Mimoun Azizi¹, Franklin Famdie Simo² and Ibrahim Krenawi³*

¹Chief Physician, Senior Consultant Neurologist and Neurogeriatrician, Klinikverbund Südwest, Sindelfingen, Germany
²Chief Physician, Senior Consultant Neurologist and Neurogeriatrician, MEDIAN Frankenpark Klinik, Bad Kissingen, Germany
³Consultant Neurologist, Burjeel Royal Hospital, Al Ain, UAE

*Corresponding Author: Ibrahim Krenawi, Consultant Neurologist, Burjeel Royal Hospital, Al Ain, UAE.

Received: September 29, 2025; Published: October 21, 2025

Abstract

The incidence of cognitive impairment after stroke in the elderly is an emerging issue of public health concern of clinical and socioeconomic significance. This article will address the complicated relationship that exists between the factors contributing to post-stroke cognitive decline, among older adults, including the age-related neurobiological vulnerabilities, presence of atypical stroke, multimorbidity, and polypharmacy. The difficulty of diagnosis and the failure to use evidence-based practices, including thrombolysis, mechanical thrombectomy, and others, are described, as well as the element of fragmented care and narrow geriatric-specific rehabilitation pathways. Moreover, the effects of lack of good functional recovery, institutionalization, and post-stroke depression are highlighted. Based on the recent clinical trials and epidemiological evidence, the article recommends the creation of age-specific methods of diagnosis, best reperfusion strategies, and integrated care models that will also meet the needs of elderly patients. These issues need to be addressed to improve the outcomes and minimize the long-term burden of stroke-related cognitive decline in the aging population. The article ends with the recommendation to undertake specific research and to reform policies in order to address the emerging needs of geriatric stroke care.

Keywords: Stroke in the Elderly; Cognitive Impairment; Post-Stroke Dementia; Geriatric Neurology; Multimorbidity; Polypharmacy; Thrombolysis; Mechanical Thrombectomy; Stroke Rehabilitation; Future Direction of StrokeThis simulation framework offers a translational platform for hypothesis generation, noninvasive biomarker exploration, and virtual testing of early interventions.

