Nandakumar Nagaraja, MD

Previous studies have reported a decrease in the incidence of stroke in high income countries and doubling of stroke incidence in the low to middle income countries. Rosengre and colleagues conducted a study to evaluate the trends in the incidence of ischemic stroke in Sweden over a period of 24 years from 1987 – 2010. 
The authors found that there has been a continuous increase in the incidence of stroke in younger patients aged 18-44 years at a rate of 1.3% for men and 1.6% for women. However, the stroke incidence was declining in patients aged 45-64 years and it was more pronounced in the 65-84 years age group. Mortality from ischemic strokes decreased markedly in all age groups.
The decline in the incidence of ischemic stroke in patients ≥ 45 years were attributed to the better control of stroke risk factors such as hypertension and smoking cessation. The steady increase in the incidence of stroke in the younger population is concerning. The authors attribute this to the increase in the incidence of obesity, sedentary life style, smoking and heavy drinking in patients aged 18-44 years. 
Stroke in young adults is less common and many of these patients are evaluated for uncommon causes of stroke such as hypercoaguable conditions, certain genetic disorders etc. However, with the changing life style and increasing incidence of stroke risk factors such as diabetes, obesity, hypercholesterolemia and hypertention at a younger age it is important to recognize these modifiable conditions early and treat appropriately to prevent strokes. Awareness among the younger population about the risk factors of stroke and their early detection and management may help in reducing the incidence of stroke in this age group. 
Based on recent reports about 14% of strokes are missed in younger patients presenting to the emergency department with acute neurological symptoms of stroke. Because stroke is considered to be a disease of the older age group it is less commonly suspected when younger patients present to the ER with acute neurological symptoms. Similarly there may be some neglect among the younger population and also physicians caring for them not to recognize the importance of controlling the risk factors as they do so in the older age groups.