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Friday, August 28, 2015
BY REBECCA HISCOTT
The consequences of a stroke don’t just affect the survivors, many of whom experience lasting problems like physical disability, depression, and cognitive impairment. Their spouses are affected, too—especially if they are the main caregiver. Research shows that spouses of stroke survivors tend to have more physical and mental health problems than people whose spouses have not had a stroke.
Now, a new study published in Stroke suggests that these health problems may persist for as long as seven years after the spouse’s stroke. Researchers in Sweden looked at 248 people who had survived a stroke before age 70 and their spouses and compared them to a group of 245 healthy people of roughly the same age and their spouses. All participants completed questionnaires to rate their physical and mental health. Those who had survived a stroke were also tested for stroke severity, level of disability, dependence on caregivers, pain, depression, anxiety, and ability to carry out daily functions three months after the stroke and again seven years later.
Stroke Is a Game-Changer
On all self-reported measurements of mental health, including overall mental health, social functioning, and vitality, spouses of stroke survivors fared worse than spouses of people who hadn’t had a stroke. They also reported lower overall physical health, including worse physical functioning and more pain.
The results emphasize how spouses’ mental health can be affected by “demanding changes in the life situations of these families, not only during the first years after stroke but also in the long term,” said study author Josefine Persson, MSc, a PhD candidate at the Institute of Neuroscience and Physiology at Sahlgrenska Academy at the University of Gothenburg in Sweden, in a news release.
Age and Stroke Severity Worsen Health
Persson and her colleagues also found that caregivers who were older and whose spouses were more disabled by the stroke reported the most physical ailments. In addition, older caregivers whose partners were more depressed, more disabled, and had cognitive impairment reported the most mental health difficulties.
Caregivers younger than age 70 may face a different set of stressors than those over 70, Persson noted. For example, younger caregivers of stroke survivors may have to take significant time off work in order to care for their spouse, which can cause a financial strain, she said.
Caregivers Need More Support
The results emphasize the need for more social and economic support for caregivers, Persson and her colleagues wrote. In addition to poorer physical and mental health, “high strain on caregivers increases their risk for coronary heart disease, stroke, and premature death,” they noted. More attention should also be paid to treating depression among stroke survivors, they added, since this has an impact on the caregiver’s health.
Safeguard Your Own Health
Caring for a spouse or family member who has survived a stroke is demanding and requires good physical and mental health. To ensure that, keep these tips in mind:
1. Seek Out Support. Caregiving can be isolating, and can trigger feelings of grief, guilt, and anger. Consider talking to a counselor or therapist, who can help you work through these feelings and ultimately improve your physical and mental health. If you’re feeling depressed, talk to your doctor about a referral for psychotherapy and medication, if appropriate. To connect with fellow caregivers, visit the Family Caregiver Alliance to find support groups in your area. Feeling more supported may also strengthen your bond with your spouse or relative.
2. Mind Your Diet. Given the stress of caring for another person, it can be easy to rely on processed, less-than-nutritious fare. But healthy, balanced meals are crucial for good physical and mental health. As much as you can, choose fresh fruits and vegetables, lean protein, and whole grains over sugary, salty treats, fatty meats, and simple carbohydrates.
3. Break a Sweat. Research shows that regular exercise can help stave off depression, which is common among caregivers. Aim to get at least 150 minutes of aerobic exercise such as walking, jogging, cycling, or swimming weekly—and remember, any exercise is better than none at all.
4. Get Regular Medical Checkups. Don’t ignore high blood pressure, diabetes, or atrial fibrillation (irregular heartbeat). Not treating them adequately could be disastrous. Make regular checkup appointments and talk to your doctor about medications, healthy habits, and other strategies you can adopt to protect your health and get existing medical conditions under control.
For more resources for caregivers, visit the Family Caregiver Alliance at caregiver.org. For more articles about caregiving, browse our For the Caregiver column in print or online.
Image via Hugo Chisholm on Flickr.
Wednesday, August 26, 2015
BY REBECCA HISCOTT
Want to protect your aging brain? Commit to being more physically active. That’s according to a new study published in PLOS ONE that looked at how exercise affects brain structure and function.
Using brain imaging, researchers at the University of Illinois at Urbana-Champaign showed how a higher level of physical activity—at least 150 minutes of moderate to vigorous exercise such as jogging, swimming, or cycling weekly—correlates with more brain activity and greater white matter volume in aging adults.
