Objective: To examine whether intravenous recombinant tissue plasminogen activator (rt-PA) treatment given in the acute phase of ischaemic stroke has a favourable effect on cognitive and functional outcome at six mont...Objective: To examine whether intravenous recombinant tissue plasminogen activator (rt-PA) treatment given in the acute phase of ischaemic stroke has a favourable effect on cognitive and functional outcome at six months post-stroke. Methods: The present study included 92 patients with a first-ever symptomatic infarct, of whom 25 (27 %) were subjected to rt-PA treatment in the first three hours post-stroke. Multivariate logistic regression analyses adjusted for stroke severity, education, age, and sex were performed to examine whether rt-PA treatment influenced cognitive outcome (assessed with a neuropsychological examination covering 7 cognitive domains), basic ADL independence (modified Barthel Index ≥19), and instrumental ADL independence (Frenchay Activities Index ≥15) after six months. Results: The adjusted odds ratio for intact cognition was 1.0 (95%CI 0.2 to 4.3), that for basic ADL outcome 13.5 (95%CI 1.4 to 129.4) and for instrumental ADL 7.1 (95%CI 1.2 to 42.2). Conclusion: Our findings suggest that rt-PA treatment is associated with a favourable basic and instrumental ADL outcome, but not with a beneficial cognitive outcome after 6 months.展开更多
In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbance...In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbances is yet unknown. In th e current study proton magnetic resonance spectroscopy ( 1HMRS) was used to eluc idate the hypothesized relation between a lacunar infarct, metabolic alterations , and neuropsychological function. Patients with a single supratentorial lacunar infarct(n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was locatedin normal- appearing white matter of the centrum semiovale ata distance from the infarct, i n both the ipsilateral and contralateral hemisphere. On neuropsychological exami nation patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine rati o was decreased in patients with a lacunar infarct compared with the other two g roups. More important,this decrease in neurometabolites was significantly correl ated to the level of cognitive functioning for the ipsilateral hemisphere and, a lthough to a lesser extent, for the contralateral hemisphere.We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neuro metabolites and that this decrease is related to a reduced cognitive capacity.展开更多
文摘Objective: To examine whether intravenous recombinant tissue plasminogen activator (rt-PA) treatment given in the acute phase of ischaemic stroke has a favourable effect on cognitive and functional outcome at six months post-stroke. Methods: The present study included 92 patients with a first-ever symptomatic infarct, of whom 25 (27 %) were subjected to rt-PA treatment in the first three hours post-stroke. Multivariate logistic regression analyses adjusted for stroke severity, education, age, and sex were performed to examine whether rt-PA treatment influenced cognitive outcome (assessed with a neuropsychological examination covering 7 cognitive domains), basic ADL independence (modified Barthel Index ≥19), and instrumental ADL independence (Frenchay Activities Index ≥15) after six months. Results: The adjusted odds ratio for intact cognition was 1.0 (95%CI 0.2 to 4.3), that for basic ADL outcome 13.5 (95%CI 1.4 to 129.4) and for instrumental ADL 7.1 (95%CI 1.2 to 42.2). Conclusion: Our findings suggest that rt-PA treatment is associated with a favourable basic and instrumental ADL outcome, but not with a beneficial cognitive outcome after 6 months.
文摘In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbances is yet unknown. In th e current study proton magnetic resonance spectroscopy ( 1HMRS) was used to eluc idate the hypothesized relation between a lacunar infarct, metabolic alterations , and neuropsychological function. Patients with a single supratentorial lacunar infarct(n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was locatedin normal- appearing white matter of the centrum semiovale ata distance from the infarct, i n both the ipsilateral and contralateral hemisphere. On neuropsychological exami nation patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine rati o was decreased in patients with a lacunar infarct compared with the other two g roups. More important,this decrease in neurometabolites was significantly correl ated to the level of cognitive functioning for the ipsilateral hemisphere and, a lthough to a lesser extent, for the contralateral hemisphere.We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neuro metabolites and that this decrease is related to a reduced cognitive capacity.
