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The Healing Power of Music for Stroke Survivors

Laura Williamson wrote . . . . . . . . .

Julie Stillman was 55 years old when a blood vessel in her brain suddenly burst. The hemorrhagic stroke left her unable to compose a simple sentence – a hard blow for a woman who built a career in book publishing.

It also robbed her of the ability to speak properly. But not the ability to sing.

Now 69, Stillman is one of several dozen stroke and brain injury survivors who lift their voices in joy as part of the Aphasia Choir of Vermont. There are a handful of such choirs springing up around the world, giving stroke survivors and people living with dementia or other brain injuries a chance to tap into one of the few means of communication left to them.

“To hear that clarity and volume, it’s like magic,” said Stillman’s husband, Jeff Nagle, whose last fluid conversation with his wife took place 14 years ago on the phone, an hour before he found her on the floor of their home. “It’s amazing to see this happen.”

Roughly one-third of people who survive strokes have aphasia, a speech disorder that makes it difficult to express or understand language resulting from damage done to the brain. But scientists have long known that even when people with certain types of aphasia lose the ability to speak, they often are able to sing, a phenomenon attributed to the different regions of the brain responsible for producing music and language.

Studies of this phenomenon and of how music affects the brain have led to the development of a variety of music-supported therapies, such as melodic intonation therapy, which trains stroke survivors to communicate rhythmically to build stronger connections between brain regions. Other therapies focus on listening to music or teaching people to play musical instruments, such as the keyboard or drums.

A growing body of research shows these types of therapies can play an important role in helping stroke survivors heal.

As early as 2008, researchers published work in the journal Brain that showed just listening to music for an hour each day improved memory and attention, as well as mood, during the early stages of stroke recovery. A follow-up to that study in 2014 provided insights as to how and why: Listening to music stimulated structural changes in the areas of the brain responsible for verbal memory, language skills and focused attention. Digging deeper, investigators were able to show vocal music was superior to instrumental music or listening to audiobooks in stimulating the brain changes that led to memory and language recovery.

Karen McFeeters Leary, the speech-language pathologist who founded Vermont’s aphasia choir, knew stroke survivors could sing from her studies of speech pathology.

“When we would evaluate people with stroke or speech impairment, we always checked their ability to sing,” said Leary, who also is a singer and songwriter.

Stillman and Nagle were among the first to join when Leary launched the choir in 2014, with just 11 stroke survivors and their spouses and caregivers. Since then, the group has more than doubled in size. She recruits through stroke support groups and the University of Vermont, which has a speech and language pathology program and an outpatient clinic.

Much to her surprise, the choir quickly turned into something much bigger than an opportunity for people to express themselves through song. It helped establish a community for people who had become socially isolated because of their condition. “They lose friendships, sometimes spouses,” Leary said. “It’s very lonely.”

But through the choir, they find others who understand what they’re going through. “The shared experience, that’s the big thing,” she said. “I’ve seen some very, very depressed individuals absolutely find themselves again and blossom.”

“The choir has been a wonderful support group in a different way than what we had in speech therapy,” said Nagle. “We’ve made a lot of friends.”

And through those friendships, they’ve expanded Stillman’s ability to resume some of her old hobbies, such as a love of boating. Another choir member introduced them to an adaptive kayaking group in which stroke survivors and others with physical disabilities use special equipment that allows them to paddle with one arm. They are now active participants in both groups, enjoying a social life they never thought they’d see again.

Nagle also believes his wife’s language abilities improve during choir season, which lasts from March until June, when it culminates with a free public concert.

Researchers like Pablo Ripollés say it’s possible the daily music engagement is making a difference. As an assistant professor of psychology and associate director of New York University’s Music and Audio Research Laboratory in New York City, Ripollés was one of a group of investigators who identified how listening to music changes brain structure in stroke survivors.

Scientists know providing a rich environment can stimulate the brain and promote healing following a stroke, Ripollés said. His research has focused on using music to provide that enrichment, especially during the early stages of recovery when people are limited in what they can do.

“There is one thing you can do for those patients, even when they are in bed,” he said. “Maybe they cannot move very well, but you can provide an enriched environment by having them listen to music.”

Music therapy’s benefits can vary, and how much damage a stroke has caused to the brain affects how well it can recover. “We have good evidence that music therapy works in people who have not had catastrophic brain injuries,” Ripollés said. “Maybe a major one, but not a catastrophic one.”

More research is needed to see if music therapy can be more effective than traditional speech therapies, he said. But in the meantime, stroke survivors can listen to their favorite music or join a choir, if one is available in their area.

“This is something you can do on your own and for free,” Ripollés said. “It’s not going to harm you, and it might do you some good.”


Source: American Heart Association

Stroke Tied to Higher Risk for Depression and Other Mood Disorders

Thor Christensen wrote . . . . . . . . .