Physical Activity Correlates with More Neural Activity
The researchers looked at 100 adults between the ages of 60 and 80 who had no psychiatric or neurologic illness, no history of stroke or transient ischemic attack, and who were able to safely exercise. The participants wore accelerometers that tracked their movements and recorded the intensity of physical activity for one week. They then underwent functional magnetic resonance imaging (fMRI) scans so researchers could see how blood oxygen levels changed in the brain over time, as a measurement of spontaneous brain activity. The researchers also looked at the volume and overall structure of the white matter, which helps coordinate communication between different brain regions.
“We found that spontaneous brain activity showed more moment-to-moment fluctuations in the more-active adults,” said study author Agnieszka Burzynska, PhD, a postdoctoral researcher at the University of Illinois at Urbana-Champaign, in a news release. In particular, she and her colleagues saw more activity in the precuneus, hippocampus, the medial and lateral prefrontal cortices, and the temporal cortex, which are all involved in processing and communicating information across brain regions.
The researchers also found greater white matter volume among those who were more physically active.
How Exercise May Protect the Brain
In past studies, Dr. Burzynska said, she and her colleagues showed that people who have more brain activity in certain regions do better on tests of cognition, intelligence, and memory. The current study, coupled with these past findings, suggest that fitter adults have sharper cognitive skills than less-fit older adults, and that physical activity may have “protective effects” on neural processing in the aging brain, the researchers wrote.
They proposed that physical activity might decrease inflammation and preserve myelin—the fatty sheath insulating the nerve fibers—to prevent damage to the brain. (More inflammation in the brain is also linked to lower white matter volume, they noted.)
Can More Activity Reverse Brain Aging?
An important next step will be to see whether prescribed physical activity, combined with cognitive stimulation and healthy dietary choices, can affect signs of brain aging, as measured by brain structure and function and cognitive skills in older adults, the researchers wrote. Past research has suggested that these types of interventions can change the course of brain aging, but more study is needed, they said.
Read “The Exercise Effect” to learn how to exercise safely when you have a neurologic condition. To learn more about how exercise impacts brain health, browse our archives here.
Image via Varun Suresh on Flickr.
Tuesday, August 25, 2015
BY REBECCA HISCOTT
Alzheimer’s disease (AD) can’t be cured, and researchers are still teasing out the complexities of its causes, but a new analysis of more than 300 published studies suggests there are concrete ways to reduce your risk.
In their study—the largest such analysis to date—researchers from Qingdao Municipal Hospital, Ocean University of China, and the University of California, San Francisco identified nine modifiable risk factors that may contribute to up to two-thirds of Alzheimer’s cases globally. Disarming these risks by changing your diet, taking certain medications when appropriate, maintaining mental health, and managing pre-existing conditions may help reduce the global burden of dementia, they wrote in the Journal of Neurology, Neurosurgery & Psychiatry.
Researchers analyzed 323 studies and identified 93 potential modifiable risk factors in a combined population of more than 5,000 people, and rated the quality of evidence for each risk factor. They then looked at nine with the strongest link to Alzheimer’s for which statistics about global prevalence were available, and calculated how much these risk factors might contribute to the burden of AD worldwide.
The Power of Estrogen, Vitamins, and Coffee
The researchers found strong evidence that the female hormone estrogen, medications that lower cholesterol (statins) and blood pressure and reduce inflammation (non-steroidal anti-inflammatory drugs like aspirin and ibuprofen), as well as folic acid, vitamins C and E, and coffee were all associated with a lower risk of AD.
According to their analysis, estrogen reduced AD risk by about 40 percent, NSAIDs by about 26 percent, and current or longer-term use of statins by 48 and 76 percent, respectively. Folate reduced AD risk by roughly 49 percent, vitamins C and E by about 26 percent, and caffeine by about 46 percent. There was also strong evidence to suggest that eating more fish reduced AD risk, by about 36 percent.
Physical activity, cognitive activity, and higher socioeconomic status were also linked to a lowered risk of AD by 28, 13, and 43 percent, respectively, although the evidence was not as strong.
