Do you know what is stroke and what its consequence is

A stroke is nothing but a brain attack that can happen to anyone at any time and can occur when blood flow to an area of brain is cut off.

A stroke is a brain failure or the brain attack. When this happens in brain, the brain cells are deprived of oxygen and begin to die immediately. When brain cells die when stroke happens, the abilities controlled by that area of the brain such as memory and muscle control are lost. How a person is affected by stroke depends on where the stroke occurs in the brain and how much the brain is damaged. Suppose if someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg.

According to our recent research at www.newspsychology.com it is seen that people who have larger strokes may be permanently paralyzed on one side of their body or lose their speaking ability. Some people recover completely from strokes, however, more than 2/3 of survivors will have some type of disability. We researched extensively for you and found the following results:

  • Each year nearly 800,000 people experience a new stroke,
  • In the world stroke is the fifth leading cause of death,
  • In every 4 minutes someone dies from stroke,
  • More than 80 percent of strokes can be prevented,
  • It is the leading cause of adult disability etc.

The different forms of stroke have different causes like-

  • Ischemic strokes- caused by the arteries that connect to the brain becoming blocked or narrowed,
  • Hemorrhagic strokes- caused by arteries in the brain either leaking blood or bursting open,

Transient ischemic attack- the flow of blood to the brain is only disrupted.

Screening for post-stroke depression inadequate and inconsistent, study finds

Physicians are prescribing anti-depressants for stroke patients without first giving them a proper diagnosis, they are over-treating some patients, and overlooking others, according to a study presented October 1 at the Canadian Stroke Congress.

"A lot of people are being treated for depression, but we don't know if they're the right ones," says lead researcher Ms. Katherine Salter of Parkwood Hospital in London, Ontario. "This study found that 40 per cent of stroke patients were treated for depression, but most were not screened or diagnosed. Who are we treating?"

Researchers examined medical charts for 294 patients discharged from five in-patient rehabilitation programs in southwestern Ontario over a six-month period beginning in September 2010. Only three of 294 patients given an antidepressant were formally screened, assessed and diagnosed with depression first. However, 40 per cent of all patients, whether or not they were screened or assessed for the condition, received treatment for depression.

Depression is the most common mental health issue following stroke, affecting more than a quarter of all stroke patients. Depression may affect a patient's ability to participate in post-stroke therapy and is associated with slower progress in rehabilitation and longer stay in hospital.

Researchers found that 100 per cent of patients who had already been taking an antidepressant at the time of their admission to in-patient rehabilitation still received one at the time of their discharge, largely without being reassessed. "No matter what the best practice recommendations say, if you're on an antidepressant when you show up, you will not likely be screened or assessed, but you will be given more drugs," says Ms. Salter.

Conversely, the lack of formal screening and assessment for depression means that stroke patients without a history of depression or other mental illness could be overlooked for treatment.

According to the study, patients with a previous history of psychiatric illness and those with severe impairments from their stroke are more likely to receive antidepressants.

Ms. Salter emphasizes that Canadian Best Practice Recommendations for Stroke Care call for clear and formal steps in the diagnosis and treatment of depression.

"Depression is a serious problem for people with stroke. We need to make sure that everyone who needs treatment for depression is receiving the right help," says neurologist Dr. Michael Hill, Co-Chair of the Canadian Stroke Congress.

Lack of access to mental health care professionals, as well as "some inertia" by clinicians reluctant to change their practice, may be to blame for the failure to screen patients properly, says Ms. Salter. "We need to be able to include psychological resources as part of our health care team. These professionals should be a central, integrated part of recovery."

"Screening for depression after all strokes could result in more positive outcomes for patients and their families," says Ian Joiner, the director of stroke for the Heart and Stroke Foundation. "With screening, those who would benefit from specialized medication, counselling and referral to other health professionals won't be missed."

