Strokes, Resulting Disabilities and Guidelines to Reduce the Risks
May is American Stroke Month
Every year, 15 million people around the world are affected by stroke. Of those, it is estimated 50% will live with permanent or chronic disability. The physical and mental effects of surviving a stroke can significantly impact a survivor’s chances of recovery, mental wellbeing, and future life plans such as going back to work, traveling, and more.
Disability can either be visible or invisible — stroke causes both. These are some of the disabilities caused by a stroke:
Paralysis or weakness
Many stroke survivors experience paralysis on one side of the body or inability to move a specific part of the body. Physical rehabilitation immediately after a stroke can significantly increase your chances of reactivating those muscles and being able to move again.
Aphasia or dysphagia
Some stroke survivors may experience trouble using or understanding language (aphasia) or have trouble swallowing liquids or foods (dysphagia). Speech therapists will work with the patient to address these issues, and depending on the severity of the stroke the patient will regain the ability to speak relatively soon or may need more therapy once they leave the hospital.
Sensory problems on the side affected by the stroke
The affected side can suffer changes in how it senses temperature, pain or textures. It is also common for the stroke survivor to experience the inability to feel the position of their hand, arm, foot or leg. For example, some survivors will hang on to a railing while walking with the affected hand, and then “forget” to let go of the railing — their brain does not send the appropriate signal to the hand to release what it’s holding.
Physical and/or mental fatigue
Post-stroke fatigue is very common. Stroke survivors will usually feel permanently tired or low on energy, and it does not get better with rest. Fatigue can be physical (getting up the stairs or from the kitchen to the bedroom can be a challenge) or mental (short-term memory loss, mental fog or forgetfulness). For some survivors, the fatigue is so severe it has a significant debilitating effect on their daily lives.
Anxiety and depression
Depression is currently the leading cause of disability worldwide. If not treated or addressed promptly, anxiety and depression can have significant effects on the stroke survivor’s general wellbeing and recovery. If you are experiencing symptoms of anxiety or depression, please reach out to your doctor or Mental Health America for support.
Depending on the severity of the stroke and the area of the brain affected, these disabilities may be temporary or permanent. Being aware and addressing post-stroke issues is very important — the sooner you treat them, the better chance you have of not having a permanent disability.
Guidelines for the Reduction of STROKE
Since 1990, the American Heart Association (AHA)/American Stroke Association (ASA) has translated scientific evidence into clinical practice guidelines with recommendations to improve cerebrovascular health. These guidelines, which are based on systematic methods to evaluate and classify evidence, provide a foundation for the delivery of quality cerebrovascular care. The AHA/ASA sponsors the development and publication of clinical practice guidelines without commercial support, and members volunteer their time to the writing and review efforts.
Top 10 Take-Home Messages
1. From birth to old age, every person should have access to and regular visits with a primary care health professional to identify and achieve opportunities to promote brain health.
2. Screening for and addressing adverse social determinants of health are important in the approach to prevention of incident stroke. This updated guideline includes an orientation to social determinants of health, acknowledging its impact on access to care and treatment of stroke risk factors. Therefore, screening for social determinants of health is recommended in care settings where at-risk stroke patients may be evaluated, with the acknowledgment that evidence-based interventions to address adverse social determinants of health are evolving.
3. The Mediterranean diet is a dietary pattern that has been shown to reduce the risk of stroke, especially when supplemented with nuts and olive oil. However, low-fat diets have had little impact on reducing the risk. This guideline recommends that adults with no prior cardiovascular disease and those with high or intermediate risk adhere to the Mediterranean diet.
4. Physical activity is essential for cardiovascular health and stroke risk reduction. This guideline includes a summary of high-quality data showing that prolonged sedentary behavior during waking hours is associated with an increased risk of stroke. Therefore, we provide a new recommendation for screening for sedentary behavior and counseling patients to avoid being sedentary, as well as a call for new studies of interventions to disrupt sedentary behavior. This is in addition to the recommendation to engage in regular moderate to vigorous physical activity.
5. Glucagon-like protein-1 receptor agonists have been shown to be effective not only for improving management of type 2 diabetes but also for weight loss and lowering the risk of cardiovascular disease and stroke. On the basis of these robust data, we provide a new recommendation for the use of these drugs in patients with diabetes and high cardiovascular risk or established cardiovascular disease.
6. Blood pressure management is critical for stroke prevention. Randomized controlled trials have demonstrated that treatment with 1 antihypertensive medication is effective for reaching the blood pressure goal in only ≈30% of participants and that the majority of participants achieved the goal with 2 or 3 medications. Therefore, ≥2 antihypertensive medications are recommended for primary stroke prevention in most patients who require pharmacological treatment of hypertension.
7. Antiplatelet therapy is recommended for patients with antiphospholipid syndrome or systemic lupus erythematosus without a history of stroke or unprovoked venous thromboembolism to prevent stroke. Patients with antiphospholipid syndrome who have had a prior unprovoked venous thrombosis likely benefit from vitamin K antagonist therapy (target international normalized ratio, 2–3) over direct oral anticoagulants.
8. Prevention of pregnancy-related stroke can be achieved primarily through management of hypertension. Treatment of verified systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg during pregnancy and within 6 weeks postpartum is recommended to reduce the risk of fatal maternal intracerebral hemorrhage. In addition, adverse pregnancy outcomes are common and are associated with chronic hypertension and an elevated stroke risk later in life. Therefore, screening for these pregnancy outcomes is recommended to evaluate for and manage vascular risk factors, and a screening tool is included to assist with screening in clinical practice.
9. Endometriosis, premature ovarian failure (before 40 years of age), and early-onset menopause (before 45 years of age) are all associated with an increased risk for stroke. Therefore, screening for all 3 of these conditions is a reasonable step in the evaluation and management of vascular risk factors in these individuals to reduce stroke risk.
10. Understanding transgender health is essential to truly inclusive clinical practice. Transgender women taking estrogens for gender affirmation have been identified as having an increased risk of stroke. Therefore, evaluation and modification of risk factors could be beneficial for stroke risk reduction in this population.