Background and Objectives: Many adults with mild cognitive impairment (MCI) live years with good quality of life and do not progress to dementia. It is unclear whether patients with pre-existing MCI (without dementia) are less likely to receive effective treatments for acute ischemic stroke than patients without MCI. We measured differences in intravenous (IV) tissue plasminogen activator (t-PA) treatment for ischemic stroke between MCI patients and cognitively normal patients in a population-based stroke surveillance project.
Methods: Cross-sectional analysis of prospectively obtained data of 626 first-ever ischemic stroke subjects 45 years or older without dementia in the Brain Attack Surveillance in Corpus Christi (BASIC) project from 2008 to 2012. We compared receipt of IV t-PA from chart abstraction between subjects with prestroke MCI (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE] score >3 and <3.44, a valid measure of prestroke MCI) and those with normal cognition (IQCODE score ≤3). We examined associations between receipt of t-PA and cognitive status using logistic regression and adjusting for age and sex as well as variables that were significantly associated with both MCI and receipt of t-PA.
Results: Stroke patients with MCI (median age, 70 years; interquartile range (IQR), 60-79 years; n=233) were more likely than cognitively normal patients (median age, 63 years; IQR, 55-73 years; n=393) to be older and women (both P<0.01), and to have a do-not-resuscitate (DNR) order (P=0.01). Patients with MCI were less likely to receive IV t-PA for acute ischemic stroke compared with cognitively normal patients (6% vs. 10.7%; unadjusted odds ratio (OR), 0.53; 95% CI, 0.29-1.00; P=0.05). MCI patients remained significantly less likely to receive t-PA compared with cognitively normal patients after adjusting for age, sex, DNR status, and stroke severity (adjusted OR, 0.48; 95% CI, 0.23-0.97; P=0.04).
Conclusion: Patients with MCI are less likely to receive t-PA for acute ischemic stroke compared with cognitively normal patients. Research is needed to determine whether these treatment differences are the result of differences in treatment eligibility, patient/ family preferences, or a less aggressive approach to MCI patients.