Introduction
Stroke is a serious condition that affects patients’ health and quality of life. After a stroke, patients face the risk of both short-term and long-term neurological consequences (Perna & Temple, 2015). Consequently, patients with a history of stroke require specific attention, and clinical practitioners must understand their health risks to address them successfully. Clinical outcomes may depend on a variety of factors, including the type of stroke suffered, patient demographics, and medical history (Corraini et al., 2017). Research into variations in risk factors based on the type of stroke experienced is thus vital to providing high-quality care to patients. The present paper will review a research article by Corraini et al. (2017), which reports on the findings of original research into long-term risks of dementia among patients following ischemic or hemorrhagic stroke. The methods and results of the study will be discussed, including their relevance and significance to clinical practice.
Background
Stroke is a severe threat to public health globally since it contributes to the burden of disease, disability, and mortality. According to Katan and Luft (2018), stroke is currently the second leading cause of death globally, with 15.2 million deaths from ischemic heart disease and stroke worldwide in 2015. In the United States, 795,000 people suffer from stroke every year, and more than 140,000 people die as a result of it (Perna & Temple, 2015). The incidence of stroke is the highest in older adults, and this condition is also among the leading causes of long-term disability in the country (Katan & Luft, 2018). As reported by Katan and Luft (2018), among sufferers of stroke, “26% remain disabled in basic activities of daily living (Framingham cohort), and 50% have reduced mobility due to hemiparesis” (p. 208). Other frequent causes of disability following stroke are aphasia and depression (Katan & Luft, 2018). In addition, stroke contributes significantly to healthcare costs. Studies report that approximately 3-4% of healthcare spending in the United States is attributable to stroke, and the lifetime cost per person is $140,048 (Katan & Luft, 2018). Therefore, stroke is a serious concern for care providers and patients alike.
The main subtypes of stroke considered in the literature are ischemic and hemorrhagic. In ischemic stroke, thrombi and/or emboli develop, leading to deficiencies in blood flow and oxygenation (Perna & Temple, 2015). Intracerebral hemorrhage (ICH), which is a term used to denote hemorrhagic stroke, cerebral vessels rupture, typically due to a combination of high blood pressure and atherosclerosis, aneurysm, or arteriovenous malformation (Perna and Temple, 2015). Although hemorrhagic strokes only comprise 10-15% of all strokes, they lead to more severe consequences and account for about the same number of patient deaths as ischemic strokes and for nearly 1.5 times more disability-adjusted life years (Katan & Luft, 2018; Perna & Temple, 2015). Hence, the long-term risks faced by patients vary depending on the type of stroke they experience, and providers have to understand these differences to support future care and rehabilitation.
Methods
The chosen study focused on the differences in the long-term risk of dementia among patients who had suffered an ischemic or hemorrhagic stroke. The methodology applied for the study was quantitative, and the selected design was a longitudinal population-based cohort study (Corraini et al., 2017). The research was conducted in Denmark, which did not limit its scope due to a substantial sample. The total sample included over 200,000 patients who had suffered a stroke, including 84220 ischemic stroke survivors and over 25,000 hemorrhagic stroke survivors, with 104,303 patients presenting with an unspecified type of stroke (Corraini et al., 2017). Additionally, the scholars included over 1 million patients who never suffered a stroke, and their data was used to compare the outcomes in dementia prevalence and risks (Corraini et al., 2017). The data used by the scholars were obtained from Danish medical databases, and the reporting period was over 30 years, from 1982 to 2013 (Corraini et al., 2017). Patients from the two groups were matched by age and sex, thus accounting for these factors while determining dementia prevalence and risks. Data analysis followed a simple process of constructing hazard ratios through statistical calculations, followed by sensitivity tests to verify the ratios.
The methods used by the authors were appropriate to the goals of the study. Using quantitative data allowed identifying common trends and analyzing them to determine the relationship between patient outcomes and stroke history. Additionally, this methodology enabled the researchers to gather longitudinal data and include a very large sample of patients in the analysis. This, in turn, contributed to the reliability of the findings. The fact that the authors rely on data from national hospital databases is also a strength of the study since it ensures the accuracy of the information gathered. One potential limitation of the research is that it did not consider non-demographic factors that could have contributed to dementia, such as family history, lifestyle, or overall health condition.
