Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Wednesday, July 31, 2013

Longitudinal follow-up of patients with traumatic brain injury: Outcome at 2, 5, and 10-years post-injury

And where the hell are the 2, 5, and 10 year followups for stroke?
Our stroke associations should have been doing this for the past 20 years.
http://online.liebertpub.com/doi/abs/10.1089/neu.2013.2997
Abstract Introduction: The deleterious consequences of traumatic brain injury (TBI) impair capacity to return to many avenues of premorbid life. However, there has been limited longitudinal research examining outcome beyond five years post-injury. The aim of this study was to examine aspects of function, previously shown to be affected following TBI, over a span of 10 years. Materials and Methods: One hundred and forty one patients with TBI were assessed at two, five, and 10 years post-injury using the Structured Outcome Questionnaire. Results: Fatigue and balance problems were the most common neurological symptoms, with reported rates decreasing only slightly over the 10-year period. Mobility outcomes were good in over 75 percent, with few participants requiring aids for mobility. Changes in cognitive, communication, behavioral and emotional functions were reported by approximately 60% of the sample at all time-points. Levels of independence in activities of daily living were high over the 10-year period, and up to 70 percent return to driving. Nevertheless, approximately 40% required more support than before their injury. Only half of the sample returned to previous leisure activities and less than half were employed at each assessment time post-injury. Whilst marital status remained surprisingly stable over time, approximately 30% reported difficulties in personal relationships. Older age at injury did not substantially alter the pattern of changes over time, except in employment. Conclusions: Overall, problems that were evident at 2 years post-injury persisted until 10 years post-injury. The importance of these findings is discussed with reference to rehabilitation programs. Keywords: traumatic brain injury, functional outcome, structured outcome questionnaire

A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices

Very interesting, I would love to see what medical practices are used by stroke doctors and the science behind them. But that would be suggesting that our doctors don't know what they are doing.
Our stroke associations should be doing this analysis if they were any good.

One of the reversals here from Table 2.
Mild intraoperative hypothermia during surgery for intracranial aneurysm (Todd et al,60 2005)Hypothermia was found to be helpful as a neurosurgical adjunct in 1955, especially for ischemic and traumatic insults.
At the time of this publication, the practice was used in nearly 50% of aneurysm surgeries.61 This large randomized study, the Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST), found no improvement in neurologic outcomes with hypothermia, while noting an increase in bacterial infections with the intervention .

This probably means we need more studies before we setup all ambulances with hypothermia tools.
I guess I'll quit pushing them.
Do you really think the reversals and inconclusive results are read and understood by all your stroke doctors? I think not.
http://www.mayoclinicproceedings.org/article/S0025-6196%2813%2900405-9/fulltext

Abstract 

Objective

To identify medical practices that offer no net benefits.

Methods

We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012.

Results

We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it.

Conclusion

The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.

Neuroplasticity for Dummies

I'm not a dummy so why can't they answer this simple question.
 I'll ask what should be a simple question. Or at least something I would think researchers should focus on before they prove once again that neuroplasticity works. How exactly does a neuron recruit a next door neuron to help with a task? Does it send out a cry/signal for help? Or are good samaritans running around looking for distressed neurons to help? This answer could also possibly explain why new neurons migrate to the damaged area. If we knew the answer to this the recovery of penumbra and bleed damage areas might be able to be repeatable. Heck we could send magnetic nanoparticles with the appropriate drugs to the damaged areas. If we can find the Higgs boson we can find how neurons call for help.

http://www.humansustainabilityinstitute.com/index.php?option=com_resource&controller=article&article=110&category_id=1&Itemid=24

Tuesday, July 30, 2013

Tackling Cardiovascular Health Risks in College Football Players

Be careful, especially if you are  a lineman.
The MedPage writeup here;

College Football Linked to High Blood Pressure


The full article here;
http://circ.ahajournals.org/content/128/5/477.full

Colour of sound: Man develops rare brain condition synesthesia after stroke

If we had even a decent stroke association we would have a database of all these unusual strokes catalogued so we could learn what stroke protocols worked for recovery. Rather than the stupidity of
'Every stroke is different, every stroke recovery is different'. If your doctor says that to you, FIRE THEM, they are not following research and obviously are totally out-of-date. But I'm not worth listening to because I have no medical training. 
http://www.660news.com/2013/07/30/colour-of-sound-man-develops-rare-brain-condition-synesthesia-after-stroke/
A man being treated at a Toronto hospital is believed to be only the second person in the world known to have developed a rare neurological condition called synesthesia after suffering brain damage.
Nine months after having a stroke, the anonymous patient began experiencing symptoms of synesthesia, in which certain colours evoked specific feelings. Foods were also associated with various colours.
High-pitched brass instruments like those in the theme from James Bond movies elicited euphoria and caused light blue flashes in his peripheral vision.
Neurologist Dr. Tom Schweizer of St. Michael’s Hospital says it appears that when the man’s brain tried to repair the stroke damage, the “wiring” went awry and produced synesthesia.
Most synesthetes are born with the condition and include singer-songwriter Billy Joel, composer Franz Liszt and author Vladimir Nabakov.
Functional MRI tests showed that many different areas of the man’s brain were activated while listening to the James Bond theme compared with healthy control subjects.
“The areas of the brain that lit up when he heard the James Bond theme are completely different from the areas we would expect to see light up when people listen to music,” says Schweizer. “Huge areas on both sides of the brain were activated that were not activated when he listened to other music or other auditory stimuli and were not activated in the control group.”
The case is reported in the journal Neurology.

Loneliness Promotes Inflammation During Acute Stress

Ask your doctor how this inflammation may be retarding your recovery. And 'Stop stressing about your recovery' is not a valid prescription.  TNF is very important, so your doctor needs to know the answer.
http://pss.sagepub.com/content/24/7/1089.abstract

Abstract

Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-α) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1β) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-α in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health.

Brain-wide gain modulation: the rich get richer

Hard to tell with no abstract but your doctor can expense it and tell what use this will be to your stroke protocol.
http://www.nature.com/neuro/journal/v16/n8/full/nn.3471.html
A study now shows how brain-wide gain modulation, indexed by pupil diameter, shapes the structure of brain-wide neural interactions and, consequently, trial-and-error learning.

