{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:59:39Z","timestamp":1791230379941,"version":"4.1.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T00:00:00Z","timestamp":1703635200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004411","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012498","name":"Alzheimer Society Research Program","doi-asserted-by":"publisher","award":["23-19"],"award-info":[{"award-number":["23-19"]}],"id":[{"id":"10.13039\/100012498","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) have an unclear benefit in those with pre-stroke dementia or cognitive impairment, as these patients were often excluded from landmark stroke trials. We performed a systematic review and meta-analysis to assess the outcomes of IVT and EVT in these populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>Our systematic review, conforming to the Meta-Analysis of Observational Studies in Epidemiology guidelines, investigated studies on acute ischemic stroke patients with pre-stroke dementia or cognitive impairment treated with IVT or EVT. Primary outcome was favorable 90-day outcome (mRS 0\u20132). Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (SICH), and radiographic intracranial hemorrhage (ICH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary of review:<\/jats:title>\n                    <jats:p>Nine articles were identified, with five observational studies of IVT use in patients with (n\u2009=\u20091078) and without dementia (n\u2009=\u20092805) being selected for the meta-analysis. There were no significant differences in favorable outcome (adjusted OR: 0.61, 95% CI 0.24\u20131.59), mortality (unadjusted OR: 1.19, 95% CI 0.86\u20131.64), ICH (unadjusted OR: 1.32, 95% CI 0.79\u20132.19), and symptomatic ICH (unadjusted OR: 0.94, 95% CI 0.70\u20131.25) for patients undergoing IVT with pre-stroke dementia versus those without. One EVT study (n\u2009=\u2009615 with dementia vs n\u2009=\u20099600 without) found no significant differences in outcomes apart from an increased odds of ICH for those with pre-existing dementia (adjusted OR: 1.57, 95% CI 1.03\u20132.40). A pooled analysis of three IVT studies showed no significant association of cognitive impairment (n\u2009=\u200993 vs n\u2009=\u2009211 without) with all assessed outcomes, whereas a study of EVT found that pre-stroke cognitive impairment was associated with poor 90-day outcomes (mRS 3\u20136).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These results suggest no substantial safety issues in the use of IVT or EVT for patients with pre-existing dementia or cognitive impairment compared to those without. However, the efficacy of these therapies in this demographic remains uncertain. Further rigorous studies that include a more nuanced outcome measurement approach are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>URL: https:\/\/www.crd.york.ac.uk\/PROSPERO\/ ; Unique identifier: CRD42021240499.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930231220186","type":"journal-article","created":{"date-parts":[[2023,12,3]],"date-time":"2023-12-03T22:46:22Z","timestamp":1701643582000},"page":"867-875","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Reperfusion therapies for ischemic stroke in dementia and cognitive impairment: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-2081","authenticated-orcid":false,"given":"Fouzi","family":"Bala","sequence":"first","affiliation":[{"name":"Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Betzner","sequence":"additional","affiliation":[{"name":"Departments of Clinical Neurosciences and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Beland","sequence":"additional","affiliation":[{"name":"Departments of Clinical Neurosciences and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-2070","authenticated-orcid":false,"given":"Aravind","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Departments of Clinical Neurosciences and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada"},{"name":"Matheson Centre for Mental Health Research and Education, O\u2019Brien Institute for Public Health, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"key":"bibr1-17474930231220186","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2014.06.019"},{"key":"bibr2-17474930231220186","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30442-3"},{"key":"bibr3-17474930231220186","volume":"50","author":"Powers 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