Epidemiology of Stroke in the Elderly in Thailand
ADULYA VIRIYAVEJAKUL, M.D., F.R.C.P.*, VORAPAN SENANARONG, M.D., M.R.C.P.(UK).*, NARAPORN PRAYOONWIWAT, M.D.*, RUNGNIRUND PRADITSUWAN, M.D.*, RUNGS AN CHAISEVIKUL, M.D.*, NIPHON POUNGV ARIN, M.D., F.R.C.P. *
Affiliation : * Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700.
Abstract
Epidemiology of stroke in the elderly in Thailand was conducted from August 1994 to
October 1996. The total of 3,036 Thai elderly were included in this study. They represented the
elderly population from four regions; Central Region (615 elderly, Nakhon Path om Province),
Northern Region (840 elderly, Lampang Province), North-Eastern Region (706 elderly, Sakon
Nakhon Province), and Southern Region (857 elderly, Ranong Province). All elderly in these
selected areas received general physical examinations and complete neurological examinations
from neurologists. Demographic data concerning each individual was recorded by specially
trained nurses. Data included age, sex, occupation, education, drug usage, alcohol, smoking and
pre-existing diseases. Blood was taken from each subject for complete blood count, fasting blood
sugar, cholesterol, triglyceride, high density lipoprotein cholesterol and VDRL. Data on physical
examinations were recorded with particular attention to blood pressure, carotid bruit, cardiac
murmurs, cardiac arrhythmia, speech, posture, gait, frontal lobe releasing signs, Babinski sign
and focal neurological deficit.
Thirty-four stroke patients were identified from 3,036 elderly (prevalence rate of 1.12
per cent). There were 12 stroke patients from Central Region (prevalence rate of 1.99 per cent).
5 from Northern Region (0.6 per cent), 4 from North-Eastern Region (0.6 per cent) and 13 from
Southern Region ( 1.5 per cent). Hypertension was the main risk factor for stroke in this study
whereas diabetes mellitus, smoking, alcohol consumption, hyperlipidemia and underlying heart
diseases were insignificant risk factors. The prevalence of hypertension in Thai elderly was
ranging from 16.7 to 47.2 per cent (criteria over 140/90 mmHg) or 6.1 to 24.8 per cent (criteria
over 160/90 mmHg). Prevalence of smoking and alcohol consumption in Thai elderly ranged
form 19.5 per cent (Sakon Nakhon) to 62.1 (Lampang) and 16.75 per cent (Nakhon Pathom) to 33.70
per cent (Lampang) respectively. Data from physical examinations revealed that dysarthria,
hemiplegic gait and Babinski sign were the significant signs for diagnosis of stroke in the com-
munity setting. The prevalence of carotid bruit, cardiac murmur and cardiac arrhythmia were
ranging from 1.3 to 1.8 per cent, 3.1-7.1 per cent and 0.8-1.4 per cent respectively.
From this study, it can be concluded that stroke prevention is the best policy for stroke
management. Stroke prevention measures should thus be aimed at the high risk elderly group.
This is best achieved by identifying risk factors among them and then controlling these risk
factors properly.
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