September 9, 2012
September 2, 2012
August 14, 2012
In rehab, survivors are always spoken of as having these “defecits”.
I say, maybe things aren’t working the same (as before the injury), but when we start thinking of ourselves in a negative light (actually in the shadows), we’ll put out only lesser than what we are capable of.
After all, is the cup half empty or half full?
August 2, 2012
July 31, 2012
This has been the hot debated question, though now research is showing positive advantages of drinking coffee!
According to Gary Dash, PhD., a research professor at Florida Alzheimers Research Center and University of Southern Florida, caffiene is a brain stimulant that increases cortical activity.
First thing in the morning, I drink a 2 cups of coffee in the morning (that is usually it, it is rare that I’ll drink more coffee throughout the day). Through time, people have commented (making wisecracks) about my habit, now research is proving my feelings to be right on! I have always felt it to be a good thing. It awakens my attention, otherwise, I would sluggishly approach my day. Being a brain injury survivor (together with having a case of ADD), I have become pretty attuned to my attention, what helps keep my focus and what hinders my attention. Coffee allows me to feel better in facing a new day.
For a while, I was a regular user of Lumosity (a site with exercises that help you “reclaim your brain). The tests I took showed an increase in performance in alertness based activities after drinking coffee, as compared to before my morning coffee.
So, do I endorse coffee? No, not necessarily. I am confident that you will figure out what is best for you. Weigh the pros and cons. For me, the pro is the feeling of alertness in the mornings; it also seems to affect my mood. The cons, as I see it, are: over acidity (yet there is low acid coffee – which I use), whiteness of teeth and an increased need for hydration (but coffee seems to not encourage your thirst). These are all important considerations.
To each her own!!!
Now I’ll go get myself a cup of coffee (unleaded) and I’ll toast it to all my readers on Gray Matters.
July 27, 2012
“The more I want to get something done, the less I call it work.”
~ Richard Bach
July 26, 2012
July 21, 2012
July 12, 2012
An Astonishing Case of Brain Injury
By Kendra Cherry, About.com
If you’ve taken a psychology class, or ever had a passing interest in psychology, then you have probably at least heard of Phineas Gage. As the popular story goes, Gage was seriously injured when a metal rod pierced through his skull, destroying a large section of his brain. Miraculously, the man survived, but the accident left him a changed man, a shadow of his former self. Or at least, that’s how the popular story goes. How much of this is myth and how much of this is reality? Let’s take a closer look at Gage’s story in order to sort out the fact from the fiction.
The photo above of Phineas Gage came to light in 2010. The image was in the possession of members of Gage’s family. Gage is shown proudly holding the tamping iron that so dramatically altered his life.
Who Was Phineas Gage?
Phineas Gage is often referred to as one of the most famous patients in neuroscience. He suffered a traumatic brain injury when an iron rod was driven through his entire skull, destroying much of his frontal lobe. Gage miraculously survived the accident, but was so changed as a result that many of his friends described him as an almost different man entirely.
On September 13, 1848, the then 25-year-old Gage was working as the foreman of a crew preparing a railroad bed near Cavendish, Vermont. He was using an iron tamping rod to pack explosive powder into a hole. Unfortunately, the powder detonated, sending the 43 inch long and 1.25 inch diameter rod hurtling upward. The rod penetrated Gage’s left cheek, tore through his brain, and exited his skull before reportedly landing some 80 feet away.
Shockingly, Gage not only survived the initial injury but was able to speak and walk to a nearby cart so he could be taken into town to be seen by a doctor. Dr. Edward H. Williams, the first physician to respond later described what he found:
“I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage’s statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head… Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.”
Soon after, Dr. John Martyn Harlow, took over the case. It is through Harlow’s observations of the injury and his later descriptions of Gage’s mental changes that provide much of the primary information that we now know about the case. Harlow described the initial aftermath of the accident as “literally one gore of blood.”
Later in a published description of the case, Harlow wrote that Gage was still conscious later that evening and was able to recount the names of his co-workers. Gage even suggested that he didn’t wish to see his friends, since he would be back to work in “a day or two” anyways.
