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Acute stroke patients with preexisting dementia don’t always get appropriate or timely treatment. The neurological disease can make it difficult for providers to diagnose and quickly treat the stroke. Additionally, there has been a lack of guidelines on how to provide stroke care to this population.

But, according to a scientific statement released by the American Heart Association, timely stroke treatment for individuals with dementia is vitally important. It can prevent long-term health and financial consequences for the individuals and their families. 

Adopting a person-centered approach to care and recognizing sudden changes in the individuals’ behavior can make all the difference in the long-term outcomes after stroke.

Exclusion and Biases

In the U.S., nearly 6 million people have Alzheimer’s disease or related dementias. Unfortunately, stroke research and clinical trials exclude this population. This exclusion has resulted in a lack of guidance for diagnosing and treating stroke patients with dementia.

Cathy Ciolek, PT, DPT, FAPTA, a physical therapist and dementia educator, says this presents a challenge when healthcare professionals provide care to patients with dementia who may be experiencing a stroke.

“This population has a lot of issues with ischemic stroke, yet they are left out of stroke research. Doctors frequently see these patients in a healthcare setting and they have no guidelines on diagnosing and treating them for stroke,” she says.

In addition to lack of guidelines, the statement also says biases may play a role in providers failing to treat dementia patients for stroke in a timely manner.

“Some people may think that a life with dementia is not worth living, especially in the late stages. But, if providers administer stroke treatment quickly and appropriately, an individual with dementia can avoid long-term consequences and enjoy a better quality of life,” notes Ciolek.

When it comes to treatment, evidence has suggested that people with pre-stroke dementia have a higher risk of death after being administered clot-busting medications. However, the American Heart Association said in their statement that these treatments are as safe and effective in individuals with dementia as those without cognitive impairment.

Consequences of Delayed Stroke Treatment in Individuals with Dementia

Researchers have found that stroke patients with dementia were three times more likely to have more significant disability at discharge from the hospital than those without preexisting dementia.

“Stroke greatly affects their quality of life. Following a stroke, these individuals will need more care, and they will be at an increased risk for other issues such as falls, trouble swallowing, and pneumonia,” says Ciolek. “There is a significant increase in the cost of care they receive as well. If the individual needs a higher level of care, more assistance, and additional medication, that increases the burden of healthcare costs.”

When treating stroke patients with dementia or other disabilities, the American Heart Association encourages providers to consider the benefits of treatment in reducing these long-term impacts.

Recognize Sudden Changes in Behavior to Help Diagnosis Stroke Faster

Clot-busting drugs can minimize the long-term effects of stroke if administered within the first three hours of symptoms. Stroke symptoms include sudden:

  • Numbness or weakness
  • Confusion and difficulty speaking
  • Trouble seeing
  • Trouble walking and loss of balance
  • Severe headache

People with dementia aren’t always able to communicate these symptoms, so caregivers must recognize sudden changes in behavior.

“Someone with dementia may already have difficulty communicating or walking, so early detection is hard,” says Ciolek. “As caregivers, we must look at their baseline. Dementia is a slow decline. If an individual is suddenly bumping into things or not communicating as well as usual, that may indicate they are experiencing a stroke.”

Adopt Patient-centered Care to Ensure Healthcare Preferences Are Met

Ciolek says having conversations before a person develops cognitive impairment can guide a personalized treatment plan in the unexpected event of a stroke. An in-depth questionnaire, like the PELI, which shares everyday personal care preference along with Advanced Care Planning, can help providers honor patient preferences.

“When someone is having an acute stroke, you must make quick decisions about their treatment. It can be stressful and guilt-inducing. If you have these conversations ahead of time, it is beneficial for everyone involved,” Ciolek says.

The statement from the American Heart Association encourages healthcare providers to discuss quality of life concerns and future care preferences with patients with dementia and their families. 

“Developing a plan that addresses these health emergencies ensures the person’s healthcare preferences are met,” says Ciolek. “It’s really valuable to know their wishes.”