The joy of sex: new guidelines for heart attack and stroke victims

I would love to overdo it but hell after 7 years  it may be impossible;

http://www.independent.co.uk/life-style/health-and-families/health-news/the-joy-of-sex-new-guidelines-for-heart-attack-and-stroke-victims-8737347.html

Ischaemic stroke provoked by sexual intercourse

I wish I had this problem, but alas.
http://www.docguide.com/ischaemic-stroke-provoked-sexual-intercourse?hash=7e422beb&eid=33976&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c
The association between long term risk factors and stroke has been well established, but very little is known about factors that may precipitate acute stroke. We describe two young women presenting with ischaemic stroke triggered by sexual intercourse. Patient 1 presented with a cardioembolic stroke probably secondary to the interaction between a patent foramen ovale and thrombophilic abnormalities; Patient 2, presenting with orgasmic headache, had a cryptogenic striatocapsular infarct. Sexual intercourse should be considered as an unusual, but possible, trigger of cerebral ischaemia, especially in young patients presenting with cryptogenic stroke.


Monday, July 29, 2013

Classification of falls in stroke rehabilitation – not all falls are the same

I do wonder if they learned anything about this fall prevention therapy from May of this year. 
http://cre.sagepub.com/content/early/2013/07/23/0269215513496801.abstract

Abstract

Objective: To develop a practical taxonomy of falls and to determine whether these different fall groups have different outcomes.
Design: Descriptive study examining patient characteristics at the time of each fall and iterative development of falls taxonomy.
Setting: An inpatient stroke rehabilitation ward.
Methods: All falls over 21 months were reviewed retrospectively. Case notes were reviewed and each patient’s level of functioning at the time of fall, together with admission profile and discharge outcomes, were collected. Outcomes for fallers (as opposed to falls) were compared using the predominant fall type.
Results: There were 241 falls in 122 patients and most falls occurred around the bed (196 (81%) falls). Toileting-related falls occurred in 54 patients (22.4%). The taxonomy proposes seven main fall types. One fall type (‘I’m giving it a go’) appeared quite different and was associated with better functioning at time of fall and better outcomes. Other fall types were related to high dependency needs, visuospatial difficulties or delirium. Medication-related falls were uncommon in this cohort.
Conclusions: The falls taxonomy developed showed four main types of falls with different, but overlapping, patient characteristics at time of fall with different outcomes. Different fall-prevention strategies may be required for each group.

Allen Daniel Hicks Dead: Stroke Death Of Inmate Sparks State Investigation - Tampa, Fl

And if we had an objective way of diagnosing stroke, like these 17, then we wouldn't need all this training on F.A.S.T.
The stupidity is large out there and I don't see it changing until we get the medical stroke personnel out of the stroke improvement business.
http://www.huffingtonpost.com/2013/07/29/allen-daniel-hicks-dead-stroke-inmate-investigation_n_3671121.html

Cardio Notes: Niacin and Stroke Risk

I was in this AIM-HIGH trial and dropped out just as it was shutting down. I believe that the niacin totally flared up a patch of eczema on my leg, causing me to scratch it until it bled.
But see what your doctor thinks.
http://www.medpagetoday.com/Cardiology/Strokes/40725?

The feasibility of computer-based prism adaptation to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center

Ask your doctor if anything here can help you.
http://www.frontiersin.org/human_neuroscience/10.3389/fnhum.2013.00353/full?utm_source=newsletter&utm_medium=email&utm_campaign=Neurology-w31-2013
Introduction: There is wide interest in transferring paper-and-pencil tests to a computer-based setting, resulting in more precise recording of performance. Here, we investigated the feasibility of computer-based testing and computer-based prism adaptation (PA) to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center.
Methods: Thirty-three neglect patients were included. PA was performed with a pair of goggles with wide-field point-to-point prismatic lenses inducing an ipsilesional optical shift of 10°. A variety of digitalized neuropsychological tests were performed using an interactive tablet immediately before and after PA.
Results: All 33 patients [mean age 60.36 (SD 13.30)], [mean days post-stroke 63.73 (SD 37.74)] were able to work with the tablet and to understand, perform, and complete the digitalized tests within the proposed time-frame, indicating that there is feasibility of computer-based assessment in this stage post-stroke. Analyses of the efficacy of PA indicated no significant change on any of the outcome measures, except time.
Discussion: In conclusion, there is feasibility of computer-based testing in such an early stage, which makes the computer-based setting a promising technique for evaluating more ecologically valid tasks. Secondly, the computer-based PA can be considered as a reliable procedure. We can conclude from our analysis, addressing the efficacy of PA, that the effectiveness of single session PA may not be sufficient to produce short-term effects on our static tasks. Further studies, however, need to be done to evaluate the computer-based efficacy with more ecologically valid assessments in an intensive double-blind, sham-controlled multiple PA treatment design.

More at link.

Statins protective against Parkinson's: More evidence

Anything to keep prescriptions of statins going. Your doctor should be getting Neurology so ask him/her about it.
http://www.theheart.org/article/1563939.do?utm_medium=email&utm_source=20130729_heartwire&utm_campaign=newsletter
Further evidence that statin use is associated with a reduction in risk of Parkinson's disease has come from a population study conducted in Taiwan [1].
The study, published online July 24, 2013 in Neurology, was led by Dr Yen-Chieh Lee (Cathay General Hospital, Taipei, Taiwan).
In a large population of statin users, researchers found a lower risk of Parkinson's in those who continued taking lipophilic statins compared with those who discontinued, having reached their cholesterol goal.
Authors of an accompanying editorial conclude: "For those who have to be on statins, it is a comforting thought that there is a potential added advantage of having a lower risk of Parkinson's disease and possibly other neurologic disorders as well" [2].

Will A Few Cups Of Coffee A Day Keep The Blues Away?

A couple of paragraphs to whet your appetite for more.  You would get a two-fer, need to urinate more often causing you to walk more from your hospital bed to the bathroom. I don't remember any way to get extra coffee outside of meals while in the hospital, unless I had someone go downstairs to the little store on the main floor.
http://www.forbes.com/sites/daviddisalvo/2013/07/28/will-a-few-cups-of-coffee-a-day-keep-the-blues-away/
Following the research on the health effects of caffeine is dizzying. Positive in some cases, negative in others – it’s hard to know whether that morning cup of joe is a health elixir or slow-acting  poison.
In the latest major study on caffeine’s effects, researchers from the Harvard School of Public Health found a correlation between drinking 2-4 cups of caffeinated coffee each day and lower suicide risk among adults.

The study, published in The World Journal of Biological Psychiatry, was a meta-review of three extensive U.S. health studies that included a total of 43,599 men and 164,825 women.  Consumption of caffeine (from tea, soda and chocolate), coffee and decaffeinated coffee was evaluated among study participants every four years via questionnaire. Across all three studies, coffee accounted for the majority of caffeine consumed at 71% of the total.