After developing an infection, Gage then spent September 23 to October 3 in a semi-comatose state. On October 7, he took his first steps out of bed and by October 11 his intellectual functioning began to improve. Harlow noted that Gage knew how much time had passed since the accident and remembered clearly how the accident occurred, but had difficulty estimating size and amounts of money. Within a month, Gage was even venturing out of the house and into the street.
In the months that followed, Gage returned to his parent’s home in New Hampshire to recuperate. When Harlow saw Gage again the following year, the doctor noted that while Gage had lost vision in his eye and was left with obvious scars from the accident, he was in good physical health and appeared recovered.
Unable to return to his railroad job, Gage held a series of jobs including work in a livery stable, a stagecoach driver in Chile and farm work in California. Popular reports of Gage often depict him as a hardworking, pleasant man prior to the accident. Post-accident, these reports describe him as a changed man, suggesting that the injury had transformed him into a surly, aggressive drunkard who was unable to hold down a job.
The myths surround the effects of Gage’s injury seem to have grown after his death, and many of these claims are not supported by any direct evidence from primary sources. Neither Harlow nor any others who had actual contact with Gage reported any of these behaviors. “Phineas’ story is worth remembering because it illustrates how easily a small stock of facts becomes transformed into popular and scientific myth,” explains psychologist Malcolm Macmillan, author of An Odd Kind of Fame: Stories of Phineas Gage.
So was Gage’s personality as changed as some of the reports after his death have claimed? Recently, Macmillian has suggested that the most marked changes in Gage may have been limited to the period of time immediately after the accident. Evidence suggests that many of the supposed effects of the accident were exaggerated and that he was actually far more functional than previously reported.
In 1968, Harlow presented the first account of the changes in Gage’s behavior following the accident:
“The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was ‘no longer Gage.’”
Since there is little direct evidence of the exact extent of Gage’s injuries aside from Harlow’s report, it is difficult to know exactly how severely his brain was damaged. Harlow’s accounts suggest that the injury did lead to a loss of social inhibition, leading Gage to behave in ways that were seen as inappropriate.
This image depicts the path of the iron rod through Gage’s skull. The illustration was included in Dr. Harlow’s account of the accident and subsequent impact on Gage, which was first published in 1868 in the Bulletin of the Massachusetts Medical Society.
“The missile entered by its pointed end, the left side of the face, immediately anterior to the angle of the lower jaw, and passing obliquely upwards, and obliquely backwards, emerged in the median line, at the back part of the frontal bone near the coronal suture,” Harlow wrote.
Today, researchers have only Harlow’s description of the injury and examinations of Gage’s actual skull and the tamping rod to provide evidence of the type of injury that was sustained. Several different studies have been conducted to try to determine exactly how much of Gage’s brain was affected by the projectile. One 1994 study suggested that both prefrontal cortices were affected, while a 2004 study indicated that the damage was limited to the left frontal lobe. In 2012, a new study estimated that approximately 11- percent of Gage’s frontal lobe was destroyed and that 4-percent of his cerebral cortex was impacted.
The frontal lobe plays a vital role in problem-solving, decision-making, and planning. The area known as the prefrontal cortex is associated with the expression of personality. Other functions associated with the frontal lobe including reasoning, judgment, and impulse control.
In Harlow’s descriptions of Gage after the accident, he suggests that Gage would often make plans but fail to carry them out and that many of his friends described his personality as greatly changed, to the point that they felt he was “no longer Gage.”
In a 1994 study, researchers utilized neuroimaging techniques to reconstruct Gage’s skull and determine the exact placement of the injury. Their findings indicate that he suffered injury to both the left and right prefrontal cortices, which would result in problems with emotional processing and rational decision making. Another study conducted in 2004 that involved using three-dimensional, computer aided reconstruction to analyze the extent of Gage’s injury, and found that the effects were limited to the left frontal lobe.
In 2012, new research led by Jack Van Horn of UCLA’s Laboratory of Neuroimaging (LONI) reanalyzed the high-resolution scans from the 2004 study to re-estimate the path of the projectile as it passed through Gage’s skull. They then utilized data from 110 healthy individuals from their data archive to produce a generalized map of the brain in order to better understand the connections that would have been impacted. Based upon this research, Van Horn and his colleagues estimate that the iron rod destroyed approximately 11-percent of the white matter in Gage’s frontal lobe, and 4-percent of his cerebral cortex.
Until recently, there were no known photographs depicting Gage. In 2009, a 19th-century daguerreotype owned by vintage photo collectors Jack and Beverly Wilgus was identified as that of Gage.
The photo depicts a handsome, obviously injured man holding a metal rod. The Wilgus’s had initially assumed the image might be that of an injured whaler holding a harpoon when they posted the image to the social image sharing site Flickr. A reader commented that the image might actually be of the famous Phineas Gage, and researchers later confirmed that the photo indeed depicted Gage holding what might be the infamous tamping iron that caused his injuries.
In 2010, a second image owned by members of Gage’s family was also discovered and made public.
Gage’s Influence on Psychology
Obviously, Gage’s case had a tremendous influence on early neurology. The specific changes observed in his behavior pointed to emerging theories about the localization of brain function, or the idea that certain functions are associated with specific areas of the brain. Today, scientists better understand the role that the frontal cortex has to play in important higher order functions such as reasoning, language, and social cognition. In those years, while neurology was in its infancy, Gage’s extraordinary story served as one of the first sources of evidence that the frontal lobe was involved in personality.
What Happened to Phineas Gage?
After the accident, Gage was unable to return to his previous job. According to Harlow, Gage spent some time traveling through New England and Europe with his tamping iron in order to earn money, supposedly even appearing in the Barnum American Museum in New York. Like many aspects of Gage’s case, however, this is difficult to verify.
He worked briefly at a livery stable in New Hampshire and then spent seven years as a stagecoach driver in Chile. He eventually moved to San Francisco to live with his mother as his health deteriorated. After suffering a series of epileptic seizures, Gage died on May 20, 1860, almost 13 years after his accident.
Seven years later, Gage’s body was exhumed and his skull and the tamping rod were taken to Dr. Harlow. Today, both can be seen at the Harvard University School of Medicine.
As you have seen, while many reports of Gage’s functioning in the aftermath of his mishap are often grossly exaggerated, the primary evidence does suggest that he did experience significant personality changes as a result of his injury. Unfortunately, we’ll never know the exact extent of Gage’s brain damage or precisely how his behaviors changed after the accident.
You can also learn more in this illustrated tour of Phineas Gage’s life, including images of Gage himself and illustrations depicting his injury.
Gage died in 1860 following a series of epileptic seizures, just 12 and a half years after his accident. In 1866, Harlow requested that the family exhume the body. The skull was removed and sent to Harlow, along with the iron tamping bar that had been in Gage’s possession at the time of his death. Today, both the skull and the iron rod can be seen at Harvard Medical School’s Warren Anatomical Museum.
Costandi, M. (2012). Phineas Gage’s connectome. The Guardian. Retrieved from http://www.guardian.co.uk/science/neurophilosophy/2012/may/16/neuroscience-psychology#
Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M., & Damasio, A. R. (1994). The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Science, 264(5162), 1102-1105. DOI: 10.1126/science.8178168
Harlow J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39, 389–393.
Harlow, J. M. (1868). Recovery after Severe Injury to the Head. Bulletin of the Massachusetts Medical Society. Reprinted in History of Psychiatry, 4(14), 274-281 (1993) doi:10.1177/0957154X9300401407
Ratiu, R., Talos, I. F., Haker, S., Lieberman, D., & Everett, P. (2004). Journal of Neurotrauma, 21(5), 637-643. doi:10.1089/089771504774129964.
