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Chapter 16 - Prevention, diagnosis, and management of stroke and TIA in the elderly

from Section III - Care of the elderly by organ system

Published online by Cambridge University Press:  05 June 2016

Jan Busby-Whitehead
Affiliation:
University of North Carolina
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Samuel C. Durso
Affiliation:
The Johns Hopkins University School of Medicine
Daniel Swagerty
Affiliation:
University of Kansas
Laura Mosqueda
Affiliation:
University of Southern California
Maria Fiatarone Singh
Affiliation:
University of Sydney
William Reichel
Affiliation:
Georgetown University, Washington DC
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Summary

Stroke is the leading cause of physical and cognitive disability in the United States, with a larger burden in patients over 65. Prevention of stroke includes the understanding and identification of risk factors, symptoms, and mechanisms of stroke and TIA. Atrial fibrillation is a major contributor to stroke in the elderly. Anticoagulation can prevent stroke, but is associated with significant risks. Newer anticoagulants offer novel strategies for prevention. Antiplatelet, antihypertensive, and lipid-lowering drugs are all used for stroke prevention and risk factor modification. Following stroke, recovery can be enhanced by addressing complications such as gastrointestinal complications, venous thromboembolism, fever, depression, and urinary incontinence. Addressing the challenges associated with caregiving of the older patient with stroke, and end-of- life care and decision making, are important considerations in stroke management.
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 233 - 244
Publisher: Cambridge University Press
Print publication year: 2016