Stroke survivors may have a higher risk of developing depression or another mood disorder within the first year, according to new research that compared their risk to the general public as well as people who survived a heart attack.

Past research shows depression is common after stroke, affecting nearly one-third of survivors. For the new study, researchers wanted to dig deeper and see how stroke impacts other mental disorders.

The study, published in the American Heart Association journal Stroke, focused on 86,111 people in Danish hospitals from 2004 to 2018 with no history of mental health disorders who had a stroke.

It found that stroke survivors had a 15% risk of developing a mood disorder, primarily depression, within the first year. This risk corresponded to an approximately 2.3-fold increased risk compared with matched individuals from the Danish general population. Stroke survivors also had an increased risk for other mental health problems, including substance abuse disorders and stress and anxiety disorders, as well as brain disorders such as dementia. But these conditions were less common.

“Prevention of these outcomes has obvious importance. But unfortunately, that is easier said than done,” said Nils Skajaa, the study’s lead author. He called for increased recognition of post-stroke mental disorders and early interventions, including counseling.

“Although risks tended to be higher after severe stroke, risks were still increased in patients with mild stroke – which emphasizes a need for mental health evaluation even in patients with seemingly full physical recovery,” said Skajaa, a Ph.D. student in clinical epidemiology at Aarhus University Hospital in Denmark.

The study also showed stroke survivors’ chances of developing depression are nearly 70% higher than people who survive a heart attack. A U.S. study published last year in the journal Neurology came to a similar conclusion: Stroke patients were 50% more likely than heart attack patients to develop depression.

Skajaa said the study was limited by the use of hospital data, which might have missed mild cases, and by surveillance bias – the idea that hospitalization and follow-up care might lead to an increased probability of a diagnosis for a mental disorder. While the study was conducted in Denmark, he said the findings also are applicable in the U.S.

Dr. Laura K. Stein, who was not involved in the research, said the study “gives us more insight into the mental health complications following stroke, which may be, at least in part, related to biological changes in the brain. It expands what we know about mental health disorders after stroke and shows us just how much more likely patients with stroke are to develop mental health disorders than people in the general population.”

Stein, an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai in New York City, called for future research to uncover the biological and psychosocial factors that might contribute to post-stroke depression. She also would like to see studies on the best methods of treating post-stroke depression – not just with medication, but with counseling, cognitive behavioral therapy, exercise and other lifestyle interventions.

Stein pointed out that while post-stroke depression is most common in the first year after a stroke, patients are still at risk for a long time after that.

“Patients, family members and caregivers need to be on the lookout for any signs of depression or other mental health disorders. They need to have a conversation with their doctors about any change in someone’s post-stroke trajectory,” said Stein, who also is an attending physician at the Mount Sinai and Mount Sinai Queens stroke centers.

“Post-stroke depression and other mental health disorders are treatable illnesses. If we take them seriously and investigate all causes and treatment options, it will improve the outcomes and quality of life for stroke survivors in the U.S. and around the world.”


Source: American Heart Association

Triglycerides a Stroke Danger, Even With Statin Treatment

Amy Norton wrote . . . . . . . . .

Stroke survivors may be watching their “bad” cholesterol, but a new study suggests another type of blood fat could put them at risk of a repeat stroke within the next year.

Researchers found that stroke survivors with high triglycerides suffered repeat strokes at about twice the rate of survivors with normal triglyceride levels. Their risk of heart attack and severe chest pain were similarly raised — even if they were taking cholesterol-lowering statin drugs.

However, experts said it’s not clear that high triglycerides, per se, were to blame.

They may simply be a marker of something else that’s going on, said Dr. Leah Dickstein, a clinical assistant professor of neurology at NYU Langone Health in New York City.

“We don’t know that treating high triglycerides will lower these risks,” said Dickstein, who was not involved in the study.

The good news, she added, is that many of the things routinely recommended to stroke survivors will help manage their triglycerides. Those include a diet low in saturated fat and processed carbohydrates, regular physical activity, and avoiding alcohol.

LDL (“bad”) cholesterol gets most of the attention, but triglycerides are another blood fat that can soar when people are overweight, eat too many calories (especially from foods high in sugar or saturated fat) and drink excessively. High triglycerides also tend to go hand-in-hand with conditions like obesity, type 2 diabetes, kidney disease and high blood pressure.

However, it’s been unclear whether high triglycerides predict a poorer prognosis for stroke survivors.

For the new study, Dr. Takao Hoshino and colleagues at Tokyo Women’s Medical University followed 870 patients at their hospital. All had recently suffered a stroke or “mini-stroke.” At the outset, one-quarter had high triglycerides, defined as 150 mg/dL or higher.

Over the next year, those patients suffered major “cardiovascular events” at higher rates than stroke survivors with normal triglyceride levels.

