STROKE: From Prevention to Recovery
Stroke statistics are alarming at best. It is the 4th leading cause of death in the United States. 795,000 people experience a stroke annually. Worst of all, stroke kills more than 160,000 people each year. Do I have your attention yet? Well it isn’t age specific although older folks have a higher risk of suffering a stroke. There are two categories of strokes: ischemic stroke – the blockage of blood vessels in our brain; they account for 80% of strokes suffered. Hemorrhagic strokes result from bleeding in the brain and make up the other 20% of strokes people experience.
These are not random occurrences. Lifestyle dictates the risk of having a stroke for the most part. The risk factors include: high blood pressure; cigarette smoking; heart disease; warning signs or history of TIA; diabetes; cholesterol imbalance; physical inactivity and obesity. Now if you have been following any of my brain health posts you will see the similarity of risk factors for dementia. As complex and masterful as the brain is, it demands a healthy lifestyle to keep it functioning at a high level and less vulnerable to disease.
The American Heart Association and the American Stroke Association looked at nutrition as a means of lowering stroke risk. The list they compiled for lowering the risk of stroke included:
Vegetables
Fruits
Fish (cold water fatty fish such as Salmon) – rich in Omega 3 fatty acids
Whole grain / High fiber
Dairy – fat-free and low-fat
Beans
Lean meats -> skinless poultry
These foods lower risk by lowering cholesterol that can lead to fat build-up in the arteries.
It is necessary to reduce blood pressure because it reduces strain on blood vessels and resulting inflammation.
These foods make up a brain healthy diet. Eating brain healthy allows for healthier weight and more energy because it provides a steady source of glucose to the brain. Omega 3 fatty acids improves focus and concentration and lowers the chance for depression.
A study published by the journal Stroke documented the results from a research study done by researchers from the Genomic Medicine at Kyoto University in Japan. In the study they asked 1400 people to stand with one foot raised and their eyes open for up to 60 seconds. They did this two times and the best time of the two was used for analysis. Then a MRI brain scan was done on all participants. There were some interesting findings:
Those who struggled to balance for 20 seconds had cerebral small-vessel disease (SVD) even though they weren’t exhibiting any classic symptoms. SVD is related to stroke, dementia, and Parkinson’s disease
Among the balance impaired – 15% had one micro-bleed brain lesion (30% had two) and 16% had one arterial brain blockage (35% had two)
Shortest balance times generally had the lowest cognitive performance scores
There are three sensory circuits involved with balance: vision, proprioception (sense of body position) and the vestibular system (inner ear). The brain controls all of these circuits and any loss of motor coordination may suggest brain damage. If you can’t do the balance test, then you may be at an increased risk for brain damage and cognitive decline.
Finally, what can be done to facilitate better outcomes in recovery? The brain principle of neuroplasticity plays an integral role in recovery. In terms of stroke, neuroplasticity refers to the ability of the brain to rewire or organize itself after injury. Studies over the past twenty years demonstrate that the adult brain can reorganize when damaged. Adults also have the ability to create new neurons (neurogenesis). These new neurons need support from surrounding cells, blood supply, and connections to other neurons in order to survive.
This is encouraging news about the brain but there are certain requirements that must be met during rehabilitation in order for neurogenesis and neuroplasticity to change it. Neuroplasticity principles of repetition of task and task specific practice must be effective for change to occur. So patients have to think of their therapies of physical, occupational, and speech as an adjunct to their rehabilitation. The patient must continually use the injured parts of their body and mind outside the therapy sessions in everyday life. Repetition and practice are required. Time and energy must be invested in order to see changes occur especially if dealing with a moderate or severe stroke. One more caveat – it is important to keep using a skill once you have mastered it or you will lose it.
Also, the brain adapts better in some areas of the damage more then others. Neurogenesis occurs in some areas of the brain but not in all areas of the brain. So as promising as all of the new research about the brain appears to be, recovery might be more difficult due to the area of the damage in the brain. Neuroplasticity doesn’t change therapy exercises but instead focuses on repetition and task specific practice.
There is another modality being researched for stroke recovery. Just this week an article in Medicine and Health/Neuroscience review of research on the use of anti-depressants and Alzheimer’s drugs was released. There are a number of clinical studies going on and preliminary results are starting to come out. It was cautioned at the beginning of the article that although these results seem promising, there is a need for large, well designed studies to clarify the effectiveness of these modalities.
In general, this article stated that the most promising drug treatments are anti-depressants to improve motor recovery and Alzheimer’s disease drugs to boost recovery from aphasia (impaired ability to speak, write, or understand verbal and written language). An analysis of 56 clinical trials of SSRIs (e.g. Prozac, Paxil, Celexa) found that these drugs improved dependence, disability, neurological impairment, anxiety, and depression after stroke. Caution is again urged at evaluating the results of these studies because they used different study designs. There are several clinical trials evaluating the use of antidepressants to enhance stroke recovery.
The class of Alzheimer’s disease drugs, acetylcholinesterase inhibitors (including Aricept, Exelon, and Razadyne) can improve aphasia in stroke patients. Memantine (Namenda) when used in combination with therapy has shown language benefits lasting at least for one year when compared to a placebo.
These studies are promising but more research needs to be done to confirm the viability of effectiveness. But utilizing the miracle we call our brain provides great hope for stroke recovery.
American Heart Association/American Stroke Association (December 12, 2014. Food for thought: heart healthy diet is also good for your brain. Retrieved October 29, 2015 from http://strokeassociation.org.
Antidepressants and Alzheimer’s disease drugs might boost recovery in stroke patients. (October 22, 2015). Medicine and Health/Neuroscience. Retrieved October 28, 2105 from http://medicalexpress.com
Neuroplasticity. Retrieved October 29, 2015 from http://strokerehab.com.
Rosse,C. (December 19, 2014). If you can’t stand for 20 seconds on one leg, here’s what it could say about your brain. Retrieved October 29, 2015 from http://prevention.com.
Have questions or interested in learning more? Contact me at: patricia@myboomerbrain.com
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