Routine stroke prevention therapies are underused in the very elderly, but could be very effective in this age group. The issues are discussed in a Review published Online First and in the November edition of The Lancet Neurology, Dr Nerses Sanossian and Dr Bruce Ovbiagele, University of Southern California, Los Angeles, CA, USA.

As the average human lifespan increases there are more individuals above the age of 80 years who have a high quality of life. However, these very elderly individuals are particularly susceptible to stroke. Despite substantial advances in stroke research, with several therapeutic drugs able to enhance clinical outcomes in people with stroke or who are at risk of stroke, the very elderly seem to receive fewer vascular protection interventions that have been shown to be effective in their younger counterparts. Although there has been an under-representation of the very elderly in studies of stroke therapy, these treatments might be of benefit to this group of patients. Indeed, emerging data indicate that the use of several of these therapies in routine clinical practice in the very elderly can be effective.

The authors conclude: "With the rapidly growing population of individuals above 80 years, future stroke trials need to include the very elderly to facilitate ready generalisability of results and to convince sceptical clinicians that all patients with stroke should benefit from prompt evidence-based treatment, regardless of age."

A second Lancet Neurology Review discusses epilepsy in later life, and is Professor Martin Brodie, Western Infirmary, Glasgow, UK, and colleagues. They say: "Epilepsy is most likely to develop in later life. The burden of this disorder on health-care resources will rise further as the world's population continues to age."

Despite the rising prevalence and potentially profound physical and psychosocial effects of new-onset epilepsy in elderly people, this disorder has received surprisingly little research focus. There is increasing consensus that future treatment strategies should move beyond symptomatic relief (seizure control) to achieving cure and prevention for those at risk. In line with this goal, the European scientific community has recently identified a number of research priorities. Aspects that are particularly pertinent to the elderly population include preventing the development of epilepsy after brain trauma, translating genetic knowledge to optimise care of patients, reducing the life-burden of seizures, and improving treatment and prognosis.

The authors conclude: "Old age has become the most common time in life to develop epilepsy in high-income societies. Because of the often atypical presentation, concomitant cognitive impairment, and non-specific abnormalities in routine investigations, establishing a correct diagnosis can be particularly challenging. A multispecialty, multi-professional strategy can help to facilitate rapid diagnosis and ensure a comprehensive approach in ameliorating the physical as well as the psychosocial effects of the diagnosis of epilepsy on elderly patients and their families."

An accompanying Lancet Neurology Leading Edge editorial says: "The rapidly increasing elderly population poses a major challenge for future health-care systems. Many of the diseases of old age are neurological disorders, so neurological practice is likely to be disproportionately affected by an ageing society...there is a dearth of clinical trials among older people-indeed, very elderly patients are systematically excluded from many clinical trials. If we are to meet the challenge of caring for rising numbers of elderly patients in the future, more good-quality trials in older people are needed to inform clinical practice."

Link to reviews
Link to editorial

The Lancet Neurology

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