Roughly 16% had a second stroke, compared with 8% of patients with normal triglycerides. Meanwhile, 4% had a heart attack or chest pain caused by restricted blood flow to the heart, versus less than 1% of the normal-triglyceride group, the findings showed.

The researchers were able to account for some other factors, like obesity, diabetes and kidney disease. And high triglycerides, themselves, were still linked to an increased risk of repeat stroke or heart problems. That was true whether patients were taking cholesterol-lowering statins or not.

Another U.S. neurologist agreed, though, that high triglycerides may not be the direct cause.

It’s possible the increased risks were at least partly due to other, unmeasured factors, said Dr. Larry Goldstein, a volunteer expert with the American Heart Association/American Stroke Association.

Plus, the study was done at a single medical center in Japan — and the findings may not generalize to patients elsewhere, said Goldstein, who is also co-director of the Kentucky Neuroscience Institute, in Lexington.

In Japan, he explained, it’s common for strokes to be related to hardened, narrowed arteries within the brain. In Western countries, Goldstein said, it’s more common for stroke patients to have disease in the neck arteries that supply blood to the brain.

That said, high triglycerides deserve attention, both neurologists said.

Triglycerides are measured as part of the standard “lipid panel” that gauges cholesterol levels, Goldstein noted. If they are high, he said, a repeat measurement should be taken — after an overnight fast, since meals affect triglyceride levels.

“I don’t think patients should panic over a single number,” Dickstein stressed.

Instead, she said, people with high triglycerides can focus on the lifestyle changes that will not only help with that issue, but benefit their overall health.

In some cases, Dickstein noted, people may need medication specifically for high triglycerides. Those options include niacin, fibrate medications (such as fenofibrate and gemfibrozil), and prescription-grade fish oil.

But, Dickstein said, more research is needed to prove that targeting triglycerides actually reduces stroke risk.

Goldstein encouraged people with high triglycerides to talk to their doctor about the various ways they can reduce their risk of cardiovascular trouble.

The findings were published online in the journal Neurology.


Source: HealthDay

A Plant-Based Diet May Protect Against Stroke

If you have had a stroke or want to lower your risk for one, the case for eating more fruits, vegetables, and other healthy plant foods—and cutting back on meat and other animal products—gets stronger every year. A recent study published in Neurology adds to the evidence that a plant-based diet can reduce the odds of a stroke and preserve overall brain health. The study also indicates that the types of plant-based foods consumed may make a difference.

Earlier studies have looked at the benefits of plant-based diets, but this one focused on the quality of those diets, says Kathryn M. Rexrode, MD, senior author of the study and a family physician at Brigham and Women’s Hospital in Boston. “Not all plant-based diets are healthy,” she notes. “After all, you can be a vegetarian and eat pasta and cake all day.”

Dr. Rexrode and colleagues at the Harvard T.H. Chan School of Public Health in Boston studied the diets of 209,508 men and women over a roughly 25-year period and found that people who ate mostly fruit, vegetables, whole grains, legumes (such as beans), and nuts reduced their overall risk for stroke by 10 percent. By contrast, they found no benefit against stroke among people who ate six daily servings of refined grains (such as white pasta and rice), potatoes (which convert to sugar rapidly in the body), fruit juice and sugar-sweetened beverages, and sugary desserts.

“If everyone in the United States followed healthy plant-based diets, we could see a reduction of about 80,000 strokes per year,” says Dr. Rexrode. “As someone who has seen the devastating impact of stroke on individuals and families, that sounds like a pretty substantial impact, and a reason to focus on diet.” Every year nearly 800,000 Americans experience a stroke, and survivors stand a one in four chance of having a second one.

A healthy diet can also help lower blood pressure and cholesterol, says Eliza Miller, MD, MS, assistant professor of neurology at Columbia University’s Irving Medical Center in New York City. While medication is typically prescribed for people with high blood pressure or high cholesterol, a diet that includes plenty of plant foods and limits red meat addresses those cardiovascular risk factors too. A plant-based diet could guard against cognitive impairment and dementia as well, says Dr. Miller.

Avoiding red meat and egg yolks may help prevent strokes and heart attacks for yet another reason, says J. David Spence, MD, professor of neurology and clinical pharmacology at the University of Western Ontario in Canada. His research and that of others show that these foods interact with naturally occurring bacteria in the intestines of some people to produce trimethylamine N-oxide (TMAO), a gut metabolite that clogs arteries and can trigger strokes and heart attacks.

Dr. Spence cites a “defining” study from 2013 in the New England Journal of Medicine that found that among subjects who produced the highest levels of TMAO, risk for a stroke or heart attack was two and a half times higher than for those with the lowest levels. How much TMAO is produced in response to eating red meat and eggs depends on the strains of bacteria in the intestines (known as the gut microbiome), which differ from one person to another. Now researchers, including Dr. Spence, are trying to identify which microbes are the culprits, with the goal of developing a therapy to replace bad bacteria with healthier bacteria.

Shifting from a traditional American diet—high in unhealthy fats and sugar, low in produce and whole grains—to one emphasizing healthy plant-based foods can start with simple changes. Here are some strategies to adopt.

Keep it lean

Dr. Spence recommends limiting consumption of meat—sticking mainly to chicken and fish—to no more than about four ounces (a palm-size serving) every other day. Eat red meat even more sparingly. You can reduce your meat intake with some culinary sleight of hand. For example, when you make meatballs or burgers, replace one-third to one-half of the ground meat with finely diced mushrooms or eggplant. “You’ll be hard-pressed to tell the difference,” says Molly Kimball, RD, CSSD, a sports and lifestyle dietitian who manages the nutrition program at Ochsner Fitness Center in New Orleans. Also consider nonmeat substitutes such as the Impossible Burger, which is made with soy and potato protein instead of beef. “It tastes surprisingly similar to meat,” says Kimball, who ran a blind taste test in which the Impossible Burger beat out all-beef burgers.

Skip egg yolks

Egg whites or egg-white-based substitutes can be purchased by the carton at most grocers. “You can make amazingly good egg salad sandwiches with egg substitutes,” says Dr. Spence. Egg-white frittatas and omelets are good meatless options too.

Join club Med

Traditional diets of people in the Mediterranean region tend to focus on fruits, vegetables, whole grains, legumes, nuts, and olive or canola oil; they include few servings of meat, dairy products, and processed foods. In a study published in the New England Journal of Medicine in 2018, the Mediterranean diet reduced the risk of strokes and heart attacks by about 30 percent versus a low-fat diet over a five-year period.

Go natural

Choose fresh foods whenever you can and eliminate as many processed products as possible. “With that change, you can reduce the amount of salt, sugar, refined carbohydrates, and unhealthy fats you consume,” says neurologist Ayesha Sherzai, MD, of Loma Linda University Health in Loma Linda, CA. Eat fruit instead of drinking juice, and opt for fruit over pastries or other prepared desserts. An apple, for example, provides nutrients and fiber but not the 5 grams of artery-clogging saturated fat and additional 175 or so calories in a slice of store-bought apple pie. If fresh or frozen foods are hard to come by where you live, look for canned vegetables, says Dr. Sherzai. “They’re not ideal, but they’re better than potato chips.”

Avoid refined carbohydrates

When people eat less meat, they may load up on pasta instead. But the standard types made from refined wheat convert to sugar rapidly during digestion, which can promote hyperglycemia—a risk factor for severe strokes. Look for whole-grain pasta or varieties made from nonwheat sources, such as zucchini and hearts of palm, says Kimball. Similarly, when buying bread, select whole-grain rather than white bread.

Beware of salt

“Sodium is sneaky,” says Dr. Miller, since you may not realize how high the sodium content is in certain foods, such as canned soup, deli meats, pizza, and even packaged bread. Too much sodium contributes to high blood pressure, a risk factor for stroke. Read food labels and find products you enjoy that have lower sodium levels, suggests Dr. Miller. Nutritionists encourage people to consume less than 20 percent of the daily value (the amount not to exceed each day) for sodium, which is 2,300 milligrams. A first step in reducing sodium intake could be eliminating crackers and potato chips as snacks; possible replacements include unsalted popcorn with a pinch of Parmesan; apple slices with unsalted peanut butter; or home-baked pita chips flavored with olive oil, paprika, and unsalted garlic powder. Dr. Miller also suggests making your own bread, which allows you to limit how much salt goes in “and can be a fun activity for families.”

Skip sodas

Sugary drinks like colas can spike blood sugar, says Dr. Sherzai. Diet sodas are no better, as artificially sweetened beverages are associated with a higher risk of stroke and dementia, according to a 2017 study in Stroke. If you don’t like water, try iced or hot tea sweetened with agave or honey.

Dine at home

“A lot of people are afraid of cooking,” says Dr. Sherzai, but learning just a few simple, healthy recipes gives you greater control over what you eat and avoids the unhealthy ingredients in processed meals and restaurant fare. “Cooking [a healthy diet at home] can save lives,” says Dr. Sherzai.


Source: Brain&Life

Vocal Music Boosts the Recovery of Language Functions After Stroke

Research has shown that listening to music daily improves language recovery in patients who have experienced a stroke. However, the neural mechanisms underlying the phenomenon have so far remained unknown.

A study conducted at the University of Helsinki and the Turku University Hospital Neurocenter compared the effect of listening to vocal music, instrumental music and audiobooks on the structural and functional recovery of the language network of patients who had suffered an acute stroke. In addition, the study investigated the links between such changes and language recovery during a three-month follow-up period. The study was published in the eNeuro journal.

