Abstract
The administration of thrombolytic therapy in elderly patients with dementia and acute ischemic stroke may be controversial, because the reported risk of rt-PA associated intracerebral hemorrhage in these patients is higher compared with that of patients without dementia and because these patients are already disabled. Moreover, there are known risk factors for hemorrhagic transformation in patients with dementia: amyloid angiopathy, leukoaraiosis and the presence of microbleeds. In this review, we describe the impact of dementia on functional outcome following thrombolytic therapy for acute ischemic stroke and discuss some of the issues related to the use of this therapy in this specific patient’s population.
Similar content being viewed by others
References
Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M, Koga M, von Kummer R, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J, Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W, Stroke Thrombolysis Trialists’ Collaborative Group (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384:1929–1935
Saposnik G, Cote R, Rochon PA, Mamdani M, Liu Y, Raptis S, Kapral MK, Black SE, Registry of the Canadian Stroke Network, Stroke Outcome Research Canada (SORCan) Working Group (2011) Care and outcomes in patients with ischemic stroke with and without preexisting dementia. Neurology 77:1664–1673
Saposnik G, Kapral MK, Cote R, Rochon PA, Wang J, Raptis S, Mamdani M, Black SE (2012) Is pre-existing dementia an independent predictor of outcome after stroke? A propensity score-matched analysis. J Neurol 259:2366–2375
Demchuk AM, Khan F, Hill MD, Barber PA, Silver B, Patel S, Levine SR, NINDS rt-PA Stroke Study Group (2008) Importance of leukoaraiosis on CT for tissue plasminogen activator decision making: evaluation of the NINDS rt-PA Stroke Study. Cerebrovasc Dis 26:120–125
Neumann-Haefelin T, Hoelig S, Berkefeld J, Fiehler J, Gass A, Humpich M, Kastrup A, Kucinski T, Lecei O, Liebeskind DS, Rother J, Rosso C, Samson Y, Saver JL, Yan B, MR Stroke Group (2006) Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke. Stroke 37:2463–2466
Palumbo V, Boulanger JM, Hill MD, Inzitari D, Buchan AM, CASES Investigators (2007) Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke. Neurology 68:1020–1024
Arba F, Palumbo V, Boulanger JM, Pracucci G, Inzitari D, Buchan AM, Hill MD, CASES Investigators (2016) Leukoaraiosis and lacunes are associated with poor clinical outcomes in ischemic stroke patients treated with intravenous thrombolysis. Int J Stroke 11:62–67
Ariës MJ, Uyttenboogaart M, Vroomen PC, De Keyser J, Luijckx GJ (2010) tPA treatment for acute ischaemic stroke in patients with leukoaraiosis. Eur J Neurol 17:866–870
Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L, LADIS Study Group (2009) Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ 6(339):b2477
McCarron MO, Nicoll JA (2004) Cerebral amyloid angiopathy and thrombolysis-related intracerebral haemorrhage. Lancet Neurol 3:484–492
Turc G, Sallem A, Moulin S, Tisserand M, Machet A, Edjlali M, Baron JC, Leclerc X, Leys D, Mas JL, Cordonnier C, Oppenheim C (2015) Microbleed status and 3-month outcome after intravenous thrombolysis in 717 patients with acute ischemic stroke. Stroke 46:2458–2463
Shoamanesh A, Kwok CS, Lim PA, Benavente OR (2013) Postthrombolysis intracranial hemorrhage risk of cerebral microbleeds in acute stroke patients: a systematic review and meta-analysis. Int J Stroke 8:348–356
Charidimou A, Shoamanesh A, Wilson D, Gang Q, Fox Z, Jäger HR, Benavente OR, Werring DJ (2015) Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk updated meta-analysis. Neurology 85:927–934
Busl KM, Nogueira RG, Yoo AJ, Hirsch JA, Schwamm LH, Rost NS (2013) Prestroke dementia is associated with poor outcomes after reperfusion therapy among elderly stroke patients. J Stroke Cerebrovasc Dis 22:718–724
Alshekhlee A, Li CC, Chuang SY, Vora N, Edgell RC, Kitchener JM, Kale SP, Feen E, Piriyawat P, Callison RC, Cruz-Flores S (2011) Does dementia increase risk of thrombolysis?: a case-control study. Neurology 76:1575–1580
Murao K, Bodenant M, Cordonnier C, Bombois S, Hénon H, Pasquier F, Bordet R, Leys D (2013) Does pre-existing cognitive impairment no-dementia influence the outcome of patients treated by intravenous thrombolysis for cerebral ischaemia? J Neurol Neurosurg Psychiatry 84:1412–1414
Gensicke H, Strbian D, Zinkstok SM, Scheitz JF, Bill O, Hametner C, Moulin S, Zini A, Kägi G, Pezzini A, Padjen V, Béjot Y, Corbiere S, Zonneveld TP, Seiffge DJ, Roos YB, Traenka C, Putaala J, Peters N, Bonati LH, Curtze S, Erdur H, Sibolt G, Koch P, Vandelli L, Ringleb P, Leys D, Cordonnier C, Michel P, Nolte CH, Lyrer PA, Tatlisumak T, Nederkoorn PJ, Engelter ST ST, Thrombolysis in Stroke Patients (TriSP) Collaborators (2016) Intravenous thrombolysis in patients dependent on the daily help of others before stroke. Stroke 47:450–456
Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE, American Heart Association Stroke Council and Council on Epidemiology and Prevention (2016) Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals From the American Heart Association/American Stroke Association. Stroke 47(2):581–641
Pantoni L, Fierini F, Poggesi A (2014) Thrombolysis in acute stroke patients with cerebral small vessel disease. Cerebrovasc Dis 37:5–13
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Paciaroni, M., Pantoni, L. Thrombolysis in dementia patients with acute stroke: is it justified?. Neurol Sci 38, 27–31 (2017). https://doi.org/10.1007/s10072-016-2725-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-016-2725-4