Hidden stroke impairment leaves thousands suffering in silence

Most people are completely unaware of one of stroke's most common, debilitating but invisible impairments, according to the first awareness survey of its kind in Canada released October 1 at the Canadian Stroke Congress.

Thirty community volunteers trained by the York-Durham Aphasia Centre, a March of Dimes Canada program, collaborated with researchers from two Ontario universities in a survey of 832 adults in southern Ontario. They found that only two per cent of respondents could correctly identify aphasia as a communication disorder affecting the ability to speak, understand, read or write.

The survey team recommends a national education campaign to promote awareness of aphasia and to increase the availability of speech-language therapy, knowledge of supportive communication strategies, as well as long-term programs and services available to people who live with this chronic communication disability.

"Aphasia is poorly understood," says neurologist Dr. Michael Hill, Co-Chair of the Canadian Stroke Congress. "The sudden loss of language after a stroke creates huge challenges for individuals and their families."

As many as 100,000 Canadians are living with chronic aphasia.

"About one third of all people who have strokes experience some degree of aphasia but despite this high prevalence, it just doesn't get much attention," says Rick Berry, project coordinator, who worked with clinical coordinator and speech-language pathologist Ruth Patterson on the survey. "We wanted to gather some Canadian data to compare with surveys that have been done in other countries."

Aphasia occurs when there is stroke damage to language and communication centres in the brain. It does not affect intelligence but can leave people unable to express themselves, find their words and respond when spoken to. Sometimes people with aphasia repeat what has been said to them, get stuck on words or misuse words. As a result of their communication disabilities, they are prone to isolation and depression.

"The public isn't familiar with communication problems, so they often mistake aphasia for intellectual impairment," says Elizabeth Rochon, co-author of the survey and Associate Professor of Speech-Language Pathology at the University of Toronto. "The lack of awareness is devastating to people with aphasia and their families."

The aphasia survey was conducted in public places in the Toronto area, including beaches, libraries, parks, bus stations and shopping centres. Survey respondents were between ages 18 and 90.

The research team found:

  • 32 per cent of people surveyed had heard the word "aphasia";
  • Only two per cent correctly identified aphasia as a communication disorder affecting speaking, reading, writing and understanding; and
  • In contrast, among those who had not heard of aphasia, 89 per cent had heard of stroke.

"Aphasia can be a frustrating barrier to recovery following a stroke," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. He says that caregivers, patients and even medical professionals need to be aware of and better understand aphasia so that people can be referred to and access much needed supports like speech-language pathologists, assistive devices and support groups.

Diet high in total antioxidants associated with lower risk of myocardial infarction in women

 Coronary heart disease is a major cause of death in women. A new study has found that a diet rich in antioxidants, mainly from fruits and vegetables, can significantly reduce the risk of myocardial infarction.

The study is published in the October issue of The American Journal of Medicine.

"Our study was the first to look at the effect of all dietary antioxidants in relation to myocardial infarction," says lead investigator Alicja Wolk, DrMedSci, Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. "Total antioxidant capacity measures in a single value all antioxidants present in diet and the synergistic effects between them."

The study followed 32,561 Swedish women aged 49-83 from September 1997 through December 2007. The women completed a food-frequency questionnaire in which they were asked how often, on average, they consumed each type of food or beverage during the last year. The investigators calculated estimates of total antioxidant capacity from a database that measures the oxygen radical absorption capacity (ORAC) of the most common foods in the United States (no equivalent database of Swedish foods exists). The women were categorized into five groups of total antioxidant capacity of diet.

During the study, 1,114 women suffered a myocardial infarction. Women in the group with the highest total antioxidant capacity had a 20% lower risk, and they consumed almost 7 servings per day of fruit and vegetables, which was nearly 3 times more than the women with the least antioxidant capacity, who on average consumed 2.4 servings.

Dr. Wolk notes that trials testing high doses of antioxidant supplements have failed to see any benefit on coronary heart disease and, in fact, in one study higher all-cause mortality was reported. "In contrast to supplements of single antioxidants, the dietary total antioxidant capacity reflects all present antioxidants, including thousands of compounds, all of them in doses present in our usual diet, and even takes into account their synergistic effects," she explains.