Twomey, S. (2010). Phineas Gage: Neuroscience’s Most Famous Patient. Smithsonian Magazine. Retrieved from http://www.smithsonianmag.com/history-archaeology/Phineas-Gage-Neurosciences-Most-Famous-Patient.html?c=y&page=1
Van Horn, J. D., et al. (2012). Mapping Connectivity Damage in the Case of Phineas Gage. PLoS ONE, 7(5), e37454. DOI: 10.1371/journal.pone.0037454
July 10, 2012
“The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty.”
Sir Winston Churchill
July 2, 2012
June 26, 2012
that a small group of thoughtful, committed citezens can change the world. Indeed, it is the only that ever has.
- Margaret Meade
Brain Injury: The Inside Perspective
Having a brain injury refigures a person’s reality. Though physically, you may not be able to discern that this person has survived a brain injury, in the unseen world, this person is not a mirror reflection of you.
Survivors are often misread and not understood; it’s not easy to understand how a survivor’s world is different without the right guidance. Their world is re-assembled; and of course, many dynamics are problematic, yet survivors usually become more genuine! Gray Matters is aimed at giving you the personal sense of what it is like to walk in the shoes of a brain injury survivor, so you can understand for yourself what type of personal alterations take place after going through a brain injury.
The lack of personal discernment and sensitivity regarding survivors of brain injury is what stirred me to write Gray Matters. When others treat survivors with lack of consideration, or even look down at them for what they’re not able to do (like follow conversation or remember what was just said – and the list goes on…), this drives survivors further into isolation or depression. With Gray Matters, I am looking to familiarize my readers with what it is like to go from abled to disabled and how the effects of brain injury are all –inclusive. I do this because “Knowledge births tolerance and acceptance. For survivors deserve to be granted their peace!” (Lerner, 2006, p. 36).
The very first poem I wrote about brain injury (see below) provoked such inner reflection, that I was inspired to keep writing, until finally, it became evident that I was writing a book. My intent is to give my readers a personal feeling, not just a cognitive library. Yet if I use any clinical terms, definitions can be found in the glossary and other references can also be found in the bibliography; the aim is to target people to learn about brain injury. The purpose is to present a new, uncomplicated method of understanding what happens when our brain is injured.
Trauma’s Unceasing Harvest
Have you heard anything
Regarding injury to the brain?
For in your heart,
You’d think it’s such a shame.
Lets take Jimmy here,
He’s a friend of mine,
Walking to school one day,
Everything was just fine,
Ready to cross the street,
Two cars hit with a crash,
One car rebounded,
And laid Jimmy in the grass.
Sent him right into dreamland,
Twenty days in a coma, or more -
And now he’s battling with himself,
Just to do every day chores.
He sees a therapist regularly,
The way he handles,
I don’t know how,
But let’s ask Jimmy
How he’s doing now.
“It was hard for me at first,
Everything seemed so strange,
Yet my teacher tells me,
That nothing’s changed!
The girl that I used to like,
We’d meet out on the track,
When our classes were free,
Now she won’t even look at me!
To tell you the truth,
I don’t know
If I want to be here in school,
They all look at me
Like I’m such a fool.”
Well thank you Jimmy,
For speaking your mind,
Just know that out there,
Are people that care,
Them, I’m sure that you will find.
Being dragged through the wringer,
Jimmy starts his wrinkled life anew,
And as much as you may have heard,
Do you really know what Jimmy’s going through?
When you read Gray Matters, you will delve into the Inside Perspective of brain injury and also come to know the importance of hope, support, love, faith and a good attitude! Survivors can gain a more complete understanding of their injury and of themselves; I have been told that reading Gray Matters has helped many to cope. Friends and family will gain a better understanding of their loved one’s condition and how they can proactively interact. For professionals in the field of Rehab, I’d like for them to walk away with new insight and sensitivities in their work with brain injury survivors. Gray Matters is uplifting and inspiring; it contains many gems! I hope that all who read Gray Matters will enjoy it and soak in its riches!
Heidi Lerner is the Founder and Director of Gray Matters Survivor Outreach, a peer-based initiative for brain injury survivors. Heidi facilitates several Gray Matters Support Groups in and outside of San Diego California. She is the Director of the Gray Matters Survivor Outreach Mentorship Program in which mentors will be utilized to individualize, accentuate and accelerate the needed developments in their rehabilitation.
