A few weeks ago I wrote a blog about Tip-of-the-Tongue phenomena. While this is a relatively benign hiccup in the brain, today I want to look at a more serious threat to staying engaged as we age. This threat is stroke. According to the Centers for Disease Control, stroke is the leading cause of long-term disability and reduces mobility in over half of all stroke survivors 65 and older.
What is a stroke? It is a threat to the brain. Blood flow is cut off and brain cells start to die. Consequently, depending on how bad the stroke is, a person can lose their ability to speak, lose muscle control, the ability to walk, experience memory problems, or even die.
There are three different kinds of stroke: ischemic, hemorrhagic, and transient ischemic attacks (TIA). Ischemic stroke is caused by a blockage in the blood vessel. Like damming up a river, a buildup in pressure occurs, preventing flow of blood and causing your blood pressure to get very high. Cholesterol is the culprit here, building up over years, and clogging your arteries.
Hemorrhagic stroke occurs when a blood vessel in the brain bursts or weakens. This causes blood to seep into the brain, literally cutting off blood supply and creating pooling. While rarer than ischemic stroke, this type often results in death or serious functional impairment.
TIAs are like smoke alarms. They are indicators that you need to take some action, right away! Blood flow is temporarily stopped, signs of stroke appear, but somehow the blockage is resolved with 24 hours, and there are no apparent lasting effects. Pay attention, though! While the symptoms may go away, a TIA is an indicator that all is not well with your circulation to your brain.
Prevention is really the best strategy to manage the risk of stroke. This is why your primary care provider encourages you to watch what you eat, take your statins as directed, exercise, and keep your blood sugars under control. Learning to manage stress is also important.
One of the reasons stroke can be so debilitating is that people often ignore the signs and symptoms and put off seeking emergency care. Knowing the signs of stroke and getting help immediately are essential for several reasons. First, if you are able to be treated quickly, the effects of the stroke may be reduced. This can result in full recovery for some people, or potentially better levels of functioning after rehabilitation, if there isn’t full recovery. Secondly, knowing the signs can help lower your anxiety over wondering whether forgetting a word means you are experiencing an emergency or just need more sleep.
So what are the signs of stroke? The easily remembered acronym is FAST:
- Face drooping (one side of the face droops)
- Arm weakness (when both arms are raised overhead, one drifts downward)
- Speech difficulty (slurred speech, slow speech, inability to produce words at all)
- Time (this is an emergency! Time matters! Call 9-1-1 right away!)
This happened to my husband. He was sitting at our dining room table and I heard him mumble something. I asked him to repeat it and this time looked at him. His face was drooping and even though he thought he was making sense, the words coming out of his mouth were incomprehensible. I called 9-1-1 and we got him to the hospital. The whole thing was very scary for both of us. I am happy to say that he recovered almost 100% through the help of a wonderful speech therapist and a change in his medications. He did have permanent changes, though, that included problems with handwriting and tiring more easily.
Speech and Stroke
Speech is one of the things that distinguish humans from other species. Language is one of the most complex tasks that our brain engages in. There are two aspects of language: producing it and understanding it. To understand what is being said to us, our brain uses about two-thirds of its energy to attend to the sound, make sense of the actual words, and place them in a context that can have multiple meanings.
Problems with the production of speech are called aphasias (from the Latin, meaning without language). To produce language, our brain relies on complex networks in different brain areas, specifically the motor cortex, Wernike’s area and Broca’s area. These networks send code that causes our tongue, mouth, throat, and diaphragm to coordinate to produce sound.
The process of “naming” something requires that we hold a concept of the “thing” and then assign a label to it. “Doggy” and “Kitty” are labels we assign to dogs and cats. We further define these concepts through learning grammatical rules. “My doggy” is different from “the doggy” is different from “all doggies”. Remembering your pet’s name for a password requires that you recall both the label and the grammar-context (noun and tense) for the thing that belongs to you (“My doggy’s name is Spot!”).
Often stroke victims have difficulty in naming things and producing speech. This inability to successfully communicate adds to the experience of sadness and grief that frequently accompany a stroke.
While aphasia is a sign of stroke, it can also occur in traumatic brain injury and in the later stages of many dementias (e.g., Alzheimer’s and Fronto-Temporal lobe). Any loss of speech has a profound effect on the quality of life for the person who has lost their speech and for those who are providing care.
For a remarkably inspiring and educational introduction to what happens when the brain is experiencing a stroke, I encourage you to read “My Stroke of Insight: A Brain Scientist’s Personal Journey” by Jill Bolte Taylor. If you don’t have the inclination to read, you can listen to her TED Talk. Dr. Taylor’s stroke happened when she was relatively young. Her recovery took 10 years.
Sadly, most older Americans are unable to sustain the intense rehabilitation that is often needed to bring the brain ‘back online’ after a stroke. Medicare only covers limited sessions with physical and occupational therapists. Many families have neither the money nor the commitment to continuing what is started in rehab, and so the stroke victim is left adapting to increasing loss of functioning.
I’ll talk more about adapting to change as we age in future blogs. What is an important take-away from today is to pay attention to changes in your overall ability to produce words. If it is just forgetting the name of a friend or a thing, make sure you get enough rest and give yourself some time to recall. If your face is drooping, you cannot raise your arms, you aren’t making sense with your words, then call 9-1-1! Always exercise, keep your blood pressure under control, manage your blood sugars, and take medications as prescribed.
Thanks for reading.