What other protocols is your doctor using to significantly improve cerebral blood flow immediately post stroke? The first hours and days? NOTHING? Then you DON'T have a functioning stroke doctor, do you?
Maybe these, why isn't your incompetent doctor already delivering these to you?
Oh, your incompetent doctor doesn't have any and doesn't fucking care about learning better ways to get you recovered! Well, fire them!
Cognitive impairment after intravenous thrombolysis in mild stroke: assessment of cerebral blood flow covariance network
Kefu Mei
Feng Li
Zhiming Kang
Dong Sun
Xuefei Luo4
Shiyuan Tian
Junjian Zhang- 1Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
- 2Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- 3Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- 4Xiangyang Polytechnic, Xiangyang, China
Background: Mild stroke may lead to cognitive impairment, and it remains unclear whether intravenous thrombolysis (IVT) can mitigate cognitive deficits. This study investigates whether IVT can help alleviate cognitive function impairment in patients and further explores changes in the topological properties of cerebral blood flow (CBF) networks.
Methods: This observational study prospectively enrolled 94 patients with acute mild ischemic stroke (44 IVT vs. 50 non-IVT) from two hospitals. A battery of neuropsychological tests and arterial spin labeling were performed to evaluate their cognitive functioning and CBF in 116 brain regions. Voxel-wise CBF was compared between patients and health controls. The CBF covariance network of patients was constructed by calculating across-subject CBF covariance among 116 brain regions. Network properties were calculated and compared between IVT and no-IVT groups.
Results: The mild stroke group demonstrated significantly lower Montreal Cognitive Assessment (MoCA) scores compared to healthy controls (p < 0.001). Patients receiving IVT showed superior performance on the Trail Making Test-B (p = 0.043), Clock Drawing Test (p = 0.001), and Verbal Fluency Test (p = 0.033). Multivariate regression analysis adjusted for covariates demonstrated significant associations between IVT and cognitive outcomes: Montreal Cognitive Assessment (β = 2.85; 95% CI, 0.64–5.13), Trail Making Test-A (β = −16.90; 95% CI, −32.89–-0.90), Trail Making Test-B (β = −43.27; 95% CI, −78.78–-7.76), Hopkins Verbal Learning Test-Revised total recall (β = 3.57; 95% CI, 1.36–5.78), HVLT-R delayed recall (β = 1.53; 95% CI, 0.43–2.63), Clock Drawing Test (β = 7.09; 95% CI, 2.40–11.79), and Verbal Fluency Test (β = 3.00; 95% CI, 1.33–4.68). IVT patients exhibited higher small-worldness, clustering coefficient, and global efficiency of the network compared to non-IVT patients.
Conclusion: Intravenous thrombolysis demonstrated early cognitive benefits across multiple domains in patients with mild stroke. Improvement in the brain CBF covariance network properties may be the underlying mechanism.
Introduction
Mild ischemic stroke, defined by a National Institutes of Health Stroke Scale (NIHSS) score of less than 6, constitutes over half of all ischemic stroke. While patients typically experience only mild disabilities, they still face significant long-term effects, including fatigue, cognitive impairment, anxiety, and depression (1, 2). The incidence of cognitive impairment following mild ischemic stroke can reach up to 60% within one year, yet no specific treatments currently exist (3, 4).
Intravenous thrombolysis (IVT) is the primary treatment for acute ischemic strokes within 4.5 h. National guidelines recommend prompt IVT within the therapeutic window for mild disabling strokes. However, the PRISMS trial (Study of the Efficacy and Safety of Alteplase in Participants with Mild Stroke) found no benefit of IVT for the mRS score in mild non-disabling stroke, leading to the exclusion of these cases from national recommendations (5). The lack of a clear definition differentiating disabling from non-disabling stroke complicates treatment decisions, as the effects of mild stroke extend beyond mRS assessments, leaving many clinicians hesitant to administer thrombolytic therapy (6).
Currently, there is limited research on the effects of IVT on cognitive impairment in patients with mild stroke. A small-sample study confirmed that alteplase can improve processing speed 90 days after onset (7). However, another observational study found no association between intravenous thrombolysis and MoCA scores (8). Post-stroke cognitive impairment significantly diminishes the quality of life for patients with mild stroke, emphasizing the need for further investigation of underlying mechanisms and new treatment strategies. Studies have identified abnormal CBF in patients experiencing cognitive decline (9, 10), highlighting issues such as reduced global gray matter CBF and altered blood flow in affected brain regions (11, 12). Recent advancements in brain network research, particularly using diffusion MRI and resting-state functional MRI, have enhanced our understanding of cognitive impairment at the connectome level. Arterial spin labeling (ASL) enables non-invasive measurement of brain blood flow, allowing CBF covariance network studies to effectively reflect changes in brain network parameters (13–15). However, the benefits of CBF network topological properties following intravenous thrombolysis in mild stroke remain unclear.
This study aims to explore whether IVT can mitigate cognitive function impairment and further investigate whether the protective role of the CBF covariance network is a potential mechanism. We hope that insights from these indicators will elucidate the potential benefits of intravenous thrombolysis for mild stroke and inform future clinical practices.
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