Nerve ‘zap’ treatment may speed stroke recovery

Healthday Copyright © 2017 HealthDay. All rights reserved.

An implanted device that provides electrical stimulation of the vagus nerve leading to the brain enhanced arm movement in a small group of stroke patients, researchers report.

Evaluating 17  with chronic arm weakness who also received intense , scientists found that three-quarters improved with vagus nerve stimulation (VNS), while only one-quarter of those receiving “sham” nerve stimulation did.

“Arm weakness affects three of every four of our  patients and persists to a disabling degree in at least 50 percent of them, so it’s a hugely important problem in the long term,” explained study author Dr. Jesse Dawson. He’s director of the Scottish Stroke Research Network and a clinical researcher at University of Glasgow.

“A unique aspect of this [device] is that patients can deliver the brain stimulation technique in their own home during exercise . . . which is an important breakthrough that opens a huge number of possibilities for increasing patient access to this potential treatment,” Dawson added.

The study was funded by the VNS device’s manufacturer, MicroTransponder Inc., based in Texas.

About 700,000 Americans suffer a stroke each year, two-thirds of whom need post-stroke rehabilitation to help them regain skills lost due to stroke-related brain damage, according to the U.S. National Institute of Neurological Disorders and Stroke.

The vagus nerve is the longest nerve leading to the head, which passes through the neck and down into the abdomen. Surgically implanted just below the collarbone, the VNS device stimulates the brain with small electrical pulses through an internal wire as patients simultaneously move.

All 17 study participants (average age nearly 60) had the device implanted, but Dawson and his team randomly assigned half to receive VNS and half to receive “sham” stimulation. All had suffered clot-caused strokes and took part in six weeks of intensive physical therapy. Their strokes had occurred up to five years prior to the study and had caused chronic arm weakness.

Not only did more patients receiving VNS experience enhanced , but those patients continued to improve throughout the 90-day study period, Dawson said.

Stimulating the vagus nerve, Dawson said, triggers the release of various chemicals in the brain, two of which are known to increase the brain’s potential to recover after injury.

“We can conclude that VNS does drive a change and have an effect for patients recovering from stroke, but we can’t [yet] conclude there’s magnitude enough to introduce it into clinical practice,” he said.

A larger clinical trial enrolling 120  from the United States and the United Kingdom will begin this summer, Dawson added.

Dr. Daniel Labovitz is director of the Stern Stroke Center for the Montefiore Health System in New York City. He said the new research was promising, but the study’s design and small number of participants made it difficult to discern if results are “sustainable.”

“I think it’s exciting to at least be working toward proof of concept—that we can influence the brain to organize itself and enhance recovery long after a stroke occurs,” said Labovitz, who wasn’t involved in the new research.

“This is the holy grail of rehabilitation,” Labovitz said. “And this technique may be the first time where we can actually get the brain to heal itself better than just having the patient move their limb around [during physical therapy].”

Dawson pointed out that implanting the VNS device does carry certain potential risks, such as infection around the device; anesthesia complications; and temporary hoarseness due to vocal cord trauma.

The study was presented at the recent International Stroke Conference in Houston. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

Explore further: Study shows stimulation helps stroke patients

More information: Jesse Dawson, M.D., director, Scottish Stroke Research Network, and clinical researcher, University of Glasgow, Scotland; Daniel Labovitz, M.D., director, Stern Stroke Center, Montefiore Health System, New York City; Feb. 24, 2017, presentation, International Stroke Conference, Houston

Read more at: https://medicalxpress.com/news/2017-03-nerve-zap-treatment-recovery.html#jCp

Walking can help improve stroke recovery

Computational walking model could help stroke patients achieve optimal recovery

by News Medical Life Sciences

After a stroke, patients typically have trouble walking and few are able to regain the gait they had before suffering a stroke. Researchers funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) have developed a computational walking model that could help guide patients to their best possible recovery after a stroke. Computational modeling uses computers to simulate and study the behavior of complex systems using mathematics, physics, and computer science. In this case, researchers are developing a computational modeling program that can construct a model of the patient from the patient’s walking data collected on a treadmill and then predict how the patient will walk after different planned rehabilitation treatments. They hope that one day the model will be able to predict the best gait a patient can achieve after completing rehabilitation, as well as recommend the best rehabilitation approach to help the patient achieve an optimal recovery.

Currently, there is no way for a clinician to determine the most effective rehabilitation treatment prescription for a patient. Clinicians cannot always know which treatment approach to use, or how the approach should be implemented to maximize walking recovery. B.J. Fregly, Ph.D. and his team (Andrew Meyer, Ph.D., Carolynn Patten, PT., Ph.D., and Anil Rao, Ph.D.) at the University of Florida developed a computational modeling approach to help answer these questions. They tested the approach on a patient who had suffered a stroke.

The team first measured how the patient walked at his preferred speed on a treadmill. Using those measurements, they then constructed a neuromusculoskeletal computer model of the patient that was personalized to the patient’s skeletal anatomy, foot contact pattern, muscle force generating ability, and neural control limitations. Fregly and his team found that the personalized model was able to predict accurately the patient’s gait at a faster walking speed, even though no measurements at that speed were used for constructing the model.

“This modeling effort is an excellent example of how computer models can make predictions of complex processes and accelerate the integration of knowledge across multiple disciplines,”says Grace Peng, Ph.D., director of the NIBIB program in Mathematical Modeling, Simulation and Analysis.

Fregly and his team believe this advance is the first step toward the creation of personalized neurorehabilitation prescriptions, filling a critical gap in the current treatment planning process for stroke patients. Together with devices that would ensure the patient is exercising using the proper force and torque, personalized computational models could one day help maximize the recovery of patients who have suffered a stroke.

“Through additional NIH funding, we are embarking with collaborators at Emory University on our first project to predict optimal walking treatments for two individuals post-stroke,” says Fregly. “We are excited to begin exploring whether model-based personalized treatment design can improve functional outcomes.”

Source:

National Institute of Biomedical Imaging and Bioengineering

NIH Stroke Scale

 shutterstock_384907717

The NIH Stroke Scale

Medical professionals and even the public have been trained to recognize basic signs of stroke. These include three features of stroke: slurred speech, drooping of one outstretched arm, and drooping of one side of the face when attempting to smile. When one of these signs is present it’s a fairly sensitive indicator of stroke. When all three are present, sensitivity for stroke is approximately 90%. However, when evaluating patients for inclusion in stroke protocols and prior to fibrinolytic stroke treatments, medical professionals use a slightly more sophisticated series of questions. They often use the NIH stroke scale.

The NIH offers training and certification in the administration and scoring of the stroke scale. An overview of the scale is listed below.

The stroke scale items should be presented in order and the score should be reported after each numbered category has been assessed. The score should be based on the patient’s actual performance and what is witnessed by the examiner. It should not be a reflection of what the examiner thinks the patient is able to do. Remember, the patient could be experiencing an acute stroke, so time is of the essence. The examiner should work quickly. On the other hand, the patient should not be coached or aided by anyone, including the examiner. If the patient cannot perform one of the items, indicate the corresponding score, and move onto the next item.

National Institutes of Health (NIH) Stroke Scale

1a. Level of consciousness 0 = Alert and responsive1 = Arousable to minor stimulation

2 = Arousable only to painful stimulation

3 = Unarousable or reflex responses

1b. Questions

Ask patient’s age and month. Must be exact.

0 = Both correct1 = One correct

2 = Neither correct

1c. Commands

Ask patient to open/close eyes, grip and release non-affected hand.

0 = Both correct1 = One correct

2 = Neither correct

2. Best gaze

Horizontal extraocular movements by voluntary or reflexive testing.

0 = Normal1 = Partial gaze palsy; abnormal gaze in one or both eyes

2 = Forced eye deviation or total paresis which cannot be overcome by oculocephalic maneuver

3. Visual fields

Test by confrontation or threat as appropriate. If monocular, score field of good eye.

0 = No visual loss1 = Partial hemianopia, quadrantanopia, extinction

2 = Complete hemianopia

3 = Bilateral hemianopia or blindness

4. Facial palsy

If stuporous, check symmetry of grimace to pain. Paralysis (lower face).

0 = Normal1 = Minor paralysis (normal looking face, asymmetric smile)

2 = Partial paralysis

3 = Complete paralysis (upper and lower face)

5a. Left motor arm

5b. Right motor arm

 

Arms outstretched 90° (if patient is sitting) or 45° (if supine) for 10 seconds. Encourage best effort, note paretic side.

0 = No drift1 = Drift but does not hit bed

2 = Some antigravity effort, but cannot sustain
3 = No antigravity effort, but minimal movement present

4 = No movement at all X = Unable to assess due to amputation, fusion, etc

6a. Left motor leg

6b. Right motor leg

 

Raise leg to 30° (always test patient supine) for 5 seconds.

