Stopping Statins After Stroke May Raise Risk of Another

Stroke survivors who stop taking cholesterol-lowering statins are at increased risk for another stroke, a new study finds.

Researchers studied more than 45,000 ischemic stroke survivors who were prescribed a statin within 90 days of leaving the hospital. Ischemic stroke is caused by blocked blood flow to the brain. It is the most common type of stroke.

Compared to those who continued taking statins, patients who stopped three to six months after their stroke were 42 percent more likely to suffer another stroke within a year, and 37 percent more likely to die from any cause.

There was no increased risk of another stroke or of death during the study period among patients who continued taking statins at a lower dose, the investigators found. Statins help prevent cholesterol from building up in the arteries.

The study was published Aug. 2 in the Journal of the American Heart Association.

“Based on our findings of this large group of patients in the ‘real world,’ we believe that statins should be a lifelong therapy for ischemic stroke patients if a statin is needed to lower the patient’s cholesterol,” study lead author Dr. Meng Lee said in a journal news release. Lee is an assistant professor in the department of neurology at Chang Gung University College of Medicine in Taiwan.
Even though the study included patients in Taiwan, the results should apply to patients in the United States and other countries, according to Lee.

“Discontinuation of statin treatment in patients with ischemic stroke should be strongly discouraged in any stage—acute or chronic—of stroke,” Lee said. “Shifting to low-intensity statin therapy could be an alternative for stroke patients not able to tolerate moderate or high-intensity statin therapy in the years following a stroke.”

Copyright © 2017 HealthDay. All rights reserved.

High-Tech Tools Show Promise for Stroke Recovery

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After months of traditional physical therapy, and still partly paralyzed, Mr. Tannenbaum turned to a videogame for help. He used a device at NYU Langone Medical Center in which an interactive, on-screen canoe trip retrains the paralyzed hand and brain in basic movements.

New therapeutic devices for stroke recovery, made possible by advances in hardware and software, are transforming the typically low-tech world of stroke rehabilitation. Though the tools are still in the early stages, doctors say that they can be more motivating and engaging for patients than current standard therapies, and that they hold promise for stroke survivors who are too injured for traditional therapy.

“We’re entering a very exciting era,” says Dr. David Putrino, director of telemedicine at the Burke Medical Research Institute in White Plains, N.Y. “All of these new tools can really help us do our jobs much better.”

Strokes, which cause brain damage, are a major cause of death and disability in the U.S. Most survivors have some type of disability, and at least half are affected severely enough to require special care or a long-term facility.

Home front

While existing stroke therapies are useful, patients typically don’t get as much of these therapies as their doctors would like, both in the hospital and after they leave. It’s especially difficult to get patients to follow through on therapy routines in the long term, in part because the routines are often repetitive and tedious. The new methods, in contrast, are more engaging for the patients, and some can be done at home.

What’s more, while most stroke therapy works by exercising the part of the body associated with the injured portion of the brain, some of the new therapies take a different approach.

For instance, the simulated canoeing device at NYU Langone—which is undergoing clinical trials—engages both arms simultaneously in an effort to retrain the paralyzed hand and the affected portion of the brain. The design is based on research findings by its inventors that using an uninjured arm can help in retraining the injured one.

Their research suggests that both sides of the brain are involved in one arm’s movement, says Preeti Raghavan, a doctor at New York-based NYU Langone who, along with Dr. Donald Weisz, a former professor at Mount Sinai Medical Center, developed the therapeutic device through their company, Mirrored Motion Works Inc.

Mr. Tannenbaum’s experience speaks to the device’s effectiveness at getting him to stick with his therapy. “Two minutes in, you forget you’re doing exercise and you feel like you’re playing a game,” he says. Mr. Tannenbaum says that since his stroke he has regained some abilities, including the ability to walk and move his right arm up and down.

Robotic exoskeletons

Among the newest therapeutic tools used for stroke victims, those most commercially available are robotic exoskeletons, which attach directly to the affected part of the body to facilitate or enable movement.

