Stroke in young age: statistical indicators, issues, and prospects of neuropsychological research

Abstract

Background. The increasing incidence of stroke among young individuals challenges its traditional understanding as of an age-associated disease. The general lack of familiarity with this issue among not only neurologists but also other specialists underscores its importance and indicates that it is understudied. In 15–40% of cases, the cause of stroke in young people remains undetermined. Special scientific interest is directed towards various (including long-term) consequences of cerebrovascular accidents in the young, primarily affecting the cognitive and emotional-personal realms. These consequences are crucial in the context of the patients' working and reproductive age, impacting their quality of life.

Objectives. To review domestic and foreign publications on the problem of stroke at a young age, analyze the available clinical and psychological data and identify promising areas of neuropsychological research on the problem.

Methods. Comparative method, a combination of methods for text analysis, analysis of clinical psychological data.

Results. A review of articles indicates that the first neuropsychological studies of young patients with strokes date back to the 1970s and 1980s. According to scientific publications, younger stroke patients have a better prognosis for physical and cognitive rehabilitation compared to older age groups. Yet, the specifics of cognitive impairments are often noted but not analyzed in depth. However, many studies focus on the issues related to professional and social adaptation of these patients.

Conclusions. Stroke in young individuals features distinct neuropsychological impairments compared to those in older and elderly age groups. These neuropsychological consequences require further research and may relate to the cognitive sphere of individuals. There is a need to standardize methodological approaches in stroke research among young people to improve data comparability and develop more effective diagnostic and treatment methods. Additionally, there is a demand for developing and adapting diagnostic tools that can detect subtle symptoms of cognitive impairments in young patients. This, in turn, will allow for linking specific cognitive deficits to difficulties in professional and social adaptation.

References

Aarnio, K., Siegerink, B., Pirinen, J., Sinisalo, J., Lehto, M., Haapaniemi, E., Nave, A.H., Kaste, M., Tatlisumak, T., Putaala, J. (2016). Cardiovascular events after ischemic stroke in young adults: A prospective follow-up study. Neurology, 86(21), 1872–1879. https://doi.org/10.1212/WNL.0000000000002689

Arnett, J.J. (2000). Emerging adulthood. A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480.

Basso, A., Bracchi, M., Capitani, E., Laiacona, M., Zanobio, M.E. (1987). Age and evolution of language area functions. A study on adult stroke patients. Cortex, 23(3), 475–483. https://doi.org/10.1016/s0010-9452(87)80008-4

Bukhari, S., Yaghi, S., Bashir, Z. (2023). Stroke in Young Adults. Journal of Clinical Medicine, 12(15), 4999. https://doi.org/10.3390/jcm12154999

Cao, M., Ferrari, M., Patella, R., Marra, C., Rasura, M. (2007). Neuropsychological findings in young-adult stroke patients. Archives of Clinical Neuropsychology, 22(2), 133–142. https://doi.org/10.1016/j.acn.2006.09.005

Chung, G.E., Cho, E.J., Yoo, J.J., Chang, Y., Cho, Y., Park, S.H., Han, K., Jeong, S.M., Yoon, K.W., Shin, D.W., Yu, S.J., Kim, Y.J., Yoon, J.-H. (2022). Young adults with nonalcoholic fatty liver disease, defined using the fatty liver index, can be at increased risk of myocardial infarction or stroke. Diabetes, Obesity and Metabolism, 24(3), 465–472. https://doi.org/10.1111/dom.14597

de Bruijn, M.A., Synhaeve, N.E., van Rijsbergen, M.W., de Leeuw, F.E., Jansen, B.P., de Kort, P.L. (2014). Long-term cognitive outcome of ischemic stroke in young adults. Cerebrovascular Diseases, 37(5), 376–381. https://doi.org/10.1159/000362592

Edwards, J.D., Kapoor, A., Linkewich, E., Swartz, R.H. (2018). Return to work after young stroke: A systematic review. International Journal of Stroke, 13(3), 243–256. https://doi.org/10.1177/1747493017743059

Ekker, M.S., Verhoeven, J.I., Vaartjes, I., van Nieuwenhuizen, K.M., Klijn, C.J.M., de Leeuw, F.E. (2019). Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology, 92(21), e2444-e2454. https://doi.org/10.1212/WNL.0000000000007533

Eslinger, P.J., Damasio, A.R. (1981). Age and type of aphasia in patients with stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 44(5), 377–381. https://doi.org/10.1136/jnnp.44.5.377

