Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1991 Sep 1;145(5):433–443.

Mechanisms and management of stroke in the elderly.

A Shuaib 1, V C Hachinski 1
PMCID: PMC1335826  PMID: 1878825

Abstract

OBJECTIVE: To highlight the mechanisms, common causes and management of stroke in the elderly. DATA SOURCES: MEDLINE was searched for articles published from 1967 to 1990. The following key words were used: "stroke," "cerebrovascular disease," "elderly," "aging," "hypertension," "drug interactions," "etiology," "evaluation," "management" and "recovery of function." Original articles with large series of patients were reviewed in detail. STUDY SELECTION: Of about 750 original articles reviewed 116 were finally selected for detailed analysis. Those that dealt with cause, pathophysiologic features and management of stroke with emphasis on the elderly were chosen. DATA SYNTHESIS: With increasing age the incidence of stroke increases, cardiovascular reserve decreases, catecholamine responsiveness diminishes and cardiac arrhythmias become more common. Blood pressure, especially systolic, rises, and the benefits of its treatment become both more difficult to assess and less certain. In the elderly population embolic stroke, particularly that due to nonvalvular atrial fibrillation, is seen with increasing frequency. Because of postural hypotension, cardiac arrhythmias and overmedication, watershed infarction occurs more frequently with increasing age. Amyloid angiopathy now represents the most common cause of spontaneous intracerebral hemorrhage. CONCLUSIONS: Because of the altered drug metabolism and pharmacodynamics in the elderly the therapeutic armamentarium is growing, and so are the risks of such treatments. Stroke in the elderly poses unique problems that deserve distinctive solutions. Further research is needed to study the effect of cerebral ischemia to understand better how the older brain handles the stress of the ischemic insult.

Full text

PDF
443

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bassi S., Albizzati M. G., Sbacchi M., Frattola L., Massarotti M. Double-blind evaluation of monosialoganglioside (GM1) therapy in stroke. J Neurosci Res. 1984;12(2-3):493–498. doi: 10.1002/jnr.490120232. [DOI] [PubMed] [Google Scholar]
  2. Baughman V. L., Hoffman W. E., Thomas C., Miletich D. J., Albrecht R. F. Neurologic outcome in aged rats after incomplete cerebral ischemia. Anesth Analg. 1988 Jul;67(7):677–682. [PubMed] [Google Scholar]
  3. Bem J. L., Mann R. D., Rawlins M. D. Review of yellow cards--1986 and 1987. Br Med J (Clin Res Ed) 1988 May 7;296(6632):1319–1319. doi: 10.1136/bmj.296.6632.1319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bogousslavsky J., Regli F. Unilateral watershed cerebral infarcts. Neurology. 1986 Mar;36(3):373–377. doi: 10.1212/wnl.36.3.373. [DOI] [PubMed] [Google Scholar]
  5. Brailowsky S., Knight R. T., Efron R. Phenytoin increases the severity of cortical hemiplegia in rats. Brain Res. 1986 Jun 18;376(1):71–77. doi: 10.1016/0006-8993(86)90900-5. [DOI] [PubMed] [Google Scholar]
  6. Böttiger L. E., Furhoff A. K., Holmberg L. Drug-induced blood dyscrasias. A ten-year material from the Swedish Adverse Drug Reaction Committee. Acta Med Scand. 1979;205(6):457–461. [PubMed] [Google Scholar]
