Caring Currents

It's the million dollar question for people with high blood pressure: Which is more important, your genes or your diet? A new report published in the current issue of The American Journal of Clinical Nutrition shows a direct correlation between sodium -- or salt -- intake and high blood pressure.

In a study of more than 11,000 people, researchers found that those who ate more salt were the ones with high blood pressure -- regardless of what form they had of a particular gene involved in blood pressure regulation. Although this certainly doesn't close the book on the genes-versus-diet debate, it's a compelling reason for people with high blood pressure to watch how much salt they eat. As Dr. Paul Conlin points out in an editorial accompanying the report, there’s no sense worrying about your genes, but you can control your sodium intake. According to the American Heart Association, people with high blood pressure or other cardiovascular risk factors should eat less than 1,500 mg of salt each day...  Read more

When someone's having a stroke, every second counts. But according to a report in the current issue of Stroke, most stroke victims don't get treatment quickly enough. The study had some other interesting findings:

• People were treated more quickly when they arrived by ambulance.
• Treatment was faster in hospitals that were certified stroke centers.
• Women were less likely than men to get timely treatment.

What does "timely treatment" mean? The clock starts ticking the moment a blood clot blocks a vessel in the brain. The clot-busting drug tPA can limit brain damage, but there's a catch: The drug needs to be given within the first three hours.

Here's what you should know if you or someone you're caring for is at risk for a stroke:

Know the signs of stroke. I've listed the warning signs before, but they're worth repeating:

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body...  Read more

Does your parent breathe easy at night? New research suggests a possible link between nighttime heart attacks and the breathing disorder sleep apnea.

Researchers from the Mayo Clinic studied the breathing patterns of 92 people admitted to the hospital after heart attacks. "For those who had heart attacks at night, the vast majority had undiagnosed sleep apnea," said cardiologist Virend Somers, the study's lead author. "So, perhaps sleep apnea is acting as a trigger for nighttime heart attacks."

How can you tell if someone has sleep apnea? The most common sign is loud snoring, often interrupted by pauses followed by choking or gasping. Some other signs of sleep apnea include:

• Morning headaches
• Memory or learning problems and not being able to concentrate
• Feeling irritable, depressed, or having mood swings or personality changes
• Urination at night
• A dry throat when you wake up

If you're concerned that your parent might be depressed, take note: New research suggests that depression may increase the risk of stroke in elderly patients.

Researchers found that 85-year-olds with depression had almost three times the risk of having a stroke within three years. "The possible risk reduction of stroke is thus one more reason why individuals with depression should be diagnosed and adequately treated," the authors write in their report, published in the current issue of Stroke.

The National Institute of Mental Health lists these warning signs of depression:

• Persistent sad, anxious, or "empty" feelings
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies that once brought pleasure
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making...  Read more

If you or your parent has to give up alcohol for medical reasons, take note: New research suggests that stopping moderate drinking may lead to depression.

In a study recently published in Neuropsychopharmacology, mice that were allowed to drink for 28 days appeared depressed 14 days after the alcohol was taken away. The mice also showed decreased brain cell development in an area of the brain important for learning, memory, and mood regulation.

But don't reach for a wineglass yet: The researchers also found that giving the mice antidepressants during the 14 days of abstinence prevented depression and restored the brain's ability to make new cells.

The take-home message? When giving up alcohol, look out for signs of depression.

Image by Flickr user piddy77 used under the Creative Commons attribution license.

Now hear this: a new study published in last week's Stroke: Journal of the American Medical Association suggests that sudden hearing loss may be a sign of a future stroke.

Researchers in Taiwan studied five-year follow-up data on patients who were hospitalized for an acute episode of sudden hearing loss. Compared to patients who were hospitalized for an appendectomy, the hearing loss patients were significantly more likely to suffer a stroke. And the strokes didn't happen right away: More than half of them occurred by the end of the second year after the episode of hearing loss.

The researchers themselves point out that the study was fairly limited, so these findings should be considered preliminary. Still, they recommend that people who experience a sudden loss of hearing undergo a comprehensive neurological exam and blood testing to gauge their stroke risk.

So if your parent complains of a...  Read more

I've written before about the importance of being able to recognize the signs of stroke. But what if your parent -- or you -- had a stroke and never even noticed?

In a report published in the latest issue of Stroke: Journal of the American Heart Association, researchers found that almost 11 percent of seemingly healthy, middle-aged study participants had some brain damage from one or more "silent" strokes. The researchers also found a correlation between silent stroke and cardiovascular risk factors, such as high blood pressure, atrial fibrillation, and thickening or partial blockage of the carotid arteries.

Also known as silent cerebral infarction, a silent stroke is a true stroke that causes actual brain injury without any noticeable symptoms. People who've had a silent stroke have a higher risk of having more strokes, and are more likely to suffer from vascular dementia later in life...  Read more

Last week, USA Today ran this interesting piece on vascular dementia. Also called multi-infarct dementia, vascular dementia is caused by multiple strokes that disrupt blood flow to the brain, leading to damaged tissue. The symptoms are very similar to those of Alzheimer's disease, and the two types of dementia often occur together.

Although the USA Today piece focused on a woman in her 30s, vascular dementia usually begins between the ages of 60 and 75. And since it's the second leading cause of dementia in the US (after Alzheimer's), I thought I'd list some blogs and resources especially for those of you caring for people with vascular dementia:

• In his memoir Dementia Diary: A Caregiver's Journal, Bob Tell writes about his mother's 16-year decline into what he calls "the opaque fog of dementia." Check out Bob's blog for more about vascular dementia and his experiences caring for his mother...  Read more

This week Carol O'Dell, Caring.com's Family Advisor and author of the memoir Mothering Mother, wrote a fantastic piece about one of those frightening topics we'd all rather not think about: elder suicide. But the fact that seniors have the highest suicide rates of any age group is one that we simply can't afford to ignore.

Why are older people at such high risk for suicide? Depression is the biggest culprit, and it's a condition that often goes undiagnosed in seniors. Some other factors that lead to suicide include debilitating illness, chronic pain, financial difficulties, isolation, and loss of a loved one or pet.

What can you do if you think your parent or loved one might be depressed or at risk for suicide? One of the most important things is to know the warning signs of suicide:

• Talking or reading about death and suicide
• Making statements of hopelessness or suicide threats
• Not sleeping enough...  Read more

Last week I wrote about how nearly half of heart disease patients aren't familiar with the signs of heart attack. Now I'd like to point out a related issue: Women, especially those under the age of 55, may miss or ignore heart attack warning signs.

In a study presented last month at the American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, researchers interviewed 30 women who'd suffered heart attacks at a young age (average age 48). Most of the women didn't realize they were having heart attacks, attributing their symptoms instead to indigestion, fatigue, or stress.

Why are young women less likely to recognize a heart attack? Here are some of the reasons given by the women in this study:

• They thought they were too young to have a heart attack.
• They had atypical symptoms, such as jaw or neck pain, abdominal discomfort, nausea, or fatigue...  Read more

Did you know that a person with heart disease has a five to seven times greater risk of having a heart attack compared with someone with a healthy heart? In light of those numbers, you'd think that someone with heart disease would be familiar with the signs of a heart attack…right?

Wrong. New research shows that nearly half of patients with a history of heart disease not only don't know the signs of heart attack, they don't see themselves as being at increased risk. The odds of surviving a heart attack improve if treatment begins within an hour of symptom onset, so it's crucial to seek treatment as soon as possible. But if patients don't know the signs, they might not realize they're having a heart attack. And if they don't know they're at greater risk, they might attribute their symptoms to something else.

So if your parent has heart disease, now's the time for you both to boost your heart attack IQ...  Read more

More than a third of stroke survivors develop depression -- a complication that may triple their odds of dying within 10 years. New research suggests that doctors may want to treat stroke patients with antidepressants before they develop depression.

Stroke patients in the study were treated either with a sugar pill (placebo), a low dose of an antidepressant (escitalopram, trade name Lexapro), or talk therapy. After a year, 22 percent of the placebo group developed depression, compared with only 8.5 percent of patients who received Lexapro and 12 percent of those who had talk therapy.

Depression can hamper stroke recovery and make patients less likely to take medications or participate in rehabilitation. And as anyone with a depressed relative well knows, depression can wreak havoc with the rest of the family. So any treatment that can prevent depression in stroke patients seems like a great idea...  Read more

As National Stroke Awareness Month draws to a close, I bring you news from New Zealand researchers: Stroke patients are at a high risk for falling after leaving the hospital. In fact, people who've had strokes fall almost twice as often as those who haven't had strokes.

Published in this month's issue of Stroke magazine, the study revealed that more than a third of stroke survivors reported at least one fall within six months after a stroke. The researchers reported a number of other interesting findings, including:

• Women were more likely than men to suffer an injury from falling.
• People who had fallen during the year before a stroke were much more likely to fall after a stroke.
• Depressed people were almost 1.5 times more likely to fall than those who weren't depressed.