Gurková, E., Štureková, L., Mandysová, P., Šaňák, D. (2023). Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health and Quality of Life Outcomes, 21(1), 4. https://doi.org/10.1186/s12955-023-02090-5

Ferro, J.M., Crespo, M. (1988). Young adult stroke: neuropsychological dysfunction and recovery. Stroke, 19(8), 982–986. https://doi.org/10.1161/01.str.19.8.982

Ferro, J.M., Massaro, A.R., Mas, J-L. (2010). Aetiological diagnosis of ischemic stroke in young adults. The Lancet Neurology, 9(11), 1085–1096. https://doi.org/10.1016/S1474-4422(10)70251-9

Habib, M., Ali-Chérif, A., Poncet, M., Salamon, G. (1987). Age-related changes in aphasia type and stroke location. Brain and Language, 31(2), 245–251. https://doi.org/0.1016/0093-934x(87)90072-1

Kataeva, N.G., Kornetov, N.A., Karavaeva, E.V., Chistyakova, V.A., Eliseeva, A.M. (2010). Cognitive impairments after stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics, (1), 37–41. (In Russ.)

Kernan, W.N., Ovbiagele, B., Black, H.R., Bravata, D.M., Chimowitz, M.I., Ezekowitz, M.D., Fang, M.C., Fisher, M., Furie, K.L., Heck, D.V., Johnston, S.C., Kasner, S.E., Kittner, S.J., Mitchell, P.H., Rich, M.W., Richardson, de J., Schwamm, L.h., Wilson, J.A. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7), 2160–2236. https://doi.org/10.1161/STR.0000000000000024

Kulagina, I.Yu., Kolyutsky, V.N. (2004). Developmental Psychology: Human Development from Birth to Late Adulthood: Textbook for students of higher education institutions. Moscow: TC Sfera Publ. (In Russ.)

Leppert, M.H., Burke, J.F., Lisabeth, L.D., Madsen, T.E., Kleindorfer, D.O., Sillau, S., Schwamm, L.H., Daugherty, S.L., Bradley, C.J., Ho, P.M., Poisson, S.N. (2022). Systematic Review of Sex Differences in Ischemic Strokes Among Young Adults: Are Young Women Disproportionately at Risk? Stroke, 53(2), 319–327. https://doi.org/10.1161/STROKEAHA.121.037117

Mihayevich, S.A., Skoromets, A.A. (2012). Factors determining the immediate and long-term results of rehabilitation treatment in patients with brain stroke. Patient follow-up 2 and 4 years after rehabilitation treatment. Sovremennye problemy nauki i obrazovaniya = Modern Problems of Science and Education, (1), 24–24. (In Russ.). URL: https://science-education.ru/ru/article/view?id=5362 (accessed: 06.05.2024).

Musolino, R., La Spina, P., Granata, A., Gallitto, G., Leggiadro, N., Carerj, S., Manganaro, A., Tripodi, F., Epifanio, A., Gangemi, S., Di Perri, R., (2003). Ischemic stroke in young people: a prospective and long-term follow-up study. Cerebrovascular Diseases, 15(1-2), 121–128. https://doi.org/10.1159/000067139

Pinter, D., Enzinger, C., Gattringer, T., Eppinger, S., Niederkorn, K., Horner, S., Fandler, S., Kneihsl, M., Krenn, K., Bachmaier, G., Fazekas, F. (2019). Prevalence and short-term changes of cognitive dysfunction in young ischemic stroke patients. European journal of neurology, 26(5), 727–732. https://doi.org/10.1111/ene.13879

Petukhova, A.V., Kovyazina, M.S. (2022). Verbal-logical thinking in young stroke patients (analysis of the Vygotsky-Sakharov methodology). Voprosy psikhologii = Questions of Psychology, 68(4), 113–124. (In Russ.)

Putaala, J., Metso, A.J., Metso, T.M., Konkola, N., Kraemer, Y., Haapaniemi, E., Kaste, M., Tatlisumak, T. (2009). Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke, 40(4), 1195–1203. https://doi.org/10.1161/STROKEAHA.108.529883

Rebchuk, A.D., Kuzmuk, L.E., Deptuck, H.M., Silverberg, N.D., Field, T.S. (2021). Evaluating high-functioning young stroke survivors with cognitive complaints. The Canadian journal of neurological sciences, 49(3), 368–372. https://doi.org/10.1017/cjn.2021.137