7. Limb ataxia

Check finger-nose-finger; heel-shin; score only if out of proportion to weakness.

0 = No ataxia (or aphasic, hemiplegic)1 = Ataxia present in one limb

2 = Ataxia present in two limbs X = Unable to assess as above

8. Sensory

Use safety pin. Check grimace or withdrawal if stuporous. Score only stroke related losses.

0 = Normal1 = Mild to moderate unilateral sensory loss but patient aware of touch

2 = Severe to total sensory loss, patient unaware of touch (or bilateral sensory loss or comatose)

9. Best language

Ask patient to describe cookie jar picture, name objects, read sentences. May use repeating, writing, stereognosis.

0 = Normal1 = Mild-moderate aphasia

2 = Severe aphasia (almost no information exchanged)
3 = Mute, global aphasia, or coma

10. Dysarthria

Ask patient to read or repeat a list of words.

0 = Normal1 = Mild-moderate dysarthria

2 = Severe, unintelligible or mute

X = Intubation or mechanical barrier

11. Extinction and inattention

Simultaneously touch patient on both hands, show fingers in both visual fields, ask patient to describe deficit, left hand.

0 = Normal, none detected (or severe visual loss with normal cutaneous responses)1 = Neglects or extinguishes to bilateral simultaneous stimulation in any sensory modality (visual, tactile, auditory, spatial, or personal inattention)

2 = Profound hemi-inattention or extinction in more than one modality

Most people receive a score 0 after taking the NIH stroke scale. Scores as low as one to four could indicate a mild stroke. The highest possible score is 42 which would obviously be consistent with a profound stroke. The NIH stroke scale can be administered in less than 10 minutes in skilled hands. It provides excellent baseline for stroke treatment assessment and can be used for prognosis.

Images used with the NIH Stroke Scale:

stroke-img1

You know how.

Down to earth.

I got home from work.

Near the table in the dining room.

They heard him speak on the radio last night.

stroke-img2

For more information:  https://www.aclsmedicaltraining.com/

I think I rather have heartburn!

shutterstock_271332770

Study: Could Heartburn Drugs Up Stroke Risk?

Posted by Dennis Thompson, HealthDay Reporter

A popular category of heartburn medications—including Nexium, Prevacid, Prilosec and Protonix—may increase your risk of stroke, a new study suggests.

Known as proton pump inhibitors (PPIs), these drugs increased people’s overall stroke risk by 21 percent, said study lead author Dr. Thomas Sehested.

However, the risk appears to be driven by people who take high doses, added Sehested, research director at the Danish Heart Foundation in Copenhagen.

“People treated with a low dose of PPIs did not have a high risk of stroke,” he said. “Those treated with the highest doses of PPIs had the highest risk of stroke.”

The extent of risk also depends on the specific PPI taken.

At the highest dose, stroke risk ranged from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix), the researchers said.

Takeda Pharmaceutical, the maker of prescription-only Protonix, did not respond to a request for comment.

PPIs specifically affected risk of the most common type of stroke, ischemic stroke, which occurs when a clot blocks blood flow to the brain.

Proton pump inhibitors treat heartburn by blocking acid-producing cells in the lining of the stomach.

Prior studies have associated PPI use with heart disease, heart attacks and dementia, Sehested said.

However, because of its design, the new study can’t establish a direct cause-and-effect relationship between these heartburn drugs and elevated stroke risk. The research only shows an association.

For this study, researchers analyzed the records of nearly 245,000 Danish patients, average age 57. All had undergone an endoscopy, a procedure used to identify the causes of stomach pain and indigestion.

During about six years of follow-up, nearly 9,500 patients had their first ischemic stroke.
Researchers checked to see if the stroke occurred while patients were taking any of these PPIs: omeprazole (Prilosec), esomeprazole (Nexium), Prevacid or Protonix. The researchers also asked about another class of antacids known as H2 blockers, which include Pepcid and Zantac.
The research team found increased risk from PPIs, but none from H2 blockers. The relationship held even after researchers adjusted for other risk factors for stroke and heart disease, Sehested said.

No one is sure why PPIs may have a harmful effect on heart health, Sehested said. He noted that PPIs might reduce levels of biochemicals that are important for the maintenance of blood vessels. Without those biochemicals, people could experience hardening of the arteries, he theorized.