  7. Caird F. I., Andrews G. R., Kennedy R. D. Effect of posture on blood pressure in the elderly. Br Heart J. 1973 May;35(5):527–530. doi: 10.1136/hrt.35.5.527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Calderini G., Bellini F., Consolazione A., Dal Toso R., Milan F., Toffano G. Reparative processes in aged brain. Gerontology. 1987;33(3-4):227–233. doi: 10.1159/000212882. [DOI] [PubMed] [Google Scholar]
  9. Camm A. J., Evans K. E., Ward D. E., Martin A. The rhythm of the heart in active elderly subjects. Am Heart J. 1980 May;99(5):598–603. doi: 10.1016/0002-8703(80)90733-4. [DOI] [PubMed] [Google Scholar]
  10. Carter A. B. Hypotensive therapy in stroke survivors. Lancet. 1970 Mar 7;1(7645):485–489. doi: 10.1016/s0140-6736(70)91577-1. [DOI] [PubMed] [Google Scholar]
  11. Castleden C. M., George C. F., Marcer D., Hallett C. Increased sensitivity to nitrazepam in old age. Br Med J. 1977 Jan 1;1(6052):10–12. doi: 10.1136/bmj.1.6052.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Choi D. W., Maulucci-Gedde M., Kriegstein A. R. Glutamate neurotoxicity in cortical cell culture. J Neurosci. 1987 Feb;7(2):357–368. doi: 10.1523/JNEUROSCI.07-02-00357.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Collins K. J., Dore C., Exton-Smith A. N., Fox R. H., MacDonald I. C., Woodward P. M. Accidental hypothermia and impaired temperature homoeostasis in the elderly. Br Med J. 1977 Feb 5;1(6057):353–356. doi: 10.1136/bmj.1.6057.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Coope J., Warrender T. S., McPherson K. The prognostic significance of blood pressure in the elderly. J Hum Hypertens. 1988 Aug;2(2):79–88. [PubMed] [Google Scholar]
  15. Cosgrove G. R., Leblanc R., Meagher-Villemure K., Ethier R. Cerebral amyloid angiopathy. Neurology. 1985 May;35(5):625–631. doi: 10.1212/wnl.35.5.625. [DOI] [PubMed] [Google Scholar]
  16. Cujec B., Polasek P., Voll C., Shuaib A. Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients. Stroke. 1991 Jun;22(6):727–733. doi: 10.1161/01.str.22.6.727. [DOI] [PubMed] [Google Scholar]
  17. Davis S. M., Ackerman R. H., Correia J. A., Alpert N. M., Chang J., Buonanno F., Kelley R. E., Rosner B., Taveras J. M. Cerebral blood flow and cerebrovascular CO2 reactivity in stroke-age normal controls. Neurology. 1983 Apr;33(4):391–399. doi: 10.1212/wnl.33.4.391. [DOI] [PubMed] [Google Scholar]
  18. Denham M. J. Adverse drug reactions. Br Med Bull. 1990 Jan;46(1):53–62. doi: 10.1093/oxfordjournals.bmb.a072394. [DOI] [PubMed] [Google Scholar]
  19. Evans J. G. Blood pressure and stroke in an elderly English population. J Epidemiol Community Health. 1987 Dec;41(4):275–282. doi: 10.1136/jech.41.4.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. FAZEKAS J. F., ALMAN R. W. MAXIMAL DILATATION OF CEREBRAL VESSELS. Arch Neurol. 1964 Sep;11:303–309. doi: 10.1001/archneur.1964.00460210081008. [DOI] [PubMed] [Google Scholar]
  21. Feeney D. M., Gonzalez A., Law W. A. Amphetamine, haloperidol, and experience interact to affect rate of recovery after motor cortex injury. Science. 1982 Aug 27;217(4562):855–857. doi: 10.1126/science.7100929. [DOI] [PubMed] [Google Scholar]
  22. Feeney D. M., Sutton R. L. Pharmacotherapy for recovery of function after brain injury. Crit Rev Neurobiol. 1987;3(2):135–197. [PubMed] [Google Scholar]
