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Ischemic Stroke Survival and Recovery in Older Adults
Study Questions:
What are the prestroke measures of frailty and factors of vulnerability associated with poor outcomes after ischemic stroke in older adults?
Methods:
The investigators evaluated the association of several risk factors (frailty, frailty components, C-reactive protein, interleukin-6, and cystatin C) in participants aged 65-99 years with incident ischemic strokes from the Cardiovascular Health Study, with stroke outcomes of survival, cognitive decline (≥5 points on Modified Mini-Mental State Examination), and activities of daily living (ADL) decline (increase in limitations). The association between the potential risk factors measured before the stroke and survival time poststroke was assessed using Cox proportional hazard models. Logistic models were used to assess the association of potential risk factors with both measures of recovery.
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 ADL decline poststroke. C-reactive protein and interleukin-6 were associated with poststroke cognitive decline among men only. Frailty status was associated with ADL decline among women only.
Conclusions:
The authors concluded that markers of physical function (i.e., walking speed and grip strength) were consistently associated with survival and recovery after ischemic stroke.
Perspective:
This study reports that prestroke frailty, inflammation, and renal function were associated with ischemic stroke outcomes of survival and recovery. Furthermore, the low physical function components of frailty, measured by walking speed and grip strength, were the most consistent determinant of shorter survival and lack of poststroke recovery in cognition and ADL. The associations of frailty, physical function, chronic inflammation, and renal function with poor stroke outcomes suggest that these factors may indicate decreased physiological resilience to ischemic stroke events. Better understanding of the factors that lead to increased vulnerability to poor cerebrovascular outcomes may help develop strategies to improve resilience to debilitating stroke events and optimize prevention and poststroke care.
Keywords: Activities of Daily Living, C-Reactive Protein, Cognition, Cognition Disorders, Cystatin C, Hand Strength, Inflammation, Interleukin-6, Neuropsychological Tests, Primary Prevention, Risk Factors, Stroke, Survival, Vascular Diseases, Walking, Geriatrics
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