June 19, 2012
June 5, 2012
June 4, 2012
June 2, 2012
This movie is coming out soon. It is remarkable how similar of a story Heidi went through!
Director: Bob Talbot - Cast: Katie Pofahl - : Otter 501 is a feature film due in theaters this spring! When an adventuresome young woman discovers a sea otter pup stranded on the beach and in desperate need of a second chance, an entire species’
Heidi shares a real similar story (even in the same location):
Kayak Trip Report
Three Western Sea Kayakers met at Casa Verde Beach in Monterey to go surfing. Once in the surf, Heidi Lerner went to go check on one of the paddlers when he capsized his boat. She asked him if he was Ok; he said he was fine, but said something about an otter. They started looking around.
When Heidi got eye contact with the otter, it immediately approached her boat. That otter jumped aboard and snuggled into her lap (i.e. in the skirt – what attaches the paddler to the boat). She was awed at how comfortable with her it was. She decided to let the otter stay on the boat with her for a while, as this seemed to be it’s chosen preference.
The otter rode atop the boat for some time with her. It would see a wave coming that would take the boat and would dive off – Heidi would ride it in and the otter would swim up to the boat in the soup (i.e. in the whitewater, shoreward of where the waves brake) and hop on again. It was along for the ride! In total, they spent 1 1/2 – 2 hours together.
At one point, the otter began to chew on her skirt. She immediately shook her finger and said, “No!” in a firm voice. It bowed its nose like a guilty dog. It seemed that this otter just needed a MOM!!!!
After this very special surfing extravaganza, Heidi reported this otter to the Monterey Bay Aquarium research department. Karl Mayer, the otter researcher, informed her that “it” was a she and she was reported to have approached quite a few surfers and kayakers in Monterey. According to her tag number, the aquarium had raised her since she was orphaned at about two weeks old.
In hoping that she would have more of a chance to adopt wild ways, Maggie was captured and moved to a less frequented Piedras Blancas, near San Simeon. Well, this didn’t work out, as she continued to approach surfers and kayakers in San Simeon as well. The researchers then decided that even there, she was not safe and that she would only be safe, living in the confines of the aquarium. The Monterey Bay Aquarium moved her into their otter exhibit. She was named Maggie and in the exhibit, she joined other otters, Rosa and Mae.
When Heidi first heard that Maggie would be contained in the aquarium, she was saddened, but when she thought about it – Maggie loves people, perhaps this would not just be the safest route, but it may also be good for her. When Heidi visited Maggie in the otter exhibit, she saw that Maggie is kept inside of double glass, which means that she cannot see any of the people all around her who are staring at her. If she could, she’d be checking us all out!!! Now she is stuck within the exhibit – not quite the atmosphere for her to exercise her adventurous and loving character.
Heidi hesitated in writing this trip report, but she decided to put it out for educational purposes. Although she thoroughly enjoyed Maggie’s antics in the surf and was deeply touched by interacting with this supposedly wild animal, she discourages kayakers from intruding in the wild lives of animals in the sea. All kayakers/boaters/surfers should realize that we are out there in their turf and we should keep our influence to a minimum. If we contribute to taming the wildlife, we are doing them a great disservice. Help keep the animals wild and you could end up keeping them from harm – or from a fate such as Maggie’s, which is to live out her days in the confines of an aquarium exhibit.
This is not saying to hold back love for the sea critters. They are deserving of the deepest love and respect!
Paddle on in peace!
May 25, 2012
May 22, 2012
May 8, 2012
April 18, 2012
April 12, 2012
April 14: Local Author Saturday, Warwicks, La Jolla, 3 PM
Warwicks - 7812 Girard Ave.
La Jolla, CA
858 454 0347
Gray Matters, Brain Injury: The Inside Perspective
Heidi’s book, Gray Matters consists of poetic ruminations of a woman
who lived through a near fatal brain injury. Ms. Lerner experienced her
rehab as a spiritual journey; her knowledge and humor present a one of
a kind reading experience. Get the the sense of what it’s like to walk
in the shoes of a brain injury survivor.
