Neuropsychological outcomes following endovascular clot retrieval and intravenous thrombolysis in ischemic stroke.

IF 2.6 4区心理学 Q2 CLINICAL NEUROLOGY

Journal of the International Neuropsychological Society Pub Date : 2024-10-01 Epub Date: 2024-10-16 DOI:10.1017/S1355617724000535

Sam Humphrey, Kerryn E Pike, Brian Long, Henry Ma, Robert Bourke, Bradley J Wright, Dana Wong

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引用次数: 0

Abstract

Objectives: Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management.

Methods: Patients were recruited after acute treatment and invited to participate in an outcome assessment 90-120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group.

Results: Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20-86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups.

Conclusions: Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.

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缺血性中风患者血管内血栓取出术和静脉溶栓术后的神经心理学疗效。

目的：中风后常见认知障碍、焦虑、抑郁、疲劳和日常生活工具活动（ADL）依赖；然而，这些结果在接受血管内血块取出术（ECR）、静脉注射组织纤溶酶原激活剂（t-PA）或保守治疗后有何不同，目前还知之甚少：方法：招募急性期治疗后的患者，邀请他们参加卒中后 90-120 天的疗效评估。评估包括认知测试和几份问卷。COVID-19大流行导致招募和数据收集严重中断，t-PA组和保守治疗组合并为标准医疗护理（SMC）组：研究共纳入 62 名参与者（ECR = 31，SMC = 31）。平均年龄为 66.5（20-86）岁，35（56.5%）人为男性。接受 ECR 治疗的患者在发病时的美国国立卫生研究院卒中量表评分明显更高，受教育程度明显更低。在对中风严重程度、病前智力和年龄进行调整后，接受 ECR 治疗的患者在认知筛查、视觉工作记忆、语言学习和记忆等方面的表现明显更好。接受ECR治疗的患者也更少感到疲劳，更有可能在基本和工具性ADL方面实现独立。尽管如此，在接受 ECR 治疗的患者中，认知障碍和疲劳仍然很常见，两组患者的焦虑和抑郁症状也相似：结论：接受 ECR 治疗后，认知障碍和疲劳的发生率有所降低，但仍然普遍存在。这对脑卒中康复有重要的实际意义，建议对所有脑卒中幸存者进行认知、情绪和疲劳的常规评估，无论脑卒中治疗和功能结果如何。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International Neuropsychological Society 医学-精神病学

CiteScore

5.40

自引率

3.80%

发文量

185

审稿时长

4-8 weeks

期刊介绍： The Journal of the International Neuropsychological Society is the official journal of the International Neuropsychological Society, an organization of over 4,500 international members from a variety of disciplines. The Journal of the International Neuropsychological Society welcomes original, creative, high quality research papers covering all areas of neuropsychology. The focus of articles may be primarily experimental, applied, or clinical. Contributions will broadly reflect the interest of all areas of neuropsychology, including but not limited to: development of cognitive processes, brain-behavior relationships, adult and pediatric neuropsychology, neurobehavioral syndromes (such as aphasia or apraxia), and the interfaces of neuropsychology with related areas such as behavioral neurology, neuropsychiatry, genetics, and cognitive neuroscience. Papers that utilize behavioral, neuroimaging, and electrophysiological measures are appropriate. To assure maximum flexibility and to promote diverse mechanisms of scholarly communication, the following formats are available in addition to a Regular Research Article: Brief Communication is a shorter research article; Rapid Communication is intended for "fast breaking" new work that does not yet justify a full length article and is placed on a fast review track; Case Report is a theoretically important and unique case study; Critical Review and Short Review are thoughtful considerations of topics of importance to neuropsychology and include meta-analyses; Dialogue provides a forum for publishing two distinct positions on controversial issues in a point-counterpoint format; Special Issue and Special Section consist of several articles linked thematically; Letter to the Editor responds to recent articles published in the Journal of the International Neuropsychological Society; and Book Review, which is considered but is no longer solicited.