Pre-existing disabilities, dementia can interfere with stroke diagnosis and treatment

People with disabilities or dementia may not get timely or appropriate treatment when they have a stroke, according to a new report that says those conditions can make it challenging to assess the severity of new symptoms.

But treating a stroke quickly could help prevent additional disability and other health and financial impacts, an American Heart Association scientific statement finds. It was published Monday in the journal Stroke.

"The long-term consequences and costs of additional disabilities due to untreated stroke in people with preexisting neurological deficits are staggering," Dr. Mayank Goyal said in a news release. He is the statement's writing committee chair and clinical professor in the department of radiology and clinical neurosciences at the University of Calgary in Alberta, Canada.

Often, treatment of strokes caused by blood clots may be delayed or not given at all if pre-stroke dementia or disability symptoms cause doctors to mistakenly believe the stroke is more severe than it is and outside the window for optimal treatment.

But treatment still can be effective for this group even though there is some evidence they have a higher risk of death, the report said. It notes that clot-busting therapy and clot removal were as safe and effective in people with pre-existing disabilities or dementia as in those without. Treatment is considered critical for preventing further disability.

In the U.S., physical, cognitive and intellectual disabilities affect about 22% of the adult population. The statement offers advice for how people with these conditions and their families can develop plans for health emergencies, including strokes. This includes discussing quality of life concerns and care preferences before a stroke happens. If a stroke does occur, the committee suggests families discuss the risks and benefits of treatment with health providers to fully understand the spectrum of possible outcomes.

Biases such as ableism and therapeutic nihilism, which is the belief there is no hope for effective treatment, may play a role in delaying or failing to begin treatment in people with disabilities or dementia, the statement said. The writing group said greater awareness of these biases is needed and offers guidance on how to improve patient-centered care.

It also calls for greater inclusion of people with disabilities and dementia in stroke research.

"The people carrying the greatest burden of illness have been traditionally excluded from research," Goyal said. "Expansion of the dialogue and pro-active research on acute stroke therapies should include people with disability and dementia – to optimize their potential to return to their pre-stroke daily living and to reduce the potential long-term care and financial burdens."

If you have questions or comments about this story, please email [email protected].