PDF
ePub
Citation
Print
Abstract
In stroke rehabilitation, risk factors, clinical course, and outcome of functional recovery can be different among age groups. In animal model of stroke, aged animals are more severely impaired behaviorally, and the functional recovery is delayed and reduced. Development of the glial scar and apoptosis is accelerated, and the timing of the cellular and genetic response is altered. The functional outcome is usually favorable in young adult patients, but it appears that the outcome of pediatric stroke is unfavorable. In most studies, the clinical symptoms are more severe, and functional recovery is poorer in elderly stroke patients. However, it is not clear whether or not the poor outcome is attributable to the old age per se. It is apparent that co-morbidity and risk factors also signficantly affect the outocme of stroke patients. Elderly stroke patients can achieve functional improvement through the rehabilitation program, if they were not disabled at the onset of stroke, and had few co-morbidities and risk factors. Physiatrists should be aware of those differences and can make a rehabilitatin plan that is appropriate for age of the patient.
References
1. Stein J, Brandstater M. Frontera W, editor. Stroke rehabilitation. Delisa's physical medicine and rehabilitation medicine: Principles and practice. 2010. New York: Lippincott Williams & Wilkins;561.
2. Buga A, Dunoiu C, Băşeanu A, Popa-Wagner A. Cellular and molecular mechanisms underlying neurorehabilitation after stroke in aged subjects. Rom J Morphol Embryol. 2008. 49:279–302.
3. Petcu E, Sfredel V, Platt D, Herndon J, Kessler C, Popa-Wagner A. Cellular and molecular events underlying the dysregulated response of the aged brain to stroke: A mini-review. Gerontology. 2008. 54:6–17.
4. Auriel E, Gur AY, Uralev O, Brill S, Shopin L, Karni A, Tsarfaty SS, Bornstein NM. Characteristics of first ever ischemic stroke in the very elderly: Profile of vascular risk factors and clinical outcome. Clin Neurol Neurosurg. 2011. 113:654–657.
5. Sacco R, Adams R, Albers G, Alberts M, Benavente O, Furie K, Goldstein L, Gorelick P, Halperin J, Harbaugh R, Johnston S, Katzan I, Kelly-Hayes M, Kenton E, Marks M, Schwamm L, Tomsick T, Association AH. Stroke ASACo. Intervention CoCRa. Neurology. AAo. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the american heart association/american stroke association council on stroke: Co-sponsored by the council on cardiovascular radiology and intervention: The american academy of neurology affirms the value of this guideline. Stroke. 2006. 37:577–617.
6. Kim I. Age and gender differences in the relation of chronic diseases to activity of daily living (adl) disability for elderly south koreans: Based on representative data. J Prev Med Public Health. 2011. 44:32–40.
7. Popa-Wagner A, Buga A, Kokaia Z. Perturbed cellular response to brain injury during aging. Ageing Res Rev. 2011. 10:71–79.
8. Zhao C, Puurunen K, Schallert T, Sivenius J, Jolkkonen J. Effect of cholinergic medication, before and after focal photothrombotic ischemic cortical injury, on histological and functional outcome in aged and young adult rats. Behav Brain Res. 2005. 156:85–94.
9. Lindner M, Gribkoff V, Donlan N, Jones T. Long-lasting functional disabilities in middle-aged rats with small cerebral infarcts. J Neurosci. 2003. 23:10913–10922.
10. He Z, Crook J, Meschia J, Brott T, Dickson D, McKinney M. Aging blunts ischemic-preconditioning-induced neuroprotection following transient global ischemia in rats. Curr Neurovasc Res. 2005. 2:365–374.
11. Marklund N, Morales D, Clausen F, Hanell A, Kiwanuka O, Pitkanen A, Gimbel D, Philipson O, Lannfelt L, Hillered L, Strittmatter S, McIntosh T. Functional outcome is impaired following traumatic brain injury in aging nogoa/b-deficient mice. Neuroscience. 2009. 163:540–551.
12. Leasure J, Grider M. The effect of mild post-stroke exercise on reactive neurogenesis and recovery of somatosensation in aged rats. Exp Neurol. 2010. 226:58–67.
13. Shimizu H, Kawarai T, Saji N, Tadano M, Kita Y, Tabuchi M, Yokono K. Re-evaluation of clinical features and risk factors of acute ischemic stroke in japanese longevity society. Kobe J Med Sci. 2010. 55:E132–E139.
14. Wang D, Hao Z, Tao W, Kong F, Zhang S, Wu B, Lin S, Liu M. Acute ischemic stroke in the very elderly chinese: Risk factors, hospital management and one-year outcome. Clin Neurol Neurosurg. 2011. 113:442–446.
