Lacunar infarcts in patients aged 85 years and older

Objectives - To compare the occurrence of lacunar infarcts in the very elde rly (greater than or equal to 85 years of age) and in patients below 85. Ma terial and methods - Data of 374 consecutive patients with lacunar infarcts were collected from a prospective hospital-based stroke registry in which 2000 patients are included. Distinctive clinical features of lacunar infarc t in the very elderly were assessed by multiple logistic regression analysi s. Results - Lacunar infarcts were diagnosed in 39 (15%) of the 262 very el derly patients of our stroke registry. Lacunar infarcts in the very elderly accounted for 10.5% of all lacunes. There was no statistical difference in the occurrence of different lacunar syndromes between the very elderly pat ients and patients below 85. However, the very old group with lacunar infar ct showed a significantly higher proportion of the female sex (56.4% vs 37. 3%) and history of atrial fibrillation (28.2% vs 8.7%), chronic renal disea se and pathologic condition and a significantly lower proportion of hyperte nsion (61.5% vs 77.3%), diabetes (7.7% vs 28.4%), ischemic heart disease, h ypercholesterolemia, and absence of neurologic deficit at discharge from th e hospital than patients below 85. After multivariate analysis only atrial fibrillation (OR = 3.77), female gender (OR = 2.52), hypertension (OR = 0.3 5), and diabetes (OR = 0.16) were independent clinical factors for developi ng lacunar infarction in the very elderly. Conclusion - In the very elderly the higher occurrence of atrial fibrillation, the lower prevalence of hype rtension and diabetes, and the greater focal neurological impairment sugges t that the cardioembolic pathogenetic mechanisms may be more frequent than generally established for lacunar infarcts in stroke patients.