  23. Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. 1979 Dec 7;242(23):2572–2577. doi: 10.1001/jama.1979.03300230028022. [DOI] [PubMed] [Google Scholar]
  24. Fleg J. L., Kennedy H. L. Cardiac arrhythmias in a healthy elderly population: detection by 24-hour ambulatory electrocardiography. Chest. 1982 Mar;81(3):302–307. doi: 10.1378/chest.81.3.302. [DOI] [PubMed] [Google Scholar]
  25. Friedman P. J. Atrial fibrillation after stroke in the elderly. Stroke. 1991 Feb;22(2):209–214. doi: 10.1161/01.str.22.2.209. [DOI] [PubMed] [Google Scholar]
  26. Goldstein M. The decade of the brain. Neurology. 1990 Feb;40(2):321–321. doi: 10.1212/wnl.40.2.321. [DOI] [PubMed] [Google Scholar]
  27. Gordon T., Kannel W. B., Castelli W. P., Dawber T. R. Lipoproteins, cardiovascular disease, and death. The Framingham study. Arch Intern Med. 1981 Aug;141(9):1128–1131. [PubMed] [Google Scholar]
  28. Graus F., Rogers L. R., Posner J. B. Cerebrovascular complications in patients with cancer. Medicine (Baltimore) 1985 Jan;64(1):16–35. doi: 10.1097/00005792-198501000-00002. [DOI] [PubMed] [Google Scholar]
  29. Gribbin B., Pickering T. G., Sleight P., Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res. 1971 Oct;29(4):424–431. doi: 10.1161/01.res.29.4.424. [DOI] [PubMed] [Google Scholar]
  30. HARRISON T. R., DIXON K., RUSSELL R. O., Jr, BIDWAI P. S., COLEMAN H. N. THE RELATION OF AGE TO THE DURATION OF CONTRACTION, EJECTION, AND RELAXATION OF THE NORMAL HUMAN HEART. Am Heart J. 1964 Feb;67:189–199. doi: 10.1016/0002-8703(64)90370-9. [DOI] [PubMed] [Google Scholar]
  31. Hoffbrand B. I., Bingley P. J., Oppenheimer S. M., Sheldon C. D. Trial of ganglioside GM1 in acute stroke. J Neurol Neurosurg Psychiatry. 1988 Sep;51(9):1213–1214. doi: 10.1136/jnnp.51.9.1213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Horner J., Massey E. W., Riski J. E., Lathrop D. L., Chase K. N. Aspiration following stroke: clinical correlates and outcome. Neurology. 1988 Sep;38(9):1359–1362. doi: 10.1212/wnl.38.9.1359. [DOI] [PubMed] [Google Scholar]
  33. Hoyer S. Ischemia in aged brain. Gerontology. 1987;33(3-4):203–206. doi: 10.1159/000212877. [DOI] [PubMed] [Google Scholar]
  34. Hurwitz N. Predisposing factors in adverse reactions to drugs. Br Med J. 1969 Mar 1;1(5643):536–539. doi: 10.1136/bmj.1.5643.536. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Hülser P. J., Kornhuber A. W., Kornhuber H. H. Treatment of acute stroke with calcium antagonists. Eur Neurol. 1990;30 (Suppl 2):35–41. doi: 10.1159/000117190. [DOI] [PubMed] [Google Scholar]
  36. JOHNSON R. H., SMITH A. C., SPALDING J. M., WOLLNER L. EFFECT OF POSTURE ON BLOOD- PRESSURE IN ELDERLY PATIENTS. Lancet. 1965 Apr 3;1(7388):731–733. doi: 10.1016/s0140-6736(65)92090-8. [DOI] [PubMed] [Google Scholar]
  37. Jackson G., Pierscianowski T. A., Mahon W., Condon J. Inappropriate antihypertensive therapy in the elderly. Lancet. 1976 Dec 18;2(7999):1317–1318. doi: 10.1016/s0140-6736(76)91970-x. [DOI] [PubMed] [Google Scholar]
