TitleFactors Associated With Ischemic Stroke Survival and Recovery in Older Adults.
Publication TypeJournal Article
Year of Publication2017
AuthorsWinovich, DThekkethal, Longstreth, WT, Arnold, AM, Varadhan, R, Hazzouri, AZeki Al, Cushman, M, Newman, AB, Odden, MC
JournalStroke
Volume48
Issue7
Pagination1818-1826
Date Published2017 Jul
ISSN1524-4628
KeywordsActivities of Daily Living, Aged, Aged, 80 and over, Brain Ischemia, Cohort Studies, Female, Follow-Up Studies, Frail Elderly, Humans, Male, Recovery of Function, Risk Factors, Stroke, Survival Rate
Abstract
 

BACKGROUND AND PURPOSE: Little is known about factors that predispose older adults to poor recovery after a stroke. In this study, we sought to evaluate prestroke measures of frailty and related factors as markers of vulnerability to poor outcomes after ischemic stroke.

METHODS: In participants aged 65 to 99 years with incident ischemic strokes from the Cardiovascular Health Study, we evaluated the association of several risk factors (frailty, frailty components, C-reactive protein, interleukin-6, and cystatin C) assessed before stroke with stroke outcomes of survival, cognitive decline (≥5 points on Modified Mini-Mental State Examination), and activities of daily living decline (increase in limitations).

RESULTS: Among 717 participants with incident ischemic stroke with survival data, slow walking speed, low grip strength, and cystatin C were independently associated with shorter survival. Among participants <80 years of age, frailty and interleukin-6 were also associated with shorter survival. Among 509 participants with recovery data, slow walking speed, and low grip strength were associated with both cognitive and activities of daily living decline poststroke. C-reactive protein and interleukin-6 were associated with poststroke cognitive decline among men only. Frailty status was associated with activities of daily living decline among women only.

CONCLUSIONS: Markers of physical function-walking speed and grip strength-were consistently associated with survival and recovery after ischemic stroke. Inflammation, kidney function, and frailty also seemed to be determinants of survival and recovery after an ischemic stroke. These markers of vulnerability may identify targets for differing pre and poststroke medical management and rehabilitation among older adults at risk of poor stroke outcomes.

DOI10.1161/STROKEAHA.117.016726
Alternate JournalStroke
PubMed ID28526765
PubMed Central IDPMC5553701
Grant ListK01 AG039387 / AG / NIA NIH HHS / United States
R01 AG046206 / AG / NIA NIH HHS / United States