Age for a stroke

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Age and Stroke: Trends, Risk Factors, and Outcomes

Increasing Stroke Incidence in Younger Adults

Recent studies have highlighted a concerning trend: the incidence of stroke is increasing among younger adults. A population-based study in the Greater Cincinnati/Northern Kentucky region found that the mean age at stroke decreased from 71.2 years in 1993/1994 to 69.2 years in 2005, with the proportion of strokes occurring in individuals under 55 years rising from 12.9% to 18.6% during the same period. This shift towards younger ages is significant and suggests a growing public health issue.

Stroke Incidence and Subtypes in Young Adults

A systematic review of stroke incidence in young adults (under 45 years) revealed that stroke is not as rare in this age group as previously thought. Incidence rates ranged between 8.63 and 21.02 per 100,000 person-years, indicating a need for targeted preventive measures. Another study in the Netherlands found that the incidence of stroke in young adults (18-50 years) increased by 23% from 1998 to 2010, driven primarily by an increase in ischemic strokes.

Risk Factors for Stroke in Younger Adults

Conventional vascular risk factors play a significant role in strokes among younger adults. A case-control study involving 32 countries identified hypertension, smoking, binge drinking, central obesity, cardiac causes, dyslipidemia, and psychosocial stress as major risk factors for ischemic stroke in individuals under 45 years. Hypertension emerged as the most significant risk factor across all age groups and stroke subtypes.

Stroke in the Elderly: Risk Factors and Outcomes

In contrast, the elderly population (65 years and above) experiences a higher stroke incidence, with 75% of strokes occurring in this age group. Older adults face unique challenges, including higher rates of hospitalization and mortality. Factors such as heart failure and elevated high-density lipoprotein (HDL) levels are associated with worsening neurological functions in stroke patients aged 65-74 years, while direct hospital admission improves outcomes for those aged 75 and above.

Biological Brain Age and Stroke

Biological brain age, which can be estimated based on cortical and subcortical brain measures, may serve as a more sensitive marker of brain health than chronological age. Stroke survivors tend to have a higher biological brain age compared to age-matched controls, suggesting that stroke may be the culmination of gradual cerebrovascular burden and brain degeneration.

Stroke Care and Quality of Life

The quality of stroke care and clinical outcomes can vary significantly with age. A study in Ontario, Canada, found that while stroke care delivery was generally consistent across age groups, older patients (80 years and above) had higher stroke fatality rates, longer hospital stays, increased risk of pneumonia, and higher disability at discharge compared to younger patients. This underscores the need for age-specific stroke management strategies.

Global Burden of Stroke in Younger Adults

Globally, the burden of stroke among younger adults (20-64 years) has increased significantly between 1990 and 2013. The prevalence of both hemorrhagic and ischemic strokes has risen, with developing countries experiencing a 36.7% increase in stroke deaths among younger adults. This highlights the urgent need for improved stroke prevention and management strategies in these regions.

Conclusion

The increasing incidence of stroke among younger adults and the significant burden of stroke in the elderly population underscore the need for targeted preventive measures and age-specific management strategies. Addressing modifiable risk factors such as hypertension, smoking, and obesity, along with improving access to quality stroke care, can help mitigate the impact of stroke across different age groups.