  38. Jansen P. A., Gribnau F. W., Schulte B. P., Poels E. F. Contribution of inappropriate treatment for hypertension to pathogenesis of stroke in the elderly. Br Med J (Clin Res Ed) 1986 Oct 11;293(6552):914–917. doi: 10.1136/bmj.293.6552.914. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Jansen P. A., Schulte B. P., Meyboom R. H., Gribnau F. W. Antihypertensive treatment as a possible cause of stroke in the elderly. Age Ageing. 1986 May;15(3):129–138. doi: 10.1093/ageing/15.3.129. [DOI] [PubMed] [Google Scholar]
  40. KETY S. S. Human cerebral blood flow and oxygen consumption as related to aging. J Chronic Dis. 1956 May;3(5):478–486. doi: 10.1016/0021-9681(56)90146-1. [DOI] [PubMed] [Google Scholar]
  41. Kagan A., Popper J. S., Rhoads G. G. Factors related to stroke incidence in Hawaii Japanese men. The Honolulu Heart Study. Stroke. 1980 Jan-Feb;11(1):14–21. doi: 10.1161/01.str.11.1.14. [DOI] [PubMed] [Google Scholar]
  42. Kannel W. B., Gordon T., Dawber T. R. Role of lipids in the development of brain infarction: the Framingham study. Stroke. 1974 Nov-Dec;5(6):679–685. doi: 10.1161/01.str.5.6.679. [DOI] [PubMed] [Google Scholar]
  43. Kertesz A., Black S. E., Nicholson L., Carr T. The sensitivity and specificity of MRI in stroke. Neurology. 1987 Oct;37(10):1580–1585. doi: 10.1212/wnl.37.10.1580. [DOI] [PubMed] [Google Scholar]
  44. Kertesz A., Black S. E., Tokar G., Benke T., Carr T., Nicholson L. Periventricular and subcortical hyperintensities on magnetic resonance imaging. 'Rims, caps, and unidentified bright objects'. Arch Neurol. 1988 Apr;45(4):404–408. doi: 10.1001/archneur.1988.00520280050015. [DOI] [PubMed] [Google Scholar]
  45. Klag M. J., Whelton P. K., Seidler A. J. Decline in US stroke mortality. Demographic trends and antihypertensive treatment. Stroke. 1989 Jan;20(1):14–21. doi: 10.1161/01.str.20.1.14. [DOI] [PubMed] [Google Scholar]
  46. Kuhl D. E., Phelps M. E., Kowell A. P., Metter E. J., Selin C., Winter J. Effects of stroke on local cerebral metabolism and perfusion: mapping by emission computed tomography of 18FDG and 13NH3. Ann Neurol. 1980 Jul;8(1):47–60. doi: 10.1002/ana.410080108. [DOI] [PubMed] [Google Scholar]
  47. LEV M. THE PATHOLOGY OF COMPLETE ATRIOVENTRICULAR BLOCK. Prog Cardiovasc Dis. 1964 Jan;6:317–326. doi: 10.1016/s0033-0620(64)80005-0. [DOI] [PubMed] [Google Scholar]
  48. Lakatta E. G., Gerstenblith G., Angell C. S., Shock N. W., Weisfeldt M. L. Prolonged contraction duration in aged myocardium. J Clin Invest. 1975 Jan;55(1):61–68. doi: 10.1172/JCI107918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Levy M., Kewitz H., Altwein W., Hillebrand J., Eliakim M. Hospital admissions due to adverse drug reactions: a comparative study from Jerusalem and Berlin. Eur J Clin Pharmacol. 1980 Jan;17(1):25–31. doi: 10.1007/BF00561673. [DOI] [PubMed] [Google Scholar]
  50. Marmarou A., Shulman K., Rosende R. M. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg. 1978 Mar;48(3):332–344. doi: 10.3171/jns.1978.48.3.0332. [DOI] [PubMed] [Google Scholar]
  51. McGarry K., Laher M., Fitzgerald D., Horgan J., O'Brien E., O'Malley K. Baroreflex function in elderly hypertensives. Hypertension. 1983 Sep-Oct;5(5):763–766. doi: 10.1161/01.hyp.5.5.763. [DOI] [PubMed] [Google Scholar]
  52. Meissner I., Whisnant J. P., Garraway W. M. Hypertension management and stroke recurrence in a community (Rochester, Minnesota, 1950-1979). Stroke. 1988 Apr;19(4):459–463. doi: 10.1161/01.str.19.4.459. [DOI] [PubMed] [Google Scholar]
