Complexity of Stroke Increases with Dementia Patients

Time Was of the Essence

With a light in her eye, Francis Tamborrino walked into the patient room with her son, Bob Tamborrino, by her side. She was smiling.

“What did you have for breakfast?” the staff asked. Still smiling, she tilted her head in thought but didn’t answer. After a few moments Bob replied, “I asked her earlier and she said she could only remember that it was good.”

“Well, all of the food is good there,” his mom responded.

Francis moved back to Bloomington in 2015 to be near family. Soon after, she started to exhibit memory loss. She was diagnosed with dementia in 2016.

Now, this 87-year-old lives in an apartment at Redbud Hills Retirement Community in Bloomington where she has meals with friends and a standing hair appointment on Fridays. She also visits her family multiple times a week.

This schedule was interrupted at 5:15 pm on November 7, 2017 while she and her friends were waiting for dessert, her favorite part of dinner.

The house manager noticed that Francis was slumped in her chair in the dining room. The right side of her face was drooping, her right arm and leg were weak and it was hard for her to speak. She acted quickly to get her medical attention. Within minutes, Francis was being treated for a stroke by specially-trained medical technicians with the IU Health Stroke Response Team.

IU Health Southern Indiana Physicians provider Mehyar Mehrizi, MD was the on-call neurologist when Francis was brought to the IU Health Bloomington Hospital Emergency Department. Bob says the team was quick, efficient and “worked as if she were the only patient in the emergency room.”

“Dr. Mehrizi said the words, ‘If this were my mother, this is what I would do,’” said Bob. He immediately consented and the team got to work. In Bloomington, she was given medication to break up the blood clot in her main arteries and then sent by Lifeline to Indianapolis, due to the complexity of the situation.

When Bob arrived at IU Health Methodist Hospital, his mother was resting in recovery.

She stayed there for eight days before returning to her apartment.

“She had an excellent outcome,” says Dr. Mehrizi. “She was completely paralyzed on the right side and now she can move her extremities without any weakness.”

While stroke survivors can have many long-term effects, Francis’s family has only noticed some worsening of her short-term memory. 

Francis has recovered in leaps and bounds since the stroke and has now returned to her independent living at Redbud.

Bob said his mother “continues to receive the highest level of care imaginable from her doctors at IU Health. She actually looks forward to her appointments.”

And other than forgetting exactly what she had for breakfast, it’s almost as if the stroke never happened

Answers from Neurologist Dr. Mehyar Mehrizi

Do you need to look for symptoms other than FAST (Facial drooping, arm weakness, speech difficulties, time to call 911) when treating patients with dementia or another debilitating condition?

“The same symptoms apply to patients with dementia or without dementia with regards to evaluating for stroke.”

Noticing if there is a rapid decline in speech abilities is important for people living with dementia who may already have speech difficulties.

How is caring for a stroke patient different when they have already had dementia?

“It is more difficult because the patient will need much closer assistance to make sure they are taking the medications prescribed to reduce risk for future strokes. Also it can be difficult to notice changes in speech or comprehension in someone who has dementia as opposed to the average person.”

Is after-stroke care different?

“The care should be the same, but it is more difficult because patients with dementia have a baseline cognitive problem that may otherwise not be there in the average person who has experienced a stroke. It is also more difficult to assess recovery in a dementia patient as they do not have a typical baseline cognitive status.”

What do you wish all stroke survivors knew about life after a stroke?

“We should think of stroke as a warning sign of an unhealthy lifestyle. It should remind us to pay closer attention and make appropriate changes to living a healthier lifestyle whether it be healthier diet, more exercise, smoking cessation or all of the above.”

What are some early signs of dementia?

“Early signs of dementia include forgetfulness beyond simple inattentiveness or trouble concentrating and trouble with higher cognitive functions such as balancing checkbook and managing finances.”

Local Dementia and Stroke Support

Alzheimer’s Resource Service (ARS)

ARS provides support, resources and assistance to people living with dementias, their caregivers and their families. All services are offered to the community free of charge.

Learn more about ARS.

Caregiver University

ARS provides free Caregiver University sessions in Lawrence and Monroe counties. These events cover useful topics for caregivers, family members and loved ones of people living with dementia.

Find information about upcoming sessions.

Rock Steady Boxing

IU Health offers two levels of classes for different stages of health and physical fitness, and each class builds camaraderie and mutual support among participants. For more information about classes in Bloomington, call 812.353.5664.

Watch a short video on the Rock Steady program.

After-stroke Care

IU Health Rehabilitation and Sports Medicine Center East offers expert Physical Therapy, Occupational Therapy and Speech Therapy services to south central Indiana. Specialized Community Mobility for Driving Assessment and Rehabilitation with occupational therapists and speech therapy focusing on cognition/executive functioning, as well as speaking and swallowing dysfunction are only a few of the services offered. Call 812.353.3278 for more information.

Featured IU Health Southern Indiana Physicians provider seeing patients for Neurology:
Mehyar Mehrizi, MD