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Monday, November 30, 2009 - Living an Independent Life: Preventing Stroke, Vascular Dementia

With each passing year, millions of Baby Boomers join the ranks of senior citizens. Many of them live fulfilling lives, enjoying the greater freedom they have to spend time seeing the people and taking part in the activities that they love. For others, the so-called “golden years” are less than golden because they are dominated by difficult health problems.

Methodist Medical Center is providing a series of articles to help people live more independent lives as they age. This article features information from David Stanley, M.D., a board-certified surgeon and wound treatment specialist on the Methodist staff.

What is vascular disease?
Dr. Stanley: Vascular disease is a condition in which plaque -- a combination of cholesterol, calcium and other substances -- builds up in blood vessels and interferes with blood flow. It is a common cause of disability, affecting five to eight million Americans.
    
Blockage can occur in blood vessels anywhere in the body, but it is especially serious when it occurs in arteries of the limbs, heart, and neck. Obstruction of arteries in the limbs, primarily the legs and feet, can lead to amputation, while blocked arteries around the heart can cause a heart attack and plaque in the neck can lead to stroke or vascular dementia.

What happens during a stroke?
Dr. Stanley:    A stroke is sometimes referred to as a “brain attack,” and it is a medical emergency. It occurs when a blood vessel in the brain bursts or there is a sudden interruption of blood flow to the brain by plaque embolus or a blood clot. Two million brain cells die every minute during an attack, increasing the risk for permanent brain damage, disability or death.

A common symptom is sudden numbness or weakness in the face, arm or leg, especially when only one side of the body is involved. Other symptoms include sudden confusion, vision problems, dizziness, loss of balance, trouble walking or a severe headache. If these symptoms occur for a short time period, a person may be having a “transient ischemic attack,” or TIA. TIAs are emergencies because they indicate that a stroke may soon occur if the patient does not receive appropriate treatment.

If you suspect that someone is having a stroke or a TIA, ask the person to smile and see whether their face droops. Ask them to raise both arms and see whether one arm drifts down. Ask them to repeat a simple sentence and listen for any slurring or other speech problems. If you note any of these symptoms, call 911 or immediately take the person to the nearest hospital.

What can people do to reduce their risk of stroke?
Dr. Stanley: Certain factors, such as high blood pressure, heart disease, diabetes, high cholesterol, smoking and heavy alcohol use, may be controlled. Other factors such as an age of 55 or older, ethnicity, and family history of stroke cannot be changed.
    
My advice is to know your blood pressure level and talk to your doctor if it stays higher than 135 over 85. If you smoke, quit, and if you drink alcohol, do so in moderation. If you have diabetes, follow your doctor’s advice about diet, exercise and medications to manage it. If your cholesterol is high, work with your doctor to get it under control because high cholesterol can indirectly increase the risk of stroke by increasing the risk of heart disease.
    
What are the treatments for a stroke?
Dr. Stanley: Initially, treatment depends on whether the stroke was caused by a blood clot or bleeding in the brain. The physician will order a CT scan, vascular ultrasound exam, and other tests to determine which type of stroke a person has had.
    
Clot-dissolving medication may be prescribed for stroke patients who have a blood clot and are diagnosed within three hours of developing symptoms. Treating a stroke caused by bleeding in the brain is more difficult. Patients are monitored for signs of increased pressure in the brain and may receive medications to control brain swelling, blood pressure, blood sugar, or seizures, as appropriate. Surgery is not usually recommended unless the bleeding is severe or a blood vessel has ruptured.  If a TIA is related to carotid artery plaque, emergency vascular surgery may be indicated.
    
After a patient’s condition stabilizes, treatment focuses on prevention of another stroke and on rehabilitation. It generally includes use of medications and management of controllable risk factors. Depression is common after a stroke, and the patient may need treatment for this problem, as well.
    
About half of all stroke survivors have difficulties with coordination, communication and other skills needed for independent living. The greatest progress in physical recovery generally occurs within the first three months, while speech and balance improve more slowly.  

What is vascular dementia?
Dr. Stanley: Vascular dementia is one of the most common forms of dementia. It is closely related to diseases of the blood vessels and develops when blood flow to the brain is restricted.

Symptoms may appear suddenly after a major stroke involving a significant part of the brain, or they may develop over time as the cumulative effect of several small strokes. The symptoms vary depending on which area of the brain has been affected. Patients may or may not have memory problems. They may become confused, especially at night, and have difficulty speaking, concentrating, communicating, and following instructions.

What are the treatments for vascular dementia?
Dr. Stanley: Aggressive management of risk factors such as blood pressure, weight, blood sugar and cholesterol may prevent symptoms from becoming worse. The U.S. Food and Drug Administration has not approved any drugs for the treatment of vascular dementia once it develops. However, most of the drugs used for cognitive symptoms in Alzheimer’s patients seem to help.


Dr. StanleyDavid Stanley, M.D.
, is a board-certified surgeon on the staff of Methodist Medical Center of Oak Ridge and medical director of the MMC Wound Center and the Vascular Diagnostic Center in Oak Ridge. A graduate of the University of Tennessee College of Medicine in Memphis, he completed a general surgery residency at Emory University in Atlanta and at St. Francis and Veterans Hospital in Wichita, Kan. Dr. Stanley is board certified in general surgery, vascular surgery and vascular medicine. He also trained in the evaluation and treatment of chronic, non-healing wounds at The Hyperbaric and Wound Healing Center at Palmetto Health Richland in Columbia, S.C. Dr. Stanley is a fellow of the American College of Surgeons, past president of the International College of Surgeons-U.S. section, and a member of the editorial board of the International Journal of Angiology.