Ischemic Stroke in the Very Old: The Lausanne Stroke Registry
Background: Although the population of developed countries is changing and the very old represent the fastest-growing group, there are few studies on ischemic stroke in this age group. The aim of this study was to investigate characteristics of ischemic stroke in very old patients (VOP). Methods:We studied risk factors, etiology, clinical findings, lesion topography and short-term (one month) outcome in patients aged 80 years or older presenting with a first ever ischemic stroke compared to younger patients (YP), aged between 45 and 79 years. Logistic regression analysis was used to identify whether very old age was an independent predictor of poor outcome (mRS 4–6). Results:452 patients (13%) were older than 80 years, and 2,889 (87%) between 45 and 79 years. There was a higher proportion of females in the VOP than in the YP (53% vs. 34%; P<0.001). The VOP group had lower frequencies for smoking (7% vs. 32%; P<0.001), hypercholesterolemia (16% vs. 27%; P<0.001) and an elevated hematocrit (12% vs. 19%; P<0.001). In contrast, a history of atrial fibrillation (23% vs. 9%; P<0.001) and coronary artery disease (30% vs. 22%; P<0.001) was more common in the VOP. Cardioembolic stroke was more frequent in the VOP (28% vs. 21%; P<0.001), whereas large artery disease was less frequent (18% vs. 24%; P<0.001). The frequency of small artery disease was comparable in the two groups. VOP more often presented an abrupt onset of symptoms (81% vs. 73%; P<0.001) and isolated Wernicke-type aphasia (4% vs. 1%; P<0.001), but a lower frequency of headache (7% vs. 14%; P<0.001). Except for a higher proportion of lesions in the left posterior superficial branch of the middle cerebral artery in VOP (9% vs. 6%; P=0.03), there was no difference in the cerebral territories involved. A poor outcome was more frequent in VOP than in YP (17% vs. 12%; P=0.003), but this was not seen after correction for confounding factors. Conclusions: Patients older than 80 years have different risk factors and stroke features compared with patients between 45 and 79 years. Although VOP have a poorer prognosis, age per se is not a predictor of short-term disability and death. Knowledge of these findings may improve stroke prevention and acute treatment in VOP.