According to the study's lead author Ngaire Kerse, "There is an opportunity to offer fall prevention strategies as part of the initial rehabilitation for stroke patients and as part of ongoing rehabilitation in the home...  Read more

Patients who've undergone cardiac bypass surgery often develop problems with cognitive skills, like memory and language. In the past, this mental decline has often been blamed on the bypass pump used during surgery. A new study from Johns Hopkins suggests that coronary artery disease itself may actually be the culprit.

Researchers looked at cognitive function (including memory, motor speed, attention, and the ability to plan ahead) over six years in two groups of heart patients: Those who had bypass surgery, and those who received nonsurgical treatments such as medications and stents.

The results were dramatic: Patients in both groups experienced an almost identical decline in cognitive skills. This suggests that coronary artery disease itself, and not bypass surgery, is responsible for long-term loss of mental function.

Believe it or not, this may actually be good news for heart patients.

Stroke blogger David Dansereau has written a terrific piece on a controversy brewing in the stroke world. In honor of National Stroke Awareness Month, both the National Stroke Association and the Stroke Collaborative want to educate people about how to recognize stroke symptoms and get help right away. Unfortunately, the two organizations are at odds about how best to get the message out.

The National Stroke Association is focusing its efforts on teaching people how to recognize stroke symptoms and Act F.A.S.T.

Face: Ask the person to smile. Does one end of the face droop?

Arm: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?

Time: If you observe any of these signs, it's time to call 911.

According to Jonathan Bitz of the National Stroke Association, "F.A.S.T. is a proven vehicle for identifying the most common symptoms of ischemic (clot-caused) stroke...  Read more

It's National Stroke Awareness Month and the internet's abuzz with information, reminders, and personal stories. Whether you're a stroke survivor, or a caregiver, friend, or family member of someone who's had a stroke or is at risk, there's something of interest for you.

In honor of Stroke Awareness Month, I'll be bringing you the highlights of what's happening in the stroke blogosphere -- and beyond. For starters, here's a roundup of some of the personal blogs I'm loving:

• Mystroke.org, a blog for stroke survivors and their relatives
• Stroke hero, author, and Caring.com expert Cleo Hutton's Stroke Awareness and Recovery
• Caregiver Jean Riva's From The Planet Aphasia
• Caregiver Jellen's Post Stroke
• Stroke hero David Dansereau's Know-Stroke

What blogs are you reading...or writing? I'd love to build our network of resources and friends.

Image by flickr user Atmantis used under the Creative Commons attribution license...  Read more

Just in time for National Osteoporosis Month (May), a new study sets up what may be another damned-if-you-do, damned-if-you-don't scenario -- in this case, for post-menopausal women.

A study published in the April 28th Archives of Internal Medicine demonstrates that women who've taken Fosamax (also known as alendronate) for osteoporosis are nearly twice as likely to develop atrial fibrillation than are those who haven't ever used the drug.

Neither osteoporosis nor atrial fibrillation is necessarily life threatening, but both can result in serious complications. If untreated, osteoporosis can lead to painful or crippling bone fractures. And atrial fibrillation can result in congestive heart failure or even stroke.

So what should your mother do? Study leader Susan Heckbert suggests weighing the health risks and benefits. "For most women at high risk of fracture, alendronate's benefit of reducing fractures will outweigh the risk of atrial fibrillation...  Read more

Is your parent at risk for a stroke? If so, new research findings presented last week at the American Academy of Neurology meeting suggest that it may be worth having a neurologist's phone number handy.

In a survey of more than 320,000 Medicare records, researchers found that stroke patients whose care was managed by a neurologist were significantly less likely to die or be rehospitalized than those cared for by other specialists.

The study didn't address whether patients cared for by other specialists had other acute medical problems that might make their cases more complex. And the Medicare records didn't provide any information about how patients were treated after discharge, which might very well affect rehospitalization rates. Still, the results are compelling.

What does this mean for your parent? These results haven't yet been published, which means the study hasn't been reviewed by other scientists...  Read more

Last week I wrote about new research that showed listening to music for a couple of hours a day can aid in early recovery from stroke. Caring Currents reader Bert was moved to share how music helped him communicate with his mother after her stroke:

We started listening to her old records together as a way of "talking" about our past -- when I was a child and my father was alive. I think the music really made a difference for her. Her mood improved and she began to look forward to something.

