English 3 Sesi 2

8/6/2019 English 3 Sesi 2

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CONTENT

Content......................................................................................................................................1

Abstract..2

Introduction3

Discussion

Stroke.4

Causes of stroke.....5

Dementia...7

The correlation between stroke and dementia..............................................................10

Risk factor............................................................................................................11

Definitions and Clinical Syndrome of dementia..11

Treatment.12

Conclusions......13

References14

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ABSTRACT

Stroke (brain attack) is a disease of the blood vessels in and around the brain. It

occurs when part of the brain does not receive enough blood to function normally and the

cells die (infarction), or when a blood vessel ruptures (hemorrhagic stroke). Infarction ismore common than hemorrhage and has a number of causes; for example, a vessel (artery)

supplying blood to the brain can become blocked by a fatty deposit (plaque), which can form

clots and send pieces into vessels further in the brain, or these arteries become thickened or

hardened, narrowing the space where the blood flows (atherosclerosis). In addition, clots can

arise in the heart and travel to the brain. Permanent damage to brain cells can result. 1

The symptoms of stroke vary, depending on which part of the brain is affected.

Common symptoms of stroke are sudden paralysis or loss of sensation in part of the body

(especially on one side), partial loss of vision or double vision, or loss of balance. Loss of

bladder and bowel control can also occur. Other symptoms include decline in cognitive

mental functions such as memory, speech and language, thinking, organization, reasoning, orjudgment.Changes in behavior and personality may occur. If these symptoms are severe

enough to interfere with everyday activities, they are called dementia. 1

Cognitive decline related to stroke is usually called vascular dementia or vascular

cognitive impairment to distinguish it from other types of dementia. In the United States, it is

the second most common form of dementia afterAlzheimer's Disease. Vascular dementia is

preventable, but only if the underlying vascular disease is recognized and treated early.

People who have had a stroke have a 9 times greater risk of dementia than people who

have not had a stroke. About 1 in 4 people who have a stroke develop signs of dementia

within 1 year.

Vascular dementia is most common in older people, who are more likely than younger

people to have vascular diseases. It is more common in men than in women. The various

meanings of the three key terms,stroke, dementia, and theircorrelation, create challenges at

the start of this paper. A related complication is the fact that both stroke and dementia are

moving targets in science and medicine. An understanding of the complex and evolving

nature of stroke and dementia will be explored below.

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INTRODUCTION

The vascular system in the body is tasked with two functions: transport of materials

that allow cells to function and elimination of cellular byproducts that, if accumulated, could

cause disease. Brain vessels have additional, distinctive anatomical and physiological

characteristics owing to their role in exchanging substances between blood and brain. These

facts begin to shed light on the emerging understanding of the vascular foundations of

impaired brain function. Characterizing the connection between dementia and stroke in

particular is important because of the potential for reducing dementia as a collateral benefit of

preventing stroke.2,3

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DISCUSSION

Stroke

A stroke is a medical emergency. Strokes happen when blood flow to your brain

stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more

common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood

vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that

breaks and bleeds into the brain. "Mini-strokes" ortransient ischemic attacks (TIAs), occur

when the blood supply to the brain is briefly interrupted.6

The traditional definition of stroke, devised by the World Health Organization in the

1970s, is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is

interrupted by death within 24 hours".7 This definition was supposed to reflect the

reversibility of tissue damage and was devised for the purpose, with the time frame of 24

hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic

attack, which is a related syndrome of stroke symptoms that resolve completely within 24

hours. With the availability of treatments that, when given early, can reduce stroke severity,

many now prefer alternative concepts, such as brain attack and acute ischemic

cerebrovascular syndrome (modeled afterheart attackand acute coronary syndrome

respectively), that reflect the urgency of stroke symptoms and the need to act swiftly.

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Causes of stroke

1. Blockage of an artery

The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a

stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of

blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the

brain die and the part of the body that it controls stops working. Typically, a cholesterol

plaque in a small blood vessel within the brain that has gradually caused blood vessel

narrowing ruptures and starts the process of forming a small blood clot.14

Risk factors for narrowed blood vessels in the brain are the same as those that cause

narrowing blood vessels in the heart and heart attack(myocardial infarction). These risk

factors include:

high blood pressure (hypertension),

high cholesterol,

diabetes, and

smoking.

2. Embolic stroke

Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque

(cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose,

travels through the bloodstream and lodges in an artery in the brain. When blood flow stops,

brain cells do not receive the oxygen and glucose they require to function and a stroke occurs.