Based on the findings, listening to vocal music improved the recovery of the structural connectivity of the language network in the left frontal lobe compared to listening to audiobooks. These structural changes correlated with the recovery of language skills.

“For the first time, we were able to demonstrate that the positive effects of vocal music are related to the structural and functional plasticity of the language network. This expands our understanding of the mechanisms of action of music-based neurological rehabilitation methods,” says Postdoctoral Researcher Aleksi Sihvonen.

Listening to music supports other rehabilitation

Aphasia, a language impairment resulting from a stroke, causes considerable suffering to patients and their families. Current therapies help in the rehabilitation of language impairments, but the results vary and the necessary rehabilitation is often not available to a sufficient degree and early enough.

“Listening to vocal music can be considered a measure that enhances conventional forms of rehabilitation in healthcare. Such activity can be easily, safely and efficiently arranged even in the early stages of rehabilitation,” Sihvonen says.

According to Sihvonen, listening to music could be used as a cost-efficient boost to normal rehabilitation, or for rehabilitating patients with mild speech disorders when other rehabilitation options are scarce.

After a disturbance of the cerebral circulation, the brain needs stimulation to recover as well as possible. This is the goal of conventional rehabilitation methods as well.

“Unfortunately, a lot of the time spent in hospital is not stimulating. At these times, listening to music could serve as an additional and sensible rehabilitation measure that can have a positive effect on recovery, improving the prognosis,” Sihvonen adds.


Source: University of Helsinki

9 Ways to Maximize Progress When Recovering from a Stroke

For years, neurologists believed that survivors of stroke had a six-month window to recover. After that, they would be stuck with whatever physical and cognitive limitations they had. That view has changed dramatically. “Because of neuroplasticity—the ability of the brain to form new neural pathways after other pathways have been disrupted—patients can keep regaining function,” says Amy Towfighi, MD, associate professor of neurology at the University of Southern California’s Keck School of Medicine.

While patients may not regain all abilities they had before the stroke, they can recover. “The single most important predictor of recovery is the severity of the initial stroke,” says Larry B. Goldstein, MD, FAAN, chair of the neurology department at the University of Kentucky. Time is also crucial: “Clot-busting drugs such as tPA and clot-retrieval procedures can dramatically improve stroke-related deficits, but they need to be used as soon as possible after the onset of symptoms,” Dr. Goldstein emphasizes.

Most stroke survivors experience the most rapid recovery during the first few weeks and plateau after about three months, but “individuals can recover over much longer periods, even if rehabilitation is delayed,” says Dr. Goldstein.

Stroke rehabilitation is “the next frontier in the field,” says Ralph L. Sacco, MD, FAAN, chair of neurology at the Miller School of Medicine at the University of Miami. “We’ve made amazing progress with acute stroke treatment, so much so that the amount of disability is less, and recovery is better,” he says. “And there is clear evidence that physical rehabilitation and speech and cognitive therapy do make a difference.”

Here’s what specialists recommend to maximize progress after a stroke.

Start rehab immediately.

A 2017 study in the journal Stroke found that patients who started intensive rehabilitation three days after being admitted to the hospital had the best outcomes. “The frequency and intensity can maximize the benefit,” says Dr. Goldstein. “Patients can rewire networks and trails in the brain with the right kind of rehabilitation and practice,” says A.M. Barrett, MD, FAAN, executive director of the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Healthcare System.

Keep up with physical therapy.

“In an ideal world, patients would be able to continue with physical, occupational, and speech therapy so they could reach their full potential,” says Dr. Towfighi. “The key to recovery is practicing tasks over and over.” Insurance typically pays for only a limited number of sessions, but doing physical therapy exercises on your own, several times throughout the day, can make a significant difference.

Try telehealth.

“Telemedicine works well to guide therapy during the pandemic,” Dr. Goldstein says. A 2018 study in the Journal of Medical Internet Research found no differences in quality of life and improvement between stroke patients who did rehabilitation through video calls and those who did them in person. “The American Stroke Association can help patients and their families navigate the insurance system and craft a plan that is at least partially covered by insurance, whether outpatient or community-based,” says Dr. Barrett.

Incorporate other types of therapy.

Experts also recommend gait and balance training to avoid falls, as well as speech and occupational therapy. “Improvement in speech tends to take longer, but I’ve seen progress years after the initial stroke,” says Dr. Sacco.

Treat depression.

A major roadblock to adjusting to life after stroke is depression. A study in JAMA Psychiatry found that depression in stroke patients was three times as high as in the general population. Brain changes brought on by stroke can contribute to depression, as can going from being completely independent to relying on others. “It’s important for people to get support, whether they see a therapist or focus on things they want to strive for in the future,” Dr. Barrett says. Some studies suggest that treating all stroke patients—not just those known to be depressed—with antidepressants may improve functional movement and even paralysis, along with their quality of life. “Whether or not every stroke patient should be given antidepressants, it’s clear that those who do have depression will benefit from medication,” says Dr. Barrett.