  53. Murai A., Tanaka T., Miyahara T., Kameyama M. Lipoprotein abnormalities in the pathogenesis of cerebral infarction and transient ischemic attack. Stroke. 1981 Mar-Apr;12(2):167–172. doi: 10.1161/01.str.12.2.167. [DOI] [PubMed] [Google Scholar]
  54. Myers M. G., Norris J. W., Hachniski V. C., Sole M. J. Plasma norepinephrine in stroke. Stroke. 1981 Mar-Apr;12(2):200–204. doi: 10.1161/01.str.12.2.200. [DOI] [PubMed] [Google Scholar]
  55. Norris J. W., Hachinski V. C. Misdiagnosis of stroke. Lancet. 1982 Feb 6;1(8267):328–331. doi: 10.1016/s0140-6736(82)91580-x. [DOI] [PubMed] [Google Scholar]
  56. Paulson O. B., Lassen N. A., Skinhoj E. Regional cerebral blood flow in apoplexy without arterial occlusion. Neurology. 1970 Feb;20(2):125–138. doi: 10.1212/wnl.20.2.125. [DOI] [PubMed] [Google Scholar]
  57. Pearson A. C., Labovitz A. J., Tatineni S., Gomez C. R. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol. 1991 Jan;17(1):66–72. doi: 10.1016/0735-1097(91)90705-e. [DOI] [PubMed] [Google Scholar]
  58. Petersen P., Boysen G., Godtfredsen J., Andersen E. D., Andersen B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989 Jan 28;1(8631):175–179. doi: 10.1016/s0140-6736(89)91200-2. [DOI] [PubMed] [Google Scholar]
  59. Petersen P., Godtfredsen J. Atrial fibrillation--a review of course and prognosis. Acta Med Scand. 1984;216(1):5–9. doi: 10.1111/j.0954-6820.1984.tb03763.x. [DOI] [PubMed] [Google Scholar]
  60. Petersen P. Thromboembolic complications in atrial fibrillation. Stroke. 1990 Jan;21(1):4–13. doi: 10.1161/01.str.21.1.4. [DOI] [PubMed] [Google Scholar]
  61. Posner J. B., Chernik N. L. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:579–592. [PubMed] [Google Scholar]
  62. Potter J. F., Haigh R. A. Benefits of anti-hypertensive therapy in the elderly. Br Med Bull. 1990 Jan;46(1):77–93. doi: 10.1093/oxfordjournals.bmb.a072396. [DOI] [PubMed] [Google Scholar]
  63. Ramadan N. M., Deveshwar R., Levine S. R. Magnetic resonance and clinical cerebrovascular disease. An update. Stroke. 1989 Sep;20(9):1279–1283. doi: 10.1161/01.str.20.9.1279. [DOI] [PubMed] [Google Scholar]
  64. Ross J. S., Masaryk T. J., Modic M. T., Harik S. I., Wiznitzer M., Selman W. R. Magnetic resonance angiography of the extracranial carotid arteries and intracranial vessels: a review. Neurology. 1989 Oct;39(10):1369–1376. doi: 10.1212/wnl.39.10.1369. [DOI] [PubMed] [Google Scholar]
  65. Schallert T., Hernandez T. D., Barth T. M. Recovery of function after brain damage: severe and chronic disruption by diazepam. Brain Res. 1986 Jul 30;379(1):104–111. doi: 10.1016/0006-8993(86)90261-1. [DOI] [PubMed] [Google Scholar]
  66. Scheinberg P. Controversies in the management of cerebral vascular disease. Neurology. 1988 Oct;38(10):1609–1616. doi: 10.1212/wnl.38.10.1609. [DOI] [PubMed] [Google Scholar]
  67. Shaw T. G., Mortel K. F., Meyer J. S., Rogers R. L., Hardenberg J., Cutaia M. M. Cerebral blood flow changes in benign aging and cerebrovascular disease. Neurology. 1984 Jul;34(7):855–862. doi: 10.1212/wnl.34.7.855. [DOI] [PubMed] [Google Scholar]
  68. Sloan R. W. Alternative first-line therapies in geriatric hypertension. Geriatrics. 1989 Apr;44(4):61-4, 69-72, 74. [PubMed] [Google Scholar]