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References

Feigin, VL, Lawes, CM, Bennett, DA, Anderson, CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003 Jan;2(1):4353.Google Scholar
Koton, S, Schneider, AL, Rosamond, WD, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA 2014 Jul 16;312(3):259268.Google Scholar
Go, AS, Mozaffarian, D, Roger, VL, et al. Executive summary: heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation 2014 Jan 21;129(3):399410.Google Scholar
Yusuf, S, Rangarajan, S, Teo, K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014 Aug 28;371(9):818827.Google Scholar
Sacco, RL, Kasner, SE, Broderick, JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013 Jul;44(7):20642089.Google Scholar
Marini, C, Baldassarre, M, Russo, T, et al. Burden of first-ever ischemic stroke in the oldest old: evidence from a population-based study. Neurology 2004 Jan 13;62(1):7781.Google Scholar
Burke, JF, Freedman, VA, Lisabeth, LD, et al. Racial differences in disability after stroke: results from a nationwide study. Neurology 2014 Jul 29;83(5):390397.Google Scholar
Kelly, AG, Hoskins, KD, Holloway, RG. Early stroke mortality, patient preferences, and the withdrawal of care bias. Neurology 2012 Aug 28;79(9):941944.Google Scholar
Qureshi, AI, Chaudhry, SA, Connelly, B, et al. Impact of advanced healthcare directives on treatment decisions by physicians in patients with acute stroke. Crit Care Med 2013 Jun;41(6):14681475.Google Scholar
Silveira, MJ, Wiitala, W, Piette, J. Advance directive completion by elderly Americans: a decade of change. J Am Geriatr Soc 2014 Apr;62(4):706710.Google Scholar
Barber, PA, Kleinig, TJ. INTERACT2: a reason for optimism with spontaneous intracerebral hemorrhage? Int J Stroke 2014 Jan;9(1):5960.Google Scholar
McArdle, PF, Kittner, SJ, Ay, H, et al. Agreement between TOAST and CCS ischemic stroke classification: The NINDS SIGN Study. Neurology 2014 Oct 28;83(18):16531660. Epub 2014 Sep 26.Google Scholar
Adams, HP Jr, Bendixen, BH, Kappelle, LJ, et al. 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 Jan;24(1):3541.Google Scholar
Arsava, EM, Ballabio, E, Benner, T, et al. The Causative Classification of Stroke system: an international reliability and optimization study. Neurology 2010 Oct 5;75(14):12771284.CrossRefGoogle ScholarPubMed
Asimos, AW, Johnson, AM, Rosamond, WD, et al. A multicenter evaluation of the ABCD2 score’s accuracy for predicting early ischemic stroke in admitted patients with transient ischemic attack. Ann Emerg Med 2010 Feb;55(2):201210.e5.Google Scholar
Easton, JD, Saver, JL, Albers, GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009 Jun;40(6):22762293.Google Scholar
Giles, MF, Albers, GW, Amarenco, P, et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study. Neurology 2011 Sep 27;77(13):12221228.Google Scholar
Kleindorfer, D, Panagos, P, Pancioli, A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 2005 Apr;36(4):720723.Google Scholar
Johnston, SC, Gress, DR, Browner, WS, Sidney, S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000 Dec 13;284(22):29012906.Google Scholar
Rojas, JI, Zurru, MC, Romano, M, et al. Acute ischemic stroke in patients aged 80 or older. Medicina (B Aires) 2007;67(6 Pt 2):701704.Google Scholar
Agyemang, C, van Oeffelen, AA, Norredam, M, et al. Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands. Stroke 2014 Sep 30;45(11):32363242.Google Scholar
Talahma, M, Strbian, D, Sundararajan, S. Sickle cell disease and stroke. Stroke 2014 Jun;45(6):e98e100.Google Scholar
Gueguen, A, Mahevas, M, Nzouakou, R, et al. Sickle-cell disease stroke throughout life: a retrospective study in an adult referral center. Am J Hematol 2014 Mar;89(3):267272.Google Scholar
Tinetti, ME, Han, L, Lee, DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014 Apr;174(4):588595.Google Scholar
Aronow, WS, Fleg, JL, Pepine, CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Soc Hypertens 2011 Jul–Aug;5(4):259352.Google Scholar
Gouya, G, Arrich, J, Wolzt, M, et al. Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases: a systematic review and meta-analysis. Stroke 2014 Feb;45(2):492503.Google Scholar
Kernan, WN, Ovbiagele, B, Black, HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014 Jul;45(7):21602236.Google Scholar
Shin, JY, Choi, NK, Jung, SY, et al. Risk of ischemic stroke with the use of risperidone, quetiapine and olanzapine in elderly patients: a population-based, case-crossover study. J Psychopharmacol 2013 Jul;27(7):638644.Google Scholar
Everson-Rose, SA, Roetker, NS, Lutsey, PL, et al. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke 2014 Aug;45(8):23182323.Google Scholar
Lambiase, MJ, Kubzansky, LD, Thurston, RC. Prospective study of anxiety and incident stroke. Stroke 2014 Feb;45(2):438443.Google Scholar
Helms, TM, Duong, G, Zippel-Schultz, B, et al. Prediction and personalised treatment of atrial fibrillation-stroke prevention: consolidated position paper of CVD professionals. EPMA J 2014 Sep 2;5(1):15.Google Scholar