Most PPIs are now available over the counter, and doctors are concerned that people are taking the drugs when they shouldn’t, said Dr. Philip Gorelick, medical director of the Mercy Health Hauenstein Neuroscience Center in Grand Rapids, Mich.

“A lot of people continue to take these medicines for prolonged periods of time, or use these medications for indications that are suspect, or not approved by the FDA,” Gorelick said. “So one has to be careful about that.”

Using the drugs for a shorter period or at lower doses may prove to be safer, he added.
People who need PPIs and have been prescribed one by a doctor should continue using them, Sehested said.

However, people who started using a PPI without a doctor’s guidance, or kept using one after the prescribed period, should talk with their physician about whether they should cut the drugs out.

“A lot of people are using these drugs without a clear indication, such as a clear diagnosis showing they should use these drugs every day,” Sehested said. “They should think about quitting those drugs.”

Copyright © 2016 HealthDay. All rights reserved.

Can-Do Spirit

can-do-it

Posted by Emily Shearing

“I don’t aspire to be president of the United States, I don’t want to be an Olympic gold medal winner, I don’t want to be a major league ball player, but I do small things within my capabilities and set reasonable goals by just saying, ‘I’m going to do this,’” Merrill says.

Although he’s no longer able to run or swim, Merrill, 66, doesn’t let that discourage him. “I think [running and swimming] were such a part of my life for so long, but I shouldn’t expect to do the things I did 15 years ago,” he says. “I don’t look back and think there’s something I could’ve done to fix history. I can only deal with the here and now.”

Merrill stays focused on his recovery by walking, meeting new people and recently began yoga. He also cares for himself and lives alone, which he admits isn’t always easy. “Picking up prescriptions and running errands used to be simple tasks, and you don’t think anything of them, but when you have a stroke they become challenging,” he says.

In June 2015, one year after retiring as a technology management consultant, Merrill, who’s also a veteran, had a stroke while alone in his home in Phoenix. During the night, he dreamt of a buzzing sound. But when he awoke, the buzzing became louder. Merrill knew this was a sign of a stroke.

Doctors told Merrill he was lucky. “When I got inside [the hospital], the doctor turned to the rescue guy and said, ‘good job — he probably had four or five minutes to spare,’” he says. “We had a good chuckle, and I thought then that I was going to keep a positive outlook though this.”

After being cleared with speech, occupational and physical therapists, Merrill now struggles only with balance and researching which drugs and treatments his insurance will cover.

His next goal is to translate his optimism into inspiring both fellow stroke survivors and others through public speaking. For now, he’s practicing his big speech on friends until he finds the right outlet.

Speaking in inspirational snippets, Merrill does his best to motivate people, even those he’s never met standing in line at the grocery store. “I have two choices in life – I can accept my condition and move forward and try to be an inspiration and encourage others, or I can say poor me,” he says. “Seek out something you love and use your gifts to survive.

John Merrill welcomes emails.

GV Summary:  Does this sound familiar: “I don’t aspire to be president of the United States, I don’t want to be an Olympic gold medal winner, I don’t want to be a major league ball player, but I do small things within my capabilities and set reasonable goals by just saying, ‘I’m going to do this”  says John Merrill.

We have come from different backgrounds, but we have experienced the exact same thing!  I am going to email John; we never know where that will lead us.

Middle-Age Fitness Helps Ward Off Stroke Later

shutterstock_289559096

Posted by Steven Reinberg, HealthDay Reporter

“It is becoming increasingly clear that healthy mid-life behaviors pay off as we age, and lower our risk of cardiovascular disease and stroke,” said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine. He was not involved in the study.

Among nearly 20,000 adults in their mid to late 40s, researchers found the most fit had a 37 percent lower risk of having a stroke after 65, compared with the least fit.

The protective effect of fitness remained even after the researchers accounted for risk factors for stroke, such as high blood pressure, type 2 diabetes and an abnormal heart rhythm known as atrial fibrillation.

“Incorporating exercise and regular physical activity in one’s day-to-day routine is important to improve fitness and lower risk of stroke and other cardiovascular diseases in older age,” said lead researcher Dr. Ambarish Pandey. He is a cardiology fellow at the University of Texas Southwestern Medical Center in Dallas.

Pandey said an exercise routine should include aerobic exercise (such as jogging, swimming, walking or biking), plus strengthening exercise (such as free weights or strength-training machines).

Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability, Pandey noted.

Most strokes occur when a blood clot blocks a blood vessel in the brain, cutting off blood and oxygen. This causes brain cells to die and can leave permanent disability.

Pandey speculated that exercise might help prevent stroke by keeping blood vessels healthier and lowering inflammation that can affect their function.

The findings suggest doctors should consider low fitness levels a risk factor for stroke, the study authors said.

While lifelong fitness is best for optimum health, starting later in life is still beneficial. “It’s never too late to exercise to lower the risk of heart attack and stroke,” Pandey said.

Pandey and colleagues analyzed 1999-2009 data from a study conducted by the Cooper Institute in Dallas. It used treadmill tests to measure heart and lung exercise capacity when participants were 45 to 50.

The most interesting finding in this study, Sacco said, was that the effect of fitness was independent of some traditional risk factors. “Diet was not evaluated and can also be linked to health fitness lifestyles,” Sacco said.

Sacco agreed it’s never too late to start getting fit to reap health benefits.

“Other studies have shown that physical activity, even among older individuals, can also lower stroke risk and be associated with less silent stroke and mental decline,” Sacco said. “However, among older adults it is important to check with your physician before you start more vigorous physical activity.”


Copyright © 2016 HealthDay. All rights reserved.

Brain Basics

shutterstock_175160774Source: National Institute of Neurological Disorders and Stroke

Introduction

If you’re like most Americans, you plan your future. When you take a job, you examine its benefit plan. When you buy a home, you consider its location and condition so that your investment is safe. Today, more and more Americans are protecting their most important asset—their brain. Are you?

Stroke ranks as the fourth leading killer in the United States. A stroke can be devastating to individuals and their families, robbing them of their independence. It is the most common cause of adult disability. Each year approximately 795,000 Americans have a stroke, with about 160,000 dying from stroke-related causes. Officials at the National Institute of Neurological Disorders and Stroke (NINDS) are committed to reducing that burden through biomedical research.

What is a Stroke?

A stroke, or “brain attack,” occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow and those caused by bleeding into the brain. A blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes. These blockages stem from three conditions: the formation of a clot within a blood vessel of the brain or neck, called thrombosis; the movement of a clot from another part of the body such as the heart to the brain, called embolism; or a severe narrowing of an artery in or leading to the brain, called stenosis. Bleeding into the brain or the spaces surrounding the brain causes the second type of stroke, called hemorrhagic stroke.

Two key steps you can take will lower your risk of death or disability from stroke: control stroke’s risk factors and know stroke’s warning signs. Scientific research conducted by the NINDS has identified warning signs and a large number of risk factors.

What are the warning signs of a Stroke?

Warning signs are clues your body sends that your brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke or “brain attack,” don’t wait, call a doctor or 911 right away!

  • Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
  • Sudden confusion, or trouble talking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headache with no known cause

Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes.” Although brief, they identify an underlying serious condition that isn’t going away without medical help. Unfortunately, since they clear up, many people ignore them. Don’t. Paying attention to them can save your life.

What are the risk factors for a Stroke?

A risk factor is a condition or behavior that occurs more frequently in those who have, or are at greater risk of getting, a disease than in those who don’t. Having a risk factor for stroke doesn’t mean you’ll have a stroke. On the other hand, not having a risk factor doesn’t mean you’ll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increases.

Some factors for stroke can’t be modified by medical treatment or lifestyle changes.

  • Age.  Stroke occurs in all age groups.  Studies show the risk of stroke doubles for each decade between the ages of 55 and 85.  But strokes also can occur in childhood or adolescence.  Although stroke is often considered a disease of aging, the risk of stroke in childhood is actually highest during the perinatal period, which encompasses the last few months of fetal life and the first few weeks after birth.
  • Gender.  Men have a higher risk for stroke, but more women die from stroke.  Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.
  • Race.  People from certain ethnic groups have a higher risk of stroke.  For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or other racial group in the United States.  Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians.  An important risk factor for African-Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow. The incidence of the various stroke subtypes also varies considerably in different ethnic groups.
  • Family history of stroke.  Stroke seems to run in some families.  Several factors may contribute to familial stroke.  Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes.  The influence of a common lifestyle among family members also could contribute to familial stroke.

What are the treatable factors?

Some of the most important treatable risk factors for stroke are:

  • High blood pressure, or hypertension.
    Hypertension  is by far the most potent risk factor for stroke. Hypertension causes a two-to four-fold increase in the risk of stroke before age 80.  If your blood pressure is high, you and your doctor need to work out an individual strategy to bring it down to the normal range. Some ways that work: Maintain proper weight. Avoid drugs known to raise blood pressure. Eat right:  cut down on salt and eat fruits and vegetables to increase potassium in your diet. Exercise more. Your doctor may prescribe medicines that help lower blood pressure. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.
  • Cigarette smoking. 

    Cigarette smoking causes about a two-fold increase in the risk of ischemic stroke and up to a four-fold increase in the risk of hemorrhagic stroke.  It has been linked to the buildup of fatty substances (atherosclerosis) in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure; carbon monoxide from smoking reduces the amount of oxygen your blood can carry to the brain; and cigarette smoke makes your blood thicker and more likely to clot. Smoking also promotes aneurysm formation. Your doctor can recommend programs and medications that may help you quit smoking. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.

  • Heart disease. 

    Common heart disorders such as coronary artery disease, valve defects, irregular heart beat (atrial fibrillation), and enlargement of one of the heart’s chambers can result in blood clots that may break loose and block vessels in or leading to the brain. Atrial fibrillation—which is more prevalent in older people—is responsible for one in four strokes after age 80, and is associated with higher mortality and disability. The most common blood vessel disease is atherosclerosis. Hypertension promotes atherosclerosis and causes mechanical damage to the walls of blood vessels. Your doctor will treat your heart disease and may also prescribe medication, such as aspirin, to help prevent the formation of clots. Your doctor may recommend surgery to clean out a clogged neck artery if you match a particular risk profile. If you are over 50, NINDS scientists believe you and your doctor should make a decision about aspirin therapy. A doctor can evaluate your risk factors and help you decide if you will benefit from aspirin or other blood-thinning therapy.

  • Warning signs or history of TIA or stroke. 

    If you experience a TIA, get help at once. If you’ve previously had a TIA or stroke, your risk of having a stroke is many times greater than someone who has never had one. Many communities encourage those with stroke’s warning signs to dial 911 for emergency medical assistance. If you have had a stroke in the past, it’s important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by asking the unaffected brain regions to do double duty. That means a second stroke can be twice as bad.

  • Diabetes. 

    In terms of stroke and cardiovascular disease, having diabetes is the equivalent of aging 15 years. You may think this disorder affects only the body’s ability to use sugar, or glucose. But it also causes destructive changes in the blood vessels throughout the body, including the brain. Also, if blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Hypertension is common among diabetics and accounts for much of their increased stroke risk. Treating diabetes can delay the onset of complications that increase the risk of stroke.

  • Cholesterol imbalance.  Low-density lipoprotein cholesterol (LDL) carries cholesterol (a fatty substance) through the blood and delivers it to cells.  Excess LDL can cause cholesterol to build up in blood vessels, leading to atherosclerosis.  Atherosclerosis is the major cause of blood vessel narrowing, leading to both heart attack and stroke.
  • Physical inactivity and obesity.  Obesity and inactivity are associated with hypertension, diabetes, and heart disease.  Waist circumference to hip circumference ratio equal to or above the mid-value for the population increases the risk of ischemic stroke three-fold.

Do you know the risk?

Some of the most important risk factors for stroke can be determined during a physical exam at your doctor’s office. If you are over 55 years old, the worksheet in this pamphlet can help you estimate your risk of stroke and show the benefit of risk factor control.

The worksheet was developed from NINDS-supported work in the well-known Framingham Study. Working with your doctor, you can develop a strategy to lower your risk to average or even below average for your age.

Many risk factors for stroke can be managed, some very successfully. Although risk is never zero at any age, by starting early and controlling your risk factors you can lower your risk of death or disability from stroke. With good control, the risk of stroke in most age groups can be kept below that for accidental injury or death.

Americans have shown that stroke is preventable and treatable. In recent years, a better understanding of the causes of stroke has helped Americans make lifestyle changes that have cut the stroke death rate nearly in half.

Scientists at the NINDS predict that, with continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones, Americans should be able to prevent 80 percent of all strokes.

