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Shorter Reperfusion Time in Stroke is Associated with Better Cognition
Published online by Cambridge University Press: 06 December 2023
Abstract:
Background:
Cognitive changes that result from cerebrovascular disease contribute to a poor functional outcome with reduced quality of life. Among patients undergoing endovascular therapy (EVT), we aim to assess cognitive function and evaluate the impact of reperfusion time in cognitive performance.
Methods:
Patients with acute right anterior circulation strokes that underwent EVT between January 2018 and August 2020 at Centro Hospitalar de Vila Nova de Gaia/Espinho, participated in the study. Modified treatment in cerebral infarction (mTICI) assessed the level of recanalization. Cognitive evaluation was assessed with Addenbrooke’s Cognitive Examination revised (ACE-R). Multiple linear regression analyses were used to determine the association between time for recanalization and ACE-R. The level of significance adopted was 0.05.
Results:
The mean age of participants was 71.5 (interquartile range [IQR] 62.0–78.2) years, and 50% (22) were women. The median time after stroke was 28.6 months (IQR 18.94–31.55). All patients in our sample had a successful level of recanalization with EVT (mTICI ≥ 2b). Time for recanalization showed an inverse association with the ACE-R (b = −0.0207, P = 0.0203). Also the mRS at 3 months had an inverse association with cognition (b = −5.2803, p = 0.0095). Level of education had a strong and direct relationship with ACE-R results (b = 3.0869, p < 0.0001).
Conclusions:
Longer time between stroke symptoms and recanalization with EVT in patients with right hemisphere ischemic stroke lead to lower ACE-R scores. Measures to improve door-to-recanalization time are also important for cognitive performance after ischemic stroke.
Résumé:
Un temps de reperfusion plus court en cas d’AVC est associé à une meilleure cognition.
Les changements cognitifs qui résultent d’une maladie cérébrovasculaire contribuent en bout de ligne à de mauvais résultats sur le plan fonctionnel ainsi qu’à une qualité de vie réduite. Parmi des patients soumis à une thérapie endovasculaire (TEV), nous avons cherché à évaluer leur fonction cognitive et l’impact du temps de reperfusion sur leurs performances cognitives.
Des patients victimes d’un AVC en phase aiguë affectant la circulation antérieure droite et ayant bénéficié d’une TEV entre janvier 2018 et août 2020 au Centro Hospitalar de Vila Nova de Gaia e Espinho ont participé à cette étude. Le score obtenu en lien avec le traitement modifié de cas d’ischémie cérébrale (TMIC) nous a permis d’évaluer le niveau de recanalisation. De son côté, les évaluations cognitives ont été réalisées à l’aide de la version révisée du test Addenbrooke’s Cognitive Examination (ACE-R). Enfin, des analyses de régression linéaire multiple ont été effectuées pour déterminer l’association entre les délais de recanalisation et les résultats à l’ACE-R. À noter que le niveau de signification adopté était de 0,05.
L’âge moyen des participants était de 71,5 ans (EI 62,0 – 78,2) ; 50 % d’entre eux (22) étaient des femmes. Le temps médian après l’AVC était de 28,6 mois (EI 18,94 – 31,55). Tous les patients de notre échantillon ont bénéficié d’une recanalisation réussie par TEV (TMIC ≥ 2b). Les délais de recanalisation ont montré une association inverse avec l’ACE-R (b = −0,0207, p = 0,0203). Le score de de Rankin modifié (SRm) à 3 mois a également montré une association inverse avec la cognition (b = −5,2803 ; p = 0,0095). Finalement, on a pu noter une relation forte et directe entre le niveau d’éducation des patients et les résultats à l’ACE-R (b = 3,0869 ; p < 0,0001).
Des délais plus longs entre l’apparition des symptômes d’un AVC et la recanalisation par TEV chez des patients victimes d’un AVC ischémique dans l’hémisphère droit entraînent des scores à l’ACE-R plus faibles. Qui plus est, des mesures visant à améliorer les délais entre l’admission en centre hospitalier après un AVC ischémique et la recanalisation sont également importantes dans le cas des performances cognitives.
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- © The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
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