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December 12, 2012

Independent predictors of ischemic stroke in the elderly
Prospective data from a stroke unit

This article has been corrected.
VIEW CORRECTION
January 1, 2013 issue
80 (1) 29-38

ABSTRACT

Objective:

Incidence of ischemic stroke (IS) increases with age. Knowledge of factors associated with IS acute outcomes in the oldest-old (≥80 years) is needed to improve quality of care and resource allocation in this age group.

Methods:

Data are for 769 consecutive IS patients aged ≥60 years (436 aged ≥80 years) admitted to an Italian stroke unit in a 4-year period. Demographics, prestroke disability (modified Rankin Scale ≥3) and comorbidities, IS etiology and subtype, NIH Stroke Scale (NIHSS) score, clinical and laboratory admission parameters, and medical complications were prospectively registered. Independent predictors of in-hospital death, incident disability, length of stay, discharge without rehabilitation, and no direct discharge home were identified by multiple logistic regression. Risk profiles before and after age 80 were compared.

Results:

Poor outcomes were more frequent in the oldest-old compared to the younger patients. NIHSS score, clinical parameters of IS severity (need for oxygen, indwelling catheter, or nasogastric tube), incident disability, and medical complications predicted most of the study outcomes in both age groups. After age 80, IS etiology and subtype proved additional independent determinants for most outcomes along with age, sex, and prestroke functional and health status.

Conclusions:

Characteristics related to neurologic impairment on admission were the main predictors of acute outcomes of IS in this cohort. Specific IS etiology and subtype influenced IS outcomes only after age 80. In oldest-old patients, demographics and prestroke functional and health status also influenced IS outcomes with peculiar associations.

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Supplementary Material

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STUDY FUNDING

Supported by the Basic Oriented Research grant from the University of Bologna.

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Information & Authors

Information

Published In

Neurology®
Volume 80Number 1January 1, 2013
Pages: 29-38
PubMed: 23243075

Publication History

Received: April 19, 2012
Accepted: August 27, 2012
Published online: December 12, 2012
Published in print: January 1, 2013

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

Paola Forti, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Fabiola Maioli, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Gaetano Procaccianti, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Valeria Nativio, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Maria-Vittoria Lega, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Maura Coveri, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Marco Zoli, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Tommaso Sacquegna, MD
From the Department of Medical and Surgical Sciences (P.F., M.-V.L., M.Z.), University of Bologna; and the Geriatric Stroke Unit, Medical Department (F.M., V.N., M.C.), and Neurology Stroke Unit (G.P., T.S.), Maggiore Hospital, IRCSS, Bologna, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Correspondence to Dr. Forti: [email protected]

Author Contributions

Dr. P. Forti: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, statistical analysis, obtaining funding. Dr. F. Maioli: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, acquisition of data. Dr. G. Procaccianti: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, study supervision or coordination. Dr. V. Nativio: drafting/revising the manuscript for content, including medical writing for content, acquisition of data. Dr. M.-V. Lega: drafting/revising the manuscript for content, including medical writing for content, acquisition of data. Dr. M. Coveri: drafting/revising the manuscript for content, including medical writing for content, analysis or interpretation of data. Prof. M. Zoli: drafting/revising the manuscript for content, including medical writing for content, analysis or interpretation of data. Dr. T. Sacquegna: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, study supervision or coordination.

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