Implications of age-related changes in the blood-brain barrier for ischemic stroke and new treatment strategies

Ischemic strokes are prevalent across all age groups. Recent research has highlighted the importance of better understanding ischemia-induced damage of the blood-brain barrier (BBB) because it is related to both the severity of ischemic injury and neurological outcomes. The influence of advancing age on the structure and function of the BBB and the potential influence of these changes on ischemic stroke injury have received little consideration to date. Therefore, the present review outlines how ischemic injury influences the structure and function of the BBB at the anatomical, cellular, and molecular levels, and how these changes differ between adult and elderly populations with and without age-related comorbid diseases. This review further discusses how age-dependent changes and features of the BBB, and the corresponding alterations in response to ischemia, can affect the efficacy and delivery of current and future treatment options. Current research efforts are underway to develop prospective stroke treatment strategies that target the restoration of BBB functionality. This review also discusses the importance of considering the unique properties and characteristics of the BBB in elderly individuals for developing new stroke treatment strategies.