Senior Citizens Do Not Remember Strokes or Do Not
Know They Had Them, Study Indicates
Just 11.9 percent reported a history of stroke but
MRI evidence shows 31.4 had one
May 11, 2009 Senior citizens are either having
strokes and dont know it, or they are forgetting they had them. That is
the conclusion one must draw from a new study that found a significant
difference between why these older people report and what the magnetic
resonance imaging (MRI) shows.
The study is posted online today and will appear in
the July print issue of Archives of Neurology, one of the JAMA/Archives
journals.
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Self-administered questionnaires are frequently
used to obtain information about an individual's history of stroke,
according to background information in the article.
"In general, self-reports on medical conditions
that are well defined and relatively easy to diagnose often have a high
positive predictive value, in contrast to conditions characterized by
complex symptoms," the authors write.
"Stroke is associated with motor impairment but can
also be accompanied by impairments in memory, sensation and speech or
language, diminishing the ability of an individual to accurately report
a history of stroke."
Christiane Reitz, M.D., Ph.D., of Columbia
University Medical Center, New York, and colleagues acquired MRIs for
717 Medicare recipients 65 years and older (average age 80.1) living in
northern Manhattan.
Participants underwent an in-person interview about
general health and functioning, medical history, a physical and
neurological examination and psychological testing. They or their
caregivers also completed an eight-question survey about stroke history,
including whether they had ever had symptoms of or been told by a
physician they had a stroke.
● A total of 85 individuals (11.9 percent)
reported a history of stroke.
● On the MRI, evidence of a stroke was observed
in 225 participants (31.4 percent).
● The sensitivity of self-reported stroke -
meaning the number of individuals who reported having had a stroke,
divided by the total number of individuals with stroke detected on MRI -
was 32.4 percent.
● The specificity, or the number of individuals
who reported having no history of stroke divided by the total number of
individuals who had no evidence of stroke on MRI, was 78.9 percent.
"Lower-functioning memory, cognitive or language
ability or presence of hypertension (high blood pressure) or myocardial
infarction (heart attack) were associated with an increased frequency of
false-negative reports," the researchers write.
In addition, younger individuals were more likely
to accurately report their stroke history than older adults, and
sensitivity was higher among African American than white or Hispanic
individuals.
Older adults may have more difficulty recalling
prior events, contributing to lower sensitivity, the authors note.
Rates of cerebrovascular disease are higher among
African Americans, so individuals in this population may have an
increased awareness of stroke signs and symptoms due to previous
discussions with clinicians or contact with individuals who have had
strokes.
"Our results indicate that sensitivity and
specificity of stroke self-report are low when using MRI scans as
validation," the authors conclude.
"In stroke research, sensitive neuroimaging
techniques rather than stroke self-report should be used to determine
stroke history."
Editor's Note: This study was supported by grants
from the National Institutes of Health. Please see the article for
additional information, including other authors, author contributions
and affiliations, financial disclosures, funding and support, etc.