Gray Matters approaches the topics of rehabilitation, the brain, its
symptoms in an injured state, academic interventions,nature’s
healing influence or
recreational therapy and the great benefit of support groups. Having a
personal understanding of a brain injury is essential, as so many are
walking around with such an extensive injury and we never know when
we come upon someone with this often invisible disability.
Again, I am no Nutritionist, I just have come to know what works for me. I play around with it until I find what works for me.
Someone asked me to follow up on this topic. I love when readers make suggestions, it really gives me a sense that people are really reading what I have t5o say and benefitting from it! Please feel free to ask questions!
For anyone with Attention issues (Brain injury, ADD, ADHD…), I find a wonderful supplement is Omega 3s with DHA!!! It’s not cheap, but if you have attention problems, honey, I say it’s worth it! I take 2 pills a day with 800 mg of DHA (and that is a mega-dose!).
Chlorella - provides the green energy, helps detox and gives some energy.
5 HTP - Can be used for spurts of depression. I don’t suggest for chronic cases.
For digestion, Fiber – daily, Digestive Enzymes (eases digestion), Probiotic (the livelier, the better – keep in refrigerator) Magnesium (helps with irregularity).
Liquid gel multivitamin (is easily digested and the nutrients are best assimilated)
D-3 (If not getting regular sun)
Calcium/Magnesium – liquid
Listen, what I suggest is for you to ask your doctor to do a blood check so s/he can tell you what you personally need . If this is something that is foreign to the doc, I suggest finding another doctor! More holistic physicians are good. I am blessed in that I found a doc that can go either way, medical or holistic. She is my ally!! It is time that we take responsibility for our own health! Find a doctor that will work with you so you can become healthier
March 28, 2012
March 27, 2012
March 13, 2012
I guess Joni Mitchell
Was pretty right on,
When she said
That we’ll never know
What we’ve got until it’s gone.
But does that mean
We don’t usually appreciate our A, B or C
Until they’re taken from us?
But does this have to be true?
Can you possibly imagine
That this has happened to you…?
In the flash of a moment
The picture perfect sky
Cracks into millions of tiny pixels.
The sun boils, blisters,
Pops and oozes dry,
The sedatory crash of the ocean waves
Turns to high-pitched wails,
Shock sets in,
Melody siphons into monotone,
Life’s intimacies are dulled,
In a blink of circumstance,
Pains cringe out of unknown places,
Emotions turn up their volume.
How you are now is not the same,
As how you once were.
Now deal with it!
Smoke comes out of the tractor’s exhaust,
Your paradise has been paved…
And they’re installing a parking lot.
You’ll be looking for a parking space,
And you’ll never know
What was once there in that place.
Worse yet and what’s a scare,
You will not know what could have been there.
You probably don’t realize
What you cannot do,
Just try to not let it get to you.
Your paradise has been paved-
Like it or not,
You’ll have to accept it,
Because it’s what you’ve got!
Brain injury flattens out our many capabilities,
Even ones that before we were not aware,
Some of us must learn these things the hard way -
But the question remains…
Must we go through loss,
To appreciate what was once there?
To the unimpaired,
This is aimed -
So that ignorance of this loss,
Knowledge births tolerance,
For survivors deserve
To be granted their peace.
A clear portrait is being painted,
Of what we’ve got…
Don’t pave paradise and put up a parking lot!
(Joni Mitchell, 1970) Gray Matters for you!
March 8, 2012 — Having diabetes for a decade or more dramatically increases the risk for ischemic stroke, report researchers.
The new study, published online March 1 in the journal Stroke, found diabetes increases risk 3% each year and triples at 10 years.
|Dr. Mitchell Elkind|
“We were not surprised to see an increased risk,” senior investigator Mitchell Elkind, MD, from Columbia University Medical Center in New York City, told Medscape Medical News. “But we were taken aback by how high the risk was.”
