Cognitive deficits in acute mild ischemic stroke and TIA and effects of rt-PA

David Rosenbaum Halevi, Andrew W. Bursaw, Rahul R. Karamchandani, Susan E. Alderman, Joshua I. Breier, Farhaan S. Vahidy, James K. Aden, Chunyan Cai, Xu Zhang, Sean I. Savitz

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Introduction: It is unknown if treatment with rt-PA in mild acute ischemic stroke (MIS) is associated with improvement in long term cognition. Methods: Forty-five patients with suspected acute mild stroke or transient ischemic attacks with NIHSS ≤6 were enrolled in a prospective cohort. Cognitive testing was performed within 24 h of symptom onset. Follow-up assessment was performed at Day 90 on 25 patients. Prestroke baseline cognition was based on age, years of education (YrE), history of cognitive impairment, and the Fazekas score. Results: Eighty-five percent patients with suspected MIS or TIA showed cognitive abnormalities within 24 h of onset. There was no significant difference in age, sex, Fazekas score, or YrE between rt-PA versus No-rt-PA groups (N = 8 vs. 17).Two sample t-test for change in performance in the WMS-III sub-tests (follow-up – baseline) ± SD, indicated a difference between rt-PA 0.74 ± 0.77 and no-rt-PA groups -0.02 ± 0.83 (P = 0.044). Logistic regression for predicting normal status using the mental control subtest, at follow-up showed an OR 8.96, CI 0.98–82.12 (P = 0.05) favoring the rt-PA group. Improvement in Mental Control at 90 days occurred in patients with low white matter disease compared to high white matter disease, 0.60 ± 0.46 (P = 0.048). A statistical trend was observed and suggested an improvement on SDMT and Trail Making tests, 1.43 ± 0.8 (P = 0.077). Conclusion: Suspected MIS and TIA patients have cognitive impairment within 24 h of onset. rt-PA administration might be associated with improvement on some cognitive tests at 90 days.

Original languageEnglish (US)
Pages (from-to)466-474
Number of pages9
JournalAnnals of Clinical and Translational Neurology
Issue number3
StatePublished - Mar 2019


  • Adult
  • Aged
  • Aged, 80 and over
  • Cognitive Dysfunction/etiology
  • Cohort Studies
  • Female
  • Humans
  • Ischemic Attack, Transient/complications
  • Male
  • Middle Aged
  • Prospective Studies
  • Stroke/complications
  • Time Factors
  • Tissue Plasminogen Activator/therapeutic use

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


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