What does cognitive screening reveal about early cognitive performance following endovascular clot retrieval and intravenous thrombolysis in acute ischaemic stroke?

Sam Humphrey; Kerryn E. Pike; Brian Long; Henry Ma; Robert Bourke; Danielle Byrne; Bradley Wright; Dana Wong

doi:10.1071/IB23066

RESEARCH ARTICLE (Open Access)

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What does cognitive screening reveal about early cognitive performance following endovascular clot retrieval and intravenous thrombolysis in acute ischaemic stroke?

Sam Humphrey

^A ^B , Kerryn E. Pike

^A ^C ^D , Brian Long ^B ^E , Henry Ma ^F ^G , Robert Bourke ^B , Danielle Byrne ^H , Bradley Wright ^A and Dana Wong

^A ^*

+ Author Affiliations

- Author Affiliations

^A Department of Psychology, Counselling & Therapy, School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia.

^B Neuropsychology Unit, Monash Medical Centre, Melbourne, Victoria, Australia.

^C John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Victoria, Australia.

^D School of Applied Psychology, Griffith Centre for Mental Health & Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.

^E Neurosciences Unit, North Metropolitan Health Service, Perth, Western Australia, Australia.

^F Department of Neurology, Monash Medical Centre, Melbourne, Victoria, Australia.

^G Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.

^H Department of Occupational Therapy, Monash Medical Centre, Melbourne, Victoria, Australia.

^* Correspondence to: d.wong@latrobe.edu.au

Handling Editor: Cynthia Honan

Brain Impairment 25, IB23066 https://doi.org/10.1071/IB23066

Submitted: 30 April 2023 Accepted: 4 December 2023 Published: 25 January 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Little is known regarding cognitive outcomes following treatment with endovascular clot retrieval (ECR) and intravenous tissue plasminogen activator (t-PA). We aimed to determine if there were any differences on a measure of cognitive screening between patients treated with ECR, t-PA, and those who were managed conservatively.

Methods

The medical records of ischaemic stroke patients admitted to Monash Medical Centre between January 2019 and December 2019 were retrospectively reviewed. Information extracted from medical records included age, sex, National Institutes of Health Stroke Scale at presentation, location of occlusion, treatment type, medical history, and cognitive screening performance measured by the Montreal Cognitive Assessment (MoCA).

Results

Eighty-two patients met the inclusion criteria (mean age = 66.5 ± 13.9; 49 male, 33 female). Patients treated with ECR performed significantly better on the MoCA (n = 36, 24.1 ± 4.3) compared to those who were managed conservatively (n = 26, 20.7 ± 5.5). Performance for patients treated with t-PA (n = 20, 23.9 ± 3.5) fell between the ECR and conservative management groups, but they did not significantly differ from either.

Conclusion

Our retrospective chart review found that ischaemic stroke patients treated with ECR appear to perform better on cognitive screening compared to patients who are managed conservatively. We also found that patients treated with ECR and t-PA appear to have similar cognitive screening performances in the acute stages following ischaemic stroke, although this finding is likely to have been impacted by group differences in stroke characteristics and may reflect the possibility that the ECR group performed better than expected based on their stroke severity.

Keywords: cognition, cognitive screening, endovascular clot retrieval, intravenous thrombolysis, ischaemic stroke, stroke rehabilitation, thrombectomy, tissue plasminogen activator.

References

Aam S, Einstad MS, Munthe-Kaas R, Lydersen S, Ihle-Hansen H, Knapskog A-B, Ellekjær H, Seljeseth Y, Saltvedt I (2020) Post-Stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study. Frontiers in Neurology 11, 699.
| Crossref | Google Scholar | PubMed |

Broome LJ, Battle CE, Lawrence M, Evans PA, Dennis MS (2016) Cognitive Outcomes Following Thrombolysis in Acute Ischemic Stroke: A Systematic Review. Journal of Stroke and Cerebrovascular Diseases 25(12), 2868-2875.
| Crossref | Google Scholar | PubMed |

Chan E, Khan S, Oliver R, Gill SK, Werring DJ, Cipolotti L (2014) Underestimation of Cognitive Impairments by the Montreal Cognitive Assessment (MoCA) in an Acute Stroke Unit Population. Journal of the Neurological Sciences 343(1–2), 176-179.
| Crossref | Google Scholar | PubMed |