This type of stroke is referred to as an embolic stroke. For example, a blood clot might

originally form in the heart chamber as a result of an irregular heart rhythm, such as occurs

in atrial fibrillation. Usually, these clots remain attached to the inner lining of the heart, but

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occasionally they can break off, travel through the blood stream, form a plug (embolism) in a

brain artery, and cause a stroke. An embolism can also originate in a large artery (for

example, the carotid artery, a major artery in the neck that supplies blood to the brain) and

then travel downstream to clog a small artery within the brain.

3. Cerebral hemorrhage

A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the

surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes stroke

symptoms by depriving blood and oxygen to parts of the brain in a variety of ways. Blood

flow is lost to some cells. As well, blood is very irritating and can cause swelling of brain

tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage

increases pressure within the skull and causes further damage by squeezing the brain against

the bony skull further decreasing blood flow to brain tissue and cells.

4. Subarachnoid hemorrhage

In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid

membrane that lines the brain. The blood originates from an abnormal blood vessel that leaks

or ruptures. Often this is from an aneurysm (an abnormal ballooning out of the wall of the

vessel). Subarachnoid hemorrhages usually cause a sudden, severe headache,

nausea, vomiting, light intolerance, and a stiff neck. If not recognized and treated, major

neurological consequences, such as coma, and brain death may occur.

5. Vasculitis

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Another rare cause of stroke is vasculitis, a condition in which the blood vessels become

inflamed causing decreased blood flow to brain tissue.

6. Migraine headache

There appears to be a very slight increased occurrence of stroke in people with migraine

headache. The mechanism for migraine or vascular headaches includes narrowing of the

brain blood vessels. Some migraine headache episodes can even mimic stroke with loss of

function of one side of the body or vision or speech problems. Usually, the symptoms resolve

as the headache resolves.14

Dementia

In general terms, dementia is a global brain disorder in which multiple aspects of

brain function are persistently compromised in a way that interferes with a person's normal

everyday functioning. However, dementia is not a single disorder. There are a myriad of

disease processes which can lead to dementia, each one of which induces a different pattern

of behavioral changes.

For instance, Alzheimer disease, perhaps the most well known dementia of all, starts

off late in the life (commonly between the ages of 65-85) and progresses slowly. Its most

prominent symptoms include memory loss, delusions,hallucinations, anxiety, sleep

disturbances, anddepression. By contrast, fronto-temporal dementias start off earlier in life

(between the ages of 50-60) and although they still progress slowly, they do so a little more

rapidly than Alzheimer disease. Their most prominent features include personality changes

such as loss of insight, loss of empathy for others, poor self-care, emotional explosiveness,

and impulsiveness.15

Here is a list of the most common types of dementia:

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Alzheimer Disease (AD): A disease originally described in 1907 by the German

psychiatrist Alois Alzheimer, AD leaves the brains of those affected by it with a

characteristic appearance under the microscope, which is mainly due to widespread

presence of the so called "neuritic plaques" and neurofibrillary tangles.

Frontotemporal Dementia: This is a group of disorders in which

the frontal and temporallobes of the brain are selectively affected. They typically include

the following subtypes of dementia:

Picks disease

Primary progressive aphasia

Motor neuron disease and frontotemporal degeneration

2 Dementia with Lewy Bodies: A type of dementia characterized by at least two of the

following three symptoms. 1) A waxing and waning level of consciousness; 2) visual

hallucinations and 3) spontaneous movements suggestive of Parkinson's disease.

3 Parkinsonian Dementias: This is a group of dementias which always occur in the

context of the progressive movement abnormalities typical ofParkinson's disease. These

include tremors, gait disturbances, and spasticity. The common Parkinsonian dementias

are:

Degenerative (sporadic) dementias

Degenerative familial dementias

Secondary Parkinsonian dementia syndromes

Dementia pugilistica

Dementia due to inherited metabolic disorders

Vascular Dementia

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This is the type of dementia caused by strokes,ministrokes, silent strokes, and

other forms of vascular disease.

The history of this subject begins in the 1800s and early 1900s when the term

apoplectic dementia gained popularity as a medical term which described the abrupt

decline in mental function experienced by some stroke survivors. It later became accepted

that hardening of the brain arteries could cause dementia due to a poorly understood

damage to the brain. It took several decades until the 1970s when investigators found that

the stroke-induced damage to the brain their predecessors had proposed consisted of a loss

of brain volume from multiple strokes. In other words, it suddenly became clear that the

cumulative effects of multiple strokes on the brain could lead to dementia.15

This gave birth to the term vascular dementia or multi-infarct dementia, which

became the preferred term to define the specific pattern of cognitive decline associated

with having multiple strokes. In recent years, however, this term has fallen out of favor as

new imaging techniques have shown that even single strokes, referred by some as

strategic strokes, can also cause someone to become demented. Whats more, in some

cases, no clear strokes at all, but a condition closely associated with strokes which is

known as white matter disease (also known as microvascular disease or chronic

ischemic brain changes) has also been associated with the onset of dementia.15

correlation between stroke and demensia

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The relationship between vascular disease of the brain and cognitive impairment is

unclear. It is known that extensive vascular lesions in the brain, large or small, can cause

dementia. What is not known is how often this occurs and by what mechanism. Also unclear

is the extent of overlap between vascular factors and underlying degenerative dementia,

particularly Alzheimer's disease. We know that so-called mixed dementia (i.e., combined

degenerative and vascular) commonly occurs. Some investigators believe that a

commonpathophysiology may be present in some cases. We are a long way from fully

understanding vascular cognitive impairment; however, insight into this critical issue has

changed dramatically in the past several decades. 10

The final major development in the vascular dementia story to date has been the

widespread use ofmagnetic resonance imaging (MRI) of the brain. This tool is so sensitive in

its ability to demonstrate ischemic changes in the brain that it has revealed abnormalities in

many normal elderly patients, even more changes in patients diagnosed with Alzheimer's

disease, and still more extensive lesions in patients thought to have vascular dementia. This

has actually confused rather than clarified the dichotomy between vascular and degenerative

disease; but in time, with additional clinical pathologic studies, the picture should become

clearer.

There is clear evidence thatstroke and dementia are indeed associated. A systematic

review published in January 2010 examined 16 epidemiologic studies; a summary analysis

concluded that a history of stroke generally doubles the risk of incident dementia in those

over 65 years of age.28 This result points at least to the presence of common risk factors

shared by the two conditions. Consistent with this concept is the fact that individuals with an

elevated stroke risk profile also have significantly more cognitive impairment.11

Risk Factors

The risk factors for vascular dementia are the same as those for stroke in general,

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especially diseases that lead to small vessel infarcts such as hypertension, diabetes, lupus, and

other immune vasculidities. It is the small vessel disease that is more likely to cause diffuse

white (and gray) matter abnormalities; this process eventually interferes with cognition and

can produce cognitive impairment and dementia.12,13,14

Definitions and Clinical Syndromes of dementia

Dementia, most simply defined, is a progressive deterioration in cognitive and

social adaptive functions that can eventually interfere with the patient's ability to live

independently. There is, however, a continuum of cognitive change from mild cognitive

impairment to dementia. Patients may complain of mild, yet not disabling, cognitive

problems in the early stages of their disease long before they actually obtain a diagnosis of

dementia. The clinical diagnosis of this early stage of mild cognitive impairment is made

more difficult by the fact that there are some cognitive changes that naturally accompany

advanced age. Particularly after age 70 but most marked in the population over 85 is a

tendency to have increasing difficulty accessing names of people and objects, difficulty

processing information rapidly, and the need for additional time to learn things and to think

through problems. Because of these changes with aging, the clinician must be very cautious

not to overdiagnose early deme ntia in the elderly. 6,7

A diagnosis of vascular cognitive impairment or dementia is made by demonstrating the

presence of cognitive change from medical history and examination and showing that the

patient has had vascular events that are believed to be sufficient to produce the cognitive

change. It is this last requirement that is difficult. Factors that increase the likelihood of

vascular dementia are history of hypertension, history of transient ischemic attach and/or

cerebrovascular accident,stepwise change in mental status, the presence of abnormal

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neurologic signs, and extensive changes on MRI that are compatible with ischemia. 6,7

Treatment

The primary treatment for vascular dementia is control of the vascular risk factors. It

is hoped that with early risk factor identification and treatment, vascular cognitive

impairment and dementia can be decreased. Once cognitive problems are present, studies

have shown that the cholinesterase inhibitor drugs that were developed to treat Alzheimer's

disease are also effective in treating vascular dementia. As in Alzheimer's disease, the results

are modest and only seen in some patients, but they are useful and should be considered in

treatment. 13,14

CONCLUSION

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Vascular disease of the brain, particularly hypertensive small vessel disease, is a more

important factor in producing cognitive impairment and dementia than was previously

thought. We do not know the true incidence of vascular and mixed dementia nor do we know

all the risk factors. We do know that treatment of the dementia with anticholinesterase drugs

helps but we do not know if risk factor control will decrease the incidence and severity of

vascular cognitive change. We know a lot about Alzheimer's disease and vascular dementia

but we do not know if there is any common pathogenesis. Our understanding of the

interaction between cerebrovascular disease and cognition is just beginning; there are many

pieces of the puzzle still in the box.

REFERENCES

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July 2011.

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