Results
The results of the study are presented both in written form and using visual aids, such as graphs and tables. On the whole, the researchers found stroke survivors to have a higher risk of dementia in comparison with patients without a history of stroke (Corraini et al., 2017). The comparative hazard ratio for stroke survivors was 1.80, 1.72 for ischemic stroke survivors, and 2.72 for hemorrhagic stroke survivors (Corraini et al., 2017). For hemorrhagic stroke survivors, the hazard ratio of dementia was 2.70 and 2.74 after intracerebral and subarachnoid hemorrhage, respectively (Corraini et al., 2017). Age was negatively associated with hazard ratios of all stroke survivors, with younger patients facing a higher risk of dementia than older ones (Corraini et al., 2017). Hence, three main conclusions can be made from the study. Firstly, stroke increases the risk of dementia regardless of patient characteristics and type of stroke suffered. Secondly, patients with a history of hemorrhagic stroke are at a higher risk of dementia than those who suffered an ischemic stroke. Lastly, a young age increases the risk of dementia in stroke sufferers even further.
Discussion
The results of the study have important practical implications for care providers. Based on the outcomes of the study, it is evident that patients with a history of stroke have increased chances of developing dementia, and thus it is crucial for care providers to identify these patients and screen them for signs of dementia regularly. This can help to develop management strategies as soon as possible, thus mediating the damage to the patient’s quality of life. Patients who had suffered a hemorrhagic stroke at a relatively young age are of particular concern to practitioners since their risk is even higher. These patients should be assessed more frequently to identify early-onset dementia, which poses a significant threat to their quality of life and health.
Patient education is also crucial to supporting patients who face increased risks of developing dementia. According to research evidence, up to 35% of dementia cases in the general population can be prevented by addressing modifiable risk factors (Yaffe, 2018). Hence, care providers should pay particular attention to educating stroke survivors about their risks of developing dementia and how these risks can be modified or managed. This could help to reduce the occurrence of dementia among stroke survivors or postpone its onset, particularly in younger patients.
Lastly, the study also shows the need to address the growing incidence of stroke and the prevalence of severe cases, which lead to the most significant consequences. As in the case of many other severe conditions, the risk of stroke can be reduced by addressing modifiable risk factors (Katan & Luft, 2018). Providing education to patients on the importance of a healthy lifestyle, weight management, smoking cessation, and reduced sugar intake could help to reduce the incidence of stroke in the general population, leading to decreased healthcare expenditures and improved patient outcomes. Encouraging patients to monitor their blood pressure and cardiovascular health can also assist in preventing hemorrhagic strokes, which lead to more deaths and dementia cases (Corraini et al., 2017). In this way, the study could also support improvements in clinical practice aimed at reducing the burden of stroke.
Conclusion
Overall, the study is relevant to clinical practice since it focuses on one of the most threatening conditions in the modern world. The methods utilized by the researchers were appropriate to the aims of the research and ensured that the information collected was reliable and accurate. The results of the study highlight differences in dementia risks between the general population and the survivors of two types of stroke: ischemic and hemorrhagic. The results can be used to support the clinical practice by improving screening and patient education.
References
Corraini, P., Henderson, V. W., Ording, A. G., Pedersen, L., Horváth-Puhó, E., & Sørensen, H. T. (2017). Long-term risk of dementia among survivors of ischemic or hemorrhagic stroke. Stroke, 48(1), 180-186.
Katan, M., & Luft, A. (2018). Global burden of stroke. Seminars in Neurology, 38(2), 208-211.
Perna, R., & Temple, J. (2015). Rehabilitation outcomes: ischemic versus hemorrhagic strokes. Behavioural Neurology, 2015(891651), 1-6.
Yaffe, K. (2018). Modifiable risk factors and prevention of dementia: What is the latest evidence? JAMA Internal Medicine, 178(2), 281-282.