Atsushi Araki and Hideki Ito
The increased risk of stroke with old age cannot be entirely explained by conventional risk factors, such as
hypertension, diabetes, smoking, and hyperlipidemia. Incident stroke has also been associated with depression,
other negative feelings, or stressors, like life events, disabilities, and earthquakes; in contrast, protective
psychological factors against stressors that include optimism, positive coping style, positive attitude toward aging,
and a sense of coherence have been associated with a reduced incidence of stroke. Thus, enhancing protective
psychological factors may be an advantageous approach to preventing the development of stroke. However, further
studies are necessary to understand the mechanism by which psychological factors influence the risk of stroke
and atherosclerosis. Sense of coherence reflects the ability to cope with psychological stress and to tailor life style
choices for the promotion of health; thus, improving an individual’s sense of coherence could impact on their life-style
choices such as exercise, diet, and psychological approaches to stress, which in turn may contribute towards the
prevention of stroke in the elderly.