Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,991 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 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:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Exceptionally fast gait speed is associated with a lower risk for cognitive impairment, slower cognitive decline, and greater hippocampal volume in older adults, a new study showed.
While gait speed usually declines with age, the researchers identified a group of older adults with a walking pace similar to that of people 30 years younger. In a retrospective analysis of more than 3900 adults aged 80 years or older, these ‘super movers’ had gait speeds that were at least 1.5 SDs above the age- and sex-adjusted average for their cohort.
Compared with their slower-moving peers, super movers had a lower risk for cognitive impairment over 5 years of follow-up and showed slower decline in memory, processing speed, executive function, and global cognition. However, super movers did not have lower levels of Alzheimer’s disease and related dementia (ADRD) pathology.
“Our results support an exceptional aging phenotype in which superior gait performance in late life may serve as a marker of broader neurocognitive resilience,” lead investigator Oshadi Jayakody, PhD, postdoctoral research fellow, Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, and colleagues, wrote.
This is the whole problem in stroke enumerated in one word; 'care'; NOT PREVENTION!
YOU have to get involved and change this failure mindset of 'care' to 100% PREVENTION! Survivors want PREVENTION, NOT 'CARE'!
I
see nothing here that states going for 100% prevention! You need to create EXACT PROTOCOLS FOR
THAT!
ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation!
Mike Sharma, MD, MSc, FRCPC McMaster University Hamilton General Hospital Hamilton, Ontario, Canada
Mike Sharma, MD, MSc, FRCPC, has a financial interest/relationship or affiliation in the form of: Consultant for Anthos Therapeutics, Inc.; AstraZeneca; and Bayer AG. Grant/Research Support from Alexion Pharmaceuticals, Inc.; AstraZeneca; Bayer AG; Bristol Myers Squibb Company; Janssen Inc.; and Javelin Medical Ltd. Speakers Bureau participant with Bayer AG; Janssen Inc.; Novartis AG; and Vividion Therapeutics.
With that 50% risk, there should be a massive effort to solve stroke, 100% recovery. But I bet all that will occur is the fuckingly lazy general prevention guidelines. I'm sure you feel confident in that approach. Would you do something that has a 50% failure rate?
Researchers determined hazard rates, prevalence and cumulative
proportion free from stroke during a lifelong follow‐up of a
representative sample of middle‐aged men from the general
population. The sample included 855 men, all born in 1913, aged 50 years
who were followed up with repeated medical examinations at ages 54, 60,
67, 75 and 80. The researchers obtained data from hospital records and
the Cause of Death Register, and all stroke events during 48 years of
follow‐up were recorded. According to findings, one of five men in this
population sample had a stroke of any type during follow‐up from 50 to
98 years of age, and the cumulative incidence was approximately 50%.
Another great Seth Godin writeup. Applying this to stroke, We have garbage goals that our researchers are shooting for. THE ONLY GOAL IS 100% RECOVERY. Our stroke associations have garbage goals of prevention and F.A.S.T. press releases.
It has a nice ring to it. And engineers have long embraced it as a mantra. If you don’t put the right stuff in, don’t expect to get good results.
And so, when we banned leaded gasoline, the car industry complained that they’d never be able to make cars run well again.
And when HP started making printers for consumers, they were eager to point out that you needed to use special paper, and definitely not labels.
And if you’re using the command line on a computer, well, don’t spell anything wrong or whatever happens is your fault.
And if you’re a patient, be sure to take the precise amount of medicine, on time, and follow all the doctor’s instructions.
The thing is, “garbage in, garbage out” is lazy.
It’s lazy because it puts all the onus on the user or the environment. It lets the device off the hook, and puts the focus on the system, which, the device creator points out, is out of his control.
It’s one thing to make a sports car that runs beautifully on smooth roads, perfect tires and premium gas, but it’s a triumph of engineering to make one that runs beautifully all the time.
It’s one thing to organize the DMV so it works well when every person reads all the instructions, fills out the forms perfectly and patiently waits their turn, but it’s a generous act of customer service and organization when the system is resilient enough to work with actual human beings.
The extraordinary teacher adds value to every student, no matter what their home is like. She sees possibility and refuses to settle or blame the inputs. Isn’t that the way we’d like every professional to see the world?
You don’t need to measure the flatness of your bread to use a toaster. And the persistence of the car and printer industries means that the type of gas or the paper we use matters a whole lot less than it used to.
Once again, laziness and NO leadership prevails. Prevention, not solving any of the problems in stroke. 10 million yearly stroke survivors will continue to be screwed because of lousy rehabilitation. I could probably vastly reduce the number of 30 day stroke deaths by just following up on existing stroke research.
ormer CDC Director Thomas R. Frieden, MD, MPH,wants to save 100 million lives.
In his first job since leaving the government, Frieden said he will
lead a 5-year, $225-million initiative he hopes will reduce global
deaths from heart attack and stroke and prevent deadly epidemics in low- and middle-income countries.
The new initiative, called “Resolve,” will be housed at Vital
Strategies, a public health nonprofit headquartered in New York City. It
is said to be the first such program to be funded by three leading
philanthropic organizations — the Bill & Melinda Gates Foundation,
Bloomberg Philanthropies and the Chan Zuckerberg Initiative.
“After leaving CDC, I had the opportunity to think big, to look at
the leading causes of death around the world and to combine that with
lessons learned in nearly 3 decades of work in public health in this
country and around the world,” Frieden, who stepped down from the CDC on
Inauguration Day, said during a teleconference.
Frieden began his public health career in the early 1990s as a disease detective in the CDC’s Epidemic Intelligence Service
embedded in the New York City health department, which he would later
run from 2002 to 2009. During his time as head of the health department,
he led efforts to reduce the city’s number of smokers and teen smokers.
The city became the first in the U.S. to eliminate trans fats from
restaurants, starting a nationwide trend.
On Tuesday, Frieden said “a majority” of the funds for his new
initiative will be spent trying to prevent 100 million deaths from
cardiovascular disease, which he said causes one out of every three
deaths worldwide but is not targeted with nearly enough funding.
