long-term mortality were registered. RESULTS The study includes 592 patients≥80 years and 1275 patients<80 years. High NIHSS score on admission and day 7, neurological worsening, and complications were significantly more frequent among patients≥80 years. In patients with no neurological worsening, improvement in NIHSS score on day 7 was not associated with age≥80 years (P=0.75). Long-term mortality was associated with the number of risk factors in both age groups (P<0.05). CONCLUSION Avoiding neurological worsening may have a large potential for reducing the difference in short-term outcome between old and young stroke patients by preventing treatable complications including pneumonia. Risk factor burden is important for long-term survival in both stroke patients≥80 years and <80 years.
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Affiliation(s)
- H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - G. Gjerde
- Department of Neurology; Haukeland University Hospital; Bergen Norway
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Quality indicators in acute stroke care: a prospective observational survey in 13 Italian regions. Aging Clin Exp Res 2014; 26:279-86. [PMID: 24293350 DOI: 10.1007/s40520-013-0171-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Quality monitoring has great relevance in stroke care. The Project "How to guarantee adherence to effective interventions in stroke care" aimed to estimate adherence to acute-phase guidelines in stroke care in Italy. METHODS A prospective observational study was performed in 27 hospitals of 13 Italian Regions. Adherence to 15 process indicators was evaluated, comparing also stroke units (SU) with conventional wards. An overall score of care, defined as the sum of achieved indicators, was calculated. A multilevel hierarchical model described performance at patient, hospital and regional level. RESULTS Overall, 484 consecutive stroke patients (mean age, 73.4 years; 52.7 % males) were included. Total score ranged from 2 to 15 (mean 8.5 ± 2.4). SU patients were more often evaluated with the National Institutes of Health Stroke Scale (NIHSS) within 24 h, had more frequently an assessment of pre- and post-stroke disability, and a CT scan the same or the day after admission. Regional-hospital- and patient-level variability explained, respectively, 25, 34, and 41 % of total score variance. In multivariate models, patients >80 years vs. younger showed a change in total score of -0.45 (95 % CI -0.79 to -0.12), and those with NIHSS ≥14 vs. ≤5 of -0.92 (95 % CI -1.53 to -0.30). A negative change means a worse adjusted average adherence to process indicators. SU admission increased total score of 1.55 (95 % CI 0.52-2.58). CONCLUSIONS Our data confirm the need of quality monitoring in stroke care. Although SU patients showed a better adherence to quality indicators, overall compliance was unsatisfactory.
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Bentsen L, Christensen L, Christensen A, Christensen H. Outcome and risk factors presented in old patients above 80 years of age versus younger patients after ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:1944-8. [PMID: 24794945 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/30/2013] [Accepted: 02/02/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Older patients are associated with increased stroke prevalence, worse outcome, and risk of undertreatment in comparison with younger patients. The aim of the present study was to compare risk factor distribution and functional outcome in stroke survivors older and younger than 80 years. METHODS The analysis was based on consecutive patients admitted within 6 hours after stroke onset and discharged with ischemic stroke, surviving at least 3 months after ictus. To prevent bias, the analysis was based on a registry from before implementation of tissue plasminogen activator treatment; all patients received stroke unit care in accordance with the guidelines. The population was dichotomized into patients aged less than 80 years and 80 years of age or older. Modified Rankin Scale (mRS) score and Barthel Index (BI) were used to assess 3-month and 1-year outcome. RESULTS Patients 80 years of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P < .001) and remained high 3 months and 1 year after ictus (P < .001); the BI was equivalently lower (P < .001). The decline in function was comparable between groups. Patients 80 years of age or older of whom the majority were women (P < .001) presented with atrial fibrillation (P < .001), and hypertension (P = .005). CONCLUSIONS Risk factors vary significantly with age, suggesting different stroke mechanisms. Patients older than 80 years experience more severe strokes and frequently have minor impairments before stroke. The increase in impairment after stroke is comparable with what is observed in younger patients, suggesting that good recovery after stroke may also be expected in older patients.
