Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives

Jae-Sung Lim1, Hyung-Min Kwon21Department of Neurology, Armed Forces Seoul Hospital, Seoul, Republic of Korea; 2Department of Neurology, Seoul National University Boramae Hospital, Seoul, Republic of KoreaAbstract: With the increasing size of the elderly population and evolving imaging technology, silent brain infarction (SBI) has garnered attention from both the public and the physicians. Over 20% of the elderly exhibit SBI, and the prevalence of SBI increases steadily with age, ie, 30%–40% in those older than 70 years. Well-known cardiovascular risk factors such as hypertension has been identified as a risk factor of SBI (odds ratio [OR] = 3.47) Besides this, blood pressure (BP) reactivity to mental stress, morning BP surges, and orthostatic BP changes have been demonstrated to contribute to the presence of SBI. Further, a metabolic syndrome not only as a whole syndrome (OR = 2.18) but also as individual components could have an influence on SBI. Increased C-reactive protein and interleukin-6, coronary artery disease, body mass index, and alcohol consumption have also been associated with SBI. The ORs and ­possible mechanisms have been discussed in this article. Overt stroke, dementia, depression, and aspiration pneumonia were all associated with SBI. (overt stroke: hazard ratio [HR] = 1.9, 95% confidence interval [CI]; 1.2–2.8; dementia: HR = 2.26, 95% CI: 1.09–4.70). We also looked into their close relationship with SBI in this review.Keywords: silent brain infarction, elderly, risk factors, treatmen