Stroke: It’s No Accident

In academic medicine, July 1st is the beginning of a new educational year, bringing new trainees eager to learn. Every year, one of the first things I teach these trainees is the word “stroke.” For some reason, this common term that both health care providers and health care recipients understand is replaced in medical school by the term “cerebrovascular accident,” or even worse, CVA. Not only is this term incomprehensible to most speakers of the English language, it is very inaccurate as well. Some of the articles in this month’s edition of Geriatrics & Aging clearly demonstrate the predictable and preventable pathogenesis of stroke, thus making the term “accident” a complete misnomer. The past decade has seen tremendous improvements in stroke care from the emergency room to the rehab centre. Much more remains to be learned, and currently one of the great challenges in health care is ensuring that everyone who has had a stroke receives rapid and coordinated care.

Clearly it is better to prevent a stroke than to provide even the most optimal treatment. The use of acetylsalicylic acid in the setting of transient ischemic attack (or prior ischemic stroke), anticoagulants in atrial fibrillation, and control of hypertension are the mainstays of stroke prevention. Dr. Nikolai Steffenhagen and Dr. Michael Hill explore the topic further in our CME article “Prevention of Ischemic Stroke among Older Adults: Primary and Secondary.”

Depression can complicate stroke and impair functional recovery, and the article “Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation” by Elizabeth Johnson, Tamilyn Bakas, and Dr. Linda Williams will be helpful for those of us who are involved in stroke rehabilitation. As well, as the population gets older, the proportion of women becomes larger. Thus, the article “Gender Differences in Stroke among Older Adults” by Drs. Ji Chong and Guido Falcone, is particularly important for those of us who care for older adults. Even two of our regular columns this month deal with our focus on stroke. Our dementia column this month is on “Brain at Risk: Vascular Dementia Revisited and Redefined” by Drs. Ashok Devasenapathy, Rathna Muthukumaran and Vladimir Hachinksi. Dr. Hachinski, a Canadian neurologist, is one of the world’s foremost experts in the field of stroke and vascular dementia, and it is truly an honour for us to count him among our contributors. Our Drugs & Aging column this month is on the topic of stroke prevention and is entitled “Ischemic Stroke Prevention: Are Two Antiplatelet Agents Better than One in Older Adults?” by Dr. Sheri L. Koshman and Dr. Glen Pearson.

We also have our usual collection of articles on other geriatric topics. Particularly in family practice, the complaint of swollen legs is extremely common. Dr. Karen Yeates and Dr. Daniel Tascona provide an approach to this topic in our CVD feature “Leg Edema among Older Adults.” Our nutrition column this month is on “Zinc Deficiency among Older Adults” and is written by Dr. Maitreyi Raman, Dr. Elaheh Aghdassi, and Dr. Johane P. Allard. Physicians who work in long-term care settings know that pain is frequent among residents, but the communication with patients and thus the diagnosis of pain can be quite problematic. This difficult but important area is addressed in the article “Optimizing Pain Management in Long-Term Care Residents” by Dr. Evelyn Hutt, Dr. Martha Buffum, Dr. Regina Fink, Dr. Katherine Jones, and Dr. Ginette Pepper.

Enjoy this issue,
Barry Goldlist