In a commentary accompanying the article, Pamela Powers Hannley, MPH, Managing Editor of The American Journal of Medicine, observes that with the industrialization of our food supply, Americans began to consume more total calories and more calories from processed food high in fat and sugar. As a result, obesity rates began to climb steadily. "Although weight-loss diets abound in the US, the few which emphasize increasing intake of fruits and vegetables actually may be on the right track," she says. "Yet only 14% of American adults and 9.5% of adolescents eat five or more servings of fruits or vegetables a day."


Journal References:

  1. Susanne Rautiainen, Emily B. Levitan, Nicola Orsini, Agneta Åkesson, Ralf Morgenstern, Murray A. Mittleman, Alicja Wolk. Total Antioxidant Capacity from Diet and Risk of Myocardial Infarction: A Prospective Cohort of Women. The American Journal of Medicine, 2012; 125 (10): 974 DOI: 10.1016/j.amjmed.2012.03.008
  2. Pamela Powers Hannley. Back to the Future: Rethinking the Way We Eat. The American Journal of Medicine, 2012; 125 (10): 947 DOI: 10.1016/j.amjmed.2012.07.012

Rehabilitation robots uncover stroke disabilities and improve care

— When it comes to stroke rehabilitation, it takes a dedicated team to help a person regain as much independence as possible: physicians, nurses, physiotherapists, occupational therapists, speech-language pathologists, recreation therapists, caregivers and others. Now, a University of Calgary research team has added a robot to help identify and customize post-stroke therapy.

Rehabilitation robots improve detection of post-stroke impairments and can enhance the type and intensity of therapy required for recovery, according to a study presented October 1 at the Canadian Stroke Congress.

Researchers studied 185 subjects — 87 recovering from stroke and 98 people unaffected by stroke — and found that tests using a robot better measure patients' sense of limb position, speed and direction of limb movement. Patients were assessed approximately 15 days after stroke.

"For years, therapists have known that limb awareness is very important to predicting a person's outcomes after stroke. Yet we have never before been able to quantify it," says lead researcher Dr. Sean Dukelow. "Identifying these deficits opens the door to the next step: how do we treat it?"

Until now, rehabilitation experts have relied on their judgment and subjective rating scales to assess impairment after stroke. Robotic technology standardizes these measurements.

"Awareness and control of our limbs' location allows us to do everyday things like reach for a coffee cup while watching television," Dr. Dukelow says.

In the Calgary study, a robotic frame moved each patient's stroke-affected arm at a preset speed and direction while they attempted to mirror its movement with their unaffected arm. Participants were not able to rely on their vision for assistance.

Dr. Dukelow and his team found:

  • 20 per cent of the stroke patients failed to acknowledge that the robot had moved their affected arm;
  • 70 per cent of stroke patients took significantly longer to react to the robot's movements;
  • 78 per cent of stroke patients had significantly impaired sense of movement direction; and
  • 69 per cent had diminished ability to match movement speed.

"Impaired limb function is a serious problem for people with stroke," says Dr. Mark Bayley, Co-Chair of the Canadian Stroke Congress and Medical Director of the Neurological Rehabilitation Program at Toronto Rehab. "It can prevent people from performing small daily tasks that give them some measure of independence."

The final goal of precise assessment is more patient-specific treatment, a concept Dr. Dukelow calls "personalized medicine." Ideally, robotics will be used to guide patients through the repetitive movements and personalized treatment plans required to remap the brain and restore function.

"Rehabilitation is an important part of recovering from stroke," says Ian Joiner, the director of stroke for the Heart and Stroke Foundation, who is also a physiotherapist. "Robotic technology is very useful supplement to traditional rehab. The end result — the one we're all working toward — is better patient care and improved recovery."