The analysis showed that the risk of suicide among adults drinking 2-4 cups of coffee (the equivalent of about 400 mg of caffeine) a day was 50% less than the risk for adults who drank decaffeinated coffee or one cup or less of caffeinated coffee. Drinking more than 4 cups of coffee didn’t drop the suicide risk lower.

Having said that, the neurochemistry behind the finding makes sense. As discussed in a previous article, caffeine acts as an expert mimic of a chemical called adenosine in the brain and other parts of the body. Adenosine is a sort of checks-and-balances chemical produced by neurons as they fire throughout the day; the more adenosine is produced, the more the nervous system ratchets down activity, until we eventually fall asleep and reboot the process.

Seen this way, coffee may act as a mild antidepressant — at least to an extent. Previous research has found similar correlations reinforcing the possibility that coffee–the most frequently ingested psychoactive substance in the world–can help alleviate depression.
All of this research, however, should be taken with an enormous caveat that the findings are anything but conclusive.  And given the drawbacks of cohort studies, it’s possible that the latest study results are a “mirage” that wouldn’t hold true outside of this particular correlative fishbowl.

Full article at link.

Improve Movement by Training Movement – Not Specific Muscles

This sounds like something our therapists need to explore to make sure they can give us the correct protocols to recover.
http://www.bboyscience.com/improve-movement-by-training-movement/

Sunday, July 28, 2013

Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset

You will need to see if your emergency room has resolved the conflict between these two research articles.
Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset

Early Intensive Blood-Pressure Lowering Improves Recovery in Patients With Acute Intracerebral Haemorrhage

 

The damage to your brain will be the result if they get it wrong. 

Effect of Folate and Mecobalamin on Hip Fractures in Patients With Stroke

Only 8 years old. How incompetent is your stroke hospital if they haven't put this into place yet? Seems like a fireable offense for the hospital board of directors to enforce. Why would you even go to a hospital if they can't even read and apply research  to their areas of expertise? The following of Joint Commission standards is even more of a reason to never set foot in such a hospital. No innovation. But then I'm a stupid non-medical stroke survivor, they would have to be stupider than me to not see  where they can apply research to stroke protocols.
http://jama.jamanetwork.com/article.aspx?articleid=200453
Context  Stroke increases the risk of subsequent hip fracture by 2 to 4 times. Hyperhomocysteinemia is a risk factor for both ischemic stroke and osteoporotic fractures in elderly men and women. Treatment with folate and mecobalamin (vitamin B12) may improve hyperhomocysteinemia.
Objective  To investigate whether treatment with folate and vitamin B12 reduces the incidence of hip fractures in patients with hemiplegia following stroke.
Design, Setting, and Patients  A double-blind, randomized controlled study of 628 consecutive patients aged 65 years or older with residual hemiplegia at least 1 year following first ischemic stroke, who were recruited from a single Japanese hospital from April 1, 2000, to May 31, 2001. Patients were assigned to daily oral treatment with 5 mg of folate and 1500 μg of mecobalamin, or double placebo; 559 completed the 2-year follow-up.
Main Outcome Measure  Incidence of hip fractures in the 2 patient groups during the 2-year follow-up.
Results  At baseline, patients in both groups had high levels of plasma homocysteine and low levels of serum cobalamin and serum folate. After 2 years, plasma homocysteine levels decreased by 38% in the treatment group and increased by 31% in the placebo group (P<.001). The number of hip fractures per 1000 patient-years was 10 and 43 for the treatment and placebo groups, respectively (P<.001). The adjusted relative risk, absolute risk reduction, and the number needed to treat for hip fractures in the treatment vs placebo groups were 0.20 (95% confidence interval [CI], 0.08-0.50), 7.1% (95% CI, 3.6%-10.8%), and 14 (95% CI, 9-28), respectively. No significant adverse effects were reported.
Conclusion  In this Japanese population with a high baseline fracture risk, combined treatment with folate and vitamin B12 is safe and effective in reducing the risk of a hip fracture in elderly patients following stroke.
The risk of a hip fracture in patients after stroke is 2 to 4 times higher than that in age-matched healthy control patients.1 These fractures usually occur relatively late after stroke onset and affect the paretic side of the body.25 Hip fractures are associated with more deaths, disabilities, and medical costs than all other osteoporosis-related fractures combined.6 We previously measured the bone mineral density (BMD) in patients with stroke in the second metacarpal bone and demonstrated a decrease in the bone mass in the hemiplegic limb that corresponded to the degree of palsy and vitamin D deficiency,7 which may explain why hip fractures in patients poststroke occur almost exclusively on the hemiplegic side of the body.
A close association between plasma homocysteine and risk of ischemic stroke has been reported,811 and plasma homocysteine levels are higher in patients with ischemic stroke in both acute1213 and convalescent phases.1417 In patients with homocysteinuria, a rare autosomal recessive biochemical abnormality, there is an increased prevalence of skeletal abnormalities,1820 including osteoporosis, a primary risk factor for hip fracture. Thus, elevated plasma homocysteine concentrations may be associated with osteoporosis and increase the risk of a hip fracture. An increased homocysteine level appears to be a strong and independent risk factor for an osteoporotic fracture of the bones, including the hip, in older men and women.2122
In the remethylation cycle, homocysteine is salvaged for methionine synthesis by the addition of a methyl group by methionine synthase.23 Vitamin B12 (cobalamin) is an essential cofactor for methionine synthase and N5-methyl-tetrahydrofolate serves as the methyl donor. Therefore, there are close relationships between plasma homocysteine and cobalamin and folate.89,2426
We previously demonstrated a reduction in plasma homocysteine levels by combination therapy with folate and vitamin B12 in patients with ischemic stroke.26 Our goal for this study was to investigate the efficacy of the combined therapy for decreasing the risk of fractures, particularly in the hip, in a 2-year trial in elderly patients with hemiplegia following ischemic stroke.

Saturday, July 27, 2013

Can Alzheimer Disease Be Prevented?

See what your doctor thinks of this.
http://www.medscape.com/viewarticle/806594?src=wnl_edit_specol&uac=107573PV

Keep Working to Keep Dementia at Bay?