Coppens, M, Hart, RG, Eikelboom, JW. Stroke prevention in older adults with atrial fibrillation. CMAJ 2013 Nov 19;185(17):14791480.Google Scholar
Quinn, GR, Fang, MC. Atrial fibrillation: stroke prevention in older adults. Clin Geriatr Med 2012 Nov;28(4):617634.Google Scholar
Moran, PS, Flattery, MJ, Teljeur, C, et al. Effectiveness of systematic screening for the detection of atrial fibrillation. Cochrane Database Syst Rev 2013 Apr 30;4:CD009586.Google Scholar
Sanna, T, Diener, HC, Passman, RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014 Jun 26;370(26):24782486.Google Scholar
Gladstone, DJ, Spring, M, Dorian, P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014 Jun 26;370(26):24672477.Google Scholar
Weber-Kruger, M, Gelbrich, G, Stahrenberg, R, et al. Finding atrial fibrillation in stroke patients: randomized evaluation of enhanced and prolonged Holter monitoring – Find-AFRANDOMISED – rationale and design. Am Heart J 2014 Oct;168(4):438445.e1.Google Scholar
Halperin, JL, Hankey, GJ, Wojdyla, DM, et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation 2014 Jul 8;130(2):138146.Google Scholar
Sardar, P, Chatterjee, S, Chaudhari, S, Lip, GY. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc 2014 May;62(5):857864.Google Scholar
Dzik, WS. Reversal of drug-induced anticoagulation: old solutions and new problems. Transfusion 2012 May;52 Suppl 1:45S55S.Google Scholar
Salvi, F, Marchetti, A, D’Angelo, F, et al. Adverse drug events as a cause of hospitalization in older adults. Drug Saf 2012 Jan;35 Suppl 1:2945.Google Scholar
Wang, C, Yi, X, Zhang, B, et al. Clopidogrel plus aspirin prevents early neurologic deterioration and improves 6-month outcome in patients with acute large artery atherosclerosis stroke. Clin Appl Thromb Hemost 2015 Jul;21(5):453461. Epub 2014 Sep 23.Google Scholar
Wong, KS, Chen, C, Fu, J, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 2010 May;9(5):489497.Google Scholar
Markus, HS, Droste, DW, Kaps, M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the clopidogrel and aspirin for reduction of emboli in symptomatic carotid stenosis (CARESS) trial. Circulation 2005 May 3;111(17):22332240.Google Scholar
Boan, AD, Lackland, DT, Ovbiagele, B. Lowering of blood pressure for recurrent stroke prevention. Stroke 2014 Aug;45(8):25062513.CrossRefGoogle ScholarPubMed
De Lima, LG, Saconato, H, Atallah, AN, da Silva, EM. Beta-blockers for preventing stroke recurrence. Cochrane Database Syst Rev 2014 Oct 15;10:CD007890.Google Scholar
Udell, JA, Opotowsky, AR, Khairy, P, et al. Patent foramen ovale closure vs medical therapy for stroke prevention: meta-analysis of randomized trials and review of heterogeneity in meta-analyses. Can J Cardiol 2014 Oct;30(10):12161224.Google Scholar
Kmietowicz, Z. Geriatrician questions prescribing for stroke prevention in people over 80. BMJ 2014 Feb 26;348:g1788.Google Scholar
Byatt, K. Overenthusiastic stroke risk factor modification in the over-80s: are we being disingenuous to ourselves, and to our oldest patients? Evid Based Med 2014 Aug;19(4):121122.Google Scholar
Manocha, D, Bansal, N, Gumaste, P, Brangman, S. Safety profile of high-dose statin therapy in geriatric patients with stroke. South Med J 2013 Dec;106(12):658664.Google Scholar
Raley, KA, Hutchison, AM. Statin use and cognitive changes in elderly patients with dementia. Consult Pharm 2014;29(7):487489.Google Scholar
Mandas, A, Congiu, MG, Abete, C, et al. Cognitive decline and depressive symptoms in late-life are associated with statin use: evidence from a population-based study of Sardinian old people living in their own home. Neurol Res 2014 Mar;36(3):247254.Google Scholar
Tapia-Perez, JH, Gehring, S, Zilke, R, Schneider, T. Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg 2014 Mar;118:3743.Google Scholar
Tanaka, R, Ueno, Y, Miyamoto, N, et al. Impact of diabetes and prediabetes on the short-term prognosis in patients with acute ischemic stroke. J Neurol Sci 2013 Sep 15;332(1–2):4550.Google Scholar
Nardi, K, Milia, P, Eusebi, P, et al. Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia. J Diabetes Complications 2012 Mar–Apr;26(2):7076.Google Scholar
Murphy, RA, Patel, KV, Kritchevsky, SB, et al. Weight change, body composition, and risk of mobility disability and mortality in older adults: a population-based cohort study. J Am Geriatr Soc 2014 Aug;62(8):14761483.Google Scholar
Alamowitch, S, Eliasziw, M, Algra, A, et al. Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid-artery stenosis. Lancet 2001 Apr 14;357(9263):11541160.Google Scholar
Brott, TG, Hobson, RW 2nd, Howard, G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010 Jul 1;363(1):1123.Google Scholar
Gonzales, NR, Demaerschalk, BM, Voeks, JH, et al. Complication rates and center enrollment volume in the carotid revascularization endarterectomy versus stenting trial. Stroke 2014 Sep 25.Google Scholar
Rerkasem, K, Rothwell, PM. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 2011 Apr 13;(4):CD001081.Google Scholar