The Canadian Stroke Congress is co-hosted by the Canadian Stroke Network, the Heart and Stroke Foundation and the Canadian Stroke Consortium.

Home-based stroke therapy improves outcomes, eliminates wait times, saves money, study suggests

 Home delivery of stroke rehabilitation improves care, eliminates waiting lists for treatment and saves hundreds of thousands of dollars annually in hospital costs, according to a quality improvement project presented October 1 at the Canadian Stroke Congress.

Early Supported Discharge, introduced as a permanent part of the Calgary Stroke Program in 2011, has resulted in equally good or better cognition, communication and physical function for people who receive therapy in their own homes as opposed to in a hospital or facility.

Not only that, the program has helped to virtually eliminate waiting lists for inpatient stroke therapy in Calgary, reduced lengths of stay in inpatient rehabilitation by an average 12 days, and saved approximately $1 million in the first year.

The 160 Calgary residents who received therapy in their homes for an average of five weeks following stroke saw significant improvements in knowledge use, upper limb use, domestic life and interpersonal interactions. All participants said they would recommend this approach to other people with stroke.

The program "blurs the boundaries between different disciplines providing care," including occupational therapy, physical therapy, recreation therapy, speech-language pathology, social work and nursing, says project lead Darren Knox, Unit Manager of the Calgary Stroke Program. Individualized therapy takes place three to five times a week for up to eight weeks.

The Calgary team focuses on skills involved in activities meaningful for daily living in the community. For example, a client's goal of visiting the local coffee shop requires work on walking and route-finding, cognitive skills involved in money management and the language necessary for ordering a beverage.

"Addressing multiple areas of care every day keeps the person with stroke interested and motivated, which leads to a higher intensity of care, better carry-over from rehabilitation to real life, and faster improvements in a shorter period of time," Knox says.

"Providing people with therapy in their own homes or community is very effective," says neurologist Dr. Michael Hill, Co-Chair of the Canadian Stroke Congress. "By sending the person with stroke home and bringing rehabilitation to them, a more personalized approach to health care is being delivered with excellent results."

"This program demonstrates the benefits of focusing on clients' individual needs and aspirations following stroke," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Imagine the savings to the health care system if similar programs were made available to all Canadians."

The Canadian Stroke Congress is co-hosted by the Canadian Stroke Network, the Heart and Stroke Foundation and the Canadian Stroke Consortium.

Many emergency programs get failing grade when it comes to stroke training, Canadian research suggests

— Medical residents training to work in the emergency department need more formal stroke training, says a study presented October 1 at the Canadian Stroke Congress, noting that, as the first point of contact in stroke care, they see nearly 100 per cent of stroke patients taken to hospital.

Researchers surveyed 20 emergency medicine residency programs across Canada and found that very limited lecture time and mandatory on-the-job training are devoted to stroke and neurological care.

Only two of 20 emergency medicine residency programs required on-the-job training in stroke neurology. The major benefits of on-the-job training are more practical experience with stroke and more thorough training by specialists in the field.

"The treatment of stroke and TIA — transient ischemic attack or 'mini-stroke' — has changed dramatically over the last 15 years," says Dr. Devin Harris, lead researcher of the study and staff emergency physician at St Paul's Hospital in Vancouver. "We need to meet these challenges."

He recommends that emergency residency programs include more stroke training to match the prevalence of stroke and the growing number of time-sensitive treatments.

Without supplementary training in stroke, emergency physicians may take longer to diagnose stroke and administer clot-dissolving drugs. "If you can intervene after a TIA with drugs that block the formation of blood clots and tests to detect irregular heartbeat, you can prevent stroke," says Dr. Harris.

Researchers found:

  • Three of 20 emergency medicine residency programs had compulsory on-the-job training in general neurology, compared to mandatory cardiology training in 19 out of 20 programs;
  • Only five of 20 programs offered training electives in general or stroke neurology; and
  • Only one of 20 programs offered on-the-job training in radiology or neuroradiology.