Chiti G, Pantoni L (2014) Use of Montreal Cognitive Assessment in Patients with Stroke. Stroke 45(10), 3135-3140.
| Crossref | Google Scholar | PubMed |

Demeyere N, Riddoch MJ, Slavkova ED, Jones K, Reckless I, Mathieson P, Humphreys GW (2016) Domain-Specific Versus Generalized Cognitive Screening in Acute Stroke. Journal of Neurology 263(2), 306-315.
| Crossref | Google Scholar | PubMed |

Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CBLM, van der Lugt A, de Miquel MA, Donnan GA, Roos YBWEM, Bonafe A, Jahan R, Diener H-C, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, et al. (2016) Endovascular Thrombectomy after Large-Vessel Ischaemic Stroke: A Meta-Analysis of Individual Patient Data from Five Randomised Trials. The Lancet 387(10029), 1723-1731.
| Crossref | Google Scholar | PubMed |

Jacquin A, Virat-Brassaud M-E, Rouaud O, Osseby G-V, Aboa-Eboulé C, Hervieu M, Ménassa M, Ricolfi F, Giroud M, Béjot Y (2014) Vascular Aphasia Outcome after Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis for Ischemic Stroke. European Neurology 71(5–6), 288-295.
| Crossref | Google Scholar | PubMed |

Jaillard A, Grand S, Le Bas JF, Hommel M (2010) Predicting Cognitive Dysfunctioning in Nondemented Patients Early after Stroke. Cerebrovascular Diseases 29(5), 415-423.
| Crossref | Google Scholar | PubMed |

Kettunen JE, Laihosalo M, Ollikainen J, Dastidar P, Nurmi L, Koivisto A-M, Jehkonen M (2012a) Rightward Bias in Right Hemisphere Infarct Patients with or without Thrombolytic Treatment and in Healthy Controls. Neurocase 18(5), 359-365.
| Crossref | Google Scholar |

Kettunen JE, Nurmi M, Koivisto A-M, Dastidar P, Jehkonen M (2012b) The Presence of Visual Neglect after Thrombolytic Treatment in Patients with Right Hemisphere Stroke. The Scientific World Journal 2012, 434120.
| Crossref | Google Scholar |

Laihosalo M, Kettunen JE, Koivisto A-M, Dastidar P, Ollikainen J, Jehkonen M (2011) Thrombolytic Therapy and Visuoperceptual Functions in Right Hemisphere Infarct Patients. Journal of Neurology 258(6), 1021-1025.
| Crossref | Google Scholar | PubMed |

Lattanzi S, Coccia M, Pulcini A, Cagnetti C, Galli FL, Villani L, Campa S, Dobran M, Polonara G, Ceravolo MG, Silvestrini M (2020) Endovascular Treatment and Cognitive Outcome after Anterior Circulation Ischemic Stroke. Scientific Reports 10(1), 18524.
| Crossref | Google Scholar | PubMed |

Levine DA, Wadley VG, Langa KM, Unverzagt FW, Kabeto MU, Giordani B, Howard G, Howard VJ, Cushman M, Judd SE, Galecki AT (2018) Risk Factors for Poststroke Cognitive Decline: The REGARDS Study (Reasons for Geographic and Racial Differences in Stroke). Stroke 49(4), 987-994.
| Crossref | Google Scholar | PubMed |

López-Cancio E, Jovin TG, Cobo E, Cerdá N, Jiménez M, Gomis M, Hernández-Pérez M, Cáceres C, Cardona P, Lara B, Renú A, Llull L, Boned S, Muchada M, Dávalos A (2017) Endovascular Treatment Improves Cognition after Stroke: A secondary analysis of REVASCAT trial. Neurology 88(3), 245-251.
| Crossref | Google Scholar | PubMed |

Munthe-Kaas R, Aam S, Saltvedt I, Wyller TB, Pendlebury ST, Lydersen S, Ihle-Hansen H (2021) Test Accuracy of the Montreal Cognitive Assessment in Screening for Early Poststroke Neurocognitive Disorder: The Nor-COAST Study. Stroke 52(1), 317-320.
| Crossref | Google Scholar | PubMed |