References

1. Lim WS., et al. “Forging a frailty-ready healthcare system to meet population ageing”. International Journal of Environmental Research and Public Health12 (2017): 1448.
2. https://www.stroke.org/en/
3. “Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019” 20.10 (2021): 795-820.
4. Satue E., et al. “Incidence and risk conditions of ischemic stroke in older adults”. Acta Neurologica Scandinavica4 (2016): 250-257.
5. Hu X., et al. “Cerebral vascular disease and neurovascular injury in ischemic stroke”. Circulation Research3 (2017): 449-471.
6. Vitt JR., et al. “Multimodal and autoregulation monitoring in the neurointensive care unit”. Frontiers in Neurology14 (2017): 1155986.
7. Kathner-Schaffert C., et al. “Early stroke induces long-term impairment of adult neurogenesis accompanied by hippocampal-mediated cognitive decline”. Cells12 (2019): 1654.
8. Filler J., et al. “Risk factors for cognitive impairment and dementia after stroke: a systematic review and meta-analysis”. The Lancet Healthy Longevity1 (2024): e31-e44.
9. Greenberg SM., et al. “2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association”. Stroke7 (2022).
10. Feigin V. “Abstracts of the 8^th International Conference on Neurology and Epidemiology 2022”. Neuroepidemiology (2022): 56.
11. Zhang F., et al. “Systemic-immune-inflammation index as a promising biomarker for predicting perioperative ischemic stroke in older patients who underwent non-cardiac surgery”. Frontiers in Aging Neuroscience 14 (2022): 865244.
12. Skains RM., et al. “Emergency department programs to support medication safety in older adults: a systematic review and meta-analysis”. JAMA Network Open3 (2025): e250814-e250814.
13. World Stroke Organization (WSO): Global Stroke Fact Sheet (2022).
14. Samaniego EA., et al. “Priorities for advancements in neuroimaging in the diagnostic workup of acute stroke”. Stroke 12 (2023): 3190-3201.
15. Chung KJ. “Improving the Reliability and Accessibility of CT Perfusion Imaging in Acute Ischemic Stroke”. (Doctoral dissertation, The University of Western Ontario (Canada)) (2023).
16. https://www.ncbi.nlm.nih.gov/books/NBK592420/
17. Qin N., et al. “Modulation of mitochondrial dysfunction: Mechanisms and strategies for the use of natural products to treat stroke”. Neural Regeneration Research (2017): 10-4103.
18. Loro A., et al. “Balance rehabilitation through robot-assisted gait training in post-stroke patients: a systematic review and meta-analysis”. Brain Sciences1 (2023): 92.
19. Wang X., et al. “Application of vagus nerve stimulation on the rehabilitation of upper limb dysfunction after stroke: a systematic review and meta-analysis”. Frontiers in Neurology14 (2023): 1189034.
20. Carmichael JP. “Novel Approaches in Rehabilitation after Total Knee Arthroplasty (Doctoral dissertation, University of Colorado Denver, Anschutz Medical Campus) (2021).
21. Forró T., et al. “Dysfunction of the neurovascular unit in ischemic stroke: highlights on microRNAs and exosomes as potential biomarkers and therapy”. International Journal of Molecular Sciences11 (2021): 5621.
22. Bhatia A and Maddox TM. “Remote patient monitoring in heart failure: factors for clinical efficacy”. International Journal of Heart Failure1 (2017): 31.
23. Antonino Francisco., et al. “Wearables and Atrial Fibrillation: Advances in Detection, Clinical Impact, Ethical Concerns, and Future Perspectives”. Cureus 1 (2025): e77404. 
24. Ortiz-Piña M., et al. “Effects of tele-rehabilitation compared with home-based in-person rehabilitation for older adult’s function after hip fracture”. International Journal of Environmental Research and Public Health10 (2021): 5493.
25. Jakovljevic M., et al. “Aging and global health. In Handbook of global health”. Cham: Springer International Publishing (2021).
26. https://www.world-stroke.org/
27. Imran A. “Why addressing digital inequality should be a priority”. The Electronic Journal of Information Systems in Developing Countries3 (2023): e12255.
28. Elizabeth Pirraglia. et al. “Lower mortality risk in APOE4 carriers with normal cognitive ageing”. Scientific Reports (2023).
29. Adcock AK., et al. “Trends in use, outcomes, and disparities in endovascular thrombectomy in US patients with stroke aged 80 years and older compared with younger patients”. JAMA Network Open 6 (2022): e2215869-e2215869.
30. Sorino P. “Leveraging artificial intelligence for enhanced and human-centered healthcare solutions”. (2025).
31. Li J., et al. “Role of Frailty in Predicting Outcomes After Stroke: A Systematic Review and Meta-Analysis”. Front Psychiatry 15 (2024): 1347476.
32. Pan Y., et al. “Frailty and Functional Outcome After Stroke: Meta-analysis”. Age AgeingS2 (2023): afad104.107.
33. Yu L., et al. “Pre-stroke Frailty Predicts 1-Year Mortality and Functional Decline”. Journal of Geriatric Neurology 6 (2022): 447-455.
34. Mugisha S., et al. “Computer-Mediated Therapies for Stroke: Meta-analysis of RCTs”. arXiv Preprint (2024).
35. Saposnik G., et al. “Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation”. Stroke5 (2011): 1380-1386.
36. Rodrigues P., et al. “Design and Evaluation of Virtual Reality-Based Telerehabilitation”. arXiv preprint arXiv (2025): 2501.06899
37. Chen X., et al. “Stem Cell Therapy in Stroke: Meta-analysis of Randomized and Nonrandomized Trials”. Neurorehabilitation and Neural Repair 1 (2024): 22-34.
38. Muir KW., et al. “PISCES-II: Neural Stem Cell Transplantation for Stroke Recovery”. Lancet Neurology 5 (2023): 386-398.

Citation

Citation: Ibrahim Krenawi., et al. “Computational Modeling of Neurovascular Coupling Dysfunction in Early Silent Cerebral Small Vessel Disease: A Proof-of-Concept Study".Acta Scientific Neurology 8.11 (2025): 23-32.

Copyright

Copyright: © 2025 Ibrahim Krenawi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.