| Wednesday, March 29, 2000 |
This information is provided as a public service by the National Heart Foundation, a program of the American Health Assistance Foundation. In the midst of a normal day, perhaps at work, on your usual drive home or just sitting down to dinner, you have a sudden, intense headache. In one terrifying moment, the world around you spins, you find it difficult or impossible to speak, and you can't move the right side of your body. Unable to prevent yourself from falling, you may even lose consciousness. What happens next? Recognizing the classic signs of a stroke, you or someone near you gets you to the nearest hospital as quickly as possible. It's imperative that you take advantage of the “golden hour” - actually the first three hours - after the event when clot bursting drugs can make the difference between a frightening but temporary accident and permanent disability. But what if you never experience the above symptoms, but you're over 50 and you've developed depression, difficulty with memory and concentration and a slight lack of coordination? You may not call 911 or race to the nearest emergency room, but you should definitely see your doctor to assess whether you've had one or more small, “silent” strokes. Silent strokes, also called mini-strokes, may not even be noticed. They happen when small blood vessels and tiny capillaries of the brain become blocked by atherosclerosis or rupture and bleed into surrounding tissues. While the damage of a silent stroke may be small, if enough of them occur over time, they can be just as disabling as a major stroke, even leading to a degenerative Alzheimer's-like condition called vascular dementia. According to researchers at Duke University the first sign that mini-strokes are occurring in a person over 50 may be the onset of depression. A study led by David C. Steffens, M.D., examined more than 3,600 elderly people and used an MRI (magnetic resonance imaging) procedure of their brains to test for small lesions (caused by silent strokes) in the basal ganglia, an important region deep within the brain. One function of the basal ganglia is to produce the neurotransmitter serotonin, which is depleted in the brains of depressed individuals. The results of the MRI studies were then correlated with the subjects' scores on a test measuring depression. The small lesions were found to increase the risk of depression by 40 percent. Steffens cautioned that family physicians and even elderly patients themselves may overlook the signs of depression because they differ subtly from those of a younger person. He noted that depression in the elderly is often marked not by sadness, but by a sense of apathy and a loss of interest in activities that used to engage them. It's hard to say how many victims have suffered from silent strokes, because people are usually unaware of them and don't seek treatment. Anyone found to have had a silent stroke, however, is at risk of having a major stroke, since the mechanisms for any size stroke are the same. People over 50 who experiences dizzy spells, notices an unexplained lack of coordination or suspects the onset of depression should talk to their family doctors about the possibility of silent strokes, and ask about medications or life-style changes that can minimize their risks. For information about heart disease and stroke, phone 1-800-437-2423.
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