Antoniou, GA, Georgiadis, GS, Georgakarakos, EI, et al. Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surg 2013 Dec;148(12):11401152.Google Scholar
Kasner, SE, Lynn, MJ, Chimowitz, MI, et al. Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID. Neurology 2006 Oct 10;67(7):12751278.Google Scholar
Birkbak, J, Clark, AJ, Rod, NH. The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review. J Clin Sleep Med 2014 Jan 15;10(1):103108.Google Scholar
Petrov, ME, Howard, VJ, Kleindorfer, D, et al. Over-the-counter and Prescription Sleep Medication and Incident Stroke: The REasons for Geographic And Racial Differences in Stroke Study. J Stroke Cerebrovasc Dis 2014 Sep;23(8):21102116.Google Scholar
Birkbak, J, Clark, AJ, Rod, NH. The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review. J Clin Sleep Med 2014 Jan 15;10(1):103108.Google Scholar
Diaz, KM, Booth, JN 3rd, Calhoun, DA, et al. Healthy lifestyle factors and risk of cardiovascular events and mortality in treatment-resistant hypertension: the reasons for geographic and racial differences in stroke study. Hypertension 2014 Sep;64(3):465471.Google Scholar
Marler, JR. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995 Dec 14;333(24):15811588.Google Scholar
Yayan, J. Effectiveness of alteplase in the very elderly after acute ischemic stroke. Clin Interv Aging 2013;8:963974.Google Scholar
Gomez-Choco, M, Obach, V, Urra, X, et al. The response to IV rt-PA in very old stroke patients. Eur J Neurol 2008 Mar;15(3):253256.Google Scholar
Engelter, ST, Bonati, LH, Lyrer, PA. Intravenous thrombolysis in stroke patients of > or = 80 versus < 80 years of age – a systematic review across cohort studies. Age Ageing 2006 Nov;35(6):572580.Google Scholar
Jonsson, AC, Delavaran, H, Iwarsson, S, et al. Functional status and patient-reported outcome 10 years after stroke: the Lund Stroke Register. Stroke 2014 Jun;45(6):17841790.Google Scholar
Camara-Lemarroy, CR, Ibarra-Yruegas, BE, Gongora-Rivera, F. Gastrointestinal complications after ischemic stroke. J Neurol Sci 2014 Aug 28.Google Scholar
Martino, R, Foley, N, Bhogal, S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005 Dec;36(12):27562763.CrossRefGoogle ScholarPubMed
Lin, CJ, Hung, JW, Cho, CY, et al. Poststroke constipation in the rehabilitation ward: incidence, clinical course and associated factors. Singapore Med J 2013 Nov;54(11):624629.Google Scholar
Douds, GL, Hellkamp, AS, Olson, DM, et al. Venous thromboembolism in the Get with the Guidelines-Stroke acute ischemic stroke population: incidence and patterns of prophylaxis. J Stroke Cerebrovasc Dis 2014 Jan;23(1):123129.Google Scholar
Naccarato, M, Chiodo Grandi, F, Dennis, M, Sandercock, PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev 2010 Aug 4;8:CD001922.Google Scholar
Drury, P, Levi, C, McInnes, E, et al. Management of fever, hyperglycemia, and swallowing dysfunction following hospital admission for acute stroke in New South Wales, Australia. Int J Stroke 2014 Jan;9(1):2331.Google Scholar
Allan, LM, Rowan, EN, Thomas, AJ, et al. Long-term incidence of depression and predictors of depressive symptoms in older stroke survivors. Br J Psychiatry 2013 Dec;203(6):453460.Google Scholar
Tang, WK, Caeiro, L, Lau, CG, et al. Apathy and suicide-related ideation 3 months after stroke: a cross-sectional study. BMC Neurol 2015 Apr 23;15(1):60.CrossRefGoogle ScholarPubMed
Santos, CO, Caeiro, L, Ferro, JM, Figueira, ML. A study of suicidal thoughts in acute stroke patients. J Stroke Cerebrovasc Dis 2012 Nov;21(8):749754.Google Scholar
Vallury, KD, Jones, M, Gray, R. Do family-oriented interventions reduce poststroke depression? A systematic review and recommendations for practice. Top Stroke Rehabil 2015 Dec;22(6):459465. doi: 10/1179/1074935715Z00000000061. Epub 2015 Mar 28.CrossRefGoogle ScholarPubMed
Cai, W, Wang, J, Wang, L, et al. Prevalence and risk factors of urinary incontinence for post-stroke inpatients in Southern China. Neurourol Urodyn 2015;34(3):231235.CrossRefGoogle ScholarPubMed
Gregory, P, Edwards, L, Faurot, K, et al. Patient preferences for stroke rehabilitation. Top Stroke Rehabil 2010 Sep–Oct;17(5):394400.CrossRefGoogle ScholarPubMed
DuGoff, EH, Canudas-Romo, V, Buttorff, C, et al. Multiple chronic conditions and life expectancy: a life table analysis. Med Care 2014 Aug;52(8):688694.Google Scholar
Bilbao, G, Garibi, J, Pomposo, I, et al. A prospective study of a series of 356 patients with supratentorial spontaneous intracerebral haematomas treated in a neurosurgical department. Acta Neurochir (Wien) 2005 Aug;147(8):823829.Google Scholar
Bhatia, R, Singh, H, Singh, S, et al. A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage. Neurol India 2013 May–Jun;61(3):244248.Google Scholar
Flemming, KD, Wijdicks, EF, Li, H. Can we predict poor outcome at presentation in patients with lobar hemorrhage? Cerebrovasc Dis 2001;11(3):183189.Google Scholar

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