Year: 2026
Type: editorial
Abstract: existing cognitive impairment (PreCI) and vulnerability in acute stroke care. PreCI frequently co-exists with physical frailty and vascular comorbidities, resulting in a complex clinical profile that might influence hyperacute decision-making and long-term recovery [8].Even though the age-standardised death rates and disability-adjusted life years rates declined over the 30 years, absolute stroke deaths and disability-adjusted life years continuously rose due to rapid population ageing and metabolic disease expansion. A possible speculation is that PreCI correlates with greater baseline stroke severity, higher rates of acute complications, lower functional recovery, reduced survival, and a significantly higher rate of permanent institutionalisation.As part of the assessment of frail patients, it is important to evaluate certain biomarkers that can help determine their prognosis. One of these is sarcopenia. In this context, evaluating two retrospective cohorts -152 ischemic stroke patients undergoing EVT and 322 patients with spontaneous intracerebral haemorrhage -two studies demonstrated a consistent pattern regarding temporalis muscle thickness (TMT). While TMT-assessed sarcopenia initially correlated with poorer functional outcomes (higher mRS scores) and higher mortality in unadjusted analyses across both groups, it lost statistical significance following multivariable adjustment. These congruent results could suggest that while cranial muscle thinning highlights a vulnerable patient phenotype, TMT-assessed sarcopenia functions primarily as a marker of advanced age and comorbidity burden rather than an independent driver of post-stroke disability [9,10].Baseline frailty, evaluated in one study through a 32-item Frailty Index), was not associated with 6-month cognitive recovery; instead, male sex, higher baseline Montreal Cognitive Assessment (MoCA) scores, and thalamic lesions were identified as independent predictors of favourable cognitive recovery [8].When looking for factors that can help to predict the prognosis of frail patients, one important issue is post-stroke dysphagia: it independently drives poor outcomes in the oldest-old, highlighting the critical value of frailty screening during hyperacute care planning [11].Further interesting biomarkers are linked to the individual nutritional status and reserves, and the level of inflammation Of note, an elevated admission C-reactive protein/albumin ratio (CAR) independently predicted higher mortality in elderly patients with post-stroke dysphagia, though serum albumin alone offers comparable prognostic utility [12].Multivariable models can provide prognostic information in elderly stroke patients: in this regard, five independent risk factors (hemorrhagic stroke subtype, advanced age, hypoalbuminemia, elevated leukocyte count, and low ADL scores) were identified to predict pressure injuries during stroke recovery [13].Social frailty was significantly tied to Activities of Daily Living (ADL), depression, social support, language impairment, and stroke recurrence. To achieve an improvement in these patients, it seems necessary to highlight the need for targeted interventions focusing on depression management, ADL rehabilitation, and social support expansion.In search of biomarkers that are correlated with prognosis, some authors have suggested that serum iron exhibits a threshold effect on post-stroke functional recovery, and that its correction may be critical for preserving independence in daily activities. Moreover, the hemoglobin-tohematocrit ratio ratio exhibited a non-linear association with 3-month prognosis in acute ischemic stroke, highlighting the potential value of hemorheological balance monitoring for risk stratification [13].Finally, there are expectations for the application of artificial intelligence. For example, machine learning could be helpful to identify those patients who may not benefit from endovascular treatment [14].In conclusion, there are currently promising biomarkers and factors associated with the prognosis of frail stroke patients. To bridge remaining gaps in knowledge, future research must prioritize inclusive clinical trials, prospective multi-center registries, biomarker validation and advanced machine learning models evaluating acute effective revascularization response across stratified frailty, cognitive, and radiomic classes.Translating these prognostic insights into dedicated clinical guidelines will ensure that therapeutic decisions in older stroke patients are evidence-based, equitable, and aligned with individual functional reserve.
Source: Frontiers in Neurology
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223295579