Abstract WP568: The Effect of Pre-existing Mild Cognitive Impairment on Receipt of Treatments and Process Measures for Acute Ischemic Stroke

Abstract

Background: Mild cognitive impairment (MCI)—measurable cognitive impairment that doesn't severely affect daily functioning—is common, affecting 1 in 5 adults 65 or older. Little is known about the quality of stroke care for patients with pre-existing MCI despite evidence in other diseases that these patients may be under-treated. Methods: Prospective study of 708 patients aged ≥65 hospitalized with acute ischemic stroke between 2000 and 2014 from the Health and Retirement Study with linked Medicare and American Hospital Association data. We compared receipt of process measures after acute ischemic stroke between patients with pre-existing MCI (based on modified Telephone Interview for Cognitive Status [TICS-m] score, 7-11, a valid measure of MCI) and normal cognition (TICS-m score, 12-27). We used Cox regression to estimate the effect of pre-existing MCI on receipt of process measures after adjusting for patient and hospital factors (Table 1). Results: Patients with pre-existing MCI, compared to those with normal cognition, were less likely to receive IV t-PA, carotid revascularization, cardiac monitoring, and rehabilitation assessment, but not carotid imaging (Table 1). Pre-existing MCI was not independently associated with stroke process measures after adjusting for patient and hospital factors such as sex, educational and marriage status, and facility size. Conclusion: Modest differences in use of IV t-PA, carotid revascularization, rehabilitation assessment, cardiac monitoring, and carotid imaging exist in patients with pre-existing MCI and normal cognition after acute ischemic stroke. These differences were largely explained by patients with MCI being more likely to be women, less educated, unmarried, and using smaller hospitals.