TY - JOUR
T1 - Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults
AU - Winovich, DIvya Thekkethala
AU - Longstreth, William T.
AU - Arnold, Alice M.
AU - Varadhan, Ravi
AU - Zeki Al Hazzouri, Adina
AU - Cushman, Mary
AU - Newman, Anne B.
AU - Odden, Michelle C.
N1 - Funding Information:
This research was supported by contracts HHSN268201200036C, N01HC85239, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by R01AG023629, R01AG027002, K01AG039387, and R01AG46206 from the National Institute on Aging. A full list of principal CHS (Cardiovascular Health Study)
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - 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.
AB - 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.
KW - aging
KW - mortality
KW - recovery of function
KW - risk factors
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85019554584&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019554584&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.117.016726
DO - 10.1161/STROKEAHA.117.016726
M3 - Article
C2 - 28526765
AN - SCOPUS:85019554584
SN - 0039-2499
VL - 48
SP - 1818
EP - 1826
JO - Stroke
JF - Stroke
IS - 7
ER -