The promised one has been waiting for three years
Of course, it would be better to send a person who has suffered a stroke to a rehabilitation center, where he would receive all the help necessary to restore his health. I also came to this conclusion when, after transporting my mother from the hospital home on the very first night, I had to call an ambulance. As a result, my mother again ended up in the hospital, where she was kept for about two weeks, during which I, having raised everyone I knew, received several tips on rehabilitation centers.
According to official documents, stroke patients can recover at a government rehabilitation center for free, but I was told it could take at least two months to wait for a place to become available.
Question answer
At what age is the risk of stroke greatest?
Other centers are paid. In some, a day of stay costs 12 thousand rubles or more (depending on the patient’s condition and his needs). In one of those where I applied, they calculated that I would have to pay 16,500 rubles per day.
There are centers that are much cheaper - with a starting price of 3 thousand rubles for being there, and other services for a fee. This option seemed acceptable to me, and I arranged a meeting with the manager. However, after a conversation with her, during which I was asked the questions “Who will take care of your mother?” and “We only have classes once a day, but we need two. Who will do the extra work?”, I realized that, even having paid for rehabilitation, I would be forced to do everything myself that I did during my mother’s illness: change diapers, wipe off bedsores, do physical exercises with her, as well as with my own efforts trying to restore her ability to speak and live the way she lived before.
Physical inactivity and stress. A doctor explains why strokes have become 10 years younger Read more
Consequences of stroke: vascular dementia
Vascular dementia is one of the most unfavorable variants of the course of chronic ischemic brain disease. Our consultant: Nina Minuvalievna Khasanova, angioneurologist at the First City Hospital of Arkhangelsk.
It has been noted that this disease occurs, as a rule, in old age. The cause of dementia after a stroke is associated with damage to the part of the brain that is responsible for memory or performing certain skills.
Vascular dementia (dementia) is a combination of symptoms that are manifested by deterioration of memory, thinking, and a decrease in the ability to perform skills in everyday life, which either stops or significantly complicates the patient’s independent life and his usual work.
Vascular dementia after stroke is not necessarily an emerging symptom. This condition occurs when there is severe damage to brain tissue or as a result of a repeated stroke against the background of uncontrolled arterial hypertension.
If a person, after suffering a stroke, becomes apathetic, tearful, quickly emotionally exhausted, his mental abilities deteriorate, he ceases to be interested in the life of his family and friends, this may be the first sign of advancing dementia, which requires examination by a doctor for timely treatment.
The onset of post-stroke dementia, unlike, for example, Alzheimer's disease, is acute. For example, on Wednesday a person behaved normally, but on Thursday morning he became aggressive, uncontrollable, and his memory deteriorated sharply. It is very important not to overlook the patient’s recurrent stroke: it may be hidden behind such a sharp deterioration in well-being. Therefore, each such situation is an indication for a medical examination and calling an ambulance.
Vascular dementia as a disease can occur with light intervals. This disease, as it were, erases, layer by layer, the skills that a person has acquired throughout his life.
Dementia after a stroke is necessarily combined with coronary heart disease, diabetes mellitus, and arterial hypertension. In this case, there are always changes in the vessels of the brain, neck, and fundus of the eye. Patients must be periodically examined by a cardiologist to provide assistance and select concomitant therapy.
The risk of developing post-stroke dementia depends on how carefully the relatives or the patient himself monitor his blood pressure, the level of cholesterol and low-density lipoproteins and their correct ratio, blood viscosity, and how carefully all the recommendations of the attending physician are followed.
Recommendations for relatives of a patient with vascular dementia
Unfortunately, modern medicine does not have the ability to effectively treat dementia and prevent its progression. Prescribed medications can only remove or weaken certain unpleasant manifestations of the disease and partially slow down its development. Therefore, the leading importance in providing assistance to patients with dementia belongs to daily comprehensive care for them.
