The effect of recombinant tissue plasminogen activator on cognitive functions of patients with first ischemic stroke

Abstract Background Stroke is associated with significant comorbidities & cognitive impairment affects more than 50% of patients with ischemic stroke. Reperfusion therapy is considered the most effective therapy & has a significant positive impact on function & quality of life of stroke patients presented within 4.5 h from onset of symptoms. Aim of current study is to assess the cognitive functions among patients with first ischemic stroke who received recombinant tissue Plasminogen activator (t-PA) (r-TPA) in comparison with patients with first ischaemic stroke who didn’t receive rTPA. Patients & methods A comparative cross-sectional study was conducted among 2 groups of patients with first ischaemic stroke. Group A: included 51 patients who were presented before 4.5 h of onset of symptoms & received rTPA while group B included 51 patients who were not eligible to receive rTPA. Patients were evaluated for cognitive impairment using the Mini-Mental State Examination, Montreal Cognitive Assessment & Wisconsin Card sorting Test after 3 months of stroke for both groups. Results Three months after the intervention, Group A showed significantly better cognitive performance than Group B. Group A scored higher on the MMSE ( p < 0.001), particularly in orientation, registration, attention, calculation, & language ( p < 0.05), though both groups performed similarly in recall. On the MoCA, Group A also had higher total scores ( p < 0.001), especially in visuospatial skills, memory, attention, & executive function ( p < 0.05), with no significant difference in orientation & language. In the WCST, Group A made fewer errors & had better conceptual responses, while Group B showed more perseverative responses & errors & non-perseverative errors ( p < 0.001). In addition, MOCA, MMSE & WCST scores 3 months after intervention had significant moderate negative correlation with NIHSS scores. Conclusion Cognitive impairment is less reported among stroke patients managed with r-TPA suggesting a protective effect for r-TPA on cognitive function.