Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years.

BACKGROUND AND PURPOSE This study compared stroke features and poststroke disability in two age groups of patients with ischemic stroke: younger (55 to 70 years) and older (71 to 85 years). Stroke has an impact on daily living in many areas, but whether risk factors, stroke features, and poststroke disability differ between young and old patients with stroke is not so well established. METHODS A cohort of 486 ischemic stroke patients aged 55 to 85 years admitted consecutively to the Helsinki University Central Hospital (Finland) between December 1, 1993, and March 31, 1995, were examined 3 months after the index stroke. Structured medical, neurological, and radiological (MRI or CT) examinations, mental status, and emotional examination and interview of a close informant were done. Prestroke and poststroke activities of daily living were assessed with five scales: the Index of ADL, Instrumental Activities of Daily Living Scale, Functional Activities Questionnaire, Blessed Functional Activities Scale, and Barthel Index. RESULTS History of cardiac failure (P < .001), atrial fibrillation (P < .001), and cardioembolic stroke (P = .011) was more frequent in the older age group, whereas stroke due to large-artery atherosclerosis (P = .048) was more common in the younger age group. The older patients more often had major dominant stroke syndrome (P = .018). Comparison of activities of daily living before and after stroke showed that the older age group deteriorated significantly more than the younger age group after adjustment for sex, education, and living conditions (Barthel Index, P = .005; other scales, P < .0001). CONCLUSIONS The stroke patients in young and old age groups had different risk profiles and stroke features. The older stroke patients were more dependent and disabled beforehand, and after stroke they were relatively even more dependent than the patients in the younger age group. Because older patients already constitute the majority of stroke victims, the importance of early active diagnosis, treatment, rehabilitation, and guidance is stressed.

[1]  M. Kaste,et al.  Where and how should elderly stroke patients be treated? A randomized trial. , 1995, Stroke.

[2]  Y. Stern,et al.  Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[3]  David Lee Gordon,et al.  Classification of Subtype of Acute Ischemic Stroke: Definitions for Use in a Multicenter Clinical Trial , 1993, Stroke.

[4]  T. Erkinjuntti,et al.  Correction for age, education and other demographic variables in the use of the Mini Mental State Examination in Finland , 1992, Acta neurologica Scandinavica.

[5]  R. Mayeux,et al.  Dementia after stroke , 1992, Neurology.

[6]  J. Bamford,et al.  Classification and natural history of clinically identifiable subtypes of cerebral infarction , 1991, The Lancet.

[7]  L. Wilkins.  North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. , 1991, Stroke.

[8]  Robert A. Zimmerman,et al.  Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. , 1990, Stroke.

[9]  Lippincott Williams Wilkins,et al.  Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. , 1989, Stroke.

[10]  M. Crary,et al.  Preliminary psychometric evaluation of an acute aphasia screening protocol , 1989 .

[11]  G. Friedman,et al.  Alcohol use and subsequent cerebrovascular disease hospitalizations. , 1989, Stroke.

[12]  D. Jacobs,et al.  Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. , 1989, The New England journal of medicine.

[13]  T. Erkinjuntti,et al.  The blessed dementia scale as a screening test for dementia , 1988 .

[14]  M. Gent,et al.  The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Design, organization, and baseline results. , 1988, Stroke.

[15]  J. Bogousslavsky,et al.  The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. , 1988, Stroke.

[16]  Daniel B Hier,et al.  The Stroke Data Bank: design, methods, and baseline characteristics. , 1988, Stroke.

[17]  T. Erkinjuntti,et al.  Suspected dementia: evaluation of 323 consecutive referrals , 1987, Acta neurologica Scandinavica.

[18]  P. Wolf,et al.  Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. , 1987, Archives of internal medicine.

[19]  H. Chui,et al.  The Modified Mini-Mental State (3MS) examination. , 1987, The Journal of clinical psychiatry.

[20]  M. Fujishima,et al.  Hematocrit as a risk factor of cerebral infarction: long-term prospective population survey in a Japanese rural community. , 1986, Stroke.

[21]  Lippincott Williams Wilkins,et al.  Multicenter Trial of Hemodilution in Ischemic Stroke — Background and Study Protocol , 1985, Stroke.

[22]  K. Yano,et al.  Dietary and other risk factors for stroke in Hawaiian Japanese men. , 1985, Stroke.

[23]  M. Kotila,et al.  The Profile Of Recovery From Stroke And Factors Influencing Outcome , 1984, Stroke.

[24]  K. Davis,et al.  A new rating scale for Alzheimer's disease. , 1984, The American journal of psychiatry.

[25]  H. Kato,et al.  Cerebrovascular Diseases in a Fixed Population of 653 Hiroshima and Nagasaki, With Special Reference to Relationship Between Type and Risk Factors , 1984, Stroke.

[26]  B. Reisberg,et al.  The Global Deterioration Scale for assessment of primary degenerative dementia. , 1982, The American journal of psychiatry.

[27]  C. P. Hughes,et al.  A New Clinical Scale for the Staging of Dementia , 1982, British Journal of Psychiatry.

[28]  J. Salonen,et al.  Relation of blood pressure, serum lipids, and smoking to the risk of cerebral stroke. A longitudinal study in Eastern Finland. , 1982, Stroke.

[29]  T. Kurosaki,et al.  Measurement of functional activities in older adults in the community. , 1982, Journal of gerontology.

[30]  W. Garraway,et al.  Changing Pattern of Cerebral Infarction: 1945–1974 , 1979, Stroke.

[31]  W M O'Fallon,et al.  The declining incidence of stroke. , 1979, The New England journal of medicine.

[32]  J. Feigenson,et al.  The Disability Oriented Rehabilitation Unit - A Major Factor Influencing Stroke Outcome , 1979, Stroke.

[33]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[34]  M. Lawton,et al.  Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living , 1969 .

[35]  M. Roth,et al.  The Association Between Quantitative Measures of Dementia and of Senile Change in the Cerebral Grey Matter of Elderly Subjects , 1968, British Journal of Psychiatry.

[36]  K. Asplund,et al.  Stroke in the Elderly , 1992 .