Dados do Trabalho

Título

THE EFFECT OF THROMBOLYSIS ON 6-MONTHS OCCURRENCE OF COGNITIVE DECLINE IN FIRST-EVER ISCHEMIC STROKE

Introdução

One-third of patients have dementia in the first year after stroke, and about 60% of them suffer from some form of cognitive decline. The post-stroke cognitive impairment may progress 10% per year or 50% over 5 years and is associated with an increased risk of functional decline and mortality. On the other hand, post-stroke cognitive impairment can improve during follow-up in approximately 16%-20% of elderly patients. Theoretically, thrombolytics could improve post-stroke cognitive outcomes since early reperfusion, and the subsequent reduction of lesion volume is one of the best predictors of good outcomes after ischemic stroke.

Objetivo

To evaluate the effect of the thrombolytic therapy in adult patients (previously not demented) with first-ever ischemic stroke on the occurrence of cognitive decline in 30-90 days and 6 months of follow-up. Additionally, the effect of the treatment on 4 cognitive domains (verbal memory, executive function, visuospatial abilities, and language), functional capacity, depressive symptoms, and motor status, as well as the relation of motor status and cognitive outcome were evaluated.

Método

In a quasi-experimental design, 37 rt-PA treated and 63 conservatively treated patients were evaluated after hospital admission and reassessed at 30-90 days and 6 months after ictus. The Clinical Dementia Rating scale was used as the outcome measure. The MMSE, semantic and phonemic verbal fluencies, clock drawing test, Boston naming test, digit span, Katz activities of daily living scale, modified Barthel index, the modified Rankin scale, Fulg Meyer scale, Beck Depression Inventory, and NIHSS were used as neuropsychological, functional, motor function, depression, and stroke severity examination.

Resultados

The rt-PA group showed more severe stroke at admission. The frequency of cognitive decline in 30-90 days (45% rt-PA treated vs 33.3% non-treated, p=0.295) and 6 months (43.2% rt-PA treated vs 33.9% non-treated, p=0.389) was not different between groups. In Poisson regression controlled by stroke severity, there was no difference in cognitive outcomes between groups. The lack of significance persisted in two sub-analyses: those with cognitive decline and those with NIHSS > 5.

Conclusão

Rates of cognitive decline were similar between the rt-PA group and the conservatively treated group in 30-90 days and 6 months and were independent of the severity of motor impairment. Treatment also did not affect the 4 cognitive domains assessed for 6 months timespan.

Palavras-chave

acute ischemic stroke, thrombolysis, cognitive decline