More screening needed to identify depression, vision loss after mild stroke

On the surface they appear unaffected, but people who have mild strokes may live with hidden disabilities, including depression, vision problems and difficulty thinking, according to a study released today at the Canadian Stroke Congress.

The study calls for new guidelines for the treatment and management of mild strokes, which account for two-thirds of all strokes and usually involve a hospital stay of one to five days. Co-author Annie Rochette, Ph.D, of the University of Montreal, and her research team interviewed 200 people in Quebec, Ontario and Alberta within the first six weeks of their stroke.

"There is no such thing as a mild stroke," says Dr. Rochette, who describes high rates of sleeplessness and depression among study participants – almost a quarter of whom were clinically depressed. "These patients face huge challenges in their daily lives." Study participants reported a significantly poorer perceived quality of life.

Participants in the study were generally younger than people who have severe strokes. The mean age of study participants was 62. Seventy-five per cent of severe strokes occur in people over age 65.

People interviewed worried about returning to work (41 per cent were working before their stroke), taking care of their families and being able to drive. Yet, few were screened for visual or cognitive impairments, which are not as easily detected as impairments in movement, before leaving hospital or provided with post-stroke rehabilitation.

Nearly 25 per cent of mild stroke patients only visited the emergency room. Occupational therapists, neuropsychologists or speech therapists, who typically do these types of screenings, do not usually see mild stroke patients, says Dr. Rochette.

"Patients are told to see their family doctor, but given no other tools or rehabilitation," says Dr. Rochette. "When they go to drive again some people are too afraid to get behind the wheel."

People with mild stroke also faced the fear and increased risk of another stroke and uncertainty about the future. "This study dispels the myth that mild strokes lead to few or no consequences," Dr. Rochette says.

Study authors say new treatment guidelines, including greater access to rehabilitation services, will ensure more people get the care they require and return to their usual activities. Each year, about 15,000 people in Canada experience a mild stroke. Many more go unreported.

"Stroke patients who have had a mild stroke face many challenges getting back to their daily lives," says Dr. Antoine Hakim, CEO and Scientific Director of the CSN. "Proper evaluation to avoid a recurrence and rehabilitation after leaving hospital is essential to ease this transition and to provide people with the tools to live a healthy life."

Heart and Stroke Foundation spokesperson Dr. Michael Hill warns that mild strokes can be a warning of a future stroke. "People who have had a mild stroke are five times more likely to have a stroke over the next two years than the general population," says Dr. Hill. "Proper treatment and management of risk factors can help prevent another stroke."

In addition to managing risk factors, he notes that treatment of depression symptoms should be high on the agenda. "For the depressed patient recovering from stroke, medication and counselling can be an important aspect of patient care."

A list of common symptoms of depression include persistent:

• Sad feelings
• Fatigue or loss of energy
• Change in activity (restless, moving slower)
• Change of appetite, sudden increase or decrease
• Disturbed sleeping habits
• Difficulty concentrating
• Loss of interest in pleasurable activities
• Feelings of guilt, helplessness or worthlessness
• Thoughts about death or suicide

If you or a member of your family has survived a stroke and is having difficulty with any of these symptoms, talk to your physician, advise Drs. Hakim and Hill. Depression, untreated, could increase the risk of another stroke.