This would not be the Walmarts' greeter or McDonalds' burger flipper.
http://www.medscape.com/viewarticle/807890?src=wnl_edit_specol
Retirement may not be good for your brain, according to a new study from France, which links older age at retirement to a reduced risk of developing dementia.
Mounting evidence suggests that engaging in intellectually stimulating activity throughout life may protect against the development of Alzheimer's disease and other dementias. Professional activity may be an important determinant of mental activity.
Yet "very few studies have looked at retirement and dementia risk," said study leader Carole Dufouil, PhD, director of research in neuroepidemiology at INSERM at the Bordeaux School of Public Health in France.
These new findings underscore the "importance of maintaining high levels of cognitive and social stimulation throughout work and retiree life," Dr. Dufouil said.
Use It or Lose It
In this study, her team linked health and pension databases for 429,803 self-employed workers in France who were living and retired as of December 31, 2010. A total of 11,397 of the retirees had dementia (2.65%).
Overall, in multivariable analyses, for each extra year of age at retirement, the risk for dementia was 3.2% lower (hazard ratio, 0.968; 95% confidence interval, 0.962 - 0.973), Dr. Dufouil reported at a media briefing here July 15 at the Alzheimer's Association International Conference (AAIC) 2013.
"In this sample, all other risk factors being equal, those who retired at 65 years old had a 14.6% lower risk of getting dementia than those who retired at 60 years old," she said.
Even after exclusion of workers with dementia diagnosed within 5 years after retirement, the results remained unchanged and highly significant (P< .0001). The results also held up in further analyses stratified by age categories or year of dementia diagnosis.
"This study provides more evidence to support the 'use it or lose it' mantra; keep your brain active as long as possible to increase your changes of a healthy aging brain," Maria Carrillo, PhD, vice president of medical and scientific relations at the Alzheimer's Association, said in an interview with Medscape Medical News.
David S. Knopman, MD, from the Mayo Clinic, Rochester, Minnesota, who moderated the briefing, said this study also speaks to the issue of cognitive reserve.
"We have evidence from both epidemiology and some very nice evidence from the imaging world that shows that there are logical relationships between burden of disease and susceptibility to cognitive impairment that is a function of cognitive reserve. Clearly, cognitive activity throughout life does have an influence on your risk [of cognitive decline] later on," he said.

Prevalence of Dementia May Be Falling

Don't get complacent, ask your doctor for specific prevention ideas.
http://www.medscape.com/viewarticle/807966?src=wnl_edit_specol&uac=107573PV
Dementia prevalence in older people may be dropping. A new study that compared estimated dementia rates across 3 geographic areas in the United Kingdom (UK) in 12 groups 20 years apart shows that the actual prevalence of dementia was 24% lower than expected in the later group.
The results indicate that the older population may be getting healthier, said author Carol Brayne, MD, professor, public health medicine, University of Cambridge, UK, told Medscape Medical News. "It does suggest that all the preventive actions that are going on in midlife and early life are very important. It reinforces the message that having a healthy and active lifestyle is not only good for the heart, but is probably good for the brain, too."
The study was published online July 16 in The Lancet. Some of the data were also presented in Boston at the Alzheimer's Association International Conference (AAIC) 2013 by Fiona Matthews, Medical Research Council Biostatistics Unit, University Fourvie Site, Cambridge, United Kingdom.
Phase Integration
The analysis included the UK Cognitive Function and Ageing Study (CFAS) I, which estimated dementia prevalence in a sample of the population aged 65 and older in Cambridgeshire, Newcastle, and Nottingham, where interviews were conducted from 1990 to 1993. Researchers compared data from this study to those from CFAS II, which involved interviews with participants of the same age and in the same geographic areas but 20 years later, from 2008 to 2011.
The designs of CFAS I and CFAS II were identical, and for both, trained interviewers visited residences up to 3 times. In CFAS I, 7635 residents were interviewed; in CFAS II, 7796 were interviewed.
However, the CFAS I was a 2-stage study whereas CFAS was 1-stage. The CFAS I baseline interview included questions about sociodemographic characteristics, health, day-to-day function, social contacts, cognitive function, and medication. A random sample of 20% of those who had a baseline interview — stratified to represent the entire cognitive spectrum — was invited for assessment with the geriatric mental state (GMS) examination, a standardized interview designed to identify dementia and other psychiatric disorders in older people.