The study also found that less than two per cent of lecture time per year was devoted to stroke, but people with stroke account for 5% of emergency department patients.

"As we've increased our public awareness campaigns around the warning signs of stroke, more people are doing the right thing and calling 9-1-1 immediately," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Increased stroke training for triaging and treating them in the emergency department is vital."

"As the first point of stroke care, the emergency department sets in motion the steps required to give people the best possible outcomes," says neurologist Dr. Michael Hill, Co-Chair of the Canadian Stroke Congress. "It's important that there's a high level of training so we can ensure every Canadian who goes to hospital gets the best possible care."

Sleep apnea plays dual role in stroke

— Improvements to the diagnosis and screening of sleep apnea are critical to stroke prevention, according to new stroke care guidelines released October 2 at the Canadian Stroke Congress.

Obstructive sleep apnea, a disorder where the flow of air to the brain pauses or decreases during sleep, is both a risk factor for stroke and a complication following stroke, according to the Canadian Best Practice Recommendations for Stroke Care.

Among the general population sleep apnea increases the likelihood of having a stroke, even after controlling for other stroke risk factors, such as high blood pressure and diabetes, researchers say.

At absolute minimum, four per cent of men and two per cent of women have serious sleep apnea, says Dr. Brian Murray, an associate professor of neurology and sleep medicine at the University of Toronto. Dr. Murray adds that clinically significant forms of the disorder affect more than 10 per cent of the population.

"There are ways to prevent sleep apnea from occurring," says Dr. Murray. "Keep your body weight low as obesity is a major contributor to sleep apnea; avoid medications and substances that relax the airways and cause snoring, such as sedatives and alcohol; and sleeping on your side can minimize sleep disordered breathing."

Signs of sleep apnea include significant snoring, pauses in breathing during sleep and daytime fatigue despite adequate sleep time. If any of these symptoms are present, says Dr. Murray, you should be evaluated by your doctor to determine next steps.

Obstructive sleep apnea is common after stroke. According to the updated best practice recommendations, at least 60 per cent of stroke patients experience sleep apnea. The new recommendations call for more screening of stroke patients who say they experience snoring, fragmented sleep or fatigue. Although, in many cases with stroke patients, daytime fatigue does not appear as a symptom, says Dr. Murray.

It is crucial for stroke patients to be screened for sleep apnea because untreated sleep apnea increases the chances of a second stroke and small studies have found that stroke patients with sleep apnea tended to have worse rehabilitation outcomes, says Dr. Murray.

The best practices also describe "higher rates of mortality and other complications in patients with stroke and untreated obstructive sleep apnea."

"This innovative Canadian research continues to show that there is more to learn about rehabilitation and recovery following stroke," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Reflecting these advances in tools such as the Best Practices Recommendations for Stroke Care will help improve outcomes for Canadians."

The new recommendations are the fourth update to the Canadian Best Practice Recommendations for Stroke Care and this is the first time the recommendations have included a section on sleep apnea. The best practices were first released in 2006 to improve stroke care for Canadians living with stroke and future stroke patients. They are updated every two years.

"The new recommendations take stroke care a step further," says Dr. Michael Hill, Canadian Stroke Congress Co-Chair. "Stroke care is not only about giving the best possible treatment to patients. It is also about preventing new and recurrent strokes."

The Canadian Stroke Congress is a joint initiative of the Canadian Stroke Network, Heart and Stroke Foundation of Canada and the Canadian Stroke Consortium.

Aspirin may temper brain power decline in elderly women at risk of heart disease

Daily low dose aspirin could slow the decline in brain power among elderly women at high risk of heart disease, indicates observational research published in the online journal BMJ Open.

The researchers base their findings on 681 women between the ages of 70 and 92, 601 of whom were at high risk of heart disease and stroke, defined as a 10% or greater risk on a validated risk scale (Framingham).

All the women were subjected to a battery of tests to measure their physical health and intellectual capacity, including verbal fluency and memory speed, and dementia (mini mental state exam, or MMSE for short) in 2000-1.

