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Senior Evaluation After Stroke

Factors that may aid in determining stability, improvement or progression after a stroke:

The cognitive evolution over 2 years of the surviving stroke patients varies, but a substantial number of patients remain stable or even improve. However, some patients continue to decline. 
A stroke occurs when the blood vessel that supplies the brain becomes blocked or when bleeding within the brain impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen (hypoxia).

There is a striking relationship between the residual affects and survival of a thrombotic stroke with the time to treatment. Tissue plasminogen Activator, TPA, needs to be administered before 4.5 hours after of the onset of the stroke symptoms to have a therapeutic affect.

In regard to determining the stability or progression of cognitive impairment after stroke, those patients that remain stable are typically:

  1. Younger
  2. Have better cognitive performance before the stroke
  3. Have less atrophy in their CT scan
  4. Higher blood pressure

Although the determinants of progression of cognitive impairment are poorly known, there have been features in some patients that may predict progression. Those factors include:

  1. Older age
  2. Previous cognitive impairment
  3. Polypharmacy
  4. Low blood pressure
  5. Hypotensive episodes during admission
Cognitive impairment with a 2-year delay is more associated with hypoxia, brain atrophy, and multiple ischemic lesions than to recurrent stroke. Although there is a tendency for multiple strokes, there is significant importance of poorly controlled hypotension, a condition easy to correct.
Of course a healthy lifestyle and treatment of chronic conditions such as diabetes, high cholesterol and high blood pressure are the best ways to prevent stroke. Knowing the warning signs and quick treatment of stroke will determine the extent of the stroke and survival.

Strokes may be preceded by mini-strokes called transient ischemic attacks or TIAs; of which the symptoms mimic a stroke.
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