USA: Elderly more likely to miss signs of stroke, neurologist confirms

. CHICAGO, Illinois / Medill Reports / May 20, 2009 By Alina Dain Stroke is an often hidden problem. A new study has shown that the responses of older adults asked whether they had a stroke have been found to often contradict a diagnosis by magnetic resonance imaging (MRI) of the brain. Dr. Christiane Reitz, of Columbia University Medical Center in New York, and colleagues interviewed more than 700 older adults about their medical history and conducted comprehensive physiological exams that included an MRI. A newly released online report set to appear in the July print issue of Chicago-based Archives of Neurology shows that while only about 12 percent reported a history of stroke, about 30 percent of the patients showed evidence of stroke on the MRI. Younger individuals were shown to be more likely to accurately report their stroke history. Dr. Richard Temes, director of neurological critical care at Rush University Medical Center, reflected on the study in this interview: Do you see any parallels between this study and what you observe when you see patients? It is true that it is very important that patients understand their past medical history and conditions that they might have, but it is also true that you can have very, very small areas or stroke and not necessarily even know that you had a stroke, because there are areas of the brain that may not manifest symptoms. … High blood pressure, diabetes and high cholesterol are all medical problems which can increase your risk for stroke. Many people have them and don’t recognize that they do have them, because having high blood pressure doesn’t cause symptoms in-in-of itself, diabetes doesn’t cause symptoms. As a neurologist, have you noticed that patients report their medical history inaccurately? The brain can manifest symptoms in a whole bunch of complex ways. Things such as memory problems or headaches can occur quite commonly in patients who are elderly, and they can be falsely misinterpreted or thought that this is basically because of age that the patient is acting this way. Or, it’s not like the classical “suddenly my arm is weak” scenario. The brain is very complex and can cause a whole host of symptoms such as visual changes, language, motor, sensory, and sometimes these things can be misinterpreted. Sometimes, especially with stroke, the symptoms can be very transient, lasting for a few minutes and never recurring again. So a patient can have a false sense of security, thinking … 'I had sudden numbness or difficulty using my hand but it’s all better now,’ when in fact it’s not all better, something serious just occurred. In the study, they said that younger patients are actually more accurate in reporting their symptoms than elderly patients. I think that younger patients are probably more in tune with something serious because symptom-wise they don’t have very many things going on with them. As we get older we have more symptoms, more chronic health issues that are affecting our daily lives, and so things can be underreported and misinterpreted. This is contrary to something like when a young individual suddenly gets vertigo and gets nausea and vomiting when they start walking or moving. That’s something that never really occurs. When someone is elderly, maybe taking a lot of medications for chronic health problems, the same symptoms in that person may not be reported. But it’s not just the age group. There are differences in gender, cultural differences. There are many, many more factors that go along with underreporting than age. When patients fail to accurately report their medical history, what impact does that have? It can really cause problems regarding their treatment. Obviously any delay in diagnosis can cause problems. It can also lead to problems with ordering tests that aren’t necessary or ordering tests that are incorrect. And some of these conditions that we are talking about are preventable and treatable. Stroke is a very preventable disease in terms of it being associated with conditions which can be treated, and treated well if they are identified. What neurological medical conditions cannot be revealed with an MRI? If an MRI is done and the patient shows stroke, that means the patient has cerebral vascular disease. So the use of an MRI is not an effective screening device because it’s only telling you who has the disease. The things that you want to screen for are conditions that lead to disease, like hypertension, diabetes, smoking, cholesterol. These are modifiable risk factors that if treated early enough can prevent the disease which we’re detecting on the MRI. With symptoms that only patients can report, nothing that you can screen for, what we rely on is the patient’s self-report. The patient is going to have to be able to tell you their symptoms. This is what goes into the art of medicine. …What makes me order a specific test are the patients’ symptoms, what’s going on with them ©2001 - 2009 Medill Reports - Chicago, Northwestern University.