Reumers, S.F., Schellekens, M.M., Lugtmeijer, S., Maas, R.P., Verhoeven, J.I., Boot, E.M., Ekker, M.S., Tuladhar, A.M., van de Warrenburg, B.P., Schutter, D.J., Kessels, R.P., van Alebeek, M.E., van Norden, A., Brouwers, P.J.A.M., Arntz, R.M., van Dijk, G.W., Gons, R.A.R., van Uden, I.W.M., den Heijer, T., de Kort, P.L.M., de Laat, K.F., Vermeer, S.E., van Zagten, M.S.G., Wermer, M.J.H., Nederkoorn, P.J., van Rooij, F.G., van den Wijngaard, I.R. (2024). Cognitive impairment in young adults following cerebellar stroke: Prevalence and longitudinal course. Cortex, 178, 104–115. https://doi.org/10.1016/j.cortex.2024.05.021

Samuelsson, H., Viken, J., Redfors, P., Holmegaard, L., Blomstrand, C., Jern, C., Jood, K. (2021). Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery. European journal of neurology, 28(11), 3692–3701. https://doi.org/10.1111/ene.15014

Schöberl, F., Ringleb, P.A., Wakili, R., Poli, S., Wollenweber, F.A., Kellert, L. (2017). Juvenile Stroke. Deutsches Ärzteblatt International, 114(31-32), 527–534. https://doi.org/10.3238/arztebl.2017.0527

Schellekens, M.M., Boot, E.M., Verhoeven, J.I., Ekker, M.S., van Alebeek, M.E., Brouwers, P.J., Arntz, R.M., van Dijk, G.W., Gons, R.A., van Uden, I.W., den Heijer, T., de Kort, P.L.M., de Laat, K.F., van Norden, A., Vermeer, S.E., van Zagten, M.S.G., van Oostenbrugge, R.H., Wermer, M.J.H., Nederkoorn, P.J., van Rooij, F.G., van den Wijngaard, I.R., de Leeuw, F.-E., Kessels, R.P.C., Tuladhar, A.M. (2023). Subacute cognitive impairment after first-ever transient ischemic attack or ischemic stroke in young adults: The ODYSSEY study. European Stroke Journal, 8(1), 283–293. https://doi.org/10.1177/23969873221132032

Sultan, S., Elkind, M.S. (2013). The growing problem of stroke among young adults. Current cardiology reports, 15(12), 421. https://doi.org/10.1007/s11886-013-0421-z

Synhaeve, N.E., Arntz, R.M., Maaijwee, N.A., Rutten-Jacobs, L.C., Schoonderwaldt, H.C., Dorresteijn, L.D., de Kort, P.L., van Dijk, E.J., de Leeuw, F.E. (2014). Poor long-term functional outcome after stroke among adults aged 18 to 50 years: Follow-up of transient ischemic attack and stroke patients and unelucidated risk factor evaluation (FUTURE) study. Stroke, 45(4), 1157–1160. https://doi.org/10.1161/STROKEAHA.113.004411

Tan, S.M.L., Ong, S.H., Yeo, T.T., Nga, V.D.W., Chew, E., Tam, P.K., Su, P., Ng, M.B., Lim, H.S., Yeo, L.L., Sharma, V.K., Sia, Ch.-H., Lim, M.J.R., Tan, B.Y.Q. (2023) Ischemic and hemorrhagic strokes in young adults: Comparison of functional outcomes and return to work after stroke. Clinical Neurology and Neurosurgery, 233, 107964. https://doi.org/10.1016/j.clineuro.2023.107964

Usanova, T.A., Shelpakova, I.N. (2018). Quality of life of patients aged 18 to 50 years with ischemic stroke. Aktual'nye problemy meditsiny = Challenges in Modern Medicine, 41(4), 633–639. (In Russ.). https://doi.org/10.18413/2075-4728-2018-41-4-633-639

Usova, N.N. (2012). Brain infarction in young people. Problemy zdorov'ya i ekologii = Health and Ecology Issues, (1), 23–27. (In Russ.). https://doi.org/10.51523/2708-6011.2012-9-1-4

Weterings, R.P., Kessels, R.P., de Leeuw, F.-E., Piai, V. (2023). Cognitive impairment after a stroke in young adults: A systematic review and meta-analysis. International Journal of Stroke, 18(8), 888–897. https://doi.org/10.1177/17474930231159267

Winstein, C.J., Stein, J., Arena, R., Bates, B., Cherney, L.R., Cramer, S.C., Deruyter, F., Eng, J.J., Fisher, B., Harvey, R.L. Lang, C.E., MacKay-Lyons, M., Ottenbacher, K.J., Pugh, S., Reeves, M.J., Richards, L.G., Stiers, W., Zorowitz, R.D. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), e98–e169. https://doi.org/10.1161/STR.0000000000000098