“Most of these deaths are preventable with simple, inexpensive but
underutilized actions,” Frieden said. “The best estimate that we could
find is that less than 1% of the $35 billion that goes into health
assistance goes for prevention of cardiovascular disease, so these are
significant resources in that context.”
In comparison, Frieden said the initiative’s role in preventing
epidemics in low- and middle-income countries will be “more catalytic”
than financial.
“We believe there are potential sources of funds within countries,
with the World Bank, with other development banks, with bilateral donors
around the world and with the private sector, which has an incentive to
close those gaps,” he said. “But for both of these, our approach is to
strengthen the public sector, support civil society institutions and
establish rigorous surveillance so that we can determine whether we’re
on track and then make corrective actions in both cases.”
This was written in 1990. So 27 years have passed and the fucking incompetence of the stroke medical world is in full display by not figuring out how to solve this problem. I don't give a shit how hard this is, leaders tackle difficult problems, they don't just put out lazy prevention press releases. http://www.annualreviews.org/doi/abs/10.1146/annurev.ne.13.030190.001131?journalCode=neuro
Notice that even supposed leaders in health are basically saying, 'Screw you if you get sick, we are working on stroke prevention, not rehab'. You'll have to deal with your stroke deficits for the forseeable future and your children and grandchildren will be screwed if they have a stroke. The only solution I see is to create a great stroke association run by and for stroke survivors. Big Data and Dr. Watson could solve all the problems in stroke if only we had someone following a stroke strategy. http://scopeblog.stanford.edu/2017/05/24/predict-prevent-and-cure-precisely-stanford-medicines-lloyd-minor-urges/ Lloyd Minor, MD, dean of Stanford’s School of Medicine, opened the school’s annual Big Data in Biomedicine conference today with a call for researchers to recognize opportunities to prevent disease in entire populations. The two-day meeting focuses on using big data to promote precision health.
“Predict, prevent and cure precisely,” Minor said. “This is the opportunity of precision health.”
“For years, health care really has been about sick care,” he
continued. “It’s been about treating severe, acute diseases or their
chronic manifestations. And there’s been comparatively little attention
either in research or care delivery on prediction and prevention. But
that’s all changing today, because of the work being done in this room,
because of the work being done at Stanford.”
Minor later called attention to the recent decline in life expectancy in the United States — the first decline in two decades, he said — and to the country’s expenditure of nearly 18 percent of gross domestic product on health care.
“Precision health offers the tools, the approaches and the
opportunities to make a big dent both in the value equation — achieving
better outcomes for lower cost — and ultimately creating and enabling a
much more healthy population,” Minor said.
Stanford President Marc Tessier-Lavigne,
PhD, also spoke, offering thanks to the members of the audience for the
work they do “to advance the cause of precision health and medicine.”
Citing the enormous need of patients around the world dealing with
pain and suffering, he said, “I’m here to exhort you, as hard as you are
working on these problems, to double down again.”
“Our charge, our responsibility is to make sure we get to precision
health tomorrow and not 10 years or 20 years from now,” Tessier-Lavigne
said. “We know it will be a reality eventually. Our job is to make sure
we accelerate the development and of precision health.”
“The future is even brighter and more exciting because of the work we’re going to be doing together,” said Minor.
The conference continues through Thursday afternoon; if you can’t be here, watch the livestream or follow the hashtag #bigdatamed on Twitter.
Previously: Big Data in Biomedicine Conference kicks off on Wednesday, Precision health aims to reach everyone, Dean Lloyd Minor writes, Finding the heart of precision health and Stanford Medicine conference provided a big look at big data
Photo by Rod Searcey
Neurology
April 18, 2017
vol. 88
no. 16 Supplement
P5.297
Abstract
Abstract
Objective:
To investigate whether resting-state functional connectivity MRI (rs-fcMRI) can predict brain atrophy caused by ischemic
stroke, and whether this prediction is independent of structural connectivity from diffusion MRI (dMRI).
Background:
A stroke
in one location can have effects on remote but connected brain regions,
including focal atrophy. dMRI has previously
been shown to predict regional atrophy of
connected brain regions. Improving the prediction of these remote
effects may improve
symptom localization, prognosis, and allow for
individualized neurorehabilitation.
Design/Methods:
26
patients with acute ischemic stroke received anatomical MRI scans
shortly after their stroke and then again at a later
date (10.7±7.5 months). The change in volume
(atrophy) of 116 automated anatomical labeling (AAL) regions was
computed. Connectivity
of each AAL region to the lesion location was
assessed using rs-fcMRI from a large cohort of normal subjects (N = 98).
For
dMRI, connectivity was the percentage of tracks
from the AAL region that passed through the lesion mask, as used in
prior
work. The lesioned areas themselves were
excluded from analyses. Mixed-effects regression analyses of atrophy as
outcome,
with rs-fcMRI and/or dMRI values as fixed
effects and individual patients as random effect were conducted.
Results:
Rs-fcMRI with the lesion location was a significant predictor of remote atrophy (z = 4.03, p = 5.6e-05), whereas dMRI fell just short of significance (z = 1.70, p = .089). Regression analysis of atrophy including both rs-fcMRI and dMRI as predictors found a significant effect of rs-fcMRI
(z = 3.78, p = 0.0002) but not dMRI (z = 0.98, p = 0.33).
Conclusions:
Resting-state functional connectivity with the lesion location can predict atrophy of remote brain regions after ischemic
stroke, independent of structural white-matter connectivity.
Study Supported by:
M.D.F. was supported by the National Institutes of Health (R21 MH099196,
K23 NS083741), Dystonia Medical Research Foundation,
National Parkinson’s Foundation, and NFL Players
Association. A.J. was supported by a Postdoctoral Fellowship from the
Natural
Sciences and Engineering Research Council of
Canada (NSERC PDF 454617). A.D.B. was supported by 4K12HD027748-24.
Disclosure: Dr.
Jannati has nothing to disclose. Dr. Boes has nothing to disclose. Dr.
Horn has nothing to disclose. Dr. Pascual-Leone
has received personal compensation for
activities with Magstim, Nexstim, Neuronix, Starlab Neuroscience,
Neuroelectrics, Axilum
Robotics, and Neosync as a member of scientific
advisory boards. Dr. Pascual-Leone has received personal compensation in
an
editorial capacity for the Annals of Neurology
and the European Journal of Neuroscience. Dr. Kuceyeski has nothing to
disclose.
Dr. Fox has nothing to disclose.
We
discovered a concomitant decline in stroke and dementia incidence rates
at a whole population level in Ontario, Canada. This study explores
these trends within demographic subgroups.
METHODS:
We
analyzed administrative data sources using validated algorithms to
calculate stroke and dementia incidence rates from 2002 to 2013.
RESULTS:
For
more than 12 years, stroke incidence remained unchanged among those
aged 20 to 49 years and decreased for those aged 50 to 64, 65 to 79, and
80+ years by 22.7%, 36.9%, and 37.9%, respectively. Dementia incidence
increased by 17.3% and 23.5% in those aged 20 to 49 and 50 to 64 years,
respectively, remained unchanged in those aged 65 to 79 years, and
decreased by 15.4% in those aged 80+ years.
DISCUSSION:
The
concomitant decline in stroke and dementia incidence rates may depict
how successful stroke prevention has targeted shared risk factors of
both conditions, especially at advanced ages where such risk factors are
highly prevalent. We lend support for the development of an integrated
system of stroke and dementia prevention.
Our fucking failures of stroke associations should be leading such a movement but NO, all they do is the 'happy talk' version. Everything in stroke is just fine because we have all this prevention information. F.A.S.T. works and tPA is the miracle drug that magically reverses the stroke completely. Total lies.
Not long ago, a good friend of mine said something revealing to me: “I don’t think of you as disabled,” she confessed.
I
knew exactly what she meant; I didn’t think of myself as disabled until
a few decades ago, either, even though my two arms have been pretty
significantly asymmetrical and different from most everybody else’s my
whole life.
My
friend’s comment was meant as a compliment, but followed a familiar
logic — one that African-Americans have noted when their well-meaning
white friends have tried to erase the complications of racial identity
by saying, “I don’t think of you as black,” or when a man compliments a
woman by saying that he thinks of her as “just one of the guys.”
More at link.
I'm sure my friends don't consider me disabled, I'm always the last one at parties, never say no to any adventure.
Your doctor should have protocols to prevent both of these. http://www.medicaldaily.com/alzheimers-vs-dementia-how-they-differ-and-what-do-393669
Dementia and Alzheimer's disease may share many of the same symptoms,
but the two are not different names for the same condition. Here’s what
you need to know about both in order for you to avoid this common
mistake.
Dementia is a syndrome, or a group of symptoms that
consistently occur together. It is not a specific disease. The term
“dementia” is used to describe a set of symptoms that can include memory
loss, difficulty thinking, problem solving, or issues with language.
Dementia is caused by damage to the brain cells, and because Alzheimer’s
is a disease that destroys the brain, it is one of the most common
causes of dementia.
As many as 50 to 70 percent of all dementia cases are caused by Alzheimer’s, Alzheimers.net
reported. However, other conditions can also cause dementia, such as
Parkinson’s Disease and Creutzfeldt-Jakob disease. In addition, dementia
is often incorrectly referred to as "senility" or "senile dementia,"
which reflects the formerly widespread but incorrect belief that serious
mental decline is a normal part of aging.
According to The Alzheimer’s Association,
the symptoms of dementia vary greatly and can include factors such as
memory troubles, communication and language problems, loss of the
ability to focus and pay attention, difficulties with reasoning and
judgement, and trouble with visual perception. However, different types
of dementia are associated with different types of brain damage.
In
addition, an estimated 10 percent of people with dementia have more
than one type at the same time, with the most common combination
being Alzheimer's disease with vascular dementia, The Alzheimer’s Society reported.
According to the Alzheimer’s Association,
Alzheimer’s Disease is a specific type of dementia caused when high
levels of certain proteins inside and outside brain cells make it hard
for brain cells to stay healthy and to communicate with each other. This
leads to the loss of connections between nerve cells, and eventually to
the death of nerve cells and loss of brain tissue.
Here's the major difference
between Alzheimer’s Disease and dementia — when an individual is
diagnosed with dementia, they are diagnosed based on their symptoms
without actually knowing what's behind the symptoms. In Alzheimer’s
disease, the exact cause of the symptoms is understood. In addition,
Alzheimer's disease is not reversible, whereas some types of dementia,
such as those caused by nutritional problems or a drug interaction, can
be reversed.
Once again going down the lazy prevention route. ARE YOU THAT GODDAMNED CHICKENSHIT THAT YOU YOU WILL WAIT UNTIL HELL FREEZES OVER BEFORE EVEN ATTEMPTING TO SOLVE ALL THE PROBLEMS IN STROKE? WAITING ONCE AGAIN FOR SOMEONE ELSE TO SOLVE THE PROBLEM? http://www.healthleadersmedia.com/finance/medicares-million-hearts-initiative-aims-reduce-cardiac-disease
With the help of 516
inaugural participating healthcare providers nationwide, federal
officials are harnessing data to rise to a pair of crucial population
health challenges: reducing rates of cardiovascular disease and stroke.
Launched on July 21, the Million Hearts
Cardiovascular Disease Risk Reduction Model is a data-driven effort
designed to reduce the risk of cardiovascular disease and stroke among
Medicare beneficiaries, federal officials said in a statement.
Participating providers will work with Medicare beneficiaries
individually "to identify the best approach or approaches to reducing
their risk of having a heart attack or stroke." Factors that will be
considered include smoking cessation interventions, blood pressure
management, and the use of cholesterol-lowering drugs or aspirin.
"Each beneficiary will receive a personalized risk modification plan
that will target their specific risk factors. Organizations in the
intervention group will be paid for reducing the absolute risk for heart
disease or stroke among their high-risk beneficiaries," according to
CMS.
The Million Hearts Campaign aligns well with the population health goals at Danville, PA-based Geisinger Health System, says Sanjay Doddamani, MD, system director of advanced cardiac disease and heart failure.
"We have gone from Baby Boomers, to Generation X, to Millennials
carrying modifiable risks for heart attacks and strokes. As a steward
for healthcare in the communities we serve, we are interested to see
that our communities are smoke-free, physically on the move, eating
right, and controlling blood pressure and cholesterol and lipids by
diet, exercise, and medications. The Million Hearts initiative aligns
well with these goals," he says.
Wrong, wrong, wrong. This doesn't indicate needing better prevention. It indicates the need to solve all these fucking problems in stroke. I don't care how difficult they are, doing the prevention route is complete fucking laziness and you should be fired for that. http://www.nzdoctor.co.nz/un-doctored/2016/july-2016/26/Key-New-Zealand-health-target-must-change,-says-professor-.aspx Media release from Auckland University of Technology
One
of New Zealand’s top six priority health targets needs revision,
according to the lead author of a study published in Nature Reviews
Neurology.
The Ministry of Health is targeting 90 per cent
screening for cardiovascular risk, which shares risk factors with other
major non-communicable diseases (NCDs) such as stroke, diabetes and
dementia. However, the research paper shows that the burden of stroke
and other NCDs is increasing rapidly both in New Zealand and
internationally, and the high-risk prevention approach being taken
globally is inadequate.
“The evidence is clear. Simply screening
for high levels of cardiovascular risk, even with some counselling, is
not effective in reducing incidence or mortality from cardiovascular
disease,” says Valery Feigin, lead author and Professor of Neurology and
Epidemiology at Auckland University of Technology (AUT).
He
points to findings from the study, which analysed the most recent
literature on stroke epidemiology. “There is evidence from 240,000
participants in randomised clinical trials that screening for
cardiovascular risk had no effect on health outcomes ten years on. The
health target should be a reduction in cardiovascular risk,” he says.
Although
global stroke incidence and mortality declined from 1990 to 2013, the
absolute numbers of people affected by stroke is rising rapidly
throughout the world. This increasing burden of stroke, including the
lifelong disability many stroke survivors suffer, indicates deficiencies
in current stroke prevention strategies. These deficiencies are further
highlighted by significant gender and ethnic disparities, and a trend
towards more strokes in younger people.
According to Professor
Feigin, current screening measures give false reassurance to people
classified as low to moderate risk – the group in which approximately 80
per cent of all strokes occur. Some of these individuals have isolated
hypertension and many have other risk factors. With the exception of
smoking however, behavioural risk factors such as poor diet, sedentary
lifestyle and excessive alcohol intake are not usually included in the
cardiovascular risk algorithms that are currently used. This is despite
the fact that nearly three quarters of the global burden of stroke is
linked to lifestyle choices.
“Stroke is largely a lifestyle
disease. With better strategies in place, we could prevent three
quarters of all strokes and heart attacks, and extend our stroke, heart
attack, dementia and diabetes-free lives by 20-30 years,” he says.
Professor
Feigin and his co-authors recommend governments introduce taxation to
control nutritional, alcohol and tobacco-related risks – a proven risk
mitigation method that would generate funding for population wide
prevention initiatives and abolition of the emphasis on high risk
individuals.
“Over the last 30 years, New Zealand has
experienced a three-fold increase in the number of people affected by
stroke and living with stroke consequences, and most have very limited
access to rehabilitation services. Developing resources at the same pace
as stroke survivors is not feasible. The only solution is primary
prevention,” says Professor Feigin.
The President of the World Stroke Organization, Professor Stephen Davis, has welcomed the insights provided by the study. (And you Professor Stephen Davis are a major part of the problem. As WSO head I don't see you doing anything useful for stroke.)
“Given
the dramatically increasing global burden of stroke, this call to
action in stroke prevention, from Feigin, Norrving and colleagues, is
strongly supported by the World Stroke Organization. They have
highlighted the importance of a comprehensive population-based approach
to primary stroke prevention, integrated with strategies for other
non-communicable diseases with similar risk factors. This should include
early life interventions. They have highlighted behavioural, lifestyle
and environmental factors and the potential for specific revenue-raising
to support these initiatives. They have also indicated the potential of
using electronic information technology such as smartphone apps,” he
says.
“These strategies could potentially save millions of lives
and have a huge impact on the burden of disability after stroke,” says
Professor Davis.
It would be so simple for optimizing primary
prevention if our doctors would just put together a diet stroke protocol that reduces blood pressure using commonly available foods and supplements. But that won't occur because we have no one in the stroke medical world that has two functioning neurons they can rub together. You, your children and grandchildren are screwed.
According to new research, CVD
risk factors such as high BP before a first stroke confer higher risk
for subsequent stroke and dementia up to 5 years later.
S
“We already know that stroke
patients have an increased risk of recurrent stroke and dementia. What
we didn’t know was whether this increased risk persists for a long time
after stroke and whether heart disease risk factors present before the
first stroke influenced the risk of recurrent strokes or dementia,” M. Arfan Ikram, MD, PhD, from
Erasmus University Medical Center in Rotterdam, Netherlands, said in a
press release. “Our study found these risk factors influence future
stroke and dementia and the risks persist for an extended period in some
patients.”
The researchers analyzed based on propensity
matching 1,237 patients with first-ever stroke and 4,928 participants
without stroke from the population-based Rotterdam Study. Participants
were matched based on sex, age, examination round, and date of
selection. The outcomes of interest were stroke and dementia.
Ikram and colleagues calculated incidence
rates of stroke and dementia for both groups and determined the
population-attributable risk of prestroke CV risk factors for stroke and
dementia.
Up to 1 year after first stroke, those with
stroke had a threefold increased risk for stroke and a twofold increased
risk for dementia compared with those without stroke, Ikram and
colleagues wrote.
The researchers calculated that in the group
with stroke, 39% (95% CI, 18-66) of recurrent strokes and 10% (95% CI,
0-91) of cases of dementia after stroke could be attributed to CV risk
factors before stroke. The rates were similar in the group without
stroke.
“Long-term risks of recurrent stroke and
poststroke dementia remain high and are substantially influenced by
prestroke risk factors, emphasizing the need for optimizing primary
prevention,” the researchers wrote. – by Dave Quaile
In
a study recently published in the journal Stroke, investigators in the
REasons for Geographical And Racial Differences in Stroke Study, or
REGARDS, found that blacks are four times more likely to die of stroke
at age 45 than their white counterparts because blacks have more
strokes, not because blacks who have a stroke are more likely to die
than whites who have a stroke. Important insights from the study and
risk factors that lead to stroke indicate changes that are needed in
Americans’ health habits and in primary health care to reduce the excess
number of deaths from stroke in the black population. “Since the
driving force of the racial difference in stroke deaths is the larger
number of strokes in blacks, to reduce this disparity we have to focus
on factors prior to the stroke’s ever happening,” said George Howard,
Dr.P.H., lead author and professor of biostatistics at the University of
Alabama at BirminghamSchool of Public Health. “We need to do more to
focus on prevention and control of risk factors before they result in a
stroke. While it is important to ensure that blacks and whites receive
the same care once a stroke happens, any differences in care once the
stroke happens do not appear to be the reason that blacks die more from
stroke.”
I think this is the number one problem to resolve, because if the problems aren't even acknowledged then they will never get solved. Our fucking failure of a stroke associations are great at denying problems. Only 'happy talk' like prevention ideas, awareness, and F.A.S.T. ever come from them.
And, on the other side of the table... Challenge two: When you find someone who is
pitching a solution you don't like, it's tempting to deny that there's
much of a problem at all. After all, if you diminish the problem, you
won't have to accept the solution that's on the table.
But of course, the problem is real. The dissatisfaction or
inefficiency or wrong direction isn't going to go away merely because we
deny it.
It's amazing how much we can get done when agree to get something done.
I look at pretty much the same data and see a tremendous way to go yet. Vast problems in stroke needing to be solved. But if you listen to the 'happy talk' from our stroke associations everything is going swimmingly. Prevention and F.A.S.T. are working. Of course only 10% get to almost full recovery. That is complete failure by any measure. But that is a minor quibbling detail to the 10 million yearly stroke survivors.
For
about 20 years, my sleep was dreamless. I’m inclined to attribute this
to the things that happened inside my head in 1995, but I can’t be
certain. The brain remains a mystery. It’s certainly the scene of more
crimes against wellbeing than any other part of the body.
Everyone knows about heart attacks, but a brain attack, or stroke,
can wreak as much havoc. The heart stops in only one way, but the brain
has many ways to remind us of human frailty. I know this, because I had
one kind of brain attack 20 years ago. Since then, I have grappled every
day with the aftermath of that assault on my central nervous system.
Recently, as part of a rearguard action against some tenacious pockets
of resistance, I went back to the National Hospital for Neurology and
Neurosurgery in London to engage with what neurologists describe, in
quasi-military jargon, as my “deficits”. In plain English, the long-term
disabilities attributable to that brain attack.
Among the ways a brain can fail – tumour, aneurysm, haemorrhage,
Alzheimer’s, Parkinson’s and so on – stroke is one of the most common.
It’s a soft, inoffensive word – you stroke a baby or a lover – but a
lethal affliction.
In Britain, every year, 150,000 people of all ages will suffer what
the medical textbooks call “a severe insult to the brain”. Euphemisms
and “stroke” seem to go hand in hand. Increasingly, in Britain and North
America, the term “stroke” is slowly being replaced by “brain attack”
in the hope that new language will sponsor a new attitude towards the
illness, and help modify our behaviour, making us less complacent and
perhaps improving survival rates. Whatever the terminology, it’s a
chilling statistic that this kind of “brain attack” will occur somewhere
in the UK every three and a half minutes. Of these unfortunate souls,
one third will die; one third will be seriously disabled; and 50,000,
the lucky third, will go on to lead fairly normal lives.
But what does it mean to have a stroke and what are the routes to
recovery? And what does a stroke tell us about the way our brains work?
In the last 20 years, in a dynamic interplay between research and
ill-health, developments in our understanding of the brain have
transformed stroke treatment.
In the process, neurology has become the coolest frontline posting in
modern medicine, the place where the puzzle of mind and body meets the
latest technology. But first, before we come to the treatment, there’s
the perennial fascination of the thing that the OED describes as the
“organ of soft nervous tissue contained in the skull of vertebrates”.
You would have to be made of marble not to become intrigued by the human
brain.
Chris Tarrant suffered a stroke last year. Since then, he has become
addicted to the wonders of ‘this extraordinary machine in your head’.
Photograph: Rex
In March last year, after a flight from the Far East, the broadcaster
Chris Tarrant suffered a stroke. Since then, he’s become addicted to
the wonders of “this extraordinary machine in your head”. Fully
recovered from his attack, he reports: “I’ve learned a lot about the
brain. I’ve been going to a neuropsychologist. One day she came in with
this plastic model of a big, fat, crinkly, porridgy melon. And I went,
‘What!’ I mean, I had no idea. The brain is this most extraordinary,
fantastic thing. I did say, ‘Does this make you believe in God?’ And she
said, ‘No. But it does make you think.’”
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According
to an old medical joke, the brain is the only organ in the body to have
named itself. It’s a fact: our brains are us. Each one weighs about
1.4kg (3lb). You could hold it in the palm of your hand. But it’s more
than just an organ. It’s you, in every sense of the word: your
intelligence, demeanour, personality, and consciousness. Oscar Wilde
wrote: “It is in the brain that everything takes place. It is in the
brain that the poppy is red, that the apple is odorous, that the skylark
sings.”
In short, it’s your command centre, your HQ; and one thing is
certain. A brain attack is like having an earthquake at the centre of
your fragile self. When the brain fails, for whatever reason, the human
animal will find itself in extremis. Insults to the brain usually come
out of the blue. I was 42 when, overnight, I experienced a
right-hemisphere haemorrhagic infarct. Today, memories of my weeks on
the front line of ill-health – the aqueous blue blink-blink-blink of the
ambulance, the muffled sounds of the intensive care unit and the
cement-mixer roar of the MRI chamber – have faded to the texture of an
old nightmare. I will, however, never cease to be a veteran of that
conflict. Scan my cerebral cortex and you will see a fuzzy grey scar,
the size of a thumbnail, indicating where the wound in my brain used to
be. This “cerebral lesion” has now become part of that infinitely
complex organ in which the neurologists of the National Hospital
specialise. Professor Andrew Lees,
one of Britain’s leading Parkinson’s specialists, says that below the
surface of the brain there are the “100bn tiny nerve cells that make up
the grey matter”. Another renowned brain surgeon, Henry Marsh, from St
George’s Hospital, London, comes to the brain from a different
perspective.
In Do No Harm,
an award-winning account of his work, Marsh writes that, as he begins
to operate, “mind” and “brain” intersect. He says the idea that his
instruments are “moving through thought itself, through emotion and
reason, and that memories, dreams and reflections should consist of
jelly, is simply too strange to understand. All I can see in front of me
is matter.”
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The
neurons of this “grey matter”, according to Lees, “form part of a
kaleidoscopic internet. On its own, a nerve cell is no more effective
than an isolated termite worker, but through a sophisticated lattice of
nerve stations it creates unique trails that together produce a cosmic
highway. No single nerve cell is separated from any other by more than
six neurons.” Brains, however, nurture an awful lot of neurons. In an
ordinary brain, for instance, there are about 20bn neurons and each one
makes on average 10,000 connections. The extraordinary computational
power of a healthy brain holds the key to our lives as human beings.
To put this another way, if you could somehow connect all the laptop
computers of London or New York, you would only just begin to equal the
capacity of a single brain. This analogy comes from Dr Richard Frackowiak,
formerly of the Wellcome Institute, which faces the National Hospital
from the opposite side of Queen Square. Frackowiak also describes the
brain as “an organ in a box (the skull) with a hole at the bottom where
the brain stem is situated”. Such an oversimplification is a provocative
response to a profound mystery. The working of the brain is so complex
that even the experts still resort to metaphor to convey its functions, a
response that’s as old as Aristotle. For the Greeks, the brain’s
function was to cool the blood. For Descartes, in the 17th century, the
brain was comparable to the latest, dazzling artistic technology, the
hydrostatic fountains of Versailles.
After the industrial revolution, doctors revised this metaphor still
further, establishing an orthodoxy that persisted to the end of the last
century. To the Victorians, therefore, cerebral activity was analagous
to the latest technology. The pathways of the brain were seen as fixed
and rigid, like a railway network, and later as a telephone exchange.
We, in the computer age, have found other ways to describe the working
of the brain, derived from computer science, the phenomenon known as
“plasticity”.
An MRI scan of Robert McCrum’s brain.
“Plasticity,” says Lees, “is the major advance of the last 30 years”,
replacing the traditional view that the brain is physiologically
static. Neuroplasticity, according to the dictionary, “refers to changes
in neural pathways and synapses due to changes in behaviour,
environment, neural processes, thinking, emotions, as well as changes
resulting from bodily injury”.
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Neuroplasticity
occurs on a variety of levels and has been shown to involve dramatic
cerebral responses to brain injury, especially in the field of “cortical
remapping”. In neurology today, the role of neuroplasticity is widely
recognised in healthy development, learning, memory and in recovery from
brain damage.
Lees continues: “Plasticity recognises some adaptability in nerve
cells and the circuits of the brain. The younger you are, the more
adaptable your brain is. We know this from ‘brain mapping’. In a damaged
brain you find some areas taking on the functions of other areas.
Compare the liver, for instance. You can lose almost all your liver and
it will regenerate. In the brain, the nerve cells are not the same. It
does not regenerate in the same way. But there’s now more understanding
of the ways the brain can respond to injury.”
To explore “plasticity” for myself, I enrolled in an experimental NHS
programme in Queen Square. Perhaps it was inevitable that I should make
my way back to the National Hospital where I had first been treated in
1995. There, as part of my coming to terms with what had happened to me,
I wrote a kind of war memoir, My Year Off: Rediscovering Life After A Stroke, and have been associated with the hospital ever since.
Still, it was strange and unsettling to return to the world of
neuro-rehabilitation. This used to be a depressing and primitive
environment. However, a new approach to “brain attack”, combined with
new attitudes to the doctor-patient contract, has transformed the
relationship between neurologists and stroke survivors. Once, it was
dour and fatalistic, today it’s dynamic. Where doctors used to speak
about a patient’s likely recovery from brain injury with the greatest
caution, and in the most guarded terms, now there’s an air of optimism.
This comes from a renewed sense of wonder at the working of the
brain. Lees says that this last great mystery of the human body “is why
so many young people are getting interested in neurology. Neuroscience
has almost replaced philosophy and become virtually a surrogate name
for philosophy. Young people are going into ‘neuro-science’ to
understand the mind.” There are still acres of uncharted cerebral
terrain to explore here, from the research labs to the patient, backed
by new resources of time and money. At a pioneering neurological
hospital like the National, this new mood is symbolised by refurbished
wards, shiny new equipment and a reinvigorated attitude to
physiotherapy.
Where stroke patients used to be wheeled down gloomy linoleum
corridors into dark Victorian wards equipped with little more than rows
of adjustable exercise beds, now there’s an air of hope and
determination From the pine floors, and coffee dispensers, to the
cheerful decor, television, and shelves overflowing with paperbacks,
magazines, and picture books, the atmosphere is upbeat and positive.
Robert McCrum with Salman Rushdie in 1995, shortly before his stroke. Photograph: Caroline Forbes
In 1995, “plasticity” played no part in the vocabulary of
convalescence. Now it has utterly transformed the stroke doctors’
approach to neuro-rehabilitation. For Lees and his generation, it’s the
game-changer. “We never used to talk about plasticity. The brain was
considered to be immutable and there was nothing you could do about it.”
The upshot has been a comprehensive renewal of routine procedures in
the treatment of stroke in the UK. Lees again: “We now have acute stroke
units in a way we didn’t before. There’s been a big push through the
acute medical services to get people into A&E as quickly as
possible.”
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After
the acute phase, there’s the long-haul business of physiotherapy, that
heart-sinking word. Here, too, the techniques of neuro-rehab have become
more brain-aware. Lees says: “We now have much better ways of
rehabilitating patients with [physical] deficits. If you survive the
first few dangerous weeks, it then becomes a question of time and of
exactly how much recovery you eventually make.”
This is a question to which Dr Richard Greenwood, a Queen Square
colleague of Lees, has devoted much of his life. For Greenwood, his work
in neurophysical rehab is now wholly underpinned by plasticity. “The
term began to enter the profession in 1980s, and became popularised
through the 1990s,” says Greenwood, widely acknowledged to be one of
Britain’s rehab experts. “It’s important to remember that plasticity
happens to everyone, whether or not they have a brain injury.” The
principle of plasticity is that it underlies relearning. So, if you
perform a task (for instance, picking up a fork) that attracts cerebral
attention, it will generate “plastic” changes in the part of the brain
that no longer fulfils that function. But the task has to be part of our
consciousness. According to Greenwood: “You need an ‘enriched
environment’ to generate plasticity. It’s not just a matter of 100
hours. The patient has to attend to what he or she is learning. You are
teaching the brain – not a muscle.”
Enter the Silver Spring monkeys. These 17 macaques from the
Philippines, which were kept in the Institute of Behavioral Research in
Silver Spring, in the US state of Maryland, from 1981 until 1991, became
famous lab animals as a result of a battle between animal researchers,
animal advocates, politicians and the courts. Among scientists, these
monkeys are known for their use in experiments into the ability of the
adult primate brain to reorganise itself. In simple terms, the
researchers severed the tendons in the monkeys’ right arms, achieving
the kind of impairment that mimics a stroke, disabling their right side.
Conventionally, the adult primate’s response to this disability is to
deploy the unaffected, fully-functioning left side (arm, hand, fingers
etc).
At Silver Spring, however, the monkeys’ “good” left side was
inhibited by the researchers. So now – to feed and function – the
monkeys had somehow to recruit mobility in their disabled right side. In
theory, this should have been impossible. What the Silver Spring
researchers discovered, however, was that, after a while, the monkeys’
brains found new “pathways”. Miraculously, their right arms began to
work. At Silver Spring, they called this “plasticity”, a phenomenon
described by Greenwood as “underpinned by structural changes at a
microscopic level in the brain”. He says: “The frustrating thing is that
we can demonstrate and explore this in animals, but we can’t do it in
man.” This discovery quickly became one of the most exciting medical
breakthroughs of the 20th century.
In neuro-rehab, Greenwood believes that some of the most useful
advances in physiotherapy have been inspired by the lessons of
plasticity. “When I started, people compared physiotherapy to water
divining or herbal remedies. In the last generation, there’s been a
complete change. What we do in neuro-rehab is no longer part of the
wacky fringe.” The degree to which physiotherapy has become mainstream
is demonstrated by the case of broadcaster Andrew Marr, who suffered a stroke in January 2013.
Marr has waged a remarkable public battle with his disability, but
admits to me that “I’ve now gradually come to terms with the fact that
I’ll never be 100%”. A lifelong fitness fanatic, Marr has treated his
rehab in very practical terms, undergoing long bouts of extreme physio
in the pioneering Arni (Action for Rehabilitation from Neurological
Injury) programme.
This speaks directly to one issue that interests Richard Greenwood.
“Can you,” he asks, “take thought to get better?” To which he replies:
“People who can’t generate effort (because of brain injury) have a
serious problem in achieving physiotherapeutic goals. MRI imaging has
demonstrated that imagining a task does light up appropriate parts of
the brain.” Now, says Greenwood, as the importance of plasticity becomes
fully recognised, physiotherapy is being infiltrated by robotics:
“Robots can assist physiotherapists and provide more hours of
retraining. How we apply robotics in rehab is just beginning to be
explored. This cannot be a mindless programme. Having a robot is not
just a question of wiggling a lever. There need to be individualised
programmes. There may even be a role for robots in gyms. Currently, the
problem for the stroke patient is that rehab ends after two or three
months.” Greenwood says that the potential of robots underlines the need
for a long-term strategy. “There’s been a huge amount of work done in
the UK on stroke,” he says. “But people still get less rehab than they
need. Patients often get put out to grass, through the association of
stroke with old age. Some of the treatment must be psychological.
Patients get depressed. The patient’s family must be involved as part of
the recovery team.”
Simultaneously, the breakthroughs of plasticity have also inspired an
upgrading of neurological language. “Thirty years ago,” Greenwood says,
“you could not mention the brain. One used to say ‘head injury’. It was
almost pornographic to talk about ‘brains’. When you said ‘stroke’,
most people didn’t have a clue what you were talking about. Now
everything has changed.” Greenwood agrees with me that, compared with
cardiac and cancer treatment, stroke/“brain attack” has suffered from an
image problem. “People are more open about stroke now,” he says. “Look
at Andrew Marr.
In the past, people did not want to confront the consequences of brain
damage.” This is partly because, compared with, say, a broken leg, the
consequences are difficult to comprehend and grapple with.
Broadcaster Andrew Marr, who had a stroke in 2013, says: ‘I’ve now
gradually come to terms with the fact that I’ll never be 100%.’
