Influence of cognitive impairment on the management of ischaemic stroke

Rev Neurol (Paris). 2014 Mar;170(3):177-86. doi: 10.1016/j.neurol.2014.01.665. Epub 2014 Mar 6.


Background: Because of ageing of the population, it is more and more frequent to treat ischaemic stroke patients with pre-stroke cognitive impairment (PSCI). Currently, there is no specific recommendation on ischaemic stroke management in these patients, both at the acute stage and in secondary prevention. However, these patients are less likely to receive treatments proven effective in randomised controlled trials, even in the absence of contra-indication.

Objective: To review the literature to assess efficacy and safety of validated therapies for acute ischaemic stroke and secondary prevention in PSCI patients.

Results: Most randomised trials did not take into account the pre-stroke cognitive status. The few observational studies conducted at the acute stage or in secondary prevention, did not provide any information that the benefit could be either lost or replaced by harm in the presence of PSCI.

Conclusions: There is no reason not to treat ischaemic stroke patients with PSCI according to the currently available recommendations for acute management and secondary prevention. Further observational studies are needed and pre-stroke cognition should be taken into account in future stroke trials.

Keywords: AVC ischémique; Acute stroke; Alzheimer disease; Cognitive disorders; Démence vasculaire; Maladie d’Alzheimer; Patient outcome assessment; Troubles cognitifs; Vascular dementia; Évaluation du devenir.

Publication types

  • Review

MeSH terms

  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Brain Ischemia / prevention & control
  • Brain Ischemia / psychology
  • Brain Ischemia / therapy*
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / prevention & control
  • Cognition Disorders / complications*
  • Comprehension
  • Decompression, Surgical / statistics & numerical data
  • Diabetes Complications / prevention & control
  • Disease Management
  • Dyslipidemias / complications
  • Dyslipidemias / drug therapy
  • Endarterectomy, Carotid / statistics & numerical data
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy
  • Hypoglycemia / etiology
  • Hypoglycemia / prevention & control
  • Observational Studies as Topic
  • Patient Education as Topic
  • Patients / psychology
  • Randomized Controlled Trials as Topic
  • Recombinant Proteins / therapeutic use
  • Risk Factors
  • Secondary Prevention
  • Thrombectomy
  • Thrombolytic Therapy / statistics & numerical data
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome


  • Anticoagulants
  • Antihypertensive Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator