Unusual behavior could stem from ‘silent strokes’
DEAR DOCTOR: A relative long ago diagnosed with atrial fibrillation has been behaving differently, such as sitting with his mouth gaping open, not attending to financial matters, taking too long to do errands, that kind of thing. Could silent TIAs be the culprit?
DEAR READER: Atrial fibrillation could indeed be leading to small strokes in your relative. Often, these small “silent strokes” are not noted by the patient or by family members. Such strokes don’t have obvious symptoms; instead, they can manifest as a difficulty in performing cognitive tasks or a slowing in everyday activities. Your relative’s risk of strokes linked to atrial f ibrillation would be lower if he has been taking blood thinners, but they still could occur.
A CT scan or MRI can easily determine whether your relative has had these silent strokes. It’s important to get such a diagnosis because if his symptoms are related to a small stroke, he’ll be at greater risk of having a large, debilitating stroke.
His symptoms could be linked to another type of stroke as well — a lacunar stroke caused by very high blood pressure and diabetes, which lead to a narrowing of smaller
blood vessels in the brain. These strokes can cause loss of function in a limb or the problems traditionally found in silent strokes.
Whether caused by atrial fibrillation or a narrowing of blood vessels, multiple strokes can lead to dementia, which also may be the reason for your relative’s recent behavior. Alzheimer’s disease, Lewy body dementia and normal pressure hydrocephalus also can cause the symptoms you describe, and imaging of the brain and a consultation with a neurologist can confirm these diagnoses.
Let’s not forget another cause: depression. Depression in the elderly can have many of the same symptoms as dementia, causing difficulty in focusing on tasks, memory and self-care. Lastly, if the symptoms in your relative developed suddenly, infection could be the culprit.
Robert Ashley, M.D., is an internist and assistant professor of medicine at UCLA.
Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA 90095.