Clinical Manifestations.

Abstract

Individuals diagnosed with mild cognitive impairment and dementia (MCI/Dem) are excluded from research on intervention for acute ischemic stroke; This research gap places stroke physicians worldwide in dilemmas while treating patients with cognitive decline. One example is acute stroke of large brain arteries, typically manifesting as immediate onset of severe neurological disability. Endovascular treatment (EVT), aka catheter-base clot removal, is considered the gold-standard treatment and when applied within hours after onset, can mitigate or reverse deficits and dramatically improve outcomes. Our goal was to evaluate efficacy and safety of EVT for acute stroke in MCI/Dem. This is a single site retrospective study from Rabin Medical Center,2019-2021. Inclusion criteria was new onset acute large vessel stroke receiving EVT treatment, ages 18-85 years. Pre-stroke cognitive status was assessed using previous diagnosis, assessments in geriatric / occupational therapy clinics, nurse functional questionnaire and rehabilitation interview. Individuals were dichotomized to MCI/Dem (any severity) and unimpaired via consensus between two behavioural neurologists. The MCI/Dem group was matched to unimpaired individuals for sex, age, pre-stroke functional independence, and stroke arterial territory, severity and time to EVT. The outcomes were retrospectively assessed 90 days after stroke and included mortality, intracranial haemorrhage, and pre to post stroke difference in the modified Rankin scale (mRS), commonly used instrument for stroke functional independence. We identified 306 individuals with acute large vessel stroke who underwent EVT, of which 32 with pre-stroke MCI/Dem. After matching, we saw no differences between non impaired group to MCI/Dem group in functional outcome measured by mRS change, (56% vs.53%, p = 0.8), brain hemorrhage(22% vs. 9%, p = 0.68) and mortality (25% vs. 12%,p = 0.2). To our knowledge this is the first study to report on EVT outcomes in individuals with MCI/Dem. Our results suggest interventions for acute large vessel stroke may have similar efficacy and safety profile in individuals with pre-stroke MCI/Dementia and thus challenge previous recommendations to exclude them from therapy. Our data is retrospective and thus of inadequate design to suggest change to clinical guidelines. Further research on stroke interventions in MCI/Dem is urgently needed to guide day-to-day clinical decision making.