Highlights
- •Older patients have unfavorable functional outcomes after acute ischemic stroke.
- •The unfavorable effects of aging were greater in female sex or low body weight.
- •The favorable effects of younger age were reduced in hypertension or hyperglycemia.
- •Lifestyle-related factors modified the effects of age on clinical outcomes.
Abstract
Background and purpose
This study examined the association between age and clinical outcomes after ischemic
stroke, and whether the effect of age on post-stroke outcomes can be modified by various
factors.
Methods
We included 12,171 patients with acute ischemic stroke, who were functionally independent
before stroke onset, in a multicenter hospital-based study conducted in Fukuoka, Japan.
Patients were categorized into six groups according to age: ≤ 45, 46–55, 56–65, 66–75,
76–85, and > 85 years. Logistic regression analysis was performed to estimate an odds
ratio for poor functional outcome (modified Rankin scale score of 3–6 at 3 months)
for each age group. Interaction effects of age and various factors were analyzed using
a multivariable model.
Results
The mean age of the patients was 70.3 ± 12.2 years, and 63.9% were men. Neurological
deficits at onset were more severe in the older age groups. The odds ratio of poor
functional outcome linearly increased (P for trend <0.001), even after adjusting for
potential confounders. Sex, body mass index, hypertension, and diabetes mellitus significantly
modified the effect of age on the outcome (P < 0.05). The unfavorable effect of older age was greater in female patients and those
with low body weight, whereas the protective effect of younger age was smaller in
patients with hypertension or diabetes mellitus.
Conclusions
Functional outcome worsened with age in patients with acute ischemic stroke, especially
in females and those with low body weight, hypertension, or hyperglycemia.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
mRS (Modified Rankin scale), BMI (Body mass index), NIHSS (National Institutes of Health Stroke Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Age and National Institutes of Health stroke scale score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models.Stroke. 2004; 35: 158-162
- Predictors of early and late case-fatality in a nationwide Danish study of 26,818 patients with first-ever ischemic stroke.Stroke. 2011; 42: 2806-2812
- Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit.Neurology. 2011; 77: 965-972
- Functional recovery after ischemic stroke-a matter of age: data from the Austrian stroke unit registry.Neurology. 2012; 78: 279-285
- The influence of age on stroke outcome. The Copenhagen Stroke Study.Stroke. 1994; 25: 808-813
- Ischemic stroke patients with prestroke dependency: characteristics and long-term prognosis.Acta Neurol. Scand. 2021; 143: 78-88
- Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke.Circulation. 2010; 121: 879-891
- Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.Int. J. Stroke. 2018; 13: 717-724
- Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian stroke cooperation study.Acta Neurol. Scand. 2016; 133: 202-207
- The age-related decrease in CNS remyelination efficiency is attributable to an impairment of both oligodendrocyte progenitor recruitment and differentiation.J. Neurosci. 2002; 22: 2451-2459
- Expression of mutant huntingtin in mouse brain astrocytes causes age-dependent neurological symptoms.Proc. Natl. Acad. Sci. U. S. A. 2009; 106: 22480-22485
- Differential effects of aging and sex on stroke induced inflammation across the lifespan.Exp. Neurol. 2013; 249: 120-131
- Blood-brain barrier permeability and long-term clinical and imaging outcomes in cerebral small vessel disease.Stroke. 2013; 44: 525-527
- Microglial and macrophage polarization-new prospects for brain repair.Nat. Rev. Neurol. 2015; 11: 56-64
- White matter injury and microglia/macrophage polarization are strongly linked with age-related long-term deficits in neurological function after stroke.Exp. Neurol. 2015; 272: 109-119
- Dysfunction of the neurovascular unit in ischemic stroke and neurodegenerative diseases: an aging effect.Ageing Res. Rev. 2017; 34: 77-87
- Prestroke glycemic control is associated with the functional outcome in acute ischemic stroke: the Fukuoka stroke registry.Stroke. 2011; 42: 2788-2794
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment.Stroke. 1993; 24: 35-41
- Stroke subtype predicts outcome in young and middle-aged stroke sufferers.Acta Neurol. Scand. 2012; 126: 329-335
- Age-specific vascular risk factor profiles according to stroke subtype.J. Am. Heart Assoc. 2017; 6
- Frailty in older adults: evidence for a phenotype.J. Gerontol. A Biol. Sci. Med. Sci. 2001; 56: M146-M156
- Effect of age on functional outcomes after stroke rehabilitation.Stroke. 2002; 33: 179-185
- Predictors of short-term improvement of ischemic stroke.Neurol. Res. 2013; 35: 594-601
- Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I.Stroke. 1999; 30: 2631-2636
- Glutamate transporter function of rat hippocampal astrocytes is impaired following the global ischemia.Neurobiol. Dis. 2005; 18: 476-483
- Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.Stroke. 2003; 34: 1114-1119
- Sex differences in management and outcome after stroke: a Swedish national perspective.Stroke. 2003; 34: 1970-1975
- Quality of life after stroke: the north East Melbourne stroke incidence study (NEMESIS).Stroke. 2004; 35: 2340-2345
- Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators. Sex differences in stroke recovery and stroke-specific quality of life: results from a statewide stroke registry.Stroke. 2007; 38: 2541-2548
- Sex differences in quality of life in stroke survivors: data from the Tinzaparin in acute Ischaemic stroke trial (TAIST).Stroke. 2007; 38: 2960-2964
- Gender differences in stroke incidence and poststroke disability in the Framingham heart study.Stroke. 2009; 40: 1032-1037
- Sex differences in quality of life after ischemic stroke.Neurology. 2014; 82: 922-931
- Sex differences in short-term outcomes after acute ischemic stroke: the Fukuoka stroke registry.Stroke. 2015; 46: 471-476
- Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study.Biol. Sex Differ. 2018; 9: 11
- Factors associated with ischemic stroke survival and recovery in older adults.Stroke. 2017; 48: 1818-1826
- Association of serum estrogen level and ischemic neuroprotection in female rats.Neurosci. Lett. 2001; 297: 159-162
- Changes in experimental stroke outcome across the life span.J. Cereb. Blood Flow Metab. 2009; 29: 792-802
- Body weight after stroke: lessons from the obesity paradox.Stroke. 2011; 42: 3646-3650
- Diabetes and the brain: oxidative stress, inflammation, and autophagy.Oxidative Med. Cell. Longev. 2014; 2014102158
- Is hypertension associated with an accelerated aging of the brain?.Hypertension. 2014; 63: 894-903
Article info
Publication history
Published online: February 14, 2023
Accepted:
February 12,
2023
Received in revised form:
January 31,
2023
Received:
September 16,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
