Stroke and the aging of the brain and the arteries.

Stroke continues to be the third most common cause of death and a major cause of disability among those aged 70 years and older. The risk of stroke doubles for every decade after age 55. It is 25% higher in men. Age, cardiovascular disease, and hypertension are major determinants of cerebral blood flow; all have a negative impact on cerebral reperfusion. The risk of stroke can be reduced at any age by treating and correcting concomitant risk factors: hypertension; heart disease and cardiac arrhythmias (treatment with anticoagulants); transient ischemic attacks (treatment by platelet inhibitors or anticoagulants); and carotid stenosis (by endarterectomy). Cessation of smoking, control of diabetes, reduction of serum lipids, and control of obesity can reduce the risk of stroke. When stroke occurs, early treatment with rt-PA and aggressive patient care results in reduced mortality and morbidity and makes for better neurologic outcomes. Finally, prevention of stroke reduces risk of vascular dementia and makes a better functioning advanced age.