The most important:
1. try to prevent the development of infectious diseases and the worsening of your loved one’s physical illness, as this negatively affects the course of dementia;
2. create a comfortable and simple environment: familiar favorite objects, their location. In a familiar environment, the patient feels most comfortable. The appearance of strangers in the house and moving sharply worsen his condition. In the room where the patient is, there must be a firmly established and familiar order for placing clothes, shoes, and other items of everyday use;
3. control the regimen of taking prescribed medications. Their irregular use or overdose can dramatically worsen the patient’s condition.
Patience is required!
When communicating with a loved one who has dementia, never forget that you are communicating with a sick person whose psyche is disturbed, many of the character traits that previously attracted you have been lost, and their behavior has changed (alas, not for the better). Remember that against the background of rare temporary improvements, the disease, as a rule, will intensify and the patient’s condition will worsen. Personality changes progress, emotional attachments to loved ones and the ability to empathize weaken, grumpiness, stubbornness and resentment increase.
Subsequently, orientation in time, space, and the surrounding environment is disrupted. Patients do not know the date, may get lost in a familiar place, do not always understand where they are, and do not recognize familiar and close people. And although such a person can take care of himself and cope with personal hygiene, he is already losing the skills of using everyday household appliances, such as a telephone, gas stove, TV remote control, etc. Then he can no longer be left alone unattended.
Vascular dementia rarely reaches the level of deep total collapse of the psyche , but over time the sick person becomes a heavy burden for others and relatives. Here are some excerpts from relatives talking about their loved ones with dementia.
“After the stroke, my mother-in-law changed a lot, she became unkind, suspicious, and capricious. The person is simply unrecognizable! Her general health is now good, she even goes out to breathe on a bench at the entrance. He tells his neighbors all sorts of tall tales: either I was going to poison her, or we don’t let her sleep at night, or we lock her in the toilet. The husband talks to her, shames her, but she either denies her stories, even shouts at him or cries that we are slandering her. I once came home from work and smelled strongly of gas. The burner tap on the stove is open. Now we turn off the gas and leave the food in thermoses.”
“I put food for mom, which we immediately eat ourselves, but she says that she’s not a pig to eat something like that, and throws the plate away. I take her hand to take her to the room or the kitchen - she starts twitching and screaming that I’m hitting her. After the stroke, my mother has been living with us for almost three years, but lately she has been wanting to return home. When we leave, we have to lock it with a key, since we left once. We literally missed it in 15 minutes, and she was already gone! They searched all evening, night, morning. We called all her relatives, her friends, hospitals, and morgues. We went around all the neighboring yards. Almost went crazy! Well, an acquaintance works in the police, and he helped us (and a missing person’s report is accepted only after three days). The next day at 12 o’clock she was found on the other side of the city.”
“Mom started talking a lot. Sometimes he talks to an imaginary woman, sometimes he calls me mom, sometimes he calls me sister. I stopped reading completely and often cries.”
In such cases, do not try to convince patients, prove that you are right, or appeal to their conscience, reason, or logic. A person's personality has already been changed by illness. This is no longer the same mother, mother-in-law, wife, father, husband whom you have known all your life. You just need to remember: everything that your loved one does and says is not due to his malice, deceit, or harmfulness. This is a manifestation of the disease. Therefore, try to be patient with his “whims” and “antics”, be attentive, friendly and sensitive when communicating with him, because he still remains your loved one!
Don’t forget that dementia is one of those diseases that must be treated before the first signs appear, so medical supervision and compliance with recommendations for the treatment of chronic diseases that affect the vascular system are the key to a high-quality and fulfilling life at any age.
Steps to prevent stroke
Concluding the story about the consequences of a stroke, I would like to remind you once again: in many cases, a vascular accident can be avoided; for this, the main attention should be paid to prevention. The most significant factors that can be corrected include arterial hypertension, coronary heart disease, diabetes mellitus, smoking, increased body weight, and elevated cholesterol levels.
- Physical activity is an effective factor in the prevention of obesity, type 2 diabetes, and arterial hypertension. During physical education, blood properties improve and the risk of blood clots decreases.