The CFAS II integrated the screening and assessment phases to minimize dropouts between the 2 stages, and the analysis accounted for this difference in design, said Dr. Brayne.
Rather than clinical classifications, assessments on both occasions used the same algorithmic approach to diagnoses, to provide consistency and reasonable validity across areas and time, she said.
The study found a substantial decrease in prevalence of dementia (odds ratio [OR] in CFAS II vs CFAS I: 0.7 [95% confidence interval], 0.6 - 0.9]; P=.003, adjusted in part for age, sex, and area). Women had a consistently higher dementia prevalence than men.
The overall decrease was driven by noncare settings and was not apparent within care settings where the prevalence increased (OR, 1.7). In CFAS I, the number of people with dementia in care setting represented 34% of all dementia cases; in CFAS II, the proportion of the population with dementia living in care was 29%.
The growing percentage of dementia cases living in the community might call for health policy changes to address a growing need for support, and for primary care physicians to be sensitive to their needs, said Dr. Brayne.
Using prevalence estimates from CFAS I in 1991, 664,000 individuals in the United Kingdom were expected to have dementia at that time. Taking into account the effects of population aging, this number would now be expected to be 884,000, but CFAS II puts the number in 2011 at 670,000, or a reduction of 24%.
The researchers found only slight, nonsignificant geographic variation in both CFAS I and CFAS II, but there were strong deprivation effects. A deprivation index uses census data on unemployment, car ownership, home ownership, and household overcrowding for a particular locality.
"If you look at the map of the projections, taking deprivation into account and using the age-sex profile of each of the areas, you do get quite varying prevalence expected in each of the areas across England," said Dr. Brayne.
Highest Areas
The dementia prevalence seems to be highest in areas with older age profiles as well as a high rate of deprivation, she added. "There are areas where the estimates go right up, particularly for men; in some areas, men's estimates get to be towards that for women."
Although the study didn't look at the causes of the decline in dementia, Dr. Brayne speculated that it reflects the benefits of primary prevention — managing hypertension, smoking cessation, better diet, and other lifestyle changes — that have also resulted in a dramatic drop in mortality from stroke and heart disease. Higher education levels, too, may have provided a protective effect, she added.
"All these things caused a 'cohort' effect, so in this cohort coming through now, the good things seem to be outweighing the bad things," which include more diabetes and cognitive side effects of stroke survival.
Policy changes over the 20 years between studies, which made it more difficult to access data, and a lower response rate for the second CFAS (56% compared with 80% in the earlier study) that may reflect a reluctance of family members to allow their loved ones to be interviewed, created some barriers for CFAS II, said Dr. Brayne.
"We will be doing formal analyses of nonresponses because we think it's a very important societal change. With some studies back in the 1980s, there was a 95% response rate."
In a statement from The Lancet, Editor-in-Chief Richard Horton said, "A reduction in prevalence of dementia in the older population is an important and welcome finding. But it is not a signal for the government to deprioritise investment in dementia care and research. Dementia remains a substantial challenge for those affected, their families, the NHS, and the Treasury.
"We need to understand better why the prevalence of dementia has fallen, and what that means for prevention and treatment services," Dr. Horton adds. "Sadly, dementia care and research are too often neglected and underfunded in the UK."
Commenting in an accompanying editorial, Sube Banerjee, MD, professor, mental health and ageing, King’s College, London, United Kingdom, said the study findings are "unequivocally good news."
He agreed that the study seems to support the idea that changes in health behavior have prevented or delayed the onset of dementia at a population level. "The next questions must be: how much further can we go in pursuit of this preventive agenda? How many more cases can be prevented? What do we need to do to have the greatest effect? These questions need empirical investigation followed by purposeful strategy formulation and implementation."
The notion that lifestyle changes, for example in diet, exercise, and smoking habits, might reduce the risk for dementia and promote more general health and well-being should be incorporated into health promotion messaging, said Dr. Banerjee.
But although it's a message of empowerment, it comes with a warning, he added. If positive changes in health behavior can decrease the prevalence of dementia, then negative lifestyle choices might promote, rather than prevent, dementia. "It is plausible that the present epidemic of morbid obesity, with consequent cardiovascular disorders, stroke, and diabetes, might act to increase the proportion of people with dementia in future cohorts."
The new data do not mean that dementia should be any less of a priority. Dementia remains "very common, very expensive, and profoundly negative" in its effects on patients and their families, said Dr. Banerjee. "Even with a small decrease in incidence and prevalence, population aging will still double the numbers with dementia worldwide in the next generation."
Numbers Still Up
Weighing in on the possible implications of these lowered dementia estimates, Mathew Baumgart, senior director of public policy, Alzheimer's Association, said that just because dementia estimates fall short of projections doesn't mean that the numbers aren't going up.
"Notwithstanding all the details and minutiae of this study, I think it confirms that we have a growing problem," he said. "The current prevalence estimate in this UK study is lower than what the projection would have been 20 years ago had they made a projection 20 years ago, but the actual prevalence is higher and therefore the stress and burden on the health care system and society are still greater."
According to the Alzheimer's Association, 5 million Americans aged 65 and over currently live with Alzheimer's disease, and that number will increase to 13.8 million by the year 2050.
Although the UK study adjusted only for age and gender, the models used to develop the U.S. projections also take into account other factors, such as the changing racial and ethnic composition of the population, mortality rates, and educational attainment, said Baumgart.
But he doesn't see any discrepancy between the two. "The issue is how do you measure what happens in the future and what are the factors that go into what's going to happen in a projection in the future, and both of these models are showing higher numbers."
In a statement, the Alzheimer's Association reiterates this point. While many older and middle aged people are now undertaking potentially brain-healthy but unproven steps, such as increased access to healthcare and increased physical and mental activity, whether that is actually affecting how many get dementia, "we simply do not know yet."
"However, even if the percentage of new cases in the population is going down (and we don't know for certain that it is) because the older population is growing at such a fast rate, dementia prevalence - that is, the total number of people with the disease - is continuing to rise. In other words, it is likely that prevalence is not going down but it could be increasing at a slightly slower pace," the statement notes.
This particular study used different methods from those in current prevalence studies in the United States, and it is not expected to have implications for dementia prevalence estimates in the United States, the statement adds.
"What we do know for certain is that Alzheimer's disease and related dementias are an enormous and growing problem, affecting tens of millions of individuals and families worldwide," the Association concludes."The problem will get bigger and more burdensome as the global population continues to age. The tools we have now for diagnosis - especially early detection - and treatment are relatively ineffective by many standards and urgently need improvement."

Brain stimulation helps stroke recovery

You'll have to see  what your doctor can make of this for your aphasia.
http://www.telegraph.co.uk/health/healthnews/10146448/Brain-stimulation-helps-stroke-recovery.html
A couple of paragraphs, rest at link.

Early treatment with magnets could help stroke sufferers recover their ability to speak, according to a new study.
Patients made three times as much progress following speech and language therapy if their brains had first been stimulated with a magnetic coil.
The non-invasive technique was used to temporarily shut down properly functioning parts of the brain so that the side which had been damaged by the stroke could relearn language.
Brain stimulation should be offered within five weeks of a patient suffering a stroke because genes which allow the brain to recover are most active early on, researchers said.
The therapy is aimed at patients with aphasia, a disorder which affects two or three in every 10 stroke sufferers and lowers their ability to understand and use language.

Binge Drinking and Hypertension on Cardiovascular Disease Mortality in Korean Men and Women

I can't even imagine how you manage to put down 12 drinks at one time. If your are hypertensive don't do this.
http://stroke.ahajournals.org/content/41/10/2157.short

Abstract

Background and Purpose—The purpose of this study was to examine combined effects of hypertension and binge drinking on the risk of mortality from cardiovascular disease in Koreans.
Methods—This study followed a cohort of 6100 residents in Kangwha County, aged ≥55 years as of March 1985, for cardiovascular mortality for 20.8 years up to December 31, 2005. We calculated hazard ratios (HRs) for cardiovascular mortality by blood pressure and binge drinking habits using the Cox proportional hazard model. Binge drinkers and heavy binge drinkers were defined as having ≥6 drinks on 1 occasion and ≥12 drinks on 1 occasion.
Results—After adjusting for total alcohol consumption, male heavy binge drinkers with Grade 3 hypertension had a 12-fold increased risk of cardiovascular mortality (HR, 12.7; 95% CI, 3.47 to 46.5), whereas male binge drinkers with Grade 3 hypertension had a 4-fold increased risk of cardiovascular mortality (HR, 4.41; 95% CI, 1.38 to 14.1) when compared with nondrinkers with normal blood pressure. However, in considering separate effects of heavy binge drinking and hypertension on the risk of cardiovascular mortality, HRs were rather low (HR of heavy binge drinkers, 1.88, 1.10 to 3.20; HR of hypertensives, 2.00, 1.70 to 2.35) compared with nondrinkers with normal blood pressure.
Conclusions—Binge drinkers and heavy binge drinkers with Grade 3 hypertension showed a marked increase in cardiovascular mortality risk. Even after adjusting for total alcohol consumption, the former revealed 4.41 and the latter indicated 12.7 of HR for the risk of cardiovascular mortality.

Role of Mercury Toxicity in Hypertension, Cardiovascular Disease, and Stroke

Be careful out there,  this is from eastern Finnish men so it may not apply to you, but think about your adjustable factors.
http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7176.2011.00489.x/full

Abstract

J Clin Hypertens (Greenwich). 2011;13:621–627. ©2011 Wiley Periodicals, Inc.
Mercury has a high affinity for sulfhydryl groups, inactivating numerous enzymatic reactions, amino acids, and sulfur-containing antioxidants (N-acetyl-L-cysteine, alpha-lipoic acid, L-glutathione), with subsequent decreased oxidant defense and increased oxidative stress. Mercury binds to metallothionein and substitute for zinc, copper, and other trace metals, reducing the effectiveness of metalloenzymes. Mercury induces mitochondrial dysfunction with reduction in adenosine triphosphate, depletion of glutathione, and increased lipid peroxidation. Increased oxidative stress and reduced oxidative defense are common. Selenium and fish containing omega-3 fatty acids antagonize mercury toxicity. The overall vascular effects of mercury include increased oxidative stress and inflammation, reduced oxidative defense, thrombosis, vascular smooth muscle dysfunction, endothelial dysfunction, dyslipidemia, and immune and mitochondrial dysfunction. The clinical consequences of mercury toxicity include hypertension, coronary heart disease, myocardial infarction, cardiac arrhythmias, reduced heart rate variability, increased carotid intima-media thickness and carotid artery obstruction, cerebrovascular accident, generalized atherosclerosis, and renal dysfunction, insufficiency, and proteinuria. Pathological, biochemical, and functional medicine correlations are significant and logical. Mercury diminishes the protective effect of fish and omega-3 fatty acids. Mercury inactivates catecholaminei-0-methyl transferase, which increases serum and urinary epinephrine, norepinephrine, and dopamine. This effect will increase blood pressure and may be a clinical clue to mercury-induced heavy metal toxicity. Mercury toxicity should be evaluated in any patient with hypertension, coronary heart disease, cerebral vascular disease, cerebrovascular accident, or other vascular disease. Specific testing for acute and chronic toxicity and total body burden using hair, toenail, urine, and serum should be performed.

Friday, July 26, 2013

Is It Bell's Palsy or a Stroke? Emergency Physicians Have the Answer

Instead of congratulating themselves for correctly identifying the difference, this should result in getting objective diagnosis of stroke.  Like these 17 objective diagnosis ideas. The arrogance and stupidity is large out there.
http://www.sciencedaily.com/releases/2013/07/130726074104.htm 
From ScienceDaily
Emergency physicians correctly identified nearly 100 percent of patients with Bell's palsy, the symptoms of which are nearly identical to potentially life-threatening diseases such as stroke and brain tumors. The results of a study of 6 years of California patient records were published online yesterday in Annals of Emergency Medicine.

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"Even lacking established guidelines for diagnosing Bell's palsy, which is the most common cause of paralysis of one side of the face, emergency physicians make the right call nearly every time," said lead study author Jahan Fahimi, MD, MPH, of Alameda County Medical Center in Oakland, Calif. and the University of California, San Francisco. "The dramatic and distressing nature of facial paralysis often brings patients to the ER for evaluation, often with a concern that they are having a stroke. The combination of thorough history-taking and detailed physical exam allows emergency physicians to determine which patients have a dangerous condition and which can safely be discharged home. While there may be a role for imaging, such as CT or MRI, the overwhelming majority of patients can be evaluated without advanced diagnostic tests."
Researchers analyzed 43,979 records for patients discharged from California emergency departments with a diagnosis of Bell's palsy. At 90-day follow up, 0.8 percent of those patients received an alternate diagnosis, such as stroke, brain bleed, brain tumor, central nervous system infection, Guillain-Barre syndrome, Lyme disease, ear infection or herpes zoster. When restricted to only life-threatening alternative diagnoses associated with central facial paralysis, only 0.3 percent were misdiagnosed.
Patients with Bell's palsy commonly manifest partial or complete weakness of the muscles of half of the face, resulting in an inability to raise one eyebrow, wrinkle their foreheads or close one eyelid. Symptoms often progress fairly rapidly and strongly mimic the symptoms of certain types of stroke. It affects approximately 15 people out of 100,000 every year.

Neuroscience Findings on Coordination of Reaching to Grasp an Object

Ask your doctor if anything in here tells you how to stop the spasticity which prevents you from reaching to grasp.
http://nnr.sagepub.com/content/27/7/622.abstract?etoc

Abstract

Background. Knowledge of how damage to brain regions and pathways affects central nervous system control of coordination of reach-to-grasp (RTG) following stroke may not be sufficiently used in existing treatment interventions or in research that assesses their effectiveness. Objective. To review current knowledge of motor control of coordination of RTG and discuss the extent to which this information is being used in research evaluating treatment interventions. Method. This review (1) summarizes the current knowledge of motor control of RTG coordination in healthy individuals, including speculative models and structures of the brain identified as being involved; (2) summarizes evidence of RTG coordination deficits in people with stroke; (3) evaluates current interventions directed at retraining coordination of RTG, including a review of the extent to which these interventions are based on putative neurobiological mechanisms and reports on their effectiveness; and (4) recommends directions for research on treatment interventions for coordination of RTG. Results. Functional task-specific therapy, electrical stimulation, and robot or computerized training were identified as treatments targeted at improving coordination of RTG. However, none of the studies reporting the effect of these interventions related results to individual brain regions affected, and neurobiological mechanisms underlying improved performance were only minimally discussed. Conclusions. Research on treatment interventions for coordination of RTG needs to combine measures of interruption to brain networks and how remaining intact neural tissue and networks respond to therapy with measures of spatiotemporal motor control and upper-limb function to gain a fuller understanding of treatment effects and their mechanisms.

The EXCITE Trial Reacquiring Upper-Extremity Task Performance With Early Versus Late Delivery of Constraint Therapy

Have your doctor tell you what this means.
http://nnr.sagepub.com/content/27/7/654.abstract?etoc

Abstract

Objective. This study examines performance of Wolf Motor Function Test (WMFT) tasks in terms of the ability of EXCITE trial participants (who had suffered a stroke 3-9 months before recruitment) to complete the task within the timed interval. Methods. Data were collected from participants who received constraint-induced movement therapy (CIMT) 3 to 9 months poststroke (CIMT-I, n = 106) or 15 to 21 months poststroke (CIMT-D, n = 116). Performance on the 15 timed WMFT tasks was converted into binary values, and changes in completion of the tasks were analyzed with generalized estimating equation methods, under the assumption of a binomial or Poisson process for completion. Results. During CIMT, the CIMT-I group showed significant within-group improvements in 3 fine-movement tasks and in total noncompleted tasks (noncompletes), whereas the CIMT-D group did not (P ≤ .0036). CIMT-I improvement was significantly greater than CIMT-D improvement for the lifting pencil task and total noncompletes. During the year following CIMT, neither group showed significant changes in completion of WMFT tasks. Over all time intervals, only the CIMT-I group displayed significant improvement in several tasks and total noncompletes. Between groups, there were significant and almost-significant differences between the improvements of the 2 groups in 3 tasks requiring fine distal movement. Conclusion. Receiving CIMT earlier appears to improve reacquisition and retention of WMFT tasks, especially those requiring fine motor skills. Combined with earlier findings, these results indicate that improvements in existing motor abilities are possible with both immediate and delayed CIMT, but early CIMT is necessary for significant reacquisition of tasks.

