We often get so focused on Alzheimer’s disease that we neglect other causes of memory loss and cognitive dysfunction.  Stroke is the second most likely cause of cognitive dysfunction after Alzheimer’s disease in the elderly.  Furthermore, there is a complex interaction between cerebrovascular health and Alzheimer’s disease.

 Post-stroke cognitive impairment may affect several domains of cognitive abilities such as attention (tracking the moment), memory (recalling new information and/or details of personal history), language (expressive and/or receptive speech), orientation (for time, place, and/or person), and executive functions (planning. judgment, reasoning, and/or social graces).  The effects of stroke may be temporary (e.g., TIA) or persisting depending on the size of the lesion and timing of treatment.  The effects may be severe (e.g., cause dementia) or mild (e.g., cause mild cognitive impairment) and may affect single skills or multiple skills.

There are three basic types of stroke.  Ischemic stroke caused by blood clots (i.e., embolic) or by fat deposits (i.e., thrombotic).  Stroke may also be caused by ruptured blood vessels (i.e., hemorrhagic).  This distinction is critical in that treatment for the former is via blood thinners whereas the later are made worse by blood thinners.  TIAs are “transient” or temporary events that may resolve within minutes to hours.  Strokes may be single events or recurrent and cumulative.  Stroke is evaluated and diagnosed by means of symptoms and signs such as one-sided weakness along with a physical exam, blood work, and imaging such as MRI.

There are a number of risk factors for stroke that are fixed and cannot be modified such as age, genetics, ethnicity, and sex. However, there are also a number of factors that are modifiable or manageable to reduce risk.  These factors include cerebrovascular disease (e.g., hypertension), heart disease (e.g., infarcts, atrial fibrillation), diabetes mellitus, hyperlipidemia, cigarette smoking, and alcohol abuse.

Not all stokes cause severe enough damage to produce dementia.  Some cause minor damage.  Vascular dementia is a permanent and irreversible condition where stroke causes disability as a result of impaired cognition that interferes with long-term independence.  The exact clinical manifestation depends upon the size, location, and type of damage caused by the stroke.  Early impairment is more typically manifested as alterations of attention and executive functions rather than memory.  There are often greater deficits proximal in time to the stroke with recovery over the course of months if there is no new event.

Stroke is very pervasive and may either be the source of cognitive decline or contribute added disability to conditions like Alzheimer’s disease, head injury, Parkinson’s disease, or Lewy body disease.  Signs of stroke include sudden weakness or numbness of face, arm or leg especially on one side of the body; sudden confusion, trouble talking, or understanding; sudden trouble seeing; or sudden trouble walking, dizziness, or sudden loss of balance.  Women sometimes have unique symptoms stoke not found in men such as sudden onset of face and limb pain, hiccups, nausea, general weakness, chest pain, shortness of breath, or palpitations.  If you have any of these sudden symptoms or signs, call 911 and act quickly as early diagnosis and treatment are essential for better outcome.