- Diet aimed at preventing atherosclerosis: limiting foods containing cholesterol and animal fats. Eat more fruits, vegetables and grains, vegetable oil, and sea fish.
- Smoking cessation: nicotine causes vasoconstriction and stimulates the progression of atherosclerosis.
- Blood pressure control: arterial hypertension and atherosclerosis are closely related diseases, so their treatment and prevention must be carried out in parallel.
- Control of blood fat levels: disturbances in blood lipid composition lead to the development of atherosclerosis, which increases the risk of stroke.
- Fighting diabetes mellitus: this disease is associated with an increased risk of vascular damage and intensive development of atherosclerosis.
Material: Irina Shaposhnikova
Photo: Vladimir Trefilov
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Lots of problems
So, for the first stage of rehabilitation, I chose home conditions. After all, at home, as you know, even the walls help.
Let me note right away that it is very important for relatives of stroke patients to learn to make decisions for their patients. And this is not so easy anymore. Especially when you have to take care of your parents. The attitude of seniority in such situations must be broken without timidity or embarrassment. Now it’s not my mother, but I, who is responsible for everything that happens to her and to me.
With a list of medications needed for my mother, received from her attending physician in the hospital, a speech therapy manual for restoring speech function and a list of physical exercises, and with the support of a visiting doctor and paramedic from the district clinic (this service appeared on October 1), I was sure that my mother and I 100 percent armed against the consequences of a stroke.
However, the visiting doctor said that he would visit us once every three months, and the paramedic - once every one and a half months. The neurologist will be able to come only in two weeks. Neither a speech therapist nor a physical therapy specialist will make house visits.
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Dependence of manifestations on the location of brain damage
The area of brain damage largely determines both the degree of manifestations of consequences in the form of dementia and the direction of the lesions:
- If the focus of the stroke is located in the cerebral cortex, then abnormalities such as disturbances in orientation in space, disturbances in speech and motor activity are especially often detected. Loss of practical skills and gradual fading of self-awareness can also be diagnosed.
- When the location of the stroke is localized in the subcortical structures, the disturbances manifest themselves to a greater extent in the psycho-emotional state of the patient. This is expressed in frequent mood swings, the predominance of depressive states, the patient gradually loses normal facial expressions (this is expressed in forced laughter and crying), and the opportunity for normal expression of emotions for a healthy person decreases.
In some cases, there is a combination of the first and second signs of damage, while the intensity of progression of the pathological condition is largely determined by the presence of parallel ongoing physiological diseases.
Dementia, which is a special type of disease that occurs as a result of damage to a certain part of the brain, also requires therapeutic intervention. This makes it possible to eliminate the aggravation of pathological processes observed in brain tissue, correct the patient’s behavior and actions, and also provide treatment to restore normal behavior and daily activities.
Role reversal
But give up and say, “I did everything I could!” I had no right. And then I thought that my mother and I would play “Daughters and Mothers.” So our house was filled with all kinds of lotto, dominoes, puzzles, copybooks, coloring books intended for the youngest children, as well as letters and numbers, colored pencils, felt-tip pens, watercolors and plasticine. Some I bought at the store, some I got from friends and relatives.
It is unlikely that your parents will be offended that you treat them like children. At this moment, they really feel like children and are glad when they do something interesting with them. At least I see that mom is waiting for our classes. She likes some things more, she is more successful in some things, and some things are difficult for her.
But a variety of creative activities yield good results. Mom makes mistakes in naming colors and shapes less often, she has begun to correctly do what I ask her to do more often, she recognizes letters and already counts to eight on her own.
Brain catastrophe. What leads to a stroke? More details
A course towards positivity
We also try to give physical exercises the form of a game. Helping her do exercises or massaging her back, I invite her to sing with me, repeat nursery rhymes, counting rhymes, and tongue twisters after me.
And the other day we started washing a crystal chandelier: my mother is able to wash its parts with her left hand. Our immediate plans are to knead the dough and bake pies. But we would not have come to this if we had not had all the preparatory classes. Now my mother’s left hand has taken over the function of her right hand and is already coping with it successfully!
