Cognitive Outcomes following Thrombolysis in Acute Ischemic Stroke: A Systematic Review

• Published in: Journal of stroke and cerebrovascular diseases 2016-12, Vol.25 (12), p.2868-2875
• Main Authors: Broome, Laura Jayne, BSc (Hons), Battle, Ceri Elisabeth, PhD, Lawrence, Matthew, PhD, Evans, Phillip Adrian, MD, FRCEM, Dennis, Michael Stuart, MD, FRCPsych
• Format: Article
• Language: English
• Subjects: Brain Ischemia - diagnosis; Brain Ischemia - drug therapy; Brain Ischemia - psychology; Cardiovascular; cerebrovascular disorder; Cognition - drug effects; cognitive disorder; cognitive impairment; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Humans; neurological impairment; Neurology; Quality of Life; recombinant tissue plasminogen activator; Recovery of Function; Risk Factors; Stroke; Stroke - diagnosis; Stroke - drug therapy; Stroke - psychology; thrombolytic therapy; Thrombolytic Therapy - adverse effects; Time Factors; Time-to-Treatment; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.048

Background Patients treated with thrombolytic therapy within 4.5 hours after stroke onset appear to have improved survival and functional outcomes. Poststroke cognitive impairment is associated with reduced quality of life and survival and needs to be reviewed in consideration of the administration of thrombolysis. This review aims to systematically evaluate literature exploring the effect of thrombolysis for ischemic stroke on cognition. Methods An electronic search was conducted to identify articles and gray literature applying broad Medical Subject Heading terms. Literature was reviewed with a 2-step process against predetermined inclusion criteria. All relevant studies were included if they investigated global or individual cognitive domains. Results Three studies satisfied the inclusion criteria but were diverse in outcome measures and duration, their heterogeneity limiting any possible pooled analysis. One study examined long-term treatment effects on global cognition and did not find a positive effect at 6 months. A positive treatment effect was reported in the acute phase in 1 study examining domains of visuoconstructive and perceptive abilities. One study retrospectively analyzed treatment effects on language and found improvement in the acute phase but not in the long term. Conclusions The limited existing evidence on the effects of thrombolytic therapy on long- and short-term cognition is varied in both outcome measures and diagnostic classifications, making it difficult to extrapolate results to a global stroke population. This review should be used to inform future research in stroke treatment outcomes and highlights the immediate need for larger, more robust studies in this area.