Sunday, April 17, 2011

Stroke Takes Enormous Toll on Hollywood Stars

The findings were presented at the American Heart Association/American Stroke Association's International Stroke Conference (ISC) in Los Angeles on Feb. 10.

"Since this is the first time the ISC is being held in Los Angeles, we thought it was an appropriate occasion to investigate the frequency and impact of stroke among leading Hollywood actors," said Hannah Smith, a staff research associate at the UCLA Stroke Center. "By documenting the toll that stroke and myocardial infarction have exacted on stars like Kirk Douglas and Grace Kelly, we hope to illustrate the damage that cardiovascular disease can cause."

The team investigated the frequency and impact of stroke among best actor and best actress Oscar nominees from 1927 through 2009. They identified lifetime reports of non-fatal and fatal strokes and heart attacks through public records and prior studies of deaths from all causes among nominees. They also examined the impact of strokes and heart attacks on these performers' careers.

Of the 409 actors and actresses nominated over the 82-year period:
30 (7.3 percent) suffered strokes and 39 (9.5 percent) suffered heart attacks. The average age of nominees at their first stroke was 67. More women suffered strokes than men, accounting for 18 of the 30 stroke victims, or 60 percent. Six of them (20 percent of the total) suffered fatal strokes. Performers' annual movie/television appearances declined an average of 73 percent during the three years following a stroke or heart attack, compared with a similar period before being stricken.

Notable Oscar nominees and winners who suffered strokes include:

Mary Pickford (winner, 1929) Bette Davis (nominee, 1934; winner, 1935) James Cagney (nominee, 1938; winner 1942) Cary Grant (nominee, 1942) Kirk Douglas (nominee, 1950) Richard Burton (nominee, 1954) Grace Kelly (winner, 1954) Elizabeth Taylor (nominee, 1957, winner 1960) Patricia Neal (winner, 1963) Dudley Moore (nominee, 1982) James Garner (nominee, 1985) Sharon Stone (nominee, 1995)

According to the AHA/ASA, stroke is the fourth leading cause of death in the United States and a leading cause of serious, long-term disability. On average, someone suffers a stroke every 45 seconds, someone dies of a stroke every three minutes and 795,000 people suffer a new or recurrent stroke each year.

"Stroke and cardiovascular disease can affect one's career productivity and even result in death," UCLA's Smith said. "However, stroke is a highly preventable disease. Key prevention steps include controlling high blood pressure, controlling high cholesterol, not smoking, exercising regularly and eating a diet rich in fruits and vegetables and low in saturated fats."

Additional research authors included Rana Fiaz and Dr. Jeffrey L. Saver of UCLA.

more read...

Progressive Aphasia

Progressive Aphasia

Progressive Nonfluent Aphasia (PNFA) is a language disorder separate from aphasia resulting after a stroke. It is also called Primary Progressive Aphasia (PPA) or Agrammatic Aphasia and is reviewed here. Some consider Semantic Dementia a progressive aphasia, and it is reviewed separately.

The presenting feature in people with PNFA is a deterioration in their ability to produce speech. These patients first become hesitant in their speech, begin to talk less, and eventually become mute. Current research suggests that the fundamental loss in PNFA is a deterioration in knowledge of the grammatical organization and the production of sounds for language.

Unlike other FTD subtypes, PNFA generally does not produce changes in behavior or personality until later stages of the disease. Most people with progressive aphasia maintain the ability to care for themselves, keep up outside interests and, in some instances, remain employed for a few years after onset of the disorder.
Key Clinical Features

The aphasia in PNFA is experienced as hesitant, effortful speech. Despite this difficulty, it appears that patients’ ability to comprehend what others say is preserved longer, though this is eventually lost, as well.

* Increased difficulty producing speech due to weakness or incoordination – speech sounds weak, imprecise and uncoordinated.
* Reading and writing abilities may be preserved longer than speech, but these eventually decline, as well.
* Difficulty swallowing is often present.

Neuroimaging studies demonstrate decreased neural activity and decreased blood flow, especially in the left frontal lobe. 

In later stages, clinical features may include ones found more commonly in other FTD subtypes, particularly extrapyramidal syndromes such as corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP).
Key Pathologic Features

It is important to note that PNFA is a clinical diagnosis, defined by the symptoms the patient displays. It is common to have abnormal tau collections that differ from those of Alzheimer’s disease (FTLD-T). Loss of brain volume in the left frontal and parietal areas is also characteristic.

PNFA can be sporadic, familial, or hereditary. The majority of PNFA cases are not hereditary.

Mutism eventually develops with progression. As with all forms of FTD, there is no cure for PNFA, and in most cases its progression cannot be slowed. Physicians suggest targeting behavioral disturbances as necessary (eg. obsessive-compulsive behaviors, such as hoarding or craving sweets). Some physicians will give a trial of amantadine to ease the flow of speech, but this use has not been proven yet in a formal placebo-controlled drug trial. In one placebo controlled randomized study the cholinesterase inhibitor Reminyl (galantamine), significantly slowed deterioration and in some cases improved language function.
Management and Prognosis

Although no studies have shown improvement or slowing of progression when a patient works with a speech and language pathologist (SLP), many centers work with SLPs to hone the diagnosis of PNFA or semantic dementia and to research potential therapeutic interventions.

Some PNFA patients develop the behavioral, social, and/or motor complications seen in other forms of FTD. In these patients, prognosis is obviously poorer, and management more complicated. Patients who do not develop these additional symptoms are able to preserve their independence and active lifestyle for a longer period of time. more read...