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And of course, it is very important that a person recovering his health has the opportunity to communicate with his friends - by phone and in person. Even if my mother’s friends call and come at a time that is not most convenient for us, we are always happy to see them. I get a chance to take a break, and for mom it’s a joy!
And in general, more joy, smiles, a kind and positive atmosphere in the house where a person who has suffered a stroke is recovering! This is the most important rule!
The influence of stroke on higher nervous activity
Cognitive impairment after stroke can reach the level of dementia
Cognitive disorder is a violation of the ability to perceive, understand, and analyze information. In severe cases, it manifests itself in the form of dementia, when the patient’s intelligence is seriously affected: memory, attention, and learning ability decrease. Depending on the severity, cognitive impairment can be:
- mild (changes are caused by damage to one area of the brain and do not have a significant impact on everyday life);
- moderate (symptoms are noticeable to others and worsen the patient’s quality of life);
- severe (changes are characterized by the term dementia and are accompanied by complete maladjustment of the patient).
The latter condition not only has a detrimental effect on the intellect, but also destroys the patient’s personality. A person ceases to navigate the world around him, understand what is happening, and recognize loved ones. Mental disorders and hallucinations, behavioral disorders may occur (for example, others notice that the patient has become aggressive). Vascular atherosclerosis aggravates the situation. Neurons, already damaged by stroke, lose their ability to recover under conditions of poor blood flow.
What to do? Treatment should be aimed at eliminating the cause. For this purpose, drugs are prescribed that improve blood flow in the vessels of the brain, vasodilators, and neuroprotectors. You cannot do without symptomatic treatment (anticonvulsants, antidepressants).
Expert commentary
Neurologist, Doctor of Medical Sciences, Professor Evgeniy Shirokov:
— In recent years, our medicine has shown good results in the treatment of patients suffering from stroke. But this only applies to the hospital period of treatment. Vascular centers have good diagnostic equipment, qualified doctors and modern medicines. Patients die less often and are discharged with better results. But then... Then everything depends on the family. Recovering a patient after a stroke is a colossal and labor-intensive task, the solution of which requires months and years. This is skilled work, scheduled by the hour, requiring an integrated approach (therapeutic gymnastics, massage, classes with a psychologist, speech therapist, physiotherapy). It is impossible to fully do this at home. Hence the results: in our country, about 40% of patients die a year after a stroke, and about 15% return to normal life. There are few free rehabilitation treatment centers, but they do exist. They employ knowledgeable people. You need to use it, even if you have to wait. Even under these conditions, you can undergo a course of rehabilitation treatment 1–2 times a year. This significantly improves the lives of patients and at least slightly reduces the burden on relatives.
Factors influencing the development of dementia in stroke
The onset of dementia is often associated with reaching a certain age, when there is a deterioration in the general functioning of the human body; due to chronic and acute diseases accumulated with age, resistance to infections and diseases decreases. The weakening of brain function is accompanied by significant changes, which are characterized by weakening of memory, decreased concentration, and complications when performing certain physical actions.
However, there are a number of factors that are more likely to provoke manifestations of dementia. They affect a person to the greatest extent in the period after a stroke, when the weakening of the body occurs to a greater extent. Such provoking factors include:
- diabetes;
- advanced stages of atherosclerosis;
- hormonal imbalance;
- arterial hypertension;
- heart failure.
In addition to the listed provoking factors, there are a number of reasons that can also cause weakening of the body and cause an accelerated course of dementia against the background of a stroke. These are bad habits (abuse of alcoholic beverages, smoking), which negatively affect primarily the circulatory and cardiac systems, as well as a low educational level, and several repeated periods of cerebrovascular accidents.
Older age should also be considered a probable cause for the diagnosis of dementia, however, against the background of such a serious lesion as a stroke, this pathological condition is aggravated. Senile dementia can manifest itself with various symptoms, which largely depend on the individual characteristics of the body and the degree of neglect of the condition.
