Risk of &amp;ldquo;silent stroke&amp;rdquo; in patients older than 60 years: risk assessment and clinical perspectives

Lim, Jae Sung; Kwon, Hyung‐Min

doi:10.2147/cia.s7382

Cited by 21 publications

(8 citation statements)

References 80 publications

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“…SAP is most likely to develop in patients who are seriously ill, and aspiration due to dysphagia may be one of the most important causes of this complication. Hypertension in the elderly is a well-known risk factor for silent cerebral infarction, which is a predictor of not only overt stroke 29 but also aspiration pneumonia due to dysphagia. 29 , 30 On the other hand, known hypertension before stroke was significantly associated with elevated post-stroke BP.…”

Section: Discussionmentioning

confidence: 99%

Association of severe hypertension with pneumonia in elderly patients with acute ischemic stroke

et al. 2012

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Pneumonia is one of the most frequent complications in elderly patients with acute ischemic stroke. Although severe hypertension is often observed in the early phase of acute stroke, there are few studies of acute hypertension as a factor influencing the incidence of stroke-associated pneumonia (SAP) in elderly subjects with acute ischemic stroke. To assess the association of acute phase blood-pressure elevation with the incidence of SAP, we compared 10 elderly patients with acute ischemic stroke complicated with severe hypertension (⩾200/120 mm Hg) with 43 patients with moderate hypertension (160–199/100–119 mm Hg), as well as with 65 control normotensive or mildly hypertensive (<160/100 mm Hg) controls on admission. Data were collected on known risk factors, type of ischemic stroke and underlying chronic conditions. The significance of differences in risk factors was analyzed using univariate and multivariate comparisons of 38 SAP cases and others, 8 SAP death cases and others, and 28 patients with poor outcome associated with in-hospital death or artificial feeding at discharge and others. After adjustment for potential confounding factors, the relative risk estimates for SAP, SAP death and poor outcome were 2.83 (95% confidence interval 1.14–7.05), 5.20 (1.01–26.8) and 6.84 (1.32–35.4), respectively, for severe hypertension relative to normotensive or mildly hypertensive controls. We conclude that severe hypertension on admission is an independent predictive factor for SAP in elderly patients with acute ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Association of severe hypertension with pneumonia in elderly patients with acute ischemic stroke

et al. 2012

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“…Microvascular changes and silent strokes in vulnerable regions may lead to the so-called ‘vascular depression’ [ 12 , 13 ]. Several genes such as the genes encoding angiotensin-converting enzyme (ACE), protein kinase C (PRKCH), apolipoprotein (a) [apo(a)] and lipoprotein(a) [Lp(a)] may play an important role in the ethiology of vascular depression [ 14 – 16 ].…”

Section: Reviewmentioning

confidence: 99%

Post-stroke depression and the aging brain

et al. 2013

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Ageing is associated with changes in the function of various organ systems. Changes in the cardiovascular system affect both directly and indirectly the function in a variety of organs, including the brain, with consequent neurological (motor and sensory performance) and cognitive impairments, as well as leading to the development of various psychiatric diseases. Post-stroke depression (PSD) is among the most frequent neuropsychiatric consequences of cerebral ischemia. This review discusses several animal models used for the study of PSD and summarizes recent findings in the genomic profile of the ageing brain, which are associated with age-related disorders in the elderly. Since stroke and depression are diseases with increased incidence in the elderly, great clinical benefit may especially accrue from deciphering and targeting basic mechanisms underlying PSD. Finally, we discuss the relationship between ageing, circadian rhythmicity and PSD.

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“…Cerebral microbleeds (CMB) are known as focal accumulations of hemosiderin-containing macrophages in the perivascular spaces of small blood vessels in the brain, which result from blood extravasation, due to microvasculature structural changes in the brain caused by a high BP load [ 8 ]. This is regarded as a hypertensive target organ disease in the brain akin to leukoaraiosis and silent brain infarctions [ 9 , 10 ]. However, as far as we know, there are no reports evaluating the association between CMB and nocturnal dipping patterns in stroke patients.…”

Section: Introductionmentioning

confidence: 99%

Cerebral microbleeds are associated with nocturnal reverse dipping in hypertensive patients with ischemic stroke

et al. 2014

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BackgroundAbnormalities in nocturnal blood pressure dipping are well known for its relationship to cardiovascular diseases. Cerebral microbleeds are frequently observed in patients with hypertension and are known to be potent risk factors for stroke. However, there are scanty reports about the relationship between nocturnal dipping and cerebral microbleeds.MethodsWe recruited consecutive patients with both hypertension and ischemic stroke within 7 days after symptom onset, and those with cardioembolism were excluded. We applied 24-hour ambulatory blood pressure monitoring two weeks after stroke onset, and we used brain MRI to detect cerebral microbleeds. Various blood pressure parameters such as mean 24-hour blood pressure, awake/sleep blood pressure, and morning surge were compared between cerebral microbleeds (+) vs. (-) groups. Subjects were further classified according to nocturnal dipping status and were analyzed by logistic regression to determine its association with cerebral microbleeds with adjustment for age, gender, and cardiovascular risk factors.ResultsA total of 162 patients (100 males, age 65.33 ± 10.32 years) were included. Cerebral microbleeds were detected in 65 patients (40.1%). Most ambulatory blood pressure parameters except morning surge were significantly higher in those who had cerebral microbleeds. After adjusting for the confounding factors, the reverse dippers were prone to have cerebral microbleeds (odds ratio, 3.81; 95% confidential interval, 1.36-10.65; p-value = 0.01).ConclusionCerebral microbleeds are independently associated with reverse dipping on ambulatory blood pressure monitoring in hypertensive stroke patients.

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Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives

Cited by 21 publications

References 80 publications

Association of severe hypertension with pneumonia in elderly patients with acute ischemic stroke

Association of severe hypertension with pneumonia in elderly patients with acute ischemic stroke

Post-stroke depression and the aging brain

Cerebral microbleeds are associated with nocturnal reverse dipping in hypertensive patients with ischemic stroke

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