15. Soares I, Abecasis P, Ferro J. Outcome of first-ever acute ischemic stroke in the elderly. Arch Gerontol Geriatr. 2011. 53:e81–e87.
16. Giantin V, Semplicini A, Franchin A, Simonato M, Baccaglini K, Attanasio F, Toffanello E, Manzato E. Outcome after acute ischemic stroke (ais) in older patients: Effects of age, neurological deficit severity and blood pressure (bp) variations. Arch Gerontol Geriatr. 2011. 52:e185–e191.
17. Atalay A, Turhan N. Determinants of length of stay in stroke patients: A geriatric rehabilitation unit experience. Int J Rehabil Res. 2009. 32:48–52.
18. Whiting R, Shen Q, Hung W, Cordato D, Chan D. Predictors for 5-year survival in a prospective cohort of elderly stroke patients. Acta Neurol Scand. 2011. 124:309–316.
19. Denti L, Scoditti U, Tonelli C, Saccavini M, Caminiti C, Valcavi R, Benatti M, Ceda GP. The poor outcome of ischemic stroke in very old people: A cohort study of its determinants. J Am Geriatr Soc. 2010. 58:12–17.
20. Arac A, Blanchard V, Lee M, Steinberg G. Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age. Neurosurg Focus. 2009. 26:e3.
21. Gunaydin R, Karatepe A, Kaya T, Ulutas O. Determinants of quality of life (qol) in elderly stroke patients: A short-term follow-up study. Arch Gerontol Geriatr. 2011. 53:19–23.
22. Engvig A, Fjell A, Westlye L, Moberget T, Sundseth Ø, Larsen V, Walhovd K. Effects of memory training on cortical thickness in the elderly. NeuroImage. 2010. 52:1667–1676.
23. Pellicciari M, Miniussi C, Rossini P, Gennaro L. Increased cortical plasticity in the elderly: Changes in the somatosensory cortex after paired associative stimulation. Neuroscience. 2009. 163:266–276.
24. Mizrahi E, Waitzman A, Arad M, Adunsky A. Functional outcome of elderly survivors of ischemic stroke: A retrospective study comparing non-hypercholesterolemic and hypercholesterolemic patients. Isr Med Assoc J. 2011. 13:295–299.
25. McCall M, McEwen S, Colantonio A, Streiner D, Dawson D. Modified constraint-induced movement therapy for elderly clients with subacute stroke. Am J Occup Ther. 2011. 65:409–418.
26. Todd G, Kimber T, Ridding M, Semmler J. Reduced motor cortex plasticity following inhibitory rtms in older adults. Clin Neurophysiol. 2010. 121:441–447.
27. Patella R, Spalloni A, Ferrari M, Starza S, Bozzao A, Rasura M. Cerebral ischemia in young patients (under 45 years of age): Clinical and neuroradiological follow-up. Neurol Sci. 2011. 32:427–432.
28. Groppo E, Gennaro R, Granieri G, Fazio P, Cesnik E, Granieri E, Casetta I. Incidence and prognosis of stroke in young adults: A population-based study in ferrara, italy. Neurol Sci. 2012. 33:53–58.
29. Jacobs B, Boden-Albala B, Lin I, Sacco R. Stroke in the young in the northern manhattan stroke study. Stroke. 2002. 33:2789–2793.
30. Nedeltchev K, der Maur T, Georgiadis D, Arnold M, Caso V, Mattle H, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner R. Ischaemic stroke in young adults: Predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005. 76:191–195.
31. Tiamkao S, Sawanyawisuth K, Silaruks S, Kiatchoosakun S, Tatsanavivat P, Chotmongkol V, Klungboonkrong V. Correlation of causes and outcomes in stroke in the young. J Stroke Cerebrovasc Dis. 2011. [Epub ahead of print].
32. Spengos K, Vemmos K. Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 - the athens young stroke registry. Eur J Neurol. 2010. 17:1358–1364.
33. Bigi S, Fischer U, Wehrli E, Mattle H, Boltshauser E, Burki S, Jeannet P, Fluss J, Weber P, Nedeltchev K, El-Koussy M, Steinlin M, Arnold M. Acute ischemic stroke in children versus young adults. Ann Neurol. 2011. 70:245–254.
34. Cnossen M, Aarsen F, Akker S, Anen R, Appel I, Steyerberg E, Catsman-Berrevoets C. Paediatric arterial ischaemic stroke: Functional outcome and risk factors. Dev Med Child Neurol. 2010. 52:394–399.
35. Steinlin M, Roellin K, Schroth G. Long-term follow-up after stroke in childhood. Eur J Pediatr. 2004. 163:245–250.
XML Download