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Affiliation(s)
- Line Bentsen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
| | - Louisa Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Anders Christensen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
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Chandra RV, Leslie-Mazwi TM, Mehta BP, Yoo AJ, Simonsen CZ. Clinical Outcome after Intra-Arterial Stroke Therapy in the Very Elderly: Why is it so Heterogeneous? Front Neurol 2014; 5:60. [PMID: 24808887 PMCID: PMC4010729 DOI: 10.3389/fneur.2014.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/13/2014] [Indexed: 12/13/2022] Open
Abstract
Very elderly patients (i.e., ≥80 years) are disproportionally affected by acute ischemic stroke. They account for a third of hospital stroke admissions, but two-thirds of overall stroke-related morbidity and mortality. There is some evidence of clinical benefit in treating selected very elderly patients with intravenous thrombolysis (IVT). For very elderly patients ineligible or non-responsive to IVT, intra-arterial therapy (IAT) may have promise in improving clinical outcome. However, its unequivocal efficacy in the general population remains to be proven in randomized trials. Small cohort studies reveal that the rate of good clinical outcome for very elderly patients after IAT is highly variable, ranging from 0 to 28%. In addition, they experience higher rates of futile reperfusion than younger patients. Thus, it is imperative to understand the factors that impact on clinical outcome in very elderly patients after IAT. The aim of this review is to examine the factors that may be responsible for the heterogeneous clinical response of the very elderly to IAT. This will allow the reader to integrate the current available evidence to individualize intra-arterial stroke therapy in very elderly patients. Placing emphasis on pre-stroke independent living, smaller infarct core size, short procedure times, and avoiding general anesthesia where feasible, will help improve rates of good clinical outcome.
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Affiliation(s)
- Ronil V Chandra
- Diagnostic and Interventional Neuroradiology, Monash Health, Monash University , Melbourne, VIC , Australia
| | - Thabele M Leslie-Mazwi
- Neuroendovascular and Neurologic Critical Care, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Brijesh P Mehta
- Neuroendovascular and Neurologic Critical Care, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Albert J Yoo
- Neuroendovascular and Neuroradiology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital , Aarhus , Denmark
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Villwock MR, Singla A, Padalino DJ, Deshaies EM. Acute ischaemic stroke outcomes following mechanical thrombectomy in the elderly versus their younger counterpart: a retrospective cohort study. BMJ Open 2014; 4:e004480. [PMID: 24650806 PMCID: PMC3963096 DOI: 10.1136/bmjopen-2013-004480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Many physicians debate the efficacy of mechanical thrombectomy for ischaemic stroke, but most agree that to establish potential benefit, patient selection must be examined further. People >80 years are a growing population of patients with ischaemic stroke but are largely excluded from clinical trials. The benefit of thrombectomy for them may be greatly reduced due to diminishing neuroplasticity and a larger number of medical comorbidities. To address this knowledge gap, we examined clinical and economic outcomes after mechanical thrombectomy in the ischaemic stroke population from the Nationwide Inpatient Sample. Our null hypotheses were that elderly patients (>80 years) would have a similar rate of inpatient mortality in comparison to their younger counterparts and incur a similar economic expense. DESIGN Retrospective cohort study. SETTING A 20% stratified sample of US community hospitals within the Nationwide Inpatient Sample. PARTICIPANTS All patients from 2008 to 2010 with a primary diagnosis of ischaemic stroke that received mechanical thrombectomy were included. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was inpatient mortality. Secondary outcomes included hospital charges and length of stay. RESULTS Less than 1% of all ischaemic stroke cases (9300) were treated with mechanical thrombectomy. Of these, 18% involved patients over 80 years of age. The odds of inpatient mortality in elderly patients treated with mechanical thrombectomy were approximately twice that of their younger counterparts (OR1.993, p < 0.001). The elderly experienced no significant difference in hospital charges (p=0.105) and length of stay (p=0.498). CONCLUSIONS The odds of inpatient mortality after mechanical thrombectomy in patients over 80 years of age were twice that of their younger counterparts. This is consistent with the overall worse prognosis seen in the natural history of this age group. Studies to better identify patients that would benefit from endovascular mechanical thrombectomy may improve outcomes and reduce the gap currently observed in age stratifications.
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Affiliation(s)
- Mark R Villwock
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
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