Transfer of Training Between Distinct Motor Tasks After Stroke

I am already assuming that this will work because there are lots of task-specific things I can't do.
http://nnr.sagepub.com/content/27/7/602.abstract?etoc
Abstract 
Background. Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy. Objective. The purpose of the current study was to test whether training on one motor task in individuals with chronic hemiparesis poststroke would transfer to untrained tasks that were either spatiotemporally similar or different. Methods. In all, 11 participants with chronic mild to moderate hemiparesis following stroke completed 5 days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with 2 other untrained functional upper-extremity motor tasks (sorting, dressing) was assessed before and after training. Results. Performance of all 3 tasks improved significantly after training exclusively on 1 motor task. The amount of improvement in the untrained tasks was comparable and was not dependent on the degree of similarity to the trained task. Conclusions. Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits.

Effect of Anodal Versus Cathodal Transcranial Direct Current Stimulation on Stroke Rehabilitation

Your doctor will know the difference between anodal and cathodal.   Neither definition explained a damn thing. For you Dave, you'll have to ask for the real study.
http://nnr.sagepub.com/content/27/7/592.abstract?etoc

Abstract

Objective. We compared the long-term effect of anodal versus cathodal transcranial direct current stimulation (tDCS) on motor recovery in patients after subacute stroke. Methods. Forty patients with ischemic stroke undergoing rehabilitation were randomly assigned to 1 of 3 groups: Anodal, Cathodal (over-affected and unaffected hemisphere, respectively), and Sham. Each group received tDCS at an intensity of 2 mA for 25 minutes daily for 6 consecutive days over of the motor cortex hand area. Patients were assessed with the National Institutes of Health Stroke Scale (NIHSS), Orgogozo’s MCA scale (OMCASS), the Barthel index (BI), and the Medical Research Council (MRC) muscle strength scale at baseline, after the sixth tDCS session and then 1, 2, and 3 months later. Motor cortical excitability was measured with transcranial magnetic stimulation (TMS) at baseline and after the sixth session. Results. By the 3-month follow-up, all groups had improved on all scales with P values ranging from .01 to .0001. Improvement was equal in the Anodal and Cathodal groups. When these treated groups were combined and compared with Sham, significant interactions were seen for the OMCASS and BI scales of functional ability (P = .002 for each). There was increased cortical excitability of the affected hemisphere in all groups with the changes being greater in the real versus sham groups. There were borderline significant improvements in muscle strength. Conclusion. A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation training to improve motor recovery after stroke.

Effect of a Foot-Drop Stimulator and Ankle–Foot Orthosis on Walking Performance After Stroke

Will this change your PTs protocol for your walking therapy? When will you be notified of changes?
http://nnr.sagepub.com/content/27/7/579.abstract?etoc

Abstract

Background. Studies have demonstrated the efficacy of functional electrical stimulation in the management of foot drop after stroke. Objective. To compare changes in walking performance with the WalkAide (WA) foot-drop stimulator and a conventional ankle–foot orthosis (AFO). Methods. Individuals with stroke within the previous 12 months and residual foot drop were enrolled in a multicenter, randomized controlled, crossover trial. Subjects were assigned to 1 of 3 parallel arms for 12 weeks (6 weeks/device): arm 1 (WA–AFO), n = 38; arm 2 (AFO–WA), n = 31; arm 3 (AFO–AFO), n = 24. Primary outcomes were walking speed and Physiological Cost Index for the Figure-of-8 walking test. Secondary measures included 10-m walking speed and perceived safety during this test, general mobility, and device preference for arms 1 and 2 for continued use. Walking tests were performed with (On) and without a device (Off) at 0, 3, 6, 9, and 12 weeks. Results. Both WA and AFO had significant orthotic (On–Off difference), therapeutic (change over time when Off), and combined (change over time On vs baseline Off) effects on walking speed. An AFO also had a significant orthotic effect on Physiological Cost Index. The WA had a higher, but not significantly different therapeutic effect on speed than an AFO, whereas an AFO had a greater orthotic effect than the WA (significant at 12 weeks). Combined effects on speed after 6 weeks did not differ between devices. Users felt as safe with the WA as with an AFO, but significantly more users preferred the WA. Conclusions. Both devices produce equivalent functional gains.

Thursday, July 25, 2013

Compression Therapy Reduces Blood Clots in Stroke Patients, Study Finds

Who is comparing this to this one from Aug. 2012 or the leg wraps from Scotland in May 2013. It shouldn't take more than a year to get this inexpensive therapy rolled out to all stroke hospitals. Laggards should have their head stroke doctor fired.  How the hell else are hospitals ever going to stay current with  research unless YOU hold their feet to the fire. You may have to live with the disabilities they could easily prevent.
http://www.sbwire.com/press-releases/compression-therapy-reduces-blood-clots-in-stroke-patients-study-finds-289844.htm
New research shows that inexpensive leg compression devices help prevent fatal blood clots in stroke patients.

The thigh-length sleeves promote blood flow by periodically filling with air and gently squeezing the legs. Vascular PRN, based in Tampa, Fla., is a leading national distributor of intermittent pneumatic compression (IPC) therapy equipment. Greg Grambor, the company's president, commented on the study.

“Compression therapy has been around for over 20 years,” Grambor said. “Many doctors have already come to rely on this equipment for safe, effective, and affordable prevention of deep vein thrombosis. I'm glad this new research was done, and I hope it will help convince more doctors to give it a try.”

Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep within the body. It is common in stroke patients and immobile patients and can also occur in healthy people on long flights where movement is restricted. When a clot detaches, it can then become lodged in the arteries of the lungs, causing a potentially life-threatening pulmonary embolism.

The study involved nearly 3,000 stroke patients at over 100 hospitals across the United Kingdom. Results showed 8.5 percent of patients treated with compression devices developed blood clots, versus 12.1 percent of patients who received alternative treatments.

