Schlaganfall im höheren Alter – Prävention und Therapie ist in jedem Alter sinnvoll und effektiv

Während sich in der Altersgruppe zwischen 55 und 64 Jahren etwa 2–3 Schlaganfälle pro 1 000 Menschen und Jahr ereignen, liegt die Rate bei den über 85–Jährigen 10–fach höher. Kardiovaskuläre Erkrankungen wie arterielle Hypertonie, Hypercholesterinämie und Diabetes mellitus sind mit einem erhöhten Schlaganfallrisiko assoziiert. Sowohl die Anzahl der Erkrankten als auch die der Neuerkrankungen nimmt mit dem Alter zu. Frühzeitige Therapie und fortwährende konsequente Optimierung können Schlaganfällen vorbeugen. Gleichzeitig können durch die Verhinderung zerebraler Durchblutungsstörungen Entstehung und Progression einer vaskulären Demenz verhindert werden. Sie zählt mit der Alzheimer–Erkrankung zu den häufigsten Demenzformen. Nach bereits stattgehabtem Schlaganfall erleidet etwa 1 von 10 Patienten bereits im 1. Jahr ein Rezidiv. Die Sekundärprophylaxe besteht neben der Behandlung der Risikofaktoren vor allem in der Thrombozytenaggregationshemmung bei atherosklerotisch bedingten Ischämien bzw. in der oralen Antikoagulation bei kardioembolischen Infarkten. Die Akuttherapie des Schlaganfalls kann durch das gerinnselauflösende rtPA (recombinant tissue Plasminogen Activator, Actilyse®) erfolgen. Bislang galt ein Alter von > 80 Jahre aufgrund des erhöhten Blutungsrisikos als Kontraindikation. Neueren Untersuchungen zufolge kann der protektive Effekt von rtPA auch bei älteren Patienten deutlich überwiegen. Gleiches gilt für die Sekundärprophylaxe mit oralen Antikoagulanzien. Der seltene hämorrhagische Schlaganfall (d. h. durch eine Blutung) soll im folgenden Übersichtsartikel nicht abgehandelt werden.

While incidence of stroke in patients 55 to 64 years of age is 2–3 per 1 000 people and per year, this rate is 10fold higher in patients 85 years of age or above. Concomitant cardiovascular diseases, e. g. arterial hypertension, diabetes mellitus and hypercholesterinaemia, increase the risk for stroke. Both prevalence and incidence increase with age. Early treatment and continuous optimisation of these risk factors can prevent stroke. Prevention of cerebro–vascular complications reduces the development and progression of vascular dementia. It is one of the most frequent subtypes of dementia along with Alzheimer's disease. After recent stroke, one out of ten patients is likely to suffer from another event within the first year. Besides treatment of risk factors, secondary prevention mainly consists of platelet aggregation inhibitors after atherosclerotic stroke, and oral anticoagulation after cardio–embolic stroke. For acute therapy of stroke the fibrinolytic drug rtPA (Actilyse®) can be applied. Age above 80 years has been an exclusion criterion so far. However, recent investigations clearly indicate that the protective effect of rtPA may outweigh the bleeding risk. The same can be stated for the secondary stroke prevention with oral anticoagulants. Hemorrhagic stroke will not be discussed in this article.

Key words

Stroke - elderly patients - therapy - prevention

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1 National Institute of Health Stroke Scale

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