World Stroke Congress 2008: "Silent Stroke" Much More Common Than Assumed - World Congress To Discuss Novel Prevention Strategies

Main Category: Stroke
Also Included In: Conferences
Article Date: 26 Sep 2008 - 0:00 PDT

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"Little strokes, big trouble," is the theme of this year's World Stroke Day on October 29th. Subclinical strokes, which are a risk factor for strokes and dementia, are very common and affect every tenth apparently healthy middle-aged person. The WSO World Stroke Day Proclamation aims to improve global awareness of the "preventable catastrophe" stroke represents. Experts at the World Stroke Congress in Vienna are also presenting new studies on effective stroke prevention.

"Little strokes, big trouble," is the theme of this year's World Stroke Day on October 29th. The focus on "little" strokes is chosen for good reason. "Subclinical or silent strokes occur five times as often as clinically obvious strokes, and can affect thinking, mood, and personality," said Prof. Vladimir Hachinski (University of Western Ontario, CAN), presenting this year's global agenda at the World Stroke Congress (WSC) in Vienna (A). "A recent study found that about 10 percent of apparently healthy middle-aged participants with no symptoms of stroke were affected by silent strokes."

Prof. Hachinski, who is also a member of the Scientific Program Committee of the WSC, called for "renewed vigor in the treatment of risk factors and commitment to recognize silent strokes." Prof. Hachinski: "World Stroke Day, by focusing on subclinical strokes, emphasizes the likelihood that the earlier we intervene, the more likely we are to be successful."

Subclinical stroke, or "silent stroke" is a brain injury most commonly caused by a blood clot interrupting blood flow in the brain. It is called "silent" because there may be no observable symptoms, but the name is a misnomer. Patients who have suffered "silent" infarcts who undergo brain imaging tests prove to have neurological and neuropsychological damage.

High risk for future strokes and dementia

"By now it has become evident that 'silent strokes' are the most common type of stroke," Prof. Hachinski said. If ignored, "little strokes can spell big trouble," he said. "Silent stroke" is not only a risk factor for future strokes, but also a sign of progressive brain damage that may result in long-term dementia.

"From a practical point of view it becomes apparent that some of the symptoms that elderly individuals manifest, such as changes in judgment, intellectual ability, personality change and particularly depression may be associated with subclinical strokes and white matter changes in the brain." The expert suggested that a five-minute screening test for vascular cognitive impairment and Alzheimer's disease be used to help identify subclinical stroke, followed by brain imaging if silent stroke is suspected. "We need to implement what we know and learn as we do it, so we can continue to improve treatment and prevent all types of stroke," Prof. Hachinski said.

Increasing awareness of a preventable catastrophe

World Stroke Day, which is held each year, aims primarily to improve global awareness of stroke prevention and encourage optimal management of stroke patients. "Stroke is a preventable and treatable catastrophe," Prof. Hachinski said, quoting the World Stroke Day Proclamation launched at the WSC in Cape Town (SA) in 2006.

New research results demonstrate effect of structured programs for better risk factor control

Prevention of stroke is very high on the agenda of the 6th World Stroke Congress which has brought together more than 3,000 international experts in Vienna (A). Six major scientific sessions and numerous poster presentations deal with this important aspect of international stroke research. Interesting results are presented by Prof. Hachinski and Dr. Cheryl Mayer from what is called the PARTNERS study. PARTNERS examined the effect of a structured strategy to modify vascular risk factors, facilitated by a non-specialty-trained nurse or a trained community volunteer. "Vascular risk factors are highly prevalent and poorly controlled. While timely interventions and the adoption of healthy lifestyles can reduce the risk of stroke, the challenge is how to maintain long-term adherence," Prof. Hachinski explains.

In the trial, patients with at least one risk factor for stroke were either left to conduct regular risk factor reduction alone, or received support in a nurse-led regular risk factor modification program, or participated regularly in a volunteer vascular risk factor program. Patients motivated by trained nurses or volunteers scored significantly better on reducing their risk factors. For instance, participants in the nurse-led program reduced their weight by 2 kilos, whereas unsupervised patients gained on average 4.5 kilos in weight.

Prof. Hachinski said, "The study showed a trend which would favor introducing risk modification programs. The tools developed in our trial could be used by both trained nurses and volunteers to screen risk factors and to facilitate an action plan that could potentially result in better risk factor control."

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