Take the tougher path.

The tendency to avoid doing things that are difficult is counterproductive after a stroke. For example, a patient with limited mobility in one hand who uses only the stronger hand will never strengthen the weaker hand. A rehabilitation technique known as constraint-induced movement therapy is designed to isolate the weaker limb. Patients put their strong limb in a splint and intensively use the weaker limb for many hours a day for several weeks. “It’s hard work,” Dr. Barrett says, “but we’ve seen people progress 20 years after a stroke.”

Embrace technology.

“There are a variety of novel approaches that can supplement stroke rehabilitation therapy,” says Dr. Goldstein. One option is robotic therapy, which allows for remote rehabilitative treatments—for instance, harnesses and braces that use artificial intelligence to correct gait, which have been helpful during the pandemic and for patients who can’t travel.

Reframe expectations.

Although life may change after a stroke, patients can continue with favorite activities but do them in a new way. “It means finding the right therapy, the right equipment, and the right kind of support,” says Dr. Barrett.

Set objectives.

Establish small and realistic short-term goals, says Dr. Towfighi, co-author of What You Must Know About Strokes. “When we work with patients, we ask them, ‘What has meaning for you? What would give you a sense of accomplishment?’ Motivation can help drive the recovery.”


Source: Brain and Life

5 Critical Steps to Help Prevent a Stroke

Laura Williamson wrote . . . . . . . . .

If there’s one good thing that can be said of strokes, it’s this: The vast majority of them don’t need to happen.

Up to 80% of strokes can be prevented through healthy lifestyle changes and working with health care practitioners to control stroke risk factors. Researchers have identified numerous steps people can take to lower stroke risk, but health experts agree, trying to do them all at once can feel overwhelming.

“The biggest mistake people make is they are overly ambitious, and then they fail and give up,” said Dr. Vladimir Hachinski, a Canadian neurologist and global expert in the field of stroke. “You have to start small.”

The rewards are enormous, said Dr. Cheryl Bushnell, a neurologist and director of the Comprehensive Stroke Center at Wake Forest Baptist Health in Winston-Salem, North Carolina. It’s “not just for preventing stroke, but for preventing dementia as well. You can do the same things to prevent both. You are killing two birds with one stone.”

Here are five ways to get started on the road to prevention.

If you smoke, quit

Studies show that for every five cigarettes a person smokes each day, the risk of having a stroke goes up by 12%. For Black adults, smoking cigarettes more than doubles the risk of stroke compared to never smoking, a 2020 study found.

“People understand that smoking causes lung cancer, but they don’t understand it also damages the brain and blood vessels,” Bushnell said. “In terms of stroke prevention, quitting smoking is the lowest hanging fruit.”

Move more

More active men and women have a 25%-30% lower risk of stroke than those who are least active. Physical activity has been shown to lower cholesterol, help maintain a healthy weight and lower blood pressure – all factors that can reduce stroke risk.

“The evidence for physical activity is undeniable,” said Bushnell, who co-authored a 2014 statement from the American Heart Association and American Stroke Association on stroke prevention. “Even just moving around for 10 minutes every hour is better than sitting for an extended period of time. You don’t have to run a 5K.”

Hachinski placed exercise among the top three things a person could do to lower stroke risk – and agrees it needn’t be overly ambitious. “The worst thing that can happen is to sit all day. Walking is the best exercise there is. Get up and walk around.”

Keep blood pressure under control

High blood pressure, also called hypertension, is the leading cause of strokes. Half of all men – 52% – and 43% of women in the U.S. have blood pressure that is too high, according to AHA statistics. While it can be controlled through lifestyle changes or by taking medication, only about 1 in 5 adults keep it properly managed. Smoking, diabetes, obesity, high cholesterol and eating an unhealthy diet can push blood pressure out of the healthy range.

At-home monitoring and regular communication with doctors to make sure medications are working are important to keep high blood pressure in check, Bushnell said.

“People have to keep track of their own blood pressure,” she said. “They have to know what their numbers are, know their medications and how to take them.”

Eat a healthy diet

“One of the most subtle things that happens to people as they get older is they put on weight,” Hachinski said.

Being careful to choose healthy foods can minimize weight gain, he said. But there’s value to making healthier food choices regardless of weight.

“Nutrition is more important than weight loss,” agreed Bushnell. “There are multiple diets shown to decrease the risk of stroke,” such as the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean diets. Both emphasize eating a lot of fruits, vegetables and low-fat dairy, whole grains, fish and nuts, while cutting back on foods high in saturated fats, cholesterol and trans fats.