Using data from the Northern Manhattan Study, investigators looked at 3298 multi-ethnic participants. They found that 22% had diabetes at baseline and another 10% went on to develop the disease over the course of the study. There were 244 ischemic strokes.
“Our study provides evidence that the risk of ischemic stroke increased continuously with duration of diabetes mellitus,” the authors explain. This was after controlling for other factors such as age, smoking history, physical activity, history of heart disease, blood pressure, and cholesterol.
“The increase is not as much during the second half of the first decade,” they noted, “but it increases steeply as the disease enters its second decade.”
Duration of Diabetes and Ischemic Stroke Risk
|Diabetes (Years)||Hazard Ratio||95% Confidence Interval|
|0 to 5||1.7||1.1 – 2.7|
|5 to 10||1.8||1.1 – 3.0|
|>10||3.2||2.4 – 4.5|
Among the nearly 26 million Americans with diabetes, more than half are younger than age 65 years, according to the American Diabetes Association.
“We used to think of type 2 diabetes as a disease people get when they are older, after a lifetime of poor dietary habits,” Dr. Elkind said. “But the age at diagnosis is getting younger and younger because of the obesity problem among young people.”
The researchers pointed out that diabetes was determined by self-report in this study. “It’s possible we missed some cases,” Dr. Elkind added during an interview. An estimated one third of diabetes cases may be undiagnosed. It has also been found that true onset of diabetes may be 4 to 7 years earlier than clinical diagnosis.
As the population ages and the elderly live longer, more and more people will live with longer duration of disease, the authors note. “It is important to better understand the dynamics between diabetes, time, and stroke, and to emphasize the importance of interventions to prevent early diabetes. Minimizing the number of years a patient has diabetes would help combat the increase in stroke risk with each year of the disease.”
Some of the reasons for increased stroke risk may include an association between longer diabetes duration and thicker plaque in neck arteries and the higher prevalence of hypertension, accelerated vascular complications, and clotting abnormalities.
Northern Manhattan Study
Asked by Medscape Medical News to comment on the findings, Philip Gorelick, MD, from the Hauenstein Neuroscience Institute, in Grand Rapids, Michigan, said the Northern Manhattan Stroke Study has provided a wealth of information about risk factors for stroke over the years. One of the important risk factors for stroke is diabetes.
“In this publication, the authors have shown little incremental value of using diabetes as a time-dependent variable when compared to baseline assessment of diabetes as a risk for stroke. With duration of diabetes, however, the risk of stroke does increase. This is a key take-home message for clinicians as intensification of risk factor management may be very important amongst those who have had diabetes for a longer time period as their relative risk of having a stroke becomes higher with time.”
Although tight control of blood glucose may not reduce stroke risk, he pointed out, associated problems such as high blood pressure and dyslipidemia are prime targets for patients with diabetes.
“Young people should be educated about diabetes and how to prevent it,” Dr. Elkind added. “Eating a healthy diet, remaining physically active, and avoiding smoking are important.”
The Northern Manhattan Study is funded by the National Institute of Neurological Disorders and Stroke. The investigators have disclosed no relevant financial relationships.
Authors and Disclosures
Journalist – Allison Shelley
Allison Shelley is part of a dedicated news team specializing in neurology. After completing her master of journalism in science reporting at Carleton University in Ottawa, Allison became science affairs analyst for the Canadian Medical Association Journal. She later joined theheart.org and jointandbone.org news teams, which were acquired by WebMD. Working with the national science reporter at the Toronto Star and an associate professor at Carleton University, Allison developed guidelines for journalists covering medical news. She is a guest speaker at the Carleton University School of Journalism and Communication and a Cambridge University Press author who wrote a textbook chapter on analgesics. Allison has a commerce diploma and completed a multidisciplinary International Space University program, which included modules in the life sciences. She has edited a variety of medical association publications and has done some work in radio and television. You can follow Allison on Twitter @allishelley.
Disclosure: Allison Shelley has disclosed no relevant financial relationships.