Chronic Disease: Pathophysiology, Risk Factors, and Assessment Tools

Running head: CHRONIC DISEASE
Chronic Disease
Name of the Student
Name of the University
Author Note

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1. Introduction
1.1 Background
The term chronic condition is referred to as those diseases that last for a long period of time
and along with this the condition must last for 1 year or more. As per the guidelines of CDC,
it is reported that, such type of condition needs continuous medical assistance for a long
period of time and it has the capability of restricting the activities of daily life of the person
who is suffering from the condition. Therefore, in case of stroke it can be stated that, this
condition lasts for a long period of time and is associated with the restriction of activities of
daily life of the particular person suffering from the condition. The information of Centres for
Disease Control and Prevention (CDC) show that heart disease such as stroke, diabetes,
cancer can be marked as a chronic disease due to the aforesaid properties of those diseases
(Centres for Disease Control and Prevention, 2019; Teh et al., 2018). It is reported that, it is
one of the major area of concerns around the world. According to the statistics of World
Health Organization (WHO) it is stated that almost 15 million people around the world are
suffering from stroke in each year. Among this huge number of people, approximately 5
million people die and another 5 million people develop permanent disability (Reynolds,
Carroll, Sturdivant, Ikuta, & Zukowsky, 2015). While assessing the reason of a huge
mortality rate it is reported that, in case of high blood pressure patients, the mortality rate is
almost 12.7 million around the world. In other words, it can be stated that, high blood
pressure is responsible for 12.7 million deaths around the world. In case of Europe, it is
reported that, in each year, there are almost 650,000 stroke related death in various countries
of this continent. Although, it is reported that, the rate of stroke in developed countries is
declining, still the overall rate of this condition around the world is not showing any positive
hope to the researchers. In case of Singapore, it is reported that stroke is the fourth leading
cause of death in Singapore (Teh et al., 2018). According to the study of Teh et al. (2018) it is

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reported that, among the study participants, almost 7.6 per cent of the elder adults have the
disease and they are mainly under the age group of 60 years and above. The study result of
this study is quite similar with the data of US as in US, the prevalence of stroke among older
adults under the age group of 65 years is almost 8.3 per cent. The present study showed that,
there is an increase in the prevalence of stroke among the different ethnic groups in
Singapore. The study result showed that, the prevalence of stroke among the different ethnic
group ranges from 3.32% to 3.75%.
1.2 Search Strategy
For searching literature from the data bases the researchers use the key words like ‘Stroke’,
‘Singapore’ ‘Pathophysiology’ , ‘epidemiology’, ‘prevalence’, ‘assessment tool’ were used.
After that, in order to find more articles related to the specified topic, combination of the
above said key words are used. During the literature search process, the articles found by the
researchers from each of the databases are listed below in a tabular format.
Name of the Databases Number of articles
CINAHL 9
Google Scholar 7
Medline 6
PubMed 4
BMJ 7
Portfolio Entry 1
Pathophysiology of Stroke
While discussing the pathophysiology of the stroke, it can be stated that, the stroke is
defined as a sudden neurological deprivation due to the alteration in the perfusion of the
nervous tissue or the brain. Therefore, it can be stated that stroke can be of two types and in
both the ischemic and haemorrhagic stroke; blood vessels are directly involved as they are

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responsible for the perfusion of brain tissues. In case of deprivation in the posterior
circulation cases of diplopia, vertigo may happen. On the other hand, in case of alteration in
the left anterior circulation case of dysphagia may happen. According to the study of (), it is
stated that cerebral ischemia and infarction mainly occurs from the reduced blood flow to the
brain region of the body (Mendelow, Lo, Sacco, FAAN & Wong, 2015). The case of
ischemic stroke takes place when the blood flow to the brain region is decreases to less than
20 mL/100 g of brain tissue per minute. Along with this, it is also reported that when the
blood flow reduces to less than 16 mL/100 g of brain tissue per minute, the cells of brain
starts to die within one hour. One of the primary reasons of suffering from such type of
oxygen deprivation in the brain tissues is associated with the injury to a vessel wall from
atherosclerosis. The atherosclerosis may occur in the aortic arch, carotid arteries, or cerebral
vessels. The progress of atherosclerosis initiates with inflammation and endothelial injury,
causes formation of plaque. The plaque converts into thickened plaque and along with loss of
smooth muscle cells of the blood vessels also takes place. Therefore, it can be stated that
these sclerotic materials gradually fills the lumen of the blood vessels and thereby restricts
the blood flows to the various region of the brain (Chen, Ovbiagele, & Feng, 2016).
However, the study of (), reported that the onset of cerebral ischemic event is associated
with the gradation in brain perfusion. The condition of brain ischemia affects both the grey
and white matter of the brain tissues. In the cellular level, it is reported that the acute
neuronal injury is associated with the CNS hypoxia and ischemia. Therefore, due to the
injured cells in the brain, there are various reversible and irreversible changes. Not only this,
but various changes in the cellular levels are also reported by the researchers. As a part of
this, it is reported that, the potassium ions flow out of the cells into the extracellular space of
the cells (Cohen et al., 2016). As a result, the alteration of the potassium gradient occurs and
depolarization of the neuronal membrane occurs. As a consequence of this, intracellular