STROKES double risk of suffering DEMENTIA

All of a sudden, Vera Kurnitzki-West’s left side went totally numb.

The west-end Toronto resident was visiting a friend in January 2015, and suddenly couldn’t lift her arm or her leg. Her speech began to slur. Her friend asked if she was falling asleep, but Kurnitzki-West knew what was really happening: At the age of 54, she was having a stroke.

She also knew first-hand what could happen next.

Both of Kurnitzki-West’s parents endured multiple strokes and developed dementia as a result, dying just six months apart in 2003. Memories of their downward spiral are burned into her mind. Her father became “catatonic,” while her mother was incapacitated and needed a wheelchair. “She’d become vacant in her expression, and was able to do less and less for herself,” Kurnitzki-West said.

When she realized she was having a stroke of her own, Kurnitzki-West’s first thought was: “I hope this doesn’t happen to me.”

A sweeping new report from the Heart and Stroke Foundation is setting off alarms about this devastating but little-discussed link between stroke and dementia — and the need to prevent both conditions at the same time.

Having a stroke more than doubles someone’s risk of developing dementia, the report says. It’s also a “powerful predictor” of this life-altering cognitive impairment, with one-third of dementia risk attributed to stroke, which occurs when blood stops flowing to any part of the brain, causing irreparable damage to the surrounding brain cells.

The two brain diseases are widespread: In Canada, more than 405,000 people are living with the effects of stroke, while hundreds of thousands of Canadians over the age of 65 have some form of dementia and an increased strike in dementia — because they go hand in hand,” said Lindsay. “It’s going to be a burden on families in caring for these people, and long-term care.”

While Alzheimer’s disease is a common, well-known cause of dementia, “the link between stroke and dementia is a lot stronger than anyone ever realized,” said Patrice Lindsay, director of Best Practices and Performance, Stroke, at the Heart and Stroke Foundation.

“We know that the age of stroke is dropping, where more younger people are starting to experience stroke, and people with stroke have a much higher risk of developing dementia. That’s scary,” she added.

“We didn’t appreciate the magnitude of that until we really started putting all the research and numbers together . . . . There are lots of scientific papers talking about it, but this is the first time it’s come to light, having really quantifiable numbers for Canadians.”

Lindsay analyzed Canadian Institute for Health Information data and the latest research studies, and inventoried stroke prevention services across the country, to shed new light on this connection.

The incidence for both stroke and dementia increases the risk for the other, the report concludes, based on research showing 10 per cent of stroke patients are diagnosed as having prior dementia, while an additional 10 per cent develop dementia — and recurrent strokes continual increase the chances of someone having cognitive decline.

It’s a deadly situation, with the latest CIHI data revealing that patients hospitalized for stroke, while also coping with dementia, are at a much higher risk of dying — a 20 per cent mortality rate — than those without dementia, at 13 per cent.

A major point highlighted in the report is the potential impact of “covert” strokes, which can happen without someone even realizing. They occur when a small blood vessel in the brain becomes permanently blocked, leading to the death of nearby cells — but there is no outward physical damage or a loss of motor skills.

Dr. Eric Smith, an associate professor of neurology at the University of Calgary, is currently researching these under-the-radar strokes, and said they’re even showing up on brain scans of people in their 40s.

The strokes may be small, but when they continue to occur in the white matter of the brain — the organ’s connective infrastructure — communication between different areas can break down, potentially leading to dementia.

“It’s kind of like going into a circuit board and snipping some wires there, so the output isn’t as good as it was before,” Smith explained.

Dr. Sandra Black, director of the Brain Sciences Research Program at Sunnybrook Research Institute, has spent around 30 years researching the connection between stroke and dementia. The report’s findings may be alarming, but Black said there are some key takeaways for prevention of both diseases.

“Adopt a healthy lifestyle,” she said. That means getting regular physical exercise, sleeping well, maintaining a healthy weight, avoiding too much alcohol, quitting smoking, and keeping an eye on your blood pressure.

Current data shows one in three Canadians will develop stroke, dementia, or both, the report notes — and both disorders get more common as people get older. “As the boomers hit that age, we’re going to see an increased spike in stroke, and an increased strike in dementia — because they go hand in hand,” said Lindsay. “It’s going to be a burden on families in caring for these people, and long-term care.”

It’s a burden Kurnitzki-West herself endured, and she hopes her stroke won’t lead to the debilitating dementia of her parents.

As she later found out, it was the hemorrhagic kind — the type that occurs when a blood vessel ruptures — and, in her case, the burst vessel was at the base of her brain in the basal ganglia, a group of structures that control movement.

She spent two months in the hospital — and four months in a wheelchair — slowly re-learning how to move her left arm and foot. She’s hoping to get back to her Tourism Toronto marketing job in the fall, but it’s been an uphill climb.

“You’re like a bird that’s got to come out of its nest again,” Kurnitzki-West said.

Her message to others? Adopt healthy habits — early. “People need to live that way before they have a stroke, before they hit that point of no return.”

Toronto Star, 
Staff Reporter
Thu., June 9, 2016

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