Start early

Strokes happen to young people, too. About 10%-15% of all strokes occur in adults age 50 or under. Recent research shows Black young adults have up to four times the risk as their white peers.

And recent research shows the same factors that cause strokes in older adults – such as high blood pressure, high cholesterol, obesity and diabetes – are causing strokes in younger adults.

“You don’t think about disease when you are young,” Hachinski said. But that’s when good habits should start.

Hachinski recommends people start monitoring their blood pressure, cholesterol, lipids and blood sugar levels as soon as they transition from a pediatrician to a primary care physician as a young adult. “If you’re going off to college or leaving home, your habits will change at this time. You begin eating on your own. This is a good time to think about how to prevent disease.”

Other life transitions – such as moving in with a partner – should also be triggers for checking health metrics, he said. “It’s a good time to take inventory, because it’s when habits will change.”

It doesn’t have to be a massive undertaking, Hachinski said. Focus on just one thing to get started. “Identify the most important thing you are lacking,” he said. “Is it exercise? Are you snacking too much?”

Set a specific and measurable goal, he said, and then break it into parts and stick to it until you reach it. Having a partner can help maintain motivation, as long as that person has healthy habits. “If you can get someone to do it with you, you double your chances for success.”


Source: American Heart Association

Stroke Affecting the Eye Requires Immediate Treatment, Can Signal Future Vascular Events

While most people think of strokes affecting the brain, they can also affect the eye. Central retinal artery occlusion (CRAO) is a rare form of acute ischemic stroke that occurs when blood flow is blocked to the main artery of the eye. It typically causes painless, immediate vision loss in the impacted eye, with fewer than 20% of people regaining functional vision in that eye.

Today, the American Heart Association published a new scientific statement, “Management of Central Retinal Artery Occlusion,” in Stroke, an American Heart Association journal. The American Association of Neurological Surgeons/Congress of Neurological Surgeons Cerebrovascular Section affirms the educational benefit of the scientific statement, and it has been endorsed by the North American Neuro-Ophthalmology Society, the American Academy of Ophthalmology Quality of Care Secretariat and the American Academy of Optometry.

“Central retinal artery occlusion is a cardiovascular problem disguised as an eye problem. It is less common than stroke affecting the brain but is a critical sign of ill health and requires immediate medical attention,” said Chair of the statement writing committee Brian C. Mac Grory, M.B.B.Ch., B.A.O., M.R.C.P., an assistant professor of neurology and staff neurologist at the Duke Comprehensive Stroke Center at Duke University School of Medicine in Durham, North Carolina. “Unfortunately, a CRAO is a warning sign of other vascular issues, so ongoing follow-up is critical to prevent a future stroke or heart attack.”

In a comprehensive review of the world literature, committee members from the specialties of neurology, ophthalmology, cardiology, interventional neuroradiology, neurosurgery and vitreoretinal surgery summarized the state of the science in this condition. They found indications that this type of stroke can be caused by problems with carotid arteries, the blood vessels in the neck. However, there is also evidence CRAOs could be caused by problems with the heart, such as atrial fibrillation, which is the most common irregular heart rhythm. The risk of having a CRAO increases with age and in the presence of cardiovascular risk factors such as hypertension, hyperlipidemia, Type 2 diabetes, smoking and obesity.

The new scientific statement notes the lack of large clinical trials on CRAOs leads to uncertainty within the medical community of exactly what causes them or the best way to treat them. As a result, there is wide variability in diagnosis and treatment methods. Most concerning, according to Mac Grory, is that many practitioners may not recognize CRAO as a form of stroke resulting in patients receiving delayed testing and treatment, often in the outpatient clinic instead of the emergency department.

“We know acute CRAO is a medical emergency requiring early recognition and triage to emergency medical treatment,” Mac Grory said. “There is a narrow time window for effective treatment of CRAO and a high rate of serious related illness. So, if a person is diagnosed in a doctor’s office or other outpatient clinic, they should be immediately sent to a hospital emergency department for further evaluation and treatment.”

Current literature suggests that treatment with intravenous tissue plasminogen activator (tPA), a “clot buster” that is also used to treat brain strokes, may be effective. But tPA must be administered within 4.5 hours of the first sign of symptoms to be most effective and safe.

The writing committee also noted that emerging treatments, such as hyperbaric oxygen and intra-arterial alteplase, show promise but require further study. Other potential treatments that require further research and evaluation include novel thrombolytics to break up clots and novel neuroprotectants (substances capable of preserving brain function and structure) for use in tandem with other therapies to restore blood flow in the blocked artery.

Because of the potential for future strokes or even heart attacks, patients should undergo urgent screening and treatment of vascular risk factors. The writing committee notes that the complexities of diagnosing and treating CRAOs require a team of specialists working together. Secondary prevention (including monitoring for complications) must be a collaborative effort between neurologists, ophthalmologists, cardiologists and primary care clinicians. Risk factor modification includes lifestyle and pharmacological interventions.