Score your stroke risk for the next 10 years-MEN

Key:  SBP = systolic blood pressure (score one line only, untreated or treated); ; Diabetes = history of diabetes; Cigarettes = smokes cigarettes; CVD (cardiovascular disease) = history of heart disease; AF = history of atrial fibrillation; LVH  = diagnosis of left ventricular hypertrophy

Points 0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10
Age 55-56 57-59 60-62 63-65 66-68 69-72 73-75 76-78 79-81 83-84 85
SBP-untrd 97-105 106-115 116-125 126-135 136-145 146-155 156-165 166-175 176-185 186-195 196-205
or SBP-trtd 97-105 106-112 113-117 118-123 124-129 130-135 136-142 143-150 151-161 162-176 177-205
Diabetes No Yes
Cigarettes No Yes
CVD No Yes
AF No Yes
LVH No Yes

 

Your Points 10-Year Probability
1 3%
2 3%
3 4%
4 4%
5 5%
6 5%
7 6%
8 7%
9 8%
10 10%
11 11%
12 13%
13 15%
14 17%
15 20%
16 22%
17 26%
18 29%
19 33%
20 37%
21 42%
22 47%
23 52%
24 57%
25 63%
26 68%
27 74%
28 79%
29 84%
30 88%

 

Compare with Your Age Group Average 10-Year Probability of Stroke
55-59 5.9%
60-64 7.8%
65-69 11.0%
70-74 13.7%
75-79 18.0%
80-84 22.3%

 

Score your stroke risk for the next 10 years-WOMEN

Key:  SBP = systolic blood pressure (score one line only, untreated or treated); ; Diabetes = history of diabetes; Cigarettes = smokes cigarettes; CVD (cardiovascular disease) = history of heart disease; AF = history of atrial fibrillation; LVH  = diagnosis of left ventricular hypertrophy

Points 0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10
Age 55-56 57-59 60-62 63-64 65-67 68-70 71-73 74-76 77-78 79-81 82-84
SBP-untrd 95-106 107-118 119-130 131-143 144-155 156-167 168-180 181-192 193-204 205-216
or SBP-trtd 95-106 107-113 114-119 120-125 126-131 132-139 140-148 149-160 161-204 205-216
Diabetes No Yes
Cigarettes No Yes
CVD No Yes
AF No Yes
LVH No Yes

 

Your Points 10-Year Probability
1 1%
2 1%
3 2%
4 2%
5 2%
6 3%
7 4%
8 4%
9 5%
10 6%
11 8%
12 9%
13 11%
14 13%
15 16%
16 19%
17 23%
18 27%
19 32%
20 37%
21 43%
22 50%
23 57%
24 64%
25 71%
26 78%
27 84%

 

Compare with Your Age Group

Average 10-Year Probability of Stroke

55-59 3.0%
60-64 4.7%
65-69 7.2%
70-74 10.9%
75-79 15.5%
80-84 23.9%

 

This example helps you assess your risk of stroke. Tally your points to score your
stroke risk over the next 10 years.

Martha, age 65, wanted to determine her risk for having a stroke, so she took this stroke risk profile. This is how she arrived at her 10-year probability risk for having a stroke:

Age 65
SBP – treated, 107-113
Diabetes – No
Cigarettes – Yes
CVD – No
AF – Yes
LVH – No
4 points
2 points
0 points
3 points
0 points
6 points
0 points

TOTAL

15 points

Interpretation:
15 points carries a 16 percent, 10-year probability of having a stroke. If Martha quits smoking she can reduce her points to 12, which carries a 9 percent, 10-year probability of having a stroke.

Her current point total does not mean Martha will have a stroke, but serves as a wake-up call to ways she can lower her risk or even prevent a stroke. A lower percent score doesn’t mean that Martha won’t have a stroke, only that she is at a lower risk of having one.

No matter what your score is, it is important to work on reducing your risk factors as Martha did in this example by quitting smoking.

Source:  D’Agostino, R.B.; Wolf, P.A.; Belanger, A.J.; & Kannel, W.B.  “Stroke Risk Profile:  The Framingham Study.”  Stroke, Vol. 25, No. 1, pp. 40-43, January 1994.

Many risk factors for stroke can be managed, some very successfully. Although risk is never zero at any age, by starting early and controlling your risk factors you can lower your risk of death or disability from stroke. With good control, the risk of stroke in most age groups can be kept below that for accidental injury or death.

Americans have shown that stroke is preventable and treatable. In recent years, a better understanding of the causes of stroke has helped Americans make lifestyle changes that have cut the stroke death rate nearly in half.

Scientists at the NINDS predict that, with continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones, Americans should be able to prevent 80 percent of all strokes.