  69. Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation. 1976 Apr;53(4):720–727. doi: 10.1161/01.cir.53.4.720. [DOI] [PubMed] [Google Scholar]
  70. Strandgaard S., Olesen J., Skinhoj E., Lassen N. A. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. 1973 Mar 3;1(5852):507–510. doi: 10.1136/bmj.1.5852.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Swift C. G. Pharmacodynamics: changes in homeostatic mechanisms, receptor and target organ sensitivity in the elderly. Br Med Bull. 1990 Jan;46(1):36–52. doi: 10.1093/oxfordjournals.bmb.a072393. [DOI] [PubMed] [Google Scholar]
  72. Swift C. G., Swift M. R., Ankier S. I., Pidgen A., Robinson J. Single dose pharmacokinetics and pharmacodynamics of oral loprazolam in the elderly. Br J Clin Pharmacol. 1985 Aug;20(2):119–128. doi: 10.1111/j.1365-2125.1985.tb05041.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Sørensen P. S., Marquardsen J., Pedersen H., Heltberg A., Munck O. Long-term prognosis and quality of life after reversible cerebral ischemic attacks. Acta Neurol Scand. 1989 Mar;79(3):204–213. doi: 10.1111/j.1600-0404.1989.tb03740.x. [DOI] [PubMed] [Google Scholar]
  74. Tanaka H., Ueda Y., Hayashi M., Date C., Baba T., Yamashita H., Shoji H., Tanaka Y., Owada K., Detels R. Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community. Stroke. 1982 Jan-Feb;13(1):62–73. doi: 10.1161/01.str.13.1.62. [DOI] [PubMed] [Google Scholar]
  75. Tregaskis B. F., Stevenson L. H. Pharmacokinetics in old age. Br Med Bull. 1990 Jan;46(1):9–21. doi: 10.1093/oxfordjournals.bmb.a072397. [DOI] [PubMed] [Google Scholar]
  76. Vokonas P. S., Kannel W. B., Cupples L. A. Epidemiology and risk of hypertension in the elderly: the Framingham Study. J Hypertens Suppl. 1988 Nov;6(1):S3–S9. [PubMed] [Google Scholar]
  77. Wallace J. D., Levy L. L. Blood pressure after stroke. JAMA. 1981 Nov 13;246(19):2177–2180. [PubMed] [Google Scholar]
  78. Weisfeldt M. L., Loeven W. A., Shock N. W. Resting and active mechanical properties of trabeculae carneae from aged male rats. Am J Physiol. 1971 Jun;220(6):1921–1927. doi: 10.1152/ajplegacy.1971.220.6.1921. [DOI] [PubMed] [Google Scholar]
  79. Wilking S. V., Belanger A., Kannel W. B., D'Agostino R. B., Steel K. Determinants of isolated systolic hypertension. JAMA. 1988 Dec 16;260(23):3451–3455. [PubMed] [Google Scholar]
  80. Williamson J., Chopin J. M. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing. 1980 May;9(2):73–80. doi: 10.1093/ageing/9.2.73. [DOI] [PubMed] [Google Scholar]
  81. Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987 Sep;147(9):1561–1564. [PubMed] [Google Scholar]
  82. Wollner L., McCarthy S. T., Soper N. D., Macy D. J. Failure of cerebral autoregulation as a cause of brain dysfunction in the elderly. Br Med J. 1979 Apr 28;1(6171):1117–1118. doi: 10.1136/bmj.1.6171.1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Woodhouse K. W., James O. F. Hepatic drug metabolism and ageing. Br Med Bull. 1990 Jan;46(1):22–35. doi: 10.1093/oxfordjournals.bmb.a072387. [DOI] [PubMed] [Google Scholar]
  84. Yatsu F. M., Hart R. G., Mohr J. P., Grotta J. C. Anticoagulation of embolic strokes of cardiac origin: an update. Neurology. 1988 Feb;38(2):314–316. doi: 10.1212/wnl.38.2.314. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES