What can you do to prevent a stroke?

Understanding how stroke happens is relatively simple. "It is caused by a lack of blood flow to an area of the brain," said Williams. "Eighty to 85 percent of strokes are ischemic, meaning a blockage of blood flow in a blood vessel of the brain, much like a blockage in a pipe. The rest are hemorrhagic, meaning a breaking or rupturing of a blood vessel."

Loss of blood flow deprives brain cells of oxygen, resulting in damage to or death of those cells. Depending upon the area of the brain affected, stroke’s aftermath can include loss of speech, paralysis of limbs, and changes in personality and emotional function.

Williams and her research team have developed the "Stroke-Specific Quality of Life" (SS-QOL), a survey instrument to help determine the effectiveness of new stroke treatments. It already has been translated into five languages with other versions currently underway.

"The effects of stroke are often measured by the doctor’s examination, for example, how weak someone’s arm is," said Williams. "But what matters more to stroke survivors is what they can do with that arm. Sometimes there also are effects that are less outwardly apparent but equally important–changes in mood, ability to socialize with friends and family, and perception of self."

Williams and her team have enrolled all eligible stroke patients at the medical center’s Roudebush VA Hospital and hope to extend the study to the two other adult hospitals there.

"We do our first assessment one month after stroke and follow the patient and caregiver at 3, 6, 12, 18, 24, 30 and 36 months post-stroke," she explained. "We measure multiple effects of stroke–walking, talking and caring for oneself, changes in mood, personality and social functioning. We think this gives us the best way of saying how that stroke really affected the person as a whole. It may also bring to light previously unrecognized effects like social isolation or mood changes."

Williams suspects, for example, that depression in stroke patients is under-diagnosed and under-treated, and also is concerned with how stroke affects caregivers and what interventions might help them. She is planning a trial of post-stroke depression treatment that will look at the effect of treatment on both the patient and caregiver.