Most People Can't Identify Stroke Symptoms

In interviews with more than 1,800 individuals in the greater Cincinnati area only slightly more than half could list at least one stroke symptom and only 68 percent could name one stroke risk factor. The study, led by Arthur Pancioli, M.D., and Joseph Broderick, M.D., of the University of Cincinnati College of Medicine, and sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), will appear in the April 22, 1998, issue of The Journal of the American Medical Association (JAMA).*

The study was conducted between March and September 1995 through telephone interviews in the greater Cincinnati metropolitan area. This region has a large biracial population and is similar to the U.S. population in age, gender, annual income, and percentage of African-Americans.

One of the most striking findings reported by the investigators was that the respondents older than 75, the highest risk group for stroke, knew the least about stroke. While 60 percent of the participants under age 75 could identify one stroke symptom and 72 percent could name one risk factor, only 47 percent of those in the older group could identify one symptom of stroke and only 56 percent could name one stroke risk factor.

"This study points out the need for more extensive public education about stroke, especially in the most vulnerable population of the very old. Because we now know that every minute counts in stroke treatment, people must learn how to read the signals that are telling them to seek medical help so that they can take immediate action," said John R. Marler, M.D., of the NINDS Division of Stroke, Trauma, and Neurodegenerative Disorders.

"The best way for patients to receive the most effective stroke treatment is to get to an emergency room as quickly as possible after they've had symptoms -- that's why it is imperative that people know what these symptoms are. People also need to learn about risk factors in order to prevent a stroke in the first place," said Dr. Pancioli.

The NINDS has defined the following as symptoms of a stroke: sudden numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body; sudden confusion or trouble talking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking or loss of balance or coordination; and sudden severe headache with no known cause (often described as the worst headache in a person's life). The investigators found that only 57 percent of the study participants correctly listed at least one of these five symptoms or warning signs, 28 percent correctly listed two or more, and 8 percent correctly listed three symptoms. The most frequent symptom the survey respondents listed was dizziness, and the next most common responses were numbness, headaches, and weakness.

The respondents also demonstrated poor knowledge of risk factors for stroke, which include hypertension, cigarette smoking, heart disease, diabetes, and atrial fibrillation. Only 68 percent of the people surveyed correctly listed at least one risk factor; the most commonly listed risk factor was hypertension, followed by stress, poor eating habits, and smoking.

Most people reported getting their information about stroke from television, newspapers, magazines, and doctors in that order, although doctors were the most commonly cited source for African-Americans and for people over age 75.

Dr. Pancioli recommends that education programs include elderly adults and promote the message that "stroke is an emergency -- call 911 immediately." Because stroke patients often have an impaired ability to communicate or recognize symptoms themselves, people of all ages who might witness a stroke should also know this.

Since the Cincinnati area has been involved in a number of highly publicized stroke studies, the local population was frequently exposed to information about stroke warning signs, symptoms, and emergency treatment. Therefore, a study in Cincinnati may underestimate the lack of knowledge about stroke in other cities where less stroke research has been conducted and publicized.

The NINDS rt-PA Stroke Study Group reported in a December 1995 issue of The New England Journal of Medicine that t-PA, a clot-busting drug, is an effective treatment for acute ischemic stroke if given within the first 3 hours of stroke symptoms. Patients treated with t-PA were up to 30 percent more likely to recover from a stroke with little or no disability. Since the study was published, the challenge has been informing the public that stroke is an emergency requiring immediate transport to an emergency department. Although t-PA is the only drug currently approved by the FDA for treatment of acute stroke, other therapies being developed may also work better when given as soon as possible.

In December, 1996 the NINDS hosted a historic Symposium on Rapid Identification and Treatment of Acute Stroke, attended by representatives of more than 50 organizations concerned with stroke care who developed consensus on methods of delivering immediate treatment to stroke patients. The proceedings from this symposium are now available and have been sent to thousands of health care practitioners nationwide.

The NINDS, one of the National Institutes of Health located in Bethesda, Maryland, is the nation's leading supporter of research on the brain and nervous system and is a lead agency for the Congressionally designated Decade of the Brain.

*Pancioli, A., Broderick, J., Kothari, R., Brott, T., Tuchfarber, A., Miller, R., Khoury, J., Jauch, E. Public perception of stroke warning signs and knowledge of potential risk factors. Journal of the American Medical Association, Vol. 279, No. 16, April 22/29, 1998, pp. 1288-1292.