Poor Physical and Mental Health Linked to AD
The analysis also revealed that high levels of homocysteine—an amino acid found in the blood, which can become elevated due to excess alcohol consumption or lack of vitamin B6, vitamin B12, and folic acid—and depression were associated with an increased risk of developing AD, as were certain pre-existing medical conditions such as frailty, carotid atherosclerosis (narrowing of the carotid artery), high or low blood pressure, and type 2 diabetes (but only in the Asian population). Low education was also associated with an increased risk.
Certain Habits Are Linked to Lower Risk of AD
Surprisingly, current smoking (in the Western population), light to moderate drinking, and stress in late life were associated with a lowered AD risk. The authors didn’t offer an explanation for these findings. Moreover, health problems such as a history of arthritis, heart disease, metabolic syndrome (a combination of high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels), and cancer were linked to a lowered risk of AD.
And some factors carried a different risk at different times, the researchers noted. For example, in mid-life, body mass index (BMI) over 25 kg/m2 was associated with an increased risk of AD. But in late life, high BMI was associated with a lower risk.
Reducing Risks Could Lower Rates of AD Worldwide
The researchers identified nine risk factors for which data about global prevalence were available—obesity, which affects roughly 3.4 percent of the population worldwide; current smoking in the Asian population (34.7 to 61.1 percent for men and 0.5 to 2.6 percent for women); carotid atherosclerosis; type 2 diabetes (also in Asians); low education; high levels of homocysteine; depression; high blood pressure; and frailty—and calculated that, combined, these factors could contribute to up to two-thirds of all dementia cases worldwide. The study offers added evidence of the importance of determining the most effective interventions targeting diet, medications, mental health, pre-existing conditions, and lifestyle, they said.
4 Ways to Reduce Your Risk Today
There are no guaranteed strategies for reducing dementia risk, but this study adds to the evidence that simple healthy habits will give you a head start. Here are four strategies experts recommended in our article “5 Ways to Reduce Dementia Risk.”
1. Eat a Healthy Diet. Skip processed foods, which are loaded with salt and sugar, and fill your plate with more fruits and vegetables—and fish, as the current study suggests—instead. Choose lean protein and whole grains over fatty meats and simple carbohydrates.
2. Manage Medical Conditions. Controlling heart conditions like high blood pressure, atrial fibrillation (irregular heartbeat), and coronary artery disease can help insulate your brain against stroke and other neurovascular problems. Sleep apnea can also increase stroke risk. Talk to your doctor about medications and lifestyle changes that can help treat these conditions. (Read “Sleep Wise” for tips on treating sleep apnea.)
3. Stay Mentally and Physically Active. Cognitive and physical activity are both linked to a lower risk of Alzheimer’s disease, so challenge your body and brain as often as you can. Stimulate your mind with a crossword or Sudoku puzzle, an engaging book, a game of chess, or by learning a new skill. Aim to get a half-hour of moderate physical exercise, such as walking, swimming, cycling, or jogging, each day.
4. Take Care of Your Mental Health. Depression and dementia share a strong link, so don’t dismiss symptoms of depression. The condition can often be quite effectively treated with a combination of antidepressants and therapy, experts say. (Read “When Does Depression Signal Dementia?” to learn more.)
For more articles about risk factors for Alzheimer’s, browse our archives here. To learn more about Alzheimer’s disease, see Alzheimer’s Disease: The Basics.
Image via Wikimedia Commons.
Thursday, August 20, 2015
BY REBECCA HISCOTT
Multiple sclerosis (MS) is more common among adults, but the National MS Society estimates that as many as 10,000 US children under the age of 18 have the disease. Kids with MS are more likely to experience depression, fatigue, and cognitive impairment than children without the disease, research shows. Now, a new study suggests that exercise may be helpful in treating these symptoms.
Published this month in Neurology, the study found that kids with MS who regularly engage in strenuous exercise like running or jogging have fewer relapses (symptom flare-ups) and less disease activity in the brain, as measured by magnetic resonance imaging (MRI) scans, than those who exercise less.
The study adds to the existing evidence “that physical activity may have a beneficial effect on the health of the brain,” said study author E. Ann Yeh, MD, a neurologist at the Hospital for Sick Children in Toronto and an associate professor at the University of Toronto, in a news release.
Measuring Depression, Fatigue, and Physical Activity in Kids with MS
The researchers looked at 31 children with MS and 79 kids with a related condition called monophasic acquired demyelinating syndrome, or mono-ADS, in which doctors observe a single occurrence of brain inflammation on MRI. The kids were all between the ages of five and 18 and had received treatment at the Hospital for Sick Children’s Pediatric MS and Demyelinating Disorders Center in Toronto in June through December 2013.
