Neurology

Stroke severity strongly predicts dementia and accelerates multidomain cognitive decline

In pooled US cohorts of 42,342 adults without baseline stroke or dementia, incident ischemic stroke markedly increased dementia risk versus no stroke. Dementia hazard rose stepwise with NIHSS category: minor, mild–moderate, and moderate–severe strokes had adjusted hazard ratios of 1.93, 3.26, and 5.06. Higher stroke severity produced progressively steeper declines in global cognition and memory than in participants without stroke over long-term follow-up. These data support using NIHSS at index stroke to counsel patients about dementia risk and to prioritize secondary prevention and cognitive monitoring. 1

Chronic subdural hematoma surgery carries durable excess mortality and cognitive burden

In 359 surgically treated cSDH patients (mean age 73.4 years), long-term survival was significantly worse than matched population controls. Overall mortality risk was approximately doubled, with absolute survival deficits at 1, 5, and 10 years after surgery. Among survivors, health-related quality of life and cognitive functioning remained impaired at about 10 years compared with European reference values. These findings justify frank preoperative counseling about long-term prognosis and support structured cognitive and functional follow-up after cSDH surgery. 2

In minor stroke with occlusion, tenecteplase harms outcomes in patients older than 80

This post hoc TEMPO-2 analysis compared tenecteplase vs nonthrombolytic care in 884 patients with minor ischemic stroke and occlusion or perfusion lesion. Among patients >80 years, tenecteplase improved early recanalization and NIHSS=0 at 5 days but worsened 90-day mRS outcomes versus standard care. In those >80, serious adverse events, particularly hemorrhages and stroke progression or recurrence, were significantly more frequent with tenecteplase. Patients ≤80 years showed similar functional outcomes with or without tenecteplase, despite better recanalization with treatment. For very old patients with minor stroke, