Dear Reader,

Welcome to NeuroAiD's December 2009 Newsletter. The idea of this monthly release is to share vital information for stroke patients and their families, and help them deal successfully with the common challenges life presents after a stroke.

We have been talking about the risk factors and prevention several times in our previous newsletters. Today we would like to give you a general conclusion on all the risk factors and effectiveness of the respect therapies of prevention. All the information come from the latest research and clinical trials, we believe that it will better help you in the primary of secondary prevention of stroke. We are also going to talk about apraxia of speech which differes from aphasia.

We want this to be more than a one-way communication, and would be most happy to hear back from you. What you have experienced and learned will be very valuable to others and we will make sure it reaches as many people in our community as possible. Do also let us know what topics you wish to read in future issues of your NeuroAiD's newsletter.

We would like to assist you in your return to daily life while recovering from stroke. As you are probably already aware, making the best use of time is of vital importance in your stroke recovery. Therefore, please allow us to call you at a number, day and time of your convenience, to hear your questions and explain our answers. If you agree, kindly email us the table below at info@neuroaid.com :

• Number :
• Date :
• Location / time zone :
• Person to ask for :

If you choose to contact us yourself instead, call us on our US toll free number:
1-800-882-4046 / +65-6478-9430 or email us at info@neuroaid.com

The NeuroAiD™ Team at Moleac

Stroke is a major cause of morbidity and mortality. Its prevention is more than critical. During these years, a large amount of high-quality evidences for primary and secondary stroke prevention have been raised and reviewed. In this synthetic article, we are going to present you a recapitulative of these evidences.

Stroke is a major cause of morbidity and mortality. Its prevention is more than critical. During these years, a large amount of high-quality evidences for primary and secondary stroke prevention have been raised and reviewed. In this synthetic article, we are going to present you a recapitulative of these evidences.

Which factors increase the risk of a stroke? There are a number of them, most associated with atherosclerosis, which is known as ASVD describing thickened artery wall resulting of fatty material. In the following table the risks supports by high evidence are listed:

Those diseases are generally called “modifiable risks”. Other “non-modifiable risks” refer to old age, male sex (generally 1.5 times higher risk), and positive family history for stroke or transient ischemic attacks (TIA, which has been introduced in our previous newsletter).

Certainly because of the large proportion of hypertension sufferers, treatment of hypertension becomes the primary prevention of ischemic and hemorrhagic stroke (reduction of 35%-45%).

Secondly comes the treatment of hyperlipidemia. It is shown that the most lipid-lowering therapy like the easiest “diet” didn’t reduce the risk of stroke. Another approach consists of statins, a class of hypolipidemic drugs is currently the most widely studied form of therapy. It has been proved that it could reduce the risk by 25%. It is a safe and effective prevention method of the risk of first stroke, even if the absolute benefits are greater for heart diseases.

A fraction of patients having atrial fibrillation (quivering of the heart muscles of the atria, instead of a coordinated contraction) have doubled rate of mortality. In this point, the risk of stroke doubles. Anti-thrombotic therapy (warfarin or aspirin) provides patients with AF benefits, it effectively prevents strokes of all severities, and the stokes in patients receiving wafarin or aspirin are not as severe as they are in placebo-controlled patients. Attention, it is important to target this therapy to patients having low bleeding risk since it might be risky.

Diabetic patients are having increased risk for all forms of ischemic stroke and are more likely to have hypertension and hyperlipidemia. However, the scientists don’t have enough evidence to show that a better glycemic control is associated with reduced stroke risk.

Stroke sufferers are always afraid of having a second stroke. They are right. For instance, approximately 7% of all patients with a history of TIA or stroke will have a recurrent event each year. The secondary prevention of stroke is likely to be more cost effective – since the absolute risk is higher in patients who have already experienced a stroke.

The treatment of hypertension stays the most effective one. There is a continuous, strong relation between blood pressure level and the subsequent occurrence of stroke in patients who have already had a brain disease. Similarly, stroke patients with hyper lipidemia will benefit from statin therapy. For antithrombotic therapy, data confirmed a substantial benefit with adjusted-dose warfarin (over 70%) and aspirin(around 25%).

It is important to protect yourself from disease. Stroke is a major public health concern, the efforts should be focused on its prevention.

Sources:
Journal of the American Medical Association

Apraxia is a neurological disorder which is characterized by disability to carry out learned movements; even the person has the desire and the physical ability to perform the movements.

Apraxia is actually a general term. It can cause problems in parts of the body, such as arms and legs, in which patients have either inability to carry out a motor command or inability to create a plan for a specific movement. But in most of the time we talk about the Apraxia of speech. In previous newsletters we have talked about Aphasia which is an inability to produce and/or understand language. Apraxia should not be confused with it. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips) either sensory loss or incoordination.

Symptoms of Apraxia of Speech
A patient with apraxia of speech tells how she feels: “I have to depend on being able to hear myself when I speak – hearing my own voice as I speak provides me with auditory feedback. It is necessary for me to think what I need to say next… therefore I can’t think of speaking when another person is talking or when there is a lot of background noise such as loud TV, a crowded restaurant or noisy party.”

Apraxia of speech can be mild or severe. One of the most common symptoms of apraxia of speech is to be unable to string together sounds and syllables to make coherent words. The individual may be able to say a word correctly but mispronouncing it within a short time of each other, or by mispronouncing it the other day consistently. Patients with apraxia of speech may also have varying rhythms and stresses to their speech, or their accents seem strange. In severe case, the patient can’t produce sound at all.

Treatment
For most individuals, speech language therapy would help to improve their speech and use of language. Exercises are designed to allow to the person to repeat sounds over and over and to practice correct mouth monuments for sounds. The person with apraxia of speech may need to slow his or her speech rate down or work on "pacing" their speech so that he or she can produce all necessary sounds.

If apraxia of speech is so severe that verbal communication becomes impossible, a speech language therapist will be able to create another means of communication for the individual, such as the use of simple gestures or more sophisticated electronic equipment may all be options for other means of communication.

A number of organisations exist in different countries to support individuals with speech disorders. For instance, in United Kingdom, the Speech, Language and Hearing Centre and Talking Point are just two of the organisations that may be able to provide further information on support on apraxia of speech to individuals and their families.

Sources:
American Stroke Association