All 110 children or their caregivers completed questionnaires to rate their levels of fatigue and depression. They also indicated how often they participated in strenuous physical activity such as running or jogging, moderate activity such as fast walking, and mild activity such as leisurely walking for a period of at least 15 during a usual week. Sixty children—13 with MS and 47 with mono-ADS—also received MRI scans, which allowed the researchers to look for brain lesions suggestive of disease progression.
Exercise May Protect the Brains of Kids with MS
The researchers found that only 45 percent of children with MS reported participating in any strenuous physical activity, compared with 82 percent of those with mono-ADS. Kids with MS also reported more fatigue and depression.
They also found that children with MS who reported more strenuous physical activity had fewer brain lesions than those who did not engage in strenuous exercise, and they had fewer relapses on average (0.5 per year vs. 1 per year). Those who exercised more also reported less fatigue and depression.
Cause-Effect Link Is Unclear
Because of the study’s design, the researchers could not say for certain whether physical activity exerts a positive effect on the brain or on fatigue and depression. “Does less physical activity worsen fatigue and depression? Or are fatigue and depression among the reasons for reduced physical activity?” questioned Maria A. Rocca, MD, and Massimo Filippi, MD, of the Neuroimaging Institute at Vita-Salute San Raffaele University in Milan, and Kumaran Deiva, MD, PhD, of Assistance Publique-Hôpitaux de Paris, in an accompanying editorial.
Encourage Kids with MS to Get Active
But if the findings can be confirmed in future studies, it’s possible that getting kids with MS to be more physically active can help slow their disease progression and improve feelings of depression and fatigue, Dr. Yeh and her colleagues said.
Drs. Rocca, Filippi, and Deiva agreed. “The current study offers tantalizing results that have the potential to guide future studies,” they wrote. Based on these findings, they said, encouraging physical activity may represent an “easy approach” to improving outcomes for kids with MS in the long term.
For more articles about pediatric MS, browse our archives here.
Image via peace6x on Flickr.
Wednesday, August 19, 2015
BY REBECCA HISCOTT
If you’re a smoker who regularly experiences migraines, the results of a new study from Neurology might persuade you to stub out your cigarette. The study suggests that smokers with migraines may have a tripled risk of stroke compared with non-smokers.
The researchers, led by Teshamae Monteith, MD, an assistant professor of clinical neurology and chief of the Headache Division at the University of Miami’s Miller School of Medicine and a member of the Neurology Now editorial advisory board, looked at 1,292 participants over age 40, including 198 current smokers, who were enrolled in the Northern Manhattan Study. They were 68 years old on average and were followed for an average of 11 years.
Of the 262 patients who reported experiencing migraines, 187 had migraine without aura (sensory abnormalities like seeing flashing lights or smelling strange odors before the migraine) and 75 had migraine with aura. There were 114 strokes, 94 heart attacks, and 178 deaths related to heart disease during the 11-year study period.
Smokers with Migraine Have Higher Stroke Risk
Dr. Monteith and her colleagues did not find any link between experiencing migraines with or without aura and risk of stroke, heart attacks, or vascular death. However, migraine was associated with a three-fold increased risk of stroke among the 35 smokers who also reported having migraines. Current smokers with migraines also had an 83 percent increased risk for a composite of vascular events including stroke, heart attack, and deaths compared with non-smokers with migraines.
Research Supports Past Studies
“Statistically, we could not rule out the possibility that the relationship between migraine and stroke in smokers was due to chance,” Dr. Monteith and her colleagues wrote. “However, we believe the association is biologically plausible” and consistent with past research, they said.
While the analysis found no association between migraine of either type and stroke risk, past research has shown that women under age 45 who have migraine with aura have an increased risk of stroke independent of smoking status, they noted.
Incentive to Butt Out
Since smoking may be common among people who experience migraines, doctors should counsel their patients of the increased risk of stroke and help them quit smoking, the researchers said, adding that it may help reduce the number of older adults with migraines who experience strokes.
Need help quitting? Visit www.smokefree.gov for resources to help you get started.
For more articles on smoking and stroke risk, browse our archives here.
Image via Matt Trostle on Flickr.