A Clinical Study On The Relationship Between Cognitive Impairment And Rt-PA Intravenous Thrombolysis In Cerebral Infarction

Objective:To investigate the correlation between vascular cognitive impairment (VCI) and intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute cerebral infarct.MethodsWe prospectively collected consecutive registered data of acute ischemic patients between February2011and August2012in department of neurology, Jinhua Traditional Chinese Medical Hospital. Patients were divided into thrombolysis group and non-thrombolysis group (control group) based on intravenous rt-PA thrombolytic therapy. We compared the demographic, laboratory, radiological variables and neurological outcome in24hours and in3months between thrombolysis group group and non- thrombolysis group, including Mini-Mental State Examination (MMSE),Montreal cognitive assessment (MoCA), National Institutes of Health Stroke scale (NIHSS). Univariate analysis and binary logistic regression were used to investigate the independent predictors for3month outcome.ResultsFinally,43patients were enrolled into this study, including21thrombolytic patients and22non-thrombolytic patients.Univariate analysis showed that NIHSS (P<0.05, P=0.046)MoCA(P<0.05, P=0.036)and MMSE(P<0.05, P=0.029) scores were significantly different between thrombolysis group and control group. Univariate analysis showed that age, history of hypertension, C reactive protein, use of rt-PA, infarction of key position and educational status were significantly different in patients with MMSE> or<26(P<0.05) at3months. Binary logistic regression showed that age (OR:0.674,95%CI:0.410-0.887, P=0.048), key position infarction(OR:0.355,95%CI0.127-0.536, P=0.037), and use of rt-PA (OR:1.521,95%CI1.304-1.780, P=0.041) were independent influencing factors for vascular cognitive impairment (VCI) at3months after onset of acute ischemic stroke. We also found that age, use of rt-PA, infarction of key position and educational status were significantly different in patients with MoCA> or<26(P<0.05) at3months (P<0.05).Binary logistic regression showed age (OR:0.536,95%CI0.357-0.763, P=0.040), infarction of key position (OR:0.262,95%CI0.065-0.574, P=0.026), and use of rt-PA (OR1.701,95%CI1.461-1.975, P=0.033) were independent influencing factors for VCI at3months after onset of acute ischemic stroke. ConclusionsIntravenous thrombolysis with rt-PA can improve vascular cognitive impairment in patients with acute ischemic stroke.