Cognitive decline, common dementia after stroke

CNN
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Up to 60% of all stroke survivors develop memory and thinking problems within a year, and a third will develop dementia within five years, according to a new scientific statement from the American Stroke Association.

“The numbers are staggering, aren’t they? said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

“It’s a call to action to up our game and focus on prevention,” said Freeman, who was not part of the scientific committee that prepared the statement.

An estimated 9.4 million American adults – about 3.6% of the American adult population – report having had a stroke, according to statistics 2023 of the American Heart Association.

“Cognitive impairment is an often underreported and underdiagnosed, yet very common, condition in stroke survivors,” said Dr. Nada El Husseini, associate professor of neurology at Duke University Medical Center in Durham, in North Carolina, in a statement.

About 40% of stroke survivors have mild cognitive impairment that does not meet diagnostic criteria for dementia. Mild or not, mental difficulties can seriously affect quality of life, said El Husseini, who chaired the statement’s drafting committee.

“Cognitive impairment after stroke ranges from mild impairment to dementia and can affect many aspects of life, such as memory, thinking, planning, language and attention, as well as the ability to a person to work, drive or live independently,” El Husseini said.

Cognitive impairment is more common in the first two weeks after a stroke, according to the statement. Mental decline can go hand in hand along with other conditions associated with stroke such as behavioral and personality changes, depression, physical disability, and sleep disturbance, all of which can contribute to a lower quality of life.

The statement from the American Stroke Association did not offer good news: about 20% of people who experience mild cognitive impairment after stroke recover their cognitive function completely, usually within the first six months.

People are at higher risk of stroke if they have atrial fibrillation, an irregular heartbeat that sufferers often describe as shaking, fluttering, or rocking. heart in the chest. People with uncontrolled high cholesterol or high blood pressure are also at high risk, as are people who smoke or use drugs or alcohol. Being diabetic or obese can be a risk factor, Also.

Ischemic strokes, caused by a clot in the blood vessels that supply blood to the brain, account for 87% of all strokes, according to the statement. Brain hemorrhages caused by the rupture of a weak vessel in the brain, called hemorrhagic strokes, are much less common and account for about 13% of all strokes.

Here are the signs of a stroke, according to the National Institute of Neurological Disorders and Stroke:

Other less common symptoms include dizziness, disorientation, nausea, memory loss, or vomiting.

Any of the warning signs may only last a few moments and then disappear, which could means the person is having a minor stroke or transient ischemic attack, or TIA. Any symptom should not be ignored, experts say, as it can signal a more serious stroke to come.

“You could call a TIA a ‘fluke’ because it’s less severe, but it’s definitely a sentinel event,” Freeman said.

It’s never too late for prevention, but serious effort is needed after even a mild stroke to “put out the fire if you want it, with aggressive change and aggressive drug therapy when appropriate,” added Freeman.

“That should push people to make very drastic changes to their lifestyle: Eat better, exercise more, take the right statins or aspirins or whatever their doctor suggests they do to make their risk that low. as possible,” he said.

Brain damage occurs when some cells stop getting oxygen and die, while other brain cells may die due to bleeding in the brain. As a result, permanent brain damage can occur within minutes to hours, according to the institute. “Some brain cells die quickly, but many persist in a compromised or weakened state for several hours,” he said.

Immediate medical attention is essential to lessen the impact of a stroke. Learn the symptoms of a stroke using the acronym FAST can help identify signs quickly, according to the US Centers for Disease Control and Prevention.

Be sure to capture the time when any symptoms first appear, advises the CDC, to help medical personnel determine the best treatment.

Additional strokes only worsen potential cognitive decline, according to the scientific statement, so prevention is key. Stroke risk factors, such as high blood pressure, high cholesterol, and type 2 diabetes, need to be treated, as does atrial fibrillation.

Keeping high blood pressure under control has been linked to a reduced risk of additional strokes as well as mild cognitive impairment, the statement said.

“Stroke survivors should be routinely assessed for cognitive impairment so that treatment can begin as soon as possible after signs appear,” El Husseini said.

“However, perhaps the most pressing need is the development of effective and culturally relevant treatments for post-stroke cognitive impairment,” she said. “We hope to see large enough clinical trials that evaluate various techniques, medications, and lifestyle changes in various groups of patients that may help improve cognitive function.”