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Stroke Victims' Mood Swings Could Be From Brain Lesions

Increased anger probably a physical, not emotional, result, South Korean study says

TUESDAY, April 9, 2002 (HealthDayNews) -- The increased anger and irritability stroke sufferers often exhibit may be related to brain damage from the stroke rather than to distress about their condition, scientists in South Korea report.

Moreover, that anger and irritability is more common in stroke victims than currently recognized, they add.

In a study of 145 people who had suffered a stroke, researchers from the Asian Medical Center in Seoul found a correlation between symptoms of anger and aggression and lesions on parts of the brain that are responsible for producing serotonin -- a brain chemical that moderates behavior.

"To my mind, these anger symptoms are generally neurologic but not psychiatric, and doctors should explain this to patients and relatives who are sometimes curious or even disturbed by these behavioral changes," says study author Dr. Jong S. Kim.

Most behavioral shifts are mild and don't require treatment, he adds, although some could be helped by medication.

The results of his study appear in the April issue of the journal Neurology.

Inability to control anger or aggression occurs in approximately one-third of stroke victims, Kim explains, along with a tendency to laugh or cry excessively when talking to other people or watching television, a condition called emotional incontinence.

Depression, another common behavioral problem that follows stroke, occurs in anywhere from 12 percent to 64 percent of stroke sufferers, Kim reports.

Although doctors are familiar with depression following a stroke, the inability to control emotions has been overlooked, Kim adds.

Karina Davidson, a stroke researcher at New York City's Mount Sinai Hospital, agrees with his analysis.

"We need to start studying anger and aggression in post-stroke patients, and need to understand the physiological underpinnings of that behavior and what treatments can be made available for patients and their caregivers," says Davidson, a scientist in the department of integrative and behavioral cardiology.

In the Korean study, doctors examined 97 men and 48 women, whose average age was 60, three to 12 months after their stroke. None of the patients had a previous history of stroke or depression. Using a series of tests and interviews with the patients and their relatives to assess behavior before and after the strokes, researchers found that 47 patients, or 32 percent, suffered from the inability to control anger or aggression following their strokes.

An example, Kim says, "was a patient who reported that she previously had seldom gotten angry when she lost money during a Hwa-Too game (a Korean card game), but after her stroke became easily angry and nervous even when she lost less than a dollar."

At the same time, doctors found a correlation between the condition and lesions in the frontal part of the brain, as well as in two deeper brain structures, called the pontine base and the lenticulocapsular area.

"Because these structures have abundant serotonin receptors, I think that [the condition] could be a behavioral manifestation of the serotonin system dysfunction," Kim says.

In a previous study, he notes, he found a similar correlation between brain lesions in those three areas and emotional incontinence, which he says further substantiates his theory of the connection between brain damage and emotional fallout.

What To Do

Information about strokes and their risk factors can be found at The American Stroke Association.

For a description of life for the survivor of a stroke and his family, visit National Stroke Association.

SOURCES: Jong S. Kim, M.D., department of neurology, Asian Medical Center, Seoul, Korea; Karina Davidson, Ph.D., department of integrative and behavioral cardiology, Mount Sinai Hospital, New York City; April 2002 Neurology
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