Along with bringing tears to my eyes, Bert's story highlights how challenging it can be to communicate with someone who has difficulty speaking or understanding language. Practical tips for communicating with someone with aphasia are available from a number of sources, including mystroke.org, a blog for stroke survivors and their relatives. But I'd also love to explore some more creative strategies, such as the one Bert described...  Read more

It's no secret that music can lift our spirits, but can it improve recovery from a stroke? New research shows that listening to music for a couple of hours each day can do just that.

Finnish researchers studied 54 stroke patients to see if music therapy could help with early recovery. Some patients listened to music for a couple of hours a day, others listened to books on tape, and the rest listened to nothing at all. Along with their regular stroke rehabilitation, music therapy was begun as soon as possible after hospitalization, and patients were followed for up to six months.

The researchers found that patients who listened to music had significant improvements in verbal memory and focused attention. The music listeners were also less confused and depressed than the other patients.

This study is the first to demonstrate a real link between music and stroke recovery, but it surely comes as no surprise to neurologist and music-lover Oliver Sacks...  Read more

Does your parent have trouble sleeping at night? If she's depressed, insomnia may actually make it harder for her to recover from depression.

A study published in this month's issue of the journal Sleep reveals that insomnia may prolong depression in people 60 years of age or older. Researchers found that patients with persistent insomnia were significantly more likely to remain depressed than those without insomnia. And among those with insomnia, depression was more likely to linger in patients who received standard care for depression than in those who received "enhanced care," which included education about depression and problem-focused therapy.

It's true that sleep patterns change as people age, but insomnia isn't part of normal aging. Lack of sleep can lead to a host of problems besides depression, including trouble with attention and memory, excessive sleepiness during the day, and more nighttime falls...  Read more

If you have a parent with blood-pressure issues, a just-released international study -- known as the ACCOMPLISH trial -- may offer some promise. Researchers found that a combination of two different blood pressure medications significantly lowers cardiovascular risk for people with high blood pressure. The not-yet-published results were presented earlier today at the American College of Cardiology Scientific Session in Chicago. In fact, the findings were deemed so significant that an independent research committee called an early halt to the trial.In the study, patients with high blood pressure were treated either with a tablet containing an ACE inhibitor and a calcium channel blocker (CCB), or a tablet containing the same ACE inhibitor and a diuretic. After six months, treatment with either drug combination brought the blood pressure of most patients into the acceptable range...  Read more

Caring for a family member with heart disease may increase your own risk of cardiac problems, according to a report at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.In a study of 501 family members of patients hospitalized for cardiac problems, researchers found that those who provided most or all of a heart patient's care were at a greater risk for heart disease than non-caregivers. They also found that caregivers who reported a higher level of psychological strain were more likely to suffer from depression, a condition that other studies have linked to heart disease.So what does this mean for you? As if you don't already have enough on your mind, now you have to worry about your own heart? The senior author of the study suggests that you think of this as an opportunity to start taking better care of yourself, but squeezing that into your already packed schedule may seem impossible...  Read more

Can't get Dad up off the couch? You might try switching him to a new one -- in a psychotherapist's office. In his recent article in Psychiatric Times, Mark Miller makes a compelling case for combining antidepressant and talk therapy in treating older people who are depressed. Miller cites several studies that show how psychotherapy can ease late-life depression, and he explains how talk therapy can help older people. It can help them:• Learn new ways to cope• Work on relationships with family and friends• Engage in activities they enjoy• Feel more hopefulEven if you're convinced, selling your parent on the idea might not be easy. A lot of elder parents are resistant to the idea of talk therapy, despite its potential benefits.For practical strategies to convince your parent to try psychotherapy, I thought I'd turn to you. Have you talked to your parent about trying counseling for depression...  Read more

ScienceDaily offers a sneak peek at the findings of a new study by researchers from Washington University School of Medicine. The results, which will be published in an upcoming issue of the Journal of Affective Disorders, show that a person's risk of dying after a heart attack is up to four-fold greater if he's depressed—and this increased risk lingers for at least five years.This report is one of many studies that link depression and heart disease. With all the mounting evidence, it's probably well worth having your parent's depression evaluated and treated. Of course, that's much easier said than done. Here are a couple of ways you might approach it:

• Talk to your parent's doctor about your concerns. Be prepared to describe the signs of depression you've noticed in your parent.
• Instead of pushing your parent to see a psychiatrist or psychologist, suggest a check-up with his primary care doctor...  Read more