The effect of age in stroke patients: A comparative analysis of risk factors, etiology, prognosis, and imaging features in young and elderly ischemic stroke patients

Introduction and Objective: Ischemic stroke, characterized by the loss of bodily function resulting from neuronal damage due to a sudden reduction in cerebral blood flow, is conventionally considered a disease of the elderly. However, its incidence in young adults has been progressively increasing in recent times. A stroke occurring at a young age can lead to the loss of many productive years, causing severe consequences for both the patients and their families, and may constitute a significant socioeconomic burden. In contrast to the traditional risk factors seen in elderly patients, more heterogeneous and rare etiologies are prominent in younger patients. The objective of this study is to examine the risk factors, etiologies, prognoses, and imaging features in young and elderly ischemic stroke patients and to conduct a comparative evaluation of both age groups. Material and Methods: This study included 352 young and 204 elderly ischemic stroke patients. The patients' demographic data, personal and family medical histories, medication and substance use, etiologies and clinical syndromes according to TOAST and BAMFORD classifications, NIHSS and mRS scores at admission and at the 6-month follow-up, 1-year mortality and 5-year stroke recurrence rates, and imaging characteristics were recorded. Data were analyzed using SPSS 28.0, and group comparisons and correlation analyses were performed. Results: The mean age was 47.1 for young patients and 66.4 for elderly patients. Of the patients, 36.8% were female and 63.2% were male. The most common risk factor was found to be hyperlipidemia (77%) in young patients, whereas it was hypertension (91.2%) in elderly patients. When comparing risk factors, a history of migraine and the rate of smoking were higher among young patients, whereas rates of vascular risk factors and cardiac arrhythmia were higher in elderly patients. Etiologically, cryptogenic stroke was the most frequently identified cause in young patients (27.3%), while cardioembolism was the most common in the elderly group (35.3%). According to the BAMFORD classification, the most common clinical syndrome was found to be PACS (Partial Anterior Circulation Syndrome) in both young and elderly groups. The five-year stroke recurrence (16.5%) and one-year mortality (6%) rates in young patients were found to be significantly lower compared to the elderly group (31.9% and 22.5%, respectively). Although significant neurological improvement was observed in both young and elderly patients at the 6- month follow-up, no statistically significant difference was found between the two groups in terms of recovery rates. Vascular imaging was most frequently normal in young patients, whereas extracranial atherosclerosis was most commonly observed in the elderly. Conclusion: These findings reveal that classic vascular risk factors and cardiac arrhythmias are predominant in the etiology of ischemic stroke in the elderly, while rarer causes are more common in young adults. Although both age groups showed significant improvement during follow-up according to TOAST and BAMFORD classifications, no significant difference in prognosis was detected between the two groups. The findings underscore the importance of a detailed etiological investigation in young patients. Furthermore, they highlight the critical importance of implementing secondary prevention strategies in all age groups to reduce morbidity and mortality. In this context, future multi-center studies with larger patient cohorts will contribute to the development of personalized approaches for young stroke patients.