Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke.
BACKGROUND
Comparisons between younger and older stroke patients including comorbidities are limited.


METHODS
Prospective data of consecutive patients with first ever acute ischemic stroke were compared between younger (< or = 45 years) and older patients (> 45 years).


RESULTS
Among 1004 patients, 137 (14 %) were < or = 45 years. Younger patients were more commonly female (57 % versus 34 %; p < 0.0001), had a lower frequency of diabetes (1 % versus 15 %; p < 0.0001), hypercholesterolemia (26 % versus 56 %; p < 0.0001), hypertension (19 % versus 65 %; p < 0.0001), coronary heart disease (14 % versus 40 %; p < 0.0001), and a lower mean Charlson co-morbidity index (CCI), (0.18 versus 0.84; p < 0.0001). Tobacco use was more prevalent in the young (39 % versus 26 %; P < 0.0001). Large artery disease (2 % versus 21 %; p < 0.0001), small artery disease (3 % versus 12 %; p = 0.0019) and atrial fibrillation (1 % versus 17 %; p = 0.001) were less common in young patients, while other etiologies (31 % versus 9 %; p < 0.0001), patent foramen ovale or atrial septal defect (44 % versus 26 %; p < 0.0001), and cervical artery dissection (26 % versus 7 %; p < 0.0001) were more frequent. A favorable outcome (mRS 0 or 1) was more common (57.4 % versus 46.9 %; p = 0.023), and mortality (5.1 % versus 12 %; p = 0.009) was lower in the young. After regression analysis, there was no independent association between age and outcome (p = 0.206) or mortality (p = 0.073). Baseline NIHSS score (p < 0.0001), diabetes (p = 0.041), and CCI (p = 0.002) independently predicted an unfavorable outcome.


CONCLUSIONS
Younger patients were more likely to be female, had different risk factors and etiologies and fewer co-morbidities. There was no independent association between age and clinical outcome or mortality.
Arnold
M
M
Department of Neurology, University Hospital, Inselspital, Freiburgstrasse, 3010 Berne, Switzerland. marcel.arnold@insel.ch
Halpern
M
M
Meier
N
N
Fischer
U
U
Haefeli
T
T
Kappeler
L
L
Brekenfeld
C
C
Mattle
H P
HP
Nedeltchev
K
K
D000208:Acute Disease / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D003710:Demography; D005260:Female; D006801:Humans; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome