Monash research to improve cognitive and psychological recovery for patients with stroke

Associate Professor Cadilhac

Improving cognitive difficulties for patients with stroke is the aim of two collaborative research studies at Monash University, funded by the Victorian Stroke Clinical Network (VSCN).

It is estimated that approximately one third of stroke survivors will develop memory problems, yet stroke rehabilitation centres tend to focus on physical rehabilitation rather than cognitive difficulties and psychological recovery.

Associate Professor Dominique Cadilhac from the School of Clinical Sciences at Monash Health (SCS) with Dr Rene Stolwyk and Dr Dana Wong of the Monash Institute of Cognitive and Clinical Neurosciences will undertake two projects relating to the subacute care of patients with stroke.

Associate Professor Cadilhac, Head of Translational Public Health and Evaluation (Stroke and Ageing Research), and her team will conduct program sustainability and feasibility evaluations for both projects.

“The ultimate goal is to provide evidence from these projects that will support further expanding of the availability of these neuropsychological services to patients with stroke throughout Australia,” said Associate Professor Cadilhac.

The first project, led by neuropsychologist Dr Wong, focuses on increasing access to a group rehabilitation program for patients with stroke who have memory problems.

“In collaboration with Monash Health and Austin Health, we will roll out and evaluate the effectiveness of the Monash Memory Skills Group, which has helped improve everyday memory functioning for patients with stroke,” said Associate Professor Cadilhac.

Barry Moore, a stroke survivor who has participated in the Monash Memory Skills Group, said

“With physical issues from a stroke you have access to the support of physiotherapists.  For the mental stuff, however, I really did not know where to go. The Memory Skills Group at Monash was wonderful for me; my brain suffered fairly badly in my stroke and this was the first time anyone had addressed it. The course had many practical aspects relating to memory but also treated how the mind could work better. It was terrific for us to have those discussions with experts."

Developing and evaluating a new teleneuropsychology rehabilitation service for Echuca Regional Health, a collaborating partner organisation, is the aim of the second project led by Dr Stolwyk.

“The hospital’s stroke survivors have not previously had access to such a service, which will provide assessment and treatment for stroke-related cognitive, behavioural and mood impairments,” said Dr Stolwyk.

Echuca Regional Health’s Stroke Coordinator Lauren Arthurson said the VSCN-funded research grants will enable Echuca Health to collaborate with Monash’s leading researchers to provide the necessary support to their stroke patients.

“These grants acknowledge the collaboration between the School of Clinical Sciences at Monash Health and the Monash Institute of Cognitive and Clinical Neurosciences and enable translational research with health and industry partners,” said Associate Professor Cadilhac.

“Together we are making a difference to the health of Victorians through the provision of access to cognitive assessment and rehabilitation for people living with stroke.”

Anti-Epilepsy Medication May Reduce The Effects of Stroke

Currently, new research suggests that the anticonvulsant medication, retigabine, could dramatically reduce the effects of stroke.  Researchers have already recognized the potential of this medication in treating neurologic conditions, such as migraine, tinnitus and neuropathic pain.

By observing mice models, researchers discovered that merely a single dose of retigabine prevented loss of balance and motor coordination following a stroke.  Balance and coordination was tested by using a balance beam.  The mice that were not treated with retigabine following a stroke displayed more slips and falls whereas the treated mice easily manoeuvred along the beam.  Researchers even remarked that it had appeared as though the treated mice had not even experienced a stroke.

In addition, brain tissue showed significantly less damage following a stroke when mice were treated with retigabine.  Interestingly, the medication also protected brain tissue for up to 5 days post-stroke.

The team studied ischemic stroke, the most common occurring type, where oxygen and nutrients are blocked due to a clot in a blood vessel.  After only 6 hours, cells deprived of oxygen and nutrients that are dying can be affected in such a way that they are unlikely to be repaired.  “Moreover, when cells die, they release factors that trigger many types of responses including an inflammatory response, leading to more cell death in the areas around the blood clot.”

“Retigabine and similar agents open specific proteins called potassium ion channels, whose action stops the electrical activity of nerve cells in the brain.”  Therefore, researchers theorize that electrical activity can be stopped before causing more damage and conserved until blood supply is restored.

According to researchers, “future studies will assess how long brain function can be protected after a stroke, and whether injury-related seizures can be prevented.

At this time, embolic or thrombotic strokes are treated with tissue plasminogen activator (tPA) drugs, which dissolve clots and restore blood flow. However, tPA works by thinning the blood therefore, cannot be used in many circumstances, such as patients with high blood pressure or weak blood vessels.  Additionally, it must be used within a few short hours following a stroke as later treatment with this drug may actually cause more damage.

According to the World Health Organization, 15 million people suffer a stroke each year.  Of these, 5 million die and another 5 million are permanently disabled.  Stroke is the third leading cause of death in the United States and every seven minutes, a Canadian dies of heart disease or stroke.  Now is the time to continue research and improve these figures.

Anti-epilepsy drug preserves brain function after stroke, research suggests
Stroke Statistics

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More Than Two Drinks Per Day Can Increase Your Risk of Stroke

According to a new study, drinking more than 2 alcoholic drinks each day in middle-age increases a person’s risk of stroke more than typical risk factors such as high blood pressure and diabetes.

Researchers used data gathered between 1967 and 2010 from 11,644 individuals from the Swedish Twin Registry to compare the effects of heavy drinking on risk of stroke. Heavy drinking was defined as 2 or more drinks per day and light drinking as less than 0.5 drinks per day.  

Results demonstrated that heavy drinking increased the risk of stroke by 34% in comparison to light drinking.  The heavy drinkers were also more likely to have a stroke 5 years earlier than their counterparts, regardless of genetics or other factors.  In addition, middle-aged heavy drinkers exhibited a risk of stroke comparable to individuals with high blood pressure and diabetes.  Moreover, the study found that almost 30% of participants had suffered a stroke and by age 75, blood pressure and diabetes were regarded as the main cause of stroke. 

“Among identical twin pairs, siblings who had a stroke drank more than their siblings who hadn't had a stroke, suggesting that mid-life drinking raises stroke risks regardless of genetics and early lifestyle.”

Not only does regular heavy drinking increase the risk of stroke, it also affects blood pressure and causes various health complications.  

Effects of Alcohol:

Drinking too much – on a single occasion or over time – can take a serious toll on your health.  Here’s how alcohol can affect your body:

Heart: Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including:

• Cardiomyopathy – Stretching and drooping of heart muscle
• Arrhythmias – Irregular heart beat
• Stroke
• High blood pressure  

* Research also shows that drinking moderate amounts of alcohol may protect healthy adults from developing coronary heart disease.

Liver: Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver inflammations including:

• Steatosis, or fatty liver
• Alcoholic hepatitis
• Fibrosis
• Cirrhosis

Pancreas: Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion. 

Cancer: Drinking too much alcohol can increase your risk of developing certain cancers, including cancers of the:

• Mouth
• Esophagus
• Throat
• Liver
• Breast

Immune System: Drinking too much can weaken your immune system, making your body a much easier target for disease.  Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much.  Drinking a lot on a single occasion slows your body’s ability to ward off infections – even up to 24 hours after getting drunk.

Brain: Alcohol interferes with the brain’s communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.  

People who have been drinking large amounts of alcohol for long periods of time run the risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may result indirectly, from a poor general health status or from severe liver disease.

Up to 80 percent of alcoholics, however, have a deficiency in thiamine, and some of these people will go on to develop serious brain disorders such as Wernicke–Korsakoff syndrome (WKS).  WKS is a disease that consists of two separate syndromes, a short–lived and severe condition called Wernicke’s encephalopathy and a long–lasting and debilitating condition known as Korsakoff’s psychosis.

The symptoms of Wernicke’s encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and difficulty with muscle coordination. For example, patients with Wernicke’s encephalopathy may be too confused to find their way out of a room or may not even be able to walk. 

Approximately 80 to 90 percent of alcoholics with Wernicke’s encephalopathy also develop Korsakoff’s psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoff’s psychosis are forgetful and quickly frustrated and have difficulty with walking and coordination. Although these patients have problems remembering old information (i.e., retrograde amnesia), it is their difficulty in “laying down” new information (i.e., anterograde amnesia) that is the most striking. 