Photograph: Murdo MacLeod/for the Observer
I’ve found that doctors are immensely skilled at healing, especially
when a medical intervention with tangible results is possible. That’s
their basic contract with their patients: diagnosis followed by
treatment followed by a cure. In stroke, however, there is no
intervention and nothing is fully verifiable. The brain can be scanned
by MRI, but it cannot, routinely, be examined. So a detailed diagnosis
is difficult; treatment still quite basic and a full cure elusive.
Doctors who treat afflictions of the brain are forced to use more
abstractions in the quest for a trustworthy explanation.
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Greenwood
again: “One’s job as a rehab doctor is to explain what things are, and
are not, possible. The patient has to be educated in a timescale of
recovery. A lifetime is where you start from. People have to learn to
adjust their expectations. Predictions are hard, if not impossible. Most
models are ineffective. If one says ‘you will be able to walk 50 yards
in three years’ time’, one will almost certainly be wrong. But it can
become a shared exploration, a quest for achievable goals.” Marr agrees.
“I have absolutely no doubt that the brain can rewire itself with
enough training,” he says. “My left hand was useless, now it can grip.
Things are coming back.” Does he believe you can think yourself into
better health? “I don’t know.”
He reckons his character has probably helped his recovery. “I was
always a stubborn bugger. I think that’s why my improvement has been
faster than it might otherwise have been.” Marr finds the science of the
brain enthralling. “I accept that the brain is totally dynamic.
Plasticity is philosophically and medically fascinating.” Marr is
excited by the prospect of using stem cells to rebuild the brain. Would
he become a guinea-pig? “I won’t rule it out. I mean, why not? It’s like
being in England in the 1650s. We know that America is there and we’ve
begun to make a few tiny incursions. But there’s still an entire
continent to discover and we haven’t really begun to approach it.”
If we accept Marr’s analogy, then what an MRI mainly does is to give
you a black-and-white snapshot – as it were, from outer space – which
tells us very little about the dynamic reality of the brain. For that,
you have to come down to earth and return to the frailty of the human
frame. That’s why, at the end of last year, I went back to the National
Hospital, joining Dr Nick Ward’s experimental neuro-rehabilitation unit,
a programme directly inspired by the discovery of plasticity in the
brain. In simple terms, Ward and his team of expert physiotherapists –
Kate Kelly, Fran Brander, Caroline O’Neill and Jo Briggs – choose
patients with upper- or lower-body deficits – difficulties with arm and
hand or leg and foot movements – and subject them to a programme of
intensive physiotherapy. This amounts to sequences of repetitive
exercise often involving the finely calibrated movement of a shoulder
blade, wrist, or thigh. The aim is to stimulate new pathways in the
brain to recover lost movement.
The contrast between the hi-tech world of MRI scans and neurosurgery
and the mundane reality of a neuro-rehab ward is stark. When the brain
is damaged, (through accident, stroke or geriatric deterioration),
there’s a corresponding breakdown in physical competence: paralysed
arms; legs that don’t move; words that can’t be found; inarticulate
tongues; frozen hand gestures; steps that fail. This is the gap that
Ward and his team are trying to bridge. Much of what Briggs and O’Neill
will do, at first, is traditional physio- and occupational-therapy. It’s
often crushingly boring and painfully mundane: repetitive exercises
designed to fire up some lost muscle activity.
After my introduction to the work of the unit, we moved into
robotics. One of my long-term “deficits” is my inability to make much
use of my left side (arm, hand, leg, foot). I have learned to compensate
for this by recruiting my right side. O’Neill was having none of it.
Persuasively firm, she set new goals. Typing with both hands? I haven’t
done this for 20 years, but she insisted it was possible and
demonstrated at once that I probably had more flexibility in my left arm
than I realised. After the first week, video coverage of my “typing”
had begun to show small, but significant, improvements. From there, it
was a short step to the unit’s Armeo Spring robot, a state-of-the-art
Swiss device designed to isolate specific arm and hand movements and
subject them to intensive therapy.
A patient uses the Armeo Spring rehabilitation robot. Photograph: PR
You could mistake the Armeo Spring for a video game. It uses programmes – interactive computer games like Chicken shoot, Goalkeeper and Raindrops
– to persuade the disabled side of the body to attempt a response. But
its effects, through electronic play, are far from recreational. Within
two or three sessions, my left arm, and hand, were beginning to do
things that hitherto had been unthinkable. After two weeks in Queen
Square, I had been given a new physiotherapy programme, renewed optimism
for the future and a fresh sense of purpose. Why should this not become
part of every stroke survivors’ recovery ?
In
the 20 years since I had my “brain attack”, stroke treatment in the UK
has undergone a revolution. It’s now linked to the best and brightest
technology in the world, the most advanced machines medical science can
devise. Ever so slowly, the brain is yielding its secrets. We now know
more than ever about how and where, in the cortex, the attack occurred.
In a minority of those cases that survive, it’s possible to treat the
stroke with drugs and diminish its impact.
Beyond that, the mysterious miracle of the brain continues to
frustrate efforts to elucidate its hidden pathways. The neurologist
remains like a person shining a pocket flashlight into a darkened
ballroom, hoping to pick out a single precious stone. Progress is
painfully slow with (at best) a series of small victories. Nevertheless,
the challenge remains. Individual consciousness inspires the
determination to tackle a unique conundrum – the intersection of mind
and brain. At this mysterious cross- roads, here’s one inexplicable bit
of data. In the weeks since my visit to the National, my sleep has
become animated with the most vivid dreams. I cannot begin to determine
if this is a strange by-blow of “plasticity”, but it speaks to the
ongoing quest for answers to the workings of the cerebral cortex. Who
knows when or how that will end?
Waiting one day in the hospital lift, I glimpsed my reflection
trapped between two mirrors. It seemed, at that moment, an apt summary
of my predicament. As stroke patients, it sometimes feels as if we stand
between advanced neurological research, on the one hand, and mundane
consciousness on the other, with the image of a cerebral cure regressing
infinitely into the future. Robert McCrum’s two-part programme, Brain Attack, will be broadcast on BBC Radio 4 at 11am on 2 and 9 March
Duration: 10 mins
Release: 8 April 2025
