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Understand the Long-Term Health Impacts of "Silent Strokes": The unnoticed events cause no immediate symptoms, but over time they can affect your memory, cognition, and motor skills.

They may be known as "silent strokes," but these short-lived, unnoticed brain attacks can have lasting and serious impacts on your cognition and brain health. And they occur more frequently than you might think. Research suggests that about one in 10 older adults has had at least one silent stroke, while other estimates place that figure closer to one in three.

"They're quite common," says neurologist Jonathan Rosand, MD, co-founder and co-director of the Henry and Allison McCance Center for Brain Health at Massachusetts General Hospital. "But they're not discovered through symptoms, but through imaging, like CT scans and MRIs." He explains that the signs of a silent stroke, which look like white spots on brain scans, are usually found when a person is being screened for symptoms related to other conditions, such as migraines or Parkinson's disease.

What Is a Silent Stroke?

The clinical term for a silent stroke is a silent cerebral infarction (SCI).

An infarction is a disruption of blood supply to an organ that causes tissue death. It's often caused by a blood clot that interrupts blood flow in an artery of the brain.

The reason they are known as "silent" strokes is because they can occur without your knowing anything is wrong. Unlike traditional strokes, which can cause obvious symptoms ranging from numbness and tingling on one side of the body to difficulty speaking and seeing, silent strokes come and go with no such noticeable signs. But over time, the damage inflicted by those silent infarctions can become obvious.

"They can lead to a gradual decline in things like cognition, memory, and walking," Dr. Rosand says, adding that someone's personality, speech, or fine motor skills may be affected, too. "Where in the brain the infarct is will determine what is affected."

Stroke Prevention

While it's impossible to completely eliminate your risk of a silent stroke, you can take some steps to at least lower your risk. The same preventive measures recommended for a regular stroke apply to silent strokes, too, Dr. Rosand says.

The two major risk factors for silent strokes include atrial fibrillation (AF) and high blood pressure (hypertension). AF is a chaotic beating of the heart's two upper chambers--the atria. With the atria not beating in synchronization with the lower chambers (ventricles), blood can pool in the heart, leading to blood clot formation. A blood clot that forms in the heart can eventually travel through the arteries up to the brain and cause a silent or major stroke.

Fortunately, AF can often be treated with procedures such as catheter ablation (destroying a tiny piece of heart tissue thought to trigger AF symptoms) or electrical cardioversion, which uses a mild electrical shock to reset the heart into a normal beating rhythm. Antiarrhythmic drugs can sometimes be helpful in maintaining a healthy heart rhythm.

Hypertension also can be treated with medications and lifestyle changes, such as weight loss (if overweight), a balanced and low-salt diet, regular aerobic exercise, stress reduction, no smoking, and treating conditions such as diabetes, high cholesterol, and obstructive sleep apnea.

Talk with your doctor about stroke and heart disease prevention, and about what you can do to lower your specific risks. For instance, thyroid disease and kidney problems can contribute to high blood pressure. Medications, including certain over-the-counter decongestants and some prescription drugs, may also raise your blood pressure.

When a Silent Stroke Is Found

If your doctor points out the telltale indications of a silent stroke on your MRI or CT scan, Dr. Rosand suggests you take that as a serious wake-up call. Having a silent stroke means you are at a higher risk for another silent stroke, but also for a major stroke.

"One thing you can do is control all the risk factors you can to help prevent another stroke," he says. "Treat it like a warning. Do everything you can to control cholesterol and blood pressure, quit smoking, and treat sleep apnea if that's an issue."

And if you're starting to experience the impacts of a silent stroke, talk with your doctor about treatment options.

"The most common manifestations of silent strokes are memory and thinking problems," Dr. Rosand says, noting that once you're assessed, you can't undo the injury to your brain tissue. "But cognitive therapy may be an option. It's about understanding what an individual's cognitive limitations are and helping them and their families adjust."

If memory and thinking skills challenges are present in an older adult, it can be difficult to determine which symptoms are caused by a silent stroke and which ones may be due to a condition such as Alzheimer's disease or another form of dementia.

Working with a neurologist to sort things out can be very helpful. "It's important, because it will dictate what the treatments should be," Dr. Rosand says.

It's also worth noting that many people have one or more silent strokes and never face any long-term results from the events. It may be because the SCI was very minor or because the brain compensated for the damaged tissue, so there was no noticeable change in motor skills, speech, or thinking skills. But given how common silent strokes are and how debilitating they can be over time, taking steps now to reduce your stroke risk will improve your odds of preserving healthy brain function. MMM
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Publication:Mind, Mood & Memory
Date:Jul 25, 2019
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