Robotic exoskeletons are well suited to therapy, since the support can be taken away gradually as patients improve, says Karen Nolan, a senior research scientist at the nonprofit Kessler Foundation, a West Orange, N.J., research and charitable institution for people with disabilities. Exoskeletons also may relieve physical therapists of having to manually move the patients, so they can focus on the quality of the movements instead, says Dr. Nolan.

Another approach, called telerehabilitation, aims to increase the amount of therapy stroke patients get by making supervised rehabilitation available at home—and making it fun at the same time. One system, developed by Steven Cramer, a University of California, Irvine, professor, and his team, integrates low-cost electronic videogame plug-ins, such as a Nintendo Wii remote-controlled gun. Users’ movements control the games, with remote supervision by a therapist.

“People get all freaky jazzed when they shoot the little ducky on the screen,” Dr. Cramer says. The system is in clinical trials to test its effectiveness compared with in-person physical therapy.

A canoeing videogame at NYU Langone can help stroke patients rehab a paralyzed hand.
A canoeing videogame at NYU Langone can help stroke patients rehab a paralyzed hand. PHOTO: ANDREW NEARY/NYU LANGONE MEDICAL CENTER
Benefits of VR

Videogame technology used in stroke therapy also includes virtual-reality systems, with some that render scenes and objects in 3-D. Some games with immersive environments may offer the greatest promise to stroke patients because they address cognitive problems along with sensory and motor problems, says Dr. Mindy Levin, a professor at McGill University in Montreal and president of the International Society for Virtual Rehabilitation.

While stroke patients often have physical difficulty with such basic tasks as shopping, everyday environments such as malls can leave them feeling overwhelmed as well. A simulation developed by Israeli researcher and occupational therapist Dr. Debbie Rand, called VMall, can help reintroduce patients to such environments in a low-stakes way by capturing the patient’s image and movements and placing them in an on-screen virtual mall, where they look for items on a shopping list.

The future of these technologies likely lies in a multifaceted approach that combines exercise, therapy and medication, says Lee Schwamm, director of stroke services at Massachusetts General Hospital in Boston and a professor at Harvard Medical School.

In addition to exploring the value of videogame devices such as the Wii and Microsoft’s Kinect for rehabilitative purposes, Dr. Schwamm says he would like to see what can be achieved using more everyday consumer technology, such as Fitbits, the wearable devices that encourage users to be active by monitoring their movements and vital signs. Users also can make the data available online to compare numbers and compete with others.

Questions remain

Researchers are still determining how to match each patient with the technology he or she would benefit most from, depending on the nature and severity of the injury. Canadian clinical guidelines, for instance, recommend robotic exoskeletons for the shoulder and elbow but not for the wrist and hand, based on patient outcomes seen in a review of research.

There’s also a question about how insurers will cover treatments in this burgeoning field. Not all of these new products are available for patient in-home use, and some concerns remain about the effectiveness of those that are.

“If it helps, it helps, but it’s a young field,” Dr. Cramer says. “Most of these devices have yet to publish solid, well-powered, persuasive clinical studies that establish these things do something reliably, in a consistent way.”

It’s possible that using all the new approaches together could provide maximal effect, says Leonardo Cohen, chief of neuroplasticity and neurorehabilitation at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.

“It’s conceivable, if each of them improves learning by 5%, maybe when one administers them all together, it has an additive effect,” Dr. Cohen says. “I don’t know that, but it would be interesting to explore.”

Ms. Court is a reporter for MarketWatch in New York. She can be reached at ecourt@marketwatch.com.

Helping stroke patients through gaming?


By Jodi Lundmark CJ Staff

The Thunder Bay woman is working on her masters at Lakehead University, working closely with the Thunder Bay Regional Research Institute in neuro-imaging studies and now she also has a $50,000 grant from the Ontario Brain Institute to develop a stroke recovery application.

