Stroke used to be a disease associated with age, but young adults are also starting to be affected due to the rise in metabolic syndrome.
This is especially so with the unseen condition of uncontrolled high blood pressure or hypertension.
As for those who chainsmoke, note that young heavy smokers have been known to be struck down by stroke at the tender age of 17.
While it doesn’t kill you immediately, stroke patients present a heavy burden on the healthcare industry and caregivers.
This is distressing, says consultant neurologist Associate Profes-sor Dr Hoo Fan Kee.
Of all the conditions that can affect our voluntary movement, stroke is one of the common causes of disability.
“When it comes to heart attacks, our healthcare is very well covered because there are lot of cardiologists, but stroke care is not catching up.
“Heart health attracts the attention of healthcare workers and policymakers, so a lot of funding goes into it.
“In terms of death from a heart attack, the patient dies in front of you, but for stroke, the death rate is 30-40%, but you don’t see patients die in front of you.
‘They may pass on after a few weeks, usually due to complications such as bed/pressure sores and aspiration pneumonia where the food goes through the wrong channel and ends up in the lungs, causing infection,” he says.
For a fairly common condition, not many doctors choose to sub-specialise in this area.
“We have roughly 120 neurologists in Malaysia; the majority learn about stroke, but not many sub-specialise in this.
“They may choose to sub-specialise in epilepsy, Parkinson, multiple sclerosis, etc. Only 10% are focused on stroke,” reveals Assoc Prof Hoo, who is also the president of the Malaysian Stroke Council.
Thus, general practitioners and geriatricians are being trained in stroke care to cover a wider segment of the population.
He says, “If you get early intervention, the clot-buster drugs (thrombolysis) will help.
“We also need to screen patients to see who is eligible for mechanical thrombectomy, a type of minimally-invasive procedure to remove a clot from a patient’s artery.
“The window period for stroke is within six hours, but with artificial intelligence software, we can see if the brain tissue is dead.
“If it is not fully dead, there is still an opportunity to do mechanical thrombectomy within 24 hours.
“Treatment has to be started early for better outcomes.”
Promoting brain health
Data shows that, on average, if you are 65 years or more, your brain volume reserve is about 55%; this is down from about three-quarters of your brain or memory volume at the age of 45.
The amount of brain volume you have can spiral downwards quickly with age if you do nothing to promote your brain health.
“There are many diagnostic tools to measure this volume, but when it comes to forgetfulness, it cannot be measured objectively,” says Assoc Prof Hoo.
Although everyone is harping on diet and exercise choices, other lifestyle factors are equally critical.
Assoc Prof Hoo says, “Don’t forget the basic factors like: are you sleeping at least six hours a day? Are you drinking enough water – two litres a day? Do you take enough micronutrients (vitamins and minerals) and the right combination of macronutrients?
“When it comes to exercise, many people think it’s all about aerobic exercise, but that is just the physical aspect.
“What about the brain? Do some crossword puzzles or Sudoku; take up taichi, which helps the physical and mental aspects. If you don’t use it, you lose it, so train the brain to maintain its health.
“Studies show playing mahjong among dementia patients reduces the decline of cognitive function.
“The same concept applies if you do things that require thinking and analysing. Perhaps try playing some interactive game using technology.”
Our forefathers rarely talked about getting enough nutrients, but since the invention of the refrigerator, the loss of micronutrients in our diet is up to 50%. Even if you store fresh food inside, you may not get all the nutrients.
“Whether it is convenient or a step towards changing your lifestyle, people take supplements.
“But remember that it doesn’t solve the problem. You’ve got to begin with a change in your lifestyle, which doesn’t cost money!” he says.
Nutrition for the brain
The conventional nutrition for the brain used to be omega-3 fatty acids, coenzyme Q10, and vitamins B and E.
For better nerve function and brain transmission, there was calcium and magnesium.
Vitamin E represents a family of compounds that is divided into two subgroups called tocopherols and tocotrienols.
These act as important antioxidants that regulate peroxidation reactions and control free-radical production within the body.
Compared to tocopherols, toco-trienols are proven to have higher antioxidant and anti-inflammatory properties. They also have a powerful cholesterol-lowering property.
Research shows that tocotrienols protect against cardiovascular disease by decreasing artery stiffness, which occurs due to age and the accumulation of fatty plaques on our artery walls, and high blood pressure, which is a risk factor for many cardiovascular conditions.
In cases of a silent stroke, small bright patches called white matter lesions show up on magnetic resonance imaging (MRI) of the brain.
This white matter disease affects the nerves that link various parts of the brain to each other and to the spinal cord, resulting in memory problems or slow thought processes, urinary incontinence and slow gait.
As white matter disorders can be mild, the prognosis is more optimistic than for grey matter disorders – most notably the dreaded dementia of Alzheimer’s disease, in which cortical cell bodies, synapses and receptors are destroyed by the disease.
Various studies have been published to show that taking 200mg of tocotrienols twice a day for two years can reduce the worsening of white matter disease by seven times.
“There is a potential for treating white matter disease.
“Traditionally, we tell patients to control risk factors such as hypertension and cholesterol.
“With patients with white matter that is progressive, they can try taking tocotrienols,” says Assoc Prof Hoo.
Generally, vitamin E, regardless of which kind, also improves the genitourinary system. It boosts sex and liver (fatty liver) health.
Some nutritional drinks have the added tocotrienols, which also come in pill form.
He adds, “Anyone can take it, but there’s no perfect drink out there. We have to see what is suitable for the patient.
“As for the genetic component in brain health, you cannot always blame your parents as the body doesn’t progress that way.
“Environmental factors play a huge role too and can trigger a lot of things, but you can control the switch. You choose to switch it on or off. It’s free!”