Skip to main content

Advertisement

SpringerLink
Log in

Thrombolysis in dementia patients with acute stroke: is it justified?

  • Review Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 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

    Article  CAS  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. McCarron MO, Nicoll JA (2004) Cerebral amyloid angiopathy and thrombolysis-related intracerebral haemorrhage. Lancet Neurol 3:484–492

    Article  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  CAS  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. Pantoni L, Fierini F, Poggesi A (2014) Thrombolysis in acute stroke patients with cerebral small vessel disease. Cerebrovasc Dis 37:5–13

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, 06126, Perugia, Italy

    Maurizio Paciaroni

  2. NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy

    Leonardo Pantoni

Authors
  1. Maurizio Paciaroni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonardo Pantoni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Maurizio Paciaroni or Leonardo Pantoni.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-016-2725-4

Keywords

Search

Navigation