R E V I E W Knowledge of risk factors and warning signs of stroke Marcus B Nicol Amanda G Thrift National Stroke Research Institute, Austin Health, Heidelberg Heights, VIC, Australia Correspondence: Marcus Nicol National Stroke Research Institute, Level 1, Neurosciences Building, Repatriation Hospital Heidelberg, Austin Health, 300 Waterdale Road, Heidelberg Heights, Victoria 3081, Australia Tel +61 3 9496 2780 Fax +61 3 9496 2650 Email mnicol@nsri.org.au Abstract: In this review, we have summarized the findings of fifteen studies of knowledge of stroke warning signs and risk factors in both high- and low-risk populations. In general, there appears to be low levels of knowledge of both risk factors and stroke warning signs among the communities studied. Using free recall, between 20% and 30% of respondents could not name a single risk factor, and between 10% and 60% could not name a single warning sign of stroke. Providing survey respondents with a list of potential warning signs substantially improved the identification of warning signs. Respondents in older age groups and having lower levels of educational attainment tended to have less knowledge of risk factors and warning signs of stroke than those in younger age groups and those with more education. Public campaigns to improve stroke knowledge are needed, particularly in the older age groups where the risk of stroke is greater. Keywords: stroke, awareness, risk factors, knowledge, survey Introduction Stroke is the second most common cause of death worldwide and a significant cause of chronic disability (Murray and Lopez 1997). In a study conducted in Australia, it has been reported that within 12 months of a stroke, approximately 37% will die and 10% will experience a recurrent stroke (Thrift et al 2000; Dewey et al 2001). Of those who survive their stroke, approximately 51% are disabled in some activity of daily living, and 50% exhibit either cognitive impairment or dementia (Sturm et al 2002; Srikanth et al 2004). This represents a considerable burden to our community. Despite the decline in mortality from stroke over recent years (Waters and Bennet 1995), there is a looming epidemic of stroke. The increased proportion of the population in the older age groups that is predicted to occur in future years will contribute to this epidemic because of the strong association between age and stroke incidence. Using age- and sex-specific stroke attack rates obtained in a recent population-based study in Melbourne, Australia, and applying them to the Australian population (Thrift et al 2000), it is estimated that approximately 42 200 strokes would have occurred during 1997. If we apply these same attack rates to the projected population of Australia 20 years later (2017) (Australian Bureau of Statistics 2003), it is estimated that approximately 67 500 strokes will occur in that year. This resulting rise in the number of stroke cases in the elderly will significantly increase the burden of this disease and is also likely to overwhelm the resources currently available for stroke care. There are two main ways in which we can reduce the burden of this disease. First, we can improve outcome after stroke by providing patients with proven therapies. These therapies include the use of intravenous tissue plasminogen activator (tPA) within 3 hours of ischemic stroke onset (Hacke et al 1999; Wardlaw et al 2003), Vascular Health and Risk Management 2005:1(2) 137–147 © 2005 Dove Medical Press Limited. All rights reserved 137