It is increasingly appreciated, for example, that subclinical cerebrovascular disease-including so-called “silent infarction” identified on brain imaging in up to 28% of the population over age 65 6, and ischemic white matter disease-is associated with memory loss, dementia, gait impairment, and other functional disability. 3, 5 It is likely that estimates of morbidity and cost burden, moreover, based on studies of clinical stroke and using traditional measures such as physical disability and healthcare costs, underestimate the burden of cerebrovascular disease. The morbidity associated with stroke remains high, with costs estimated at $34 billion per year for healthcare services, medications and missed days of work. Reasons for this remain uncertain, but could reflect the consequences of the obesity epidemic, and associated diabetes. 3, 4 While stroke mortality had decreased in the US over the past two decades, recent trends in mortality indicate that these decreases may have leveled off, and that stroke mortality may even be rising again. 1, 2 The aging of the population, coupled with the reduction in case fatality after stroke, is expected to increase the prevalence of stroke by 3.4 million people between 20. Stroke is the leading cause of long-term adult disability and the fifth leading cause of death in the US, with approximately 795,000 stroke events in the US each year.
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