Subtypes and proportions of cerebrovascular disease in an autopsy series in a Japanese geriatric hospital

Targeting autonomic nervous system as a biomarker of well-ageing in the prevention of stroke

Stroke prediction is a key health issue for preventive medicine. Atrial fibrillation (AF) detection is well established and the importance of obstructive sleep apneas (OSA) has emerged in recent years. Although autonomic nervous system (ANS) appears strongly implicated in stroke occurrence, this factor is more rarely considered. However, the consequences of decreased parasympathetic activity explored in large cohort studies through measurement of ANS activity indicate that an ability to improve its activity level and equilibrium may prevent stroke. In support of these observations, a compensatory neurostimulation has already proved beneficial on endothelium function. The available data on stroke predictions from ANS is based on many long-term stroke cohorts. These data underline the need of repeated ANS evaluation for the general population, in a medical environment, and remotely by emerging telemedicine digital tools. This would help uncovering the reasons behind the ANS imbalance that would need to be medically adjusted to decrease the risk of stroke. This ANS unbalance help to draw attention on clinical or non-clinical evidence, disclosing the vascular risk, as ANS activity integrates the cumulated risk from many factors of which most are modifiable, such as metabolic inadaptation in diabetes and obesity, sleep ventilatory disorders, hypertension, inflammation, and lack of physical activity. Treating these factors may determine ANS recovery through the appropriate management of these conditions. Natural aging also decreases ANS activity. ANS recovery will decrease global circulating inflammation, which will reinforce endothelial function and thus protect the vessels and the associated organs. ANS is the whistle-blower of vascular risk and the actor of vascular health. Such as, ANS should be regularly checked to help draw attention on vascular risk and help follow the improvements in response to our interventions. While today prediction of stroke relies on classical cardiovascular risk factors, adding autonomic biomarkers as HRV parameters may significantly increase the prediction of stroke.

[Prevalence and pattern of distribution of cerebrovascular diseases in 242 hospitalized elderly patients, in a general hospital, autopsied in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997]

OBJECTIVE

To describe the prevalence and the types of cerebrovascular diseases (CVDs) in autopsied elderly individuals.

METHOD

Consecutive clinical charts and neuropathological reports of 242 patients aged 61 years or older were reviewed. The patients died in Hospital das Clínicas, Federal University of Minas Gerais, in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997.

RESULTS

The prevalent diseases of the central nervous system (CNS) found in decreasing order were: CVDs (71.9%), infections (12.4%), neoplasms (7.1%), head trauma (3.7%), nutritional diseases (2.5%) and degenerative diseases (1.7%). The most common CVDs were cerebral atherosclerosis (61.2%), hypertensive cerebrovascular disease (25.6%) and cerebral infarct (14.9%). There was an increase in prevalence and severity of atherosclerosis and an increase in prevalence of hypertensive cerebrovascular disease with advancing age. A significant association between hypertensive cerebrovascular disease and atherosclerosis was found. The CVDs patients had clinical stroke and this was the direct cause of death in 42,7% and 17,3% of the cases, respectively.

CONCLUSION

The CVDs were the most prevalent group of diseases of the CNS in elderly patients. Atherosclerosis and hypertensive cerebrovascular disease were the most common CVDs, and its prevalence increased with advancing age. Hypertensive cerebrovascular disease was significantly associated with atherosclerosis.