Their health was tracked over a period of five years, at the end of which the intellectual capacity of 489 women was assessed again.

Some 129 women were taking low dose aspirin (75 to 160 mg) every day to ward off a heart attack or stroke when the monitoring period started. A further 94 were taking various other non-steroidal anti-inflammatory drugs (NSAIDs).

The MMSE score fell, on average, across the whole group at the end of the five years, but this decline was considerably less in the 66 women who had taken aspirin every day over the entire period.

This held true, even after taking account of age, genetic factors, the use of other NSAIDs, and the cardiovascular risk score.

The researchers then divided up the group into those who had taken aspirin for the entire five years (66); those who had stopped taking it by 2005-6 (18); those who were taking it by 2005-6 (67); and those who hadn't taken the drug at any point (338).

Compared with women who had not taken aspirin at all, those who had done so for all five years, increased their MMSE score, while those who had taken aspirin at some point, registered only insignificant falls in MMSE score.

The test results for verbal fluency and memory speed indicated similar patterns, although the findings weren't statistically significant.

There were no differences, however, in the rate at which the women developed dementia.

The researchers then looked only at the women with a Framingham risk score of more than 10%. Again, similar patterns were evident.

The fall in MMSE score was less among those taking aspirin than those who weren't, and there was no difference between those taking other NSAIDs and those who weren't. The same was true of the verbal and memory tests, although the differences were not statistically significant.

The authors caution that theirs was an observational study, and that the MMSE can't detect subtle changes in cognitive ability. But they suggest their findings indicate that aspirin may protect the brain — at least in women at high risk of a heart attack or stroke.


Journal Reference:

  1. S. Kern, I. Skoog, S. Ostling, J. Kern, A. Borjesson-Hanson. Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk? A 5-year follow-up of a non-demented population-based cohort of Swedish elderly women. BMJ Open, 2012; 2 (5): e001288 DOI: 10.1136/bmjopen-2012-001288

People with schizophrenia more likely to die of heart attack

The risk of death resulting from heart attack is higher in people with schizophrenia than in the general public, according to scientists at the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES).

On average, people with schizophrenia have a lifespan 20 years shorter than the general population. This is partly due to factors such as smoking, increased rates of diabetes, and metabolic problems brought on by the use of some antipsychotic medications. These factors often worsen once a cardiac condition arises because people with schizophrenia are less likely to make the necessary lifestyle changes, such as diet and exercise, to offset the problem.

This study, published online in Schizophrenia Research, examined mortality and access to cardiac care after heart attacks (acute myocardial infarction) in those with schizophrenia.

Dr. Paul Kurdyak, Chief, Division of General and Health Systems Psychiatry at CAMH, analyzed four years of Ontario-wide patient data and tracked all incidents of heart attack among people with schizophrenia, and compared results to people without schizophrenia.

"When we looked at the data, we found that people with schizophrenia were 56 per cent more likely to die after discharge from hospital following a heart attack than those who did not have schizophrenia," says Dr. Kurdyak, also an Adjunct Scientist at ICES. "We also found that patients with schizophrenia, despite the increase in mortality risk after a heart attack, were half as likely to receive life-saving cardiac procedures and care from cardiologists than those without schizophrenia."

Specifically, the study found that people with schizophrenia were 50 per cent less likely to receive cardiac procedures or to see a cardiologist within 30 days of discharge from hospital.

"The numbers tell us that people with schizophrenia– the ones who are at most risk to develop and subsequently die from heart attacks — are not receiving adequate care," says Dr. Kurdyak. "The possible solutions are two-fold: prevention is one. We need to support patients whom we know are at risk of developing medication-related metabolic issues by working with them to provide strategies to offset weight gain, such as healthy eating and physical activity. The other part is aftercare — the mental health care team, primary care providers, and the cardiac specialists need to work together to ensure that patients are seen again after a first incident of heart attack."