Source: American Heart Association

Study: Common Antidepressants Won’t Raise Risk for Bleeding Strokes

The most widely prescribed antidepressants in the United States don’t appear to increase the risk of the deadliest type of stroke, according to a new preliminary study.

It examined the association between selective serotonin reuptake inhibitors (SSRIs) and intracerebral hemorrhage. This is when a brain blood vessel bursts and blood spreads into the surrounding tissue.

The most common causes of this type of stroke are high blood pressure and head trauma, but some earlier research had suggested that SSRIs may increase the risk. SSRIs include drugs such as Prozac (fluoxetine) and Zoloft (sertraline).

“Selective serotonin reuptake inhibitors work by preventing reabsorption of the chemical serotonin, which regulates mood, into the cells, making more of it available in the brain,” said study author Dr. Mithilesh Siddu, who did the research while at the University of Miami. He’s now an assistant professor of neurology at the Medical College of Georgia at Augusta University.

“However, by interfering with serotonin, which also plays a role in blood clotting, SSRIs may increase the risk of bleeding. Therefore, to determine if these antidepressants increase the risk of bleeding strokes, we looked at a large population of people with stroke,” Siddu said in an American Academy of Neurology news release.

The study included nearly 128,000 people who had a stroke between 2010 and 2019. Of those, just over 17,000 had been prescribed antidepressants before their stroke, and nearly 111,000 had never had an SSRI prescription.

Rates of intracerebral hemorrhage were 11% in people who’d been prescribed antidepressants and 14% in those who had not, according to the findings. The results will be presented at the American Academy of Neurology’s virtual annual meeting, April 17-22.

After they adjusted for other stroke risk factors — such as age, high blood pressure and diabetes — the study authors concluded that the risk of intracerebral hemorrhage was the same in people who took antidepressants as those who didn’t take the medications.

“These findings are important, especially since depression is common after stroke, and selective serotonin reuptake inhibitors are some of the first drugs considered for people,” Siddu said.

“More research is needed to confirm our findings and to also examine if SSRIs prescribed after a stroke may be linked to risk of a second stroke,” he added.

Research presented at meetings is generally considered preliminary until peer-reviewed for publication in a medical journal.


Source: HealthDay

Researchers Identify Genetic Risk Factor for Stroke

A team of Geisinger researchers has identified a common genetic variant as a risk factor for stroke, especially in patients older than 65.

Cerebral small vessel disease (SVD) causes about a quarter of ischemic strokes worldwide and is the most common cause of vascular dementia. SVD can manifest as lesions on the brain, which typically appear on brain scan images. SVD is commonly associated with aging and hypertension, but a minority of cases are caused by cysteine altering variants in the NOTCH3 gene.

Approximately 1 in 300 people have this type of gene variant. A rare hereditary condition known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL, which is caused by this gene variant, has been associated with SVD and an increased risk of stroke.

In their study, published in Stroke, researchers evaluated a set of health records, including imaging and genomic sequencing data, of more than 300 Geisinger patients, of which 118 exhibited a NOTCH3 variant. Of this group, 12.6% had a history of stroke, compared with 4.9% of those in a control group. The risk of stroke was significantly higher in those older than 65, and patients exhibited a higher number of white matter lesions on the brain. Although all 118 patients in the study group had a NOTCH3 genetic variant, the specific variant that causes CADASIL was rarely seen.

Given the high population frequency of NOTCH3 variants, the number of individuals who may be at higher risk of SVD and stroke as a result of a NOTCH3 variant is significant, the research team wrote. The study indicates that most individuals with a NOTCH3 variant will develop NOTCH3-associated SVD after the age of 65.

“Stroke is a complex multifactorial condition,” said Vida Abedi, Ph.D., a scientist in the department of molecular and functional genomics at Geisinger and a co-author of the study. “Dissecting its risk factors and identifying ways to improve patient outcomes is a crucial part of improving patient care.”

“This study represents a novel and powerful approach to studying the genetic basis of neurologic disease,” said Ramin Zand, M.D., a vascular neurologist and clinician-scientist at Geisinger and co-author of the study. “Geisinger’s unique resources, its electronic health records and focus on precision medicine allows us to leverage this data to provide better care for all of our patients.”

To recognize the signs of a stroke, people should remember the acronym BE FAST:

  • Balance: Does the person show signs of sudden loss of balance?
  • Eyes: Are they experiencing sudden vision trouble like blurred, double or loss of vision?
  • Face: Does the person’s face look uneven when they’re asked to smile?
  • Arms: Is there weakness in one or both arms?
  • Speech: Does the person have trouble speaking or seem confused?
  • Time: Call 9-1-1 if you notice any of these signs or symptoms.


Source: Geisinger