Abstract Background and aims In recent decades, a trend toward stroke onset at a younger age has been increasingly reported. Acute ischemic stroke in middle-aged individuals represents a significant socioeconomic burden due to high disability rates in the working population. Understanding age-related differences in neurological manifestations may improve early diagnosis, severity assessment, and individualized treatment strategies. Methods A total of 140 patients with acute ischemic stroke were examined. Patients were divided into three age groups: middle-aged (44–59 years), elderly (60–74 years), and senile (75–85 years). Neurological status was assessed during the acute phase, focusing on cerebral and focal neurological symptoms. The frequency and severity of clinical syndromes were analyzed and compared across age groups. Results Middle-aged patients demonstrated a milder clinical course compared with elderly and senile groups. Hemiparesis was observed in 33.9% of middle-aged patients versus 78.5% and 95.2% in elderly and senile groups, respectively. Speech disorders occurred in 42.4% of middle-aged patients, increasing significantly with age. Cerebellar symptoms and general cerebral manifestations were common across all groups but were more pronounced in older patients. The severity and frequency of focal neurological deficits showed a clear positive correlation with age. Conclusions Acute ischemic stroke in middle-aged patients is characterized by less severe neurological deficits compared with older age groups. Age significantly influences the pattern and severity of focal neurological symptoms. Careful neurological assessment remains a valuable tool for lesion localization and severity evaluation and may guide timely, targeted therapy, particularly in the working-age population. Conflict of interest Nothing to disclose
Asadullayev et al. (Fri,) studied this question.