“Many patients at risk of DVT are prescribed blood thinning drugs,” Grambor added. “But these drugs increase the risk of bleeding, which is quite dangerous for stroke patients as it may lead to bleeding in the brain.”

So far, no study has conclusively shown that blood thinners increase the survival rate of stroke patients. Doctors at the European Stroke Conference, held in London on May 31, 2013, discussed the study's findings. Professor Martin Dennis of the University of Edinburgh said that the UK's guidelines for treatment of stroke should be revised to recommend IPC treatment for all patients at high risk of DVT. Currently, they only recommend it in cases where blood thinners are unsuccessful or too risky.

Each year, some 15 million people worldwide suffer a stroke. One third of strokes are fatal and another third result in permanent disability.

How 3D Printers May Put People at Risk for a Stroke


I don't know how they got to this alarmist heading from the abstract.
Alarmist here;
http://www.natureworldnews.com/articles/3158/20130725/3d-printers-put-people-risk-stroke.htm 
Three-dimensional printers emit nanoparticles that could be hazardous to a person's health, a study published in the journal Atmospheric Environment reports.
Though used in commercial manufacturing for decades, small-scale 3D printers were only recently introduced for home and office use, leading to a whirlwind of inventions and products including everything from guns to sex toys.
Based on this increased popularity, researchers at the Illinois Institute of Technology decided to conduct an examination of the ultrafine particles (UFP) released by the machine, reporting that inhaling high amounts of UFPs have been linked to asthma, cardiorespiratory illnesses and even strokes. To do this, they placed nine 3D printers in a room where they printed small, plastic frogs over various time periods. They then measured the concentration of UFPs and used this number to estimate the UFP emission rates from a single printer.
In the end, the team came to the conclusion that the range included 20 billion particles per minute from printers using a lower temperature polyactic acid (PLA) feedstock, or printer fuel, to roughly 200 billion particles per minute for those using the higher temperature acrylonitrile butadiene styrene (ABS) feedstock.
These rates, the scientists point out, mean 3D printers fall into the category of "high emitters" based on criteria laid out in a 2007 study analyzing office printers, according to Medical News TodayFurthermore, they note that differences in emission rates the PLA and ABS printers may also be compounded with differences in levels of toxicity due to their differing feedstocks.
Either way, the researchers argue that those using the devices should do so with a degree of wariness.
"Because most of these devices are currently sold as standalone devices without any exhaust ventilation or filtration accessories, results herein suggest caution should be used when operating in inadequately ventilated or unfiltered indoor environments," they write.
Far from serving as the last word, the study instead lays the ground work for future examinations, the scientists add, calling in their study for more experiments "to more fundamentally evaluate particle emissions from a wider arrange of desktop 3D printers."

The abstract here;
http://www.sciencedirect.com/science/article/pii/S1352231013005086

Abstract

The development of low-cost desktop versions of three-dimensional (3D) printers has made these devices widely accessible for rapid prototyping and small-scale manufacturing in home and office settings. Many desktop 3D printers rely on heated thermoplastic extrusion and deposition, which is a process that has been shown to have significant aerosol emissions in industrial environments. However, we are not aware of any data on particle emissions from commercially available desktop 3D printers. Therefore, we report on measurements of size-resolved and total ultrafine particle (UFP) concentrations resulting from the operation of two types of commercially available desktop 3D printers inside a commercial office space. We also estimate size-resolved (11.5 nm–116 nm) and total UFP (<100 nm) emission rates and compare them to emission rates from other desktop devices and indoor activities known to emit fine and ultrafine particles. Estimates of emission rates of total UFPs were large, ranging from ∼2.0 × 1010 # min−1 for a 3D printer utilizing a polylactic acid (PLA) feedstock to ∼1.9 × 1011 # min−1 for the same type of 3D printer utilizing a higher temperature acrylonitrile butadiene styrene (ABS) thermoplastic feedstock. Because most of these devices are currently sold as standalone devices without any exhaust ventilation or filtration accessories, results herein suggest caution should be used when operating in inadequately ventilated or unfiltered indoor environments. Additionally, these results suggest that more controlled experiments should be conducted to more fundamentally evaluate particle emissions from a wider arrange of desktop 3D printers.

1 in 7 strokes happen when asleep

But yet instead of realizing that a new approach is needed they go down the tPA rabbit hole again. Stupidity rules.
http://www.onlinenews.com.pk/details.php?newsid=233607&catname=Health

Taste 100 Local Beers and Support Stroke Awareness at Weedstrong Brewfest on August 18th at Quassy Amusement Park

Now thats my kind of stroke fundraiser.
If they had a coffee beer like I made once it could be even better.
http://www.watchlistnews.com/2013/07/25/taste-100-local-beers-and-support-stroke-awareness-at-weedstrong-brewfest-on-august-18th-at-quassy-amusement-park/
The Connecticut Brewers Guild is pleased to announce Weedstrong Brewfest at Quassy Amusement Park in Middlebury on Sunday August 18th from 2 to 6 p.m. to help raise stroke awareness and support for Mike Weed, a father of three young children who suffered a stroke on May 17th at the age of 37.
For an advanced ticket price of just $40, the Weedstrong Brewfest event will feature a beer tasting with more than 100 varieties of craft beer, live local music, free parking and an all-day Quassy Ride and Splash Away Bay Water Park pass from 11 to 8 p.m. Children’s all-day Ride and Splash Away Bay passes are available at a reduced price of just $15 with the advance purchase of an adult Brewfest ticket. The event will be held rain or shine, and park pass vouchers will be provided if the park closes due to inclement weather. $25 from each Brewfest ticket will benefit Mike and his family, and tickets can be purchased online at http://www.quassy.com/plan-your-visit/events.
With someone somewhere experiencing a stroke every 40 seconds, it is very important to Mike and his wife Heidi to educate others about stroke symptoms. Please visit http://www.weedstrong.org for more information including a stroke awareness video created by family and friends, a link to a facebook page to share Mike’s progress, an online donation site and more. Please share this link with your friends!
About a year before his stroke, Mike introduced the Weed Amber Ale recipe to Connecticut. While Weed Beer is growing in popularity, it is not yet helping to pay the bills and growing medical expenses as Mike fights hard on his “Weedstrong” rehabilitation journey. That’s where friends and supporters of fundraising events like the Weedstrong Brewfest are coming together to help a family in need.
Supporters can also help out by purchasing Weed Beer as any profits will benefit Mike and his family. Weed Beer can be purchased anywhere in CT, and if your favorite package store or restaurant does not yet carry it, please ask them to order it from their Budweiser distributor: HDI, Dichello or Levine.