6 New Things About the Burden of Stroke

The socioeconomic and health effect of stroke and other noncommunicable disorders (NCDs) that share many of its risk factors-eg, heart attack, dementia, and diabetes-is huge and increasing, according to the Reducing the International Burden of Stroke Using Mobile Technology Study.

NCDs account for 34.5 million deaths (66% of deaths from all causes) and 1344 million disability-adjusted life years lost worldwide in 2010, the study says, and the burden is likely to increase with the aging of the world’s population.

Turn the pages to find out more about the growing burden of stroke and the latest developments in science and patient care:

1. Heart Scans ID Stroke Risk in AFib

• Patients with atrial fibrillation (AF) who are at high risk for stroke may be identified by MRI scans of the heart.

• Left atrial (LA) dysfunction may mechanistically contribute to cerebrovascular events in patients with AF, study authors suggested.

• They investigated the association between regional LA function and a history of stroke during sinus rhythm in patients who were referred for catheter ablation of AF.

• Depressed LA reservoir function assessed by tissue‐tracking cardiac MR is significantly associated with a prior history of stroke/transient ischemic attack in patients with AF, the authors concluded.

• The findings indicate that such assessment can improve risk stratification of cerebrovascular events in patients with AF.

2. Insomnia Lowers Health-Related Quality of Life in Stroke

• Insomnia after stroke is correlated with physical disability, dementia, anxiety, depression, and fatigue. But what about its influence of on health-related quality of life (HRQoL)?

• Study authors examined the effect of insomnia on HRQoL in stroke survivors 3 months after their index stroke.

• Insomnia in the previous month was reported by 44% of stroke survivors. They had significantly lower overall Stroke Specific Quality of Life, energy, and thinking scores.

• Early screening for sleep disturbance would help prevent later development of post-stroke insomnia, the authors suggested.

• They recommended pharmacological and nonpharmacological interventions to improve HRQoL in patients with stroke who have insomnia. 

3. Air Pollution Damages Brain, May Cause Stroke

• Researchers at Beth Israel Deaconess Medical Center, Boston, and other centers used MRI to examine whether long-term exposure to ambient air pollution associated with cerebrovascular disease and cognitive impairment is related to structural changes in the brain.

• They found that exposure to elevated levels of particulate matter 2.5 is associated with smaller total cerebral brain volume and with higher odds of covert brain infarcts.

• Air pollution is associated with insidious effects on structural brain aging even in dementia- and stroke-free persons, the authors concluded.

4. Stroke in Women: Not Just a Man’s Disease

• Most women don’t know the risks or symptoms females face when having a stroke, says a national survey of 1000 women conducted by The Ohio State University Wexner Medical Center.

• Only 11% of women could correctly identify pregnancy, lupus, migraines, and oral contraception or hormone replacement therapy as female-specific stroke risks.

• Only 10% were aware that hiccups combined with atypical chest pain are among the early warning signs of a stroke in women when accompanied by or followed by typical stroke symptoms.

• Close to half of women said they don’t know what problems females face after stroke (eg, nerve damage, problems swallowing, and depression).

• “I think we have a ways to go when it comes to educating women about stroke and their unique risk factors,” said Dr Diana Greene-Chandos, a neurologist and director of neuroscience critical care at the center.

• “Women do not think they are going to have a stroke. They think of it as a man’s disease,” said Dr Greene-Chandos.

5. New Stroke Reduction Strategy

• The Reducing the International Burden of Stroke Using Mobile Technology Study is designed to do just that.

• Current prevention and intervention techniques are not effective enough in targeting persons at low or moderate risk for stroke, the groups in whom most strokes occur. New effective and affordable primary prevention strategies for stroke and other NCDs are urgently needed.

• The Stroke Riskometer App uses the smartphone platform to provide individualized stroke risk assessments. The new app will be used to inform a significant proportion of the global population about stroke risk and how to reduce it.

6.Phasing In Stroke Reduction With Mobile Technology

• The Reducing the International Burden of Stroke Using Mobile Technology Study includes 5 phases:

• Evaluate the prevalence of stroke, heart attack, type 2 diabetes, traumatic brain injury, and dementia and their risk factors in various countries and demographic groups.
• Determine an etiologic role of lifestyle, environmental, ociodemographic, and pathophysiological factors in the occurrence of these disorders-emphasis on modifiable risk factors.
• Develop specific algorithms (and associated apps) for prediction of stroke and these other disorders for specific countries and populations.
• Develop and test in a randomized controlled trial setting culturally appropriate smartphone-based interventions (cognitive-behavioral) for primary prevention of these disorders.
• Update/implement country-specific apps for primary NCDs prevention.

Take-aways:

• Patients with AFib at high risk for stroke may be identified by MRI scans of the heart.

• Insomnia after stroke is correlated with health-related quality of life as well as physical disability, dementia, anxiety, depression, and fatigue.

• Air pollution is associated with insidious effects on structural brain aging even in dementia- and stroke-free persons.

• Most women don’t know the risks or symptoms females face when having a stroke. They think of stroke as a man’s disease.

• A new study is designed to use mobile technology to reduce the international burden of stroke. A new app will be used to inform patients about stroke risk and how to reduce it.

• The Reducing the International Burden of Stroke Using Mobile Technology Study has 5 phases, starting with evaluation of stroke prevalence and risk factors.