Cognitive and functional outcome after intravenous recombinant tissue plasminogen activator treatment in patients with a first symptomatic brain infarct.
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 > or = 19), and instrumental ADL independence (Frenchay Activities Index > or = 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).


CONCLUSIONS
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.
Nys
G M S
GM
Psychological Laboratory (17.24B), Helmholtz Institute Utrecht University, The Netherlands. g.nys@fss.uu.nl
van Zandvoort
M J E
MJ
Algra
A
A
Kappelle
L J
LJ
de Haan
E H F
EH
D000203:Activities of Daily Living; D000368:Aged; D020520:Brain Infarction / Q000188:drug therapy* / Q000503:physiopathology; D003071:Cognition / Q000187:drug effects*; D016001:Confidence Intervals; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D016017:Odds Ratio; D011994:Recombinant Proteins / Q000627:therapeutic use; D020127:Recovery of Function / Q000187:drug effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator