Tuesday, July 29, 2014

Could dementia drug help stroke patients?

We see ads for the drug Namenda (or memantine) for treating Alzheimer's. Now, would it be possible for the same dementia drug work for stroke recovery?:
"We know that it's tolerated fairly well in patients with Alzheimer's, so if it can be shown to be useful in promoting stroke recovery that could be a significant event," Seemant Chaturvedi, MD, a neurologist at Wayne State University in Detroit, told MedPage Today.
"The findings are very interesting because for several decades we've been trying to identify whether any medication can help with stroke recovery, and thus far there hasn't been any definitely proven medication to help," added Chaturvedi, who was not involved in the study.
Read the whole story following the link above. To the non-health professional mind, this makes some sense - potentially, a "significant event" for stroke survivors.

Thursday, July 24, 2014

Stress, depression may boost stroke risk

Don't ignore stress and depression - it's already serious, and it could become even more serious. Check out this recent study how stress and depression may boost stroke risk:
The study found that depression seemed to raise the risk of a stroke or a transient ischemic attack (TIA) by 86 percent. It also found that stress apparently raised stroke or TIA risk by 59 percent. And hostility doubled the risk, the researchers said. A TIA is a mini-stroke caused by a temporary blockage of blood flow to the brain.
However, it's important to note that the study only found an association between the risk of stroke and negative emotions. It wasn't designed to prove that negative emotions can cause strokes.
Still, "chronic stress and negative emotions are important psychological factors that affect one's health, and findings from this study link these factors to brain health in particular," said the study's lead author, Susan Everson-Rose, an associate professor of medicine at the University of Minnesota.
"Patients and their health care providers should be aware that experiences of chronic stress and negative emotional states can increase risk for stroke," she noted.

Tuesday, July 22, 2014

Good news but still work in progress

Better results - but miles to go.

Recent released numbers show some good news about the rate of strokes overall and avoiding deaths as a result of a stroke. Still, strokes are the greatest cause of adult disability in the United States, and we still have a problem in this country with smoking, high blood pressure and diabetes.

Still, a new report shows that in the U.S., strokes and stroke deaths have decreased over past decades:
The chance of dying after having a stroke also fell during the study. Over a 10-year period, the number of deaths per 100 strokes dropped by eight. That decrease was particularly prevalent among the youngest study participants and was similar for both sexes and races.
Coresh said the decline in strokes and improvement in survival may be attributable to better control of risk factors - particularly high blood pressure, also known as hypertension - as well as increased smoking cessation and diabetes control.
“I think we’ve been working on hypertension awareness, treatment and control for 40 years now,” he said. “Largely it’s a story of success but as (with) many things in health it’s never done. We need to keep doing better and better.”
Photo from the National Institute of Neurological Disorders and Stroke

Thursday, July 17, 2014

Routine screening - careful decision-making

Medical screenings often seem benign things to do. But there's a line between smart preventive decisions and bad decisions.

Interesting article about how experts have rejected routine screening for narrowed neck arteries:
Image from the
National Heart, Lung and Blood Institute
"Screening for carotid artery stenosis often leads to follow-up testing and surgeries that can cause serious harms, including stroke, heart attack, or death," task force member Dr. Jessica Herzstein said in a news release from the group. She explained that this type of blocked artery "is uncommon in the general adult population, so screening everyone would lead to many false-positive results."
A false-positive result is when a test shows that a person has a condition that he or she actually does not have.
The new recommendation does not apply to adults with a history of stroke, mini-stroke, or signs and symptoms of stroke. These people should consult with their doctors about getting tested, the task force advised.
"The best way to prevent a stroke, and other cardiovascular diseases, is to focus on the things we know work," task force chair Dr. Michael LeFevre said in the news release. "This includes controlling high blood pressure and cholesterol, not smoking, being physically active, maintaining a healthy weight, and eating a healthful diet."
Note that rejecting this routine screening does NOT apply to people who have known risks.

As mentioned, there's a line - sometimes, a thin line - between screen vs. not screen. Carry pro-screen to an extreme, and we'd all have once-a-month colonoscopies. Not a pretty picture. Carry no-screen to an extreme, and we wouldn't know our own blood pressure.

You can find the details about the U.S. Preventive Services Task Force's recommendation here.

Tuesday, July 15, 2014

Don't just shrug off a mini-stroke

TIAs - or transient ischemic attacks - are too often shrugged off as unimportant. However, that's wrong.

Even if the person can move and speak with no difficulty after a mini-stroke, that doesn't mean the patient and professionals should walk away and do nothing. A recent study showed that many patients with TIA have long-term cognitive impairment:
"Our findings confirm what we experience in daily practice: While motor and language disturbances recover within 24 hours after a TIA, long-lasting cognitive complaints are a problem for many patients. There needs to be more clinical awareness of this issue," lead investigator Ewoud J van Dijk, MD, from the Radboud University Nijmegen Medical Centre, the Netherlands, told Medscape Medical News.
He suggested that a TIA affects complex networks that are involved in cognitive functioning. "These networks are likely more vulnerable than those involved in motor and language function. Further study is needed to confirm this, but physicians should be aware of these cognitive dysfunctions because it potentially affects quality of professional and daily living," he said.

Thursday, July 10, 2014

'My rock, my fortress and my deliverer'

The Lord is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge, my shield and the horn of my salvation, my stronghold.
Re-reading the other Psalm verses featured here, you can see several references of taking refuge in God.

Do you have a refuge - I mean by that, a physical place you go, retreat to - when trouble comes your way? I find it a couple of ways - I have a workshop in the basement of my house, where I do very amateur woodworking, and three mornings a week, I run outdoors when I can.

Can I live in those refuges indefinitely? No. Sooner or later, I need to leave my workshop or my running route and join the rest of the world.

So, in Psalm, is the writer suggesting that we simply take refuge and never leave? I don't think so. God provides refuge when life's storms hit. But when those storms subside, God sends us to join the rest of the world. A world where you can make a difference in the lives of others.

So when you need that refuge - regardless of the physical place you might go - take your troubles to God. Not to keep it to yourself, though, but rest and strengthen, then share that hope of refuge with others.


Tuesday, July 08, 2014

Avoiding more strokes: Longer heart monitoring

It's well-established that atrial fibrillation is a stroke risk. We know that sometimes, people aren't aware they have that condition until after a stroke. We know that condition might take time to detect. And finally, there are some strokes that defy explanation.

So it makes good sense, as researchers found, that a study supports longer heart monitoring for stroke patients:
In both studies, the longer monitoring periods resulted in significantly more patients being prescribed anticoagulants to lower their risk of another stroke.
Photo from U.S. Centers for Disease
Control and Prevention
“If more patients with atrial fibrillation can be detected, then more patients can receive appropriate stroke prevention therapy, and the hope is that more strokes, deaths, disability and dementia can be avoided,” said Dr. David Gladstone, an associate professor in the department of medicine at the University of Toronto and the lead author of the Embrace trial.
Some medical centers monitor patients beyond the usual 24 hours, and in May the American Heart Association updated its guidelines to say it was “reasonable” for patients with unexplained strokes to be monitored for 30 days.
The main point is in the quote: "...the hope is that more strokes, deaths, disability and dementia can be avoided."