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. Journal of the American Geriatrics Society 53(4), 695-699.
| Crossref | Google Scholar | PubMed |

Nys GMS, van Zandvoort MJE, Algra A, Kappelle LJ, de Haan EHF (2006) Cognitive and Functional Outcome after Intravenous Recombinant Tissue Plasminogen Activator Treatment in Patients with a First Symptomatic Brain Infarct. Journal of Neurology 253(2), 237-241.
| Crossref | Google Scholar | PubMed |

Pendlebury ST, Rothwell PM (2009) Prevalence, Incidence, and Factors Associated with Pre-Stroke and Post-Stroke Dementia: A Systematic Review and Meta-Analysis. The Lancet Neurology 8(11), 1006-1018.
| Crossref | Google Scholar | PubMed |

Pollock A, St George B, Fenton M, Firkins L (2014) Top 10 Research Priorities Relating to Life after Stroke – Consensus from Stroke Survivors, Caregivers, and Health Professionals. International Journal of Stroke 9(3), 313-320.
| Crossref | Google Scholar | PubMed |

Potocnik J, Ovcar Stante K, Rakusa M (2020) The Validity of the Montreal Cognitive Assessment (MoCA) for the Screening of Vascular Cognitive Impairment after Ischemic Stroke. Acta Neurologica Belgica 120(3), 681-685.
| Crossref | Google Scholar | PubMed |

Rennert RC, Wali AR, Steinberg JA, Santiago-Dieppa DR, Olson SE, Pannell JS, Khalessi AA (2019) Epidemiology, Natural History, and Clinical Presentation of Large Vessel Ischemic Stroke. Neurosurgery 85(1), S4-S8.
| Crossref | Google Scholar | PubMed |

Rost NS, Brodtmann A, Pase MP, van Veluw SJ, Biffi A, Duering M, Hinman JD, Dichgans M (2022) Post-Stroke Cognitive Impairment and Dementia. Circulation Research 130(8), 1252-1271.
| Crossref | Google Scholar | PubMed |

Sanctuary C, Hewitt L, Demeyere N, Kankkunen K, Oxenham DV, Simpson DB, Stolwyk RJ, Synn A, Webb SS, Marsden DL (2023) The Oxford Cognitive Screen for Use with Australian People after Stroke (OCS‐AU): The Adaptation Process and Determining Cut Scores for Cognitive Impairment Using a Cross‐Sectional Normative Study. Australian Occupational Therapy Journal 70(1), 73-85.
| Crossref | Google Scholar | PubMed |

State of Victoria, Department of Health and Human Services (2018) Endovascular clot retrieval for acute stroke; Statewide service protocol for Victoria. Retrieved from https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/stroke-clinical-network/endovascular-clot-retrieval-protocol

Stolwyk RJ, Mihaljcic T, Wong DK, Chapman JE, Rogers JM (2021) Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes: A Systematic Review and Meta-Analysis. Stroke 52(2), 748-760.
| Crossref | Google Scholar | PubMed |

Sun J-H, Tan L, Yu J-T (2014) Post-Stroke Cognitive Impairment: Epidemiology, Mechanisms and Management. Annals of Translational Medicine 2(8), 80.
| Crossref | Google Scholar | PubMed |

Wei X, Ma Y, Wu T, Yang Y, Yuan Y, Qin J, Bu Z, Yan F, Zhang Z, Han L (2023) Which Cut-Off Value of the Montreal Cognitive Assessment Should be Used for Post-Stroke Cognitive Impairment? A Systematic Review and Meta-Analysis of Studies on Diagnostic Test Accuracy. International Journal of Stroke 18, 908-916.
| Crossref | Google Scholar |

Xu G, Dong X, Niu X, Zheng G, Wang H, Zhang F, Li L, Lv P (2017) Cognitive Function and Prognosis of Multimodal Neuroimage-Guided Thrombectomy on Mild to Moderate Anterior Circulation Infarction Patients with Broadened Therapeutic Window: A Prospective Study. European Neurology 78(5–6), 257-263.
| Crossref | Google Scholar | PubMed |