“What I’m building is a brain-based training game designed for people who have had a stroke and lost some of the function in their hands to kind of regain that control over the motor functions in their hand,” said Parker.

She said she’s seen how difficult and frustrating it can be for stroke patients to go through physical rehabilitation.

“I wanted to make something that was going to be really fun and engaging for them to do, something that didn’t feel like work,” Parker said.

A game seemed like the ideal solution.

The game doesn’t require much physical activity as it focuses on rebuilding and strengthening connections in the brain that will help regain the physical functions.

Family members can play along and the goal is to make the game go online.

Parker couldn’t divulge too many details about the actual gameplay just yet, but said it’s a touchscreen game based on a simple concept.

“A lot of stroke patients are older people and they can be a little bit leery of technology,” she said. “I designed it to be the most simple concept I could.”

Parker was inspired to work on a project that would benefit seniors because of her close relationship with her grandparents.

“People lose patience very easily sometimes with older people so I wanted to get into something that can help them and be friendly for them and get them connected with the younger generation as well,” she added.

Parker has been working on the app with the help of LU and the TBRRI and was one of seven scientists awarded a $50,000 grant last Friday in Toronto from the OBI.

The grant is to help develop the projects commercially and the year-long funding also provides industry mentors and training.

How Stroke Affects Cognition Over Time


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Posted by Lisa O’Neill Hill

A new study has found that people who have survived a stroke may continue to have challenges with their thinking years after the brain attack, and that those challenges may get worse. The study is one of the first to follow cognitive decline in stroke survivors over a long period of time.

The study, published in JAMA, was conducted over the course of six years, and suggests that stroke survivors may need to be monitored for cognitive impairment long after their strokes.

Unlike previous studies, which have suggested that cognitive decline doesn’t speed up after a stroke unless another one occurs, the recent findings suggest the opposite.

New Long-term Expectations

“The information is useful as education for patients and their caregivers to understand what might be expected in the long term after a stroke,” said Richard D. Zorowitz, MD, Attending Physician, Outpatient Services, MedStar National Rehabilitation Network in Washington, D.C.  “This may allow patients, their caregivers, and their physicians, to anticipate potential issues that may arise in the future and plan appropriately for them. In addition, there may be medications, such as stimulants like Ritalin, or dementia drugs, that may slow cognitive decline over time.”

The study included 23,572 people from the United States who were 45 or older. They did not have cognitive challenges when they entered the study. Out of the group, 515 people had strokes—470 ischemic, 43 hemorrhagic and two of unknown type. Researchers said the people who’d had strokes were more likely to have health problems such as higher blood pressure and diabetes, be older, and be male.

The stroke survivors had a “significantly faster” rate of cognitive impairment compared to the people who hadn’t had strokes.

Specific Areas of Cognitive Decline

Stroke was associated with a decline in verbal memory, new learning, and global cognition. Compared to the non-stroke group, stroke survivors had more challenges with global cognition and things like reasoning and problem solving, but not with new learning and verbal memory.

The findings may affect the future of patient care, research, and health care policy.

Survivors, now monitored before they’re discharged from the hospital and in rehab settings, should be checked for growing cognitive impairment years after their strokes. Cognitive decline greatly increases the risk of death, depression, dementia, and functional decline, the study said.

Students liked it!

I don’t know WHY I like Homer so much…but he just says “I did it!  Here are some excellent feedback relating to my presentation!  Comments:

“I think this session is great at helping us reflect on the impact of our care has on our patients to encourage us to consider how to improve that care/impact”.

 

“What a great message and story.  Thank you.  This was fantastic”.

“Great perspective.  He can do it, we all can!”

“Very motivating and encouraging that our job is necessary.  Reminder to address the family in the room and give encouragement.”

“It absolutely made me consider how I approach families / loved ones that care for the patient.”

“Thus helped increase my awareness of what our patients are experiencing.”

“Thank you.  Great perspective.  Well Done”