Heavy drinking in middle-age may increase stroke risk more than traditional factors
National Institute on Alcohol Abuse and Alcoholism

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Samsung Develops Gadget to Detect Strokes

In recent news, engineers at the Samsung Electronics Creative Lab (C-Lab) have developed an Early Detection Sensor & Algorithm Package (EDSAP) that has the ability to detect strokes.

“The resulting headset is equipped with sensors that transfer data to algorithms that allow you to observe your brainwaves on your Smartphone, tablet or upright computer to make sure you are not at risk.”

Interestingly, this device could potentially save lives by ensuring that people obtain proper medical attention in a timely manner.  Samsung claims that it’s even more efficient than hospital equipment as it analyzes brainwaves more rapidly and detects more detail due to a rubber-like ultra-conductive material.

Apparently, the headset is merely a prototype and the sensors will actually function effectively in any type of headgear such as barrettes or even eyeglasses.

There is no word on when this device could be available to the general public; however they do suggest that this technology could lead to other applications such as monitoring heart muscle activity.

Despite the fact that the device is not approved or regulated, it is refreshing that companies like Samsung are spending some of their efforts on developing gadgets other than newer models of Smartphones and Tablets.

Until then…

“A stroke, sometimes referred to as a cerebrovascular accident (CVA), cerebrovascular insult (CVI), or colloquially brain attack is the loss of brain function due to a disturbance in the blood supply to the brain. This disturbance is due to either ischemia (lack of blood flow) or hemorrhage. As a result, the affected area of the brain cannot function normally, which might result in an inability to move one or more limbs on one side of the body, failure to understand or formulate speech, or a vision impairment of one side of the visual field.”

Warning Signs:

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

Some Statistics:

• In 2010, worldwide prevalence of stroke was 33 million, with 16.9 million people having a first stroke. 
• Stroke was the second-leading global cause of death behind heart disease, accounting for 11.13% of total deaths worldwide.
  
• Stroke is the No. 4 cause of death in the United States, killing nearly 129,000 people a year.
  
• Stroke kills someone in the U.S. about once every four minutes.
  
• African-Americans have nearly twice the risk for a first-ever stroke than white people, and a much higher death rate from stroke.
  
• Over the past 10 years, the death rate from stroke has fallen about 35 percent and the number of stroke deaths has dropped about 21 percent.
  
• About 795,000 people have a stroke every year.
  
• Someone in the U.S. has a stroke about once every 40 seconds.
  
• Stroke causes 1 of every 20 deaths in the U.S.
  
• Stroke is a leading cause of disability.
  
• Stroke is the leading preventable cause of disability.

Samsung developing wearable headset to detect strokes
Stroke
American Heart Association

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Early Emotional Neglect May Predict Strokes

New research conducted by the Rush Alzheimer's Disease Center at Rush University Medical Center suggests that emotionally neglected children are at risk of stroke as adults. 

"Studies have shown that children who were neglected emotionally in childhood are at an increased risk of a slew of psychiatric disorders. However, our study is one of few that looked at an association between emotional neglect and stroke," said study author Robert S. Wilson, PhD, a neuropsychologist at Rush.

Researchers’ selected 1,040 participants aged 55+ without dementia from the Memory and Aging Project were surveyed on physical and emotional abuse before the age of 18. Participants were questioned on such areas as how much love they felt from their parents or caregivers as children, whether they felt afraid or intimidated by their caregivers, the method of physical punishment suffered and other questions relating to divorce and family finances.

The participants were followed over a period of 3.5 years. In that time, 257 participants had died. Of the deceased participants, only 192 had brain autopsies, which revealed that 89 of them had experienced strokes. Furthermore, forty of the participants were said to have had strokes based on medical history or an examination.

Furthermore, participants that expressed moderately high levels of emotional neglect in childhood were nearly 3 times more likely to experience a stroke than those reporting moderately low levels of emotional childhood neglect, even when other factors such as diabetes, physical activity, smoking, anxiety and heart problems were controlled.

"The results add to a growing body of evidence suggesting that early life factors such as traumatic childhood experiences influence the development of physical illness and common chronic conditions of old age" says Dr. David A. Bennett, director of the Rush Alzheimer's Disease Center and co-author of the study

Of course results may not be completely reliable since this study relies on a self-report of recalled events many years later, which may be even further clouded given the nature of the potentially traumatic memories.

Emotional Neglect in Children Linked to Increased Stroke Risk Later in Life

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