It is proposed to extend the prospective findings of the Framingham Study on stroke to 30 years of follow-up, including the age groups 75-84 years and to examine a number of possible precursors for which there has been too little follow-up. These include the role of: arrhythmias as determined by one hour ECG monitoring; echocardiographic findings of valvular and myocardial dysfunction; lipid profiles including LDL and HDL cholesterol; physical activity status; menopausal status; psychosocial factors including Type A personality; carotid bruit; Ecolyzer confirmed smoking histories and, glucose tolerance based on a glucose load; among others. Further studies of asymptomatic carotid bruits will be carried out by analyzing the continuous wave Doppler signal for its direction, mean frequency, and frequency content, as they are found at selected moments in the cardiac cycle, over the carotid arteries in the neck, and phonoangiography of carotid bruit in an attempt to identify those bruits which are true precursors of stroke. A more accurate delineation of the type of stroke will be accomplished using CT scan information in addition to clinical findings. This should permit better definition of the frequency of different types of stroke and a more accurate determination of the epidemiologic features of each type. The stroke, its precursors and diability will be pursued focusing particularly in the elderly. Functional assessment of the patients; activities of daily living will be made at the time of stroke, and 3, 6, and 12 months later. Scores on recently standardized tests scales of activities of daily living - feeding, dressing, grooming, bathing, etc; assessments of function in the home and in society; and, the use of aids and appliances following stroke will be obtained by a rehabilitation nurse. These data will permit detailed evaluation of disability following stroke in a general population sample. An attempt will be made to devise a more powerful predictive stroke risk profile using those ingredients identified above as independent contributors to stroke incidence. The decline in mortality rates from stroke has accelerated in recent years. Secular trends in incidence by stroke type will require more cases occurring over time and should be available as a by product of this proposal.
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