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Deadlier Strokes in Patients with Alzheimer’s and Diabetes 

Mar 10, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Mit Suthar, PharmD. Candidate, LECOM School of Pharmacy 

Either condition alone may impact stroke risk, and the combination of Alzheimer’s and diabetes could be particularly devastating. 

Out of the two types of strokes, ischemic and hemorrhagic, hemorrhagic strokes are more difficult to treat and much deadlier. New research has introduced another concern into the already scary medical emergency: “having both diabetes and Alzheimer’s disease versus either condition alone,” could make the trouble even worse. 

The study examined 2,071 adults from the Kentucky Appalachian Stroke registry who had suffered from a hemorrhagic stroke. Each of these patient’s health records was subsequently reviewed to crossreference whether they had a previous diagnosis of diabetes or Alzheimer’s disease.  

What they found was disturbing: “75% of those with both conditions had died or needed hospice or long-term care after their stroke compared to 39% with neither condition, 42% with diabetes alone, and 62% with Alzheimer’s disease alone.” These statistics are undoubtedly surprising and indicate a possible connection between the combined disorders. 

The study’s lead researcher was a scientist from the Center for Advanced Translational Stroke Science at the University of Kentucky in Lexington named Amanda L. Trout. She plans to present the preliminary study at the American Stroke Association’s International Stroke Conference in Los Angeles. She explains that having access to the stroke registry gave the researchers “the opportunity to think about how having more than one (health condition), like diabetes and Alzheimer’s disease, could influence outcomes compared to having just one.” 

Diabetes alone dramatically increases the risk of many cardiovascular conditions, such as coronary artery disease with chest pain (angina), heart attack, narrowing of arteries (atherosclerosis), and most importantly for this research: increases risk of stroke. The increased sugar in the blood can increase the depositing of fat or blood clots on the walls of blood vessels (atherosclerosis) but can lead to narrowing or even complete blockage of blood flow to the brain. 

Unfortunately, previous studies also indicate that stroke risk is higher in patients with Alzheimer’s disease. Alzheimer’s disease slowly erases a person’s memory, limits the patient’s ability to complete simple tasks, and is also the most common cause of dementia in older adults. Research published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association revealed that nearly half of patients with Alzheimer’s disease have evidence of strokes in their brains. 

The majority of stroke cases are caused by a blood clot blocking blood flow to the brain, but around 13% are caused by a damaged blood vessel that bleeds into the brain or space around the brain.  

Uncontrolled hypertension remains the most common cause of hemorrhagic stroke. According to previous research, Kentucky has a high prevalence of high blood pressure. Researchers in this latest study examining the connection between diabetes, Alzheimer’s disease, and stroke attempted to control for a previous diagnosis of high blood pressure but were unable to verify the specific blood pressure measurements of the patients when their strokes occurred. 

Statistics from the American Heart Association estimate that around 795,000 strokes occur every year in America and that strokes account for about 146,000 deaths. 

Comparisons of state data revealed that one of the highest rates of stroke and stroke risk factors in the country was present in rural Kentucky. Due to this, a stroke registry was initiated to discover gaps in care. This program is called The Kentucky Appalachian Stroke Registry. 

As mentioned earlier, the study was unable to verify the blood pressure measurements of the patients at the time of their stroke. Dr. Robert H. Eckel, a professor emeritus of medicine and a diabetes specialist at the University of Colorado Anschutz School of Medicine in Denver, agreed that not having this information about whether these patients had high or uncontrolled blood pressure “makes it difficult to assess the overall health of the patients and determine whether it was having both Alzheimer’s disease and diabetes that put them at higher risk for a severe stroke.” Dr. Eckel himself was not involved in the study but he stated that “it does raise my curiosity about whether something is going on between the two because we know that diabetes is related to dementia.” However, Dr. Eckel affirmed that the current findings from the study would not change the way he delivers care to his patients. 

The lead researcher, Amanda Trout, said the study confirms the need for more research on why exactly patients with multiple health problems may have more severe strokes and the importance of managing diabetes with medications or lifestyle changes. 

Practice Pearls: 

  • 75% of patients who died as a result of stroke had both diabetes and Alzheimer’s disease 
  • Without knowing a patient’s blood pressure readings during a stroke, we cannot confirm the impact of the combination of diabetes and Alzheimer’s disease  
  • Further research is warranted to ascertain the connection between patients with multiple comorbidities and why these patients have more severe strokes 

“Diabetes, Alzheimer’s Together Might Increase Stroke Severity.” Www.heart.org, American Heart Association News, 17 Feb. 2020,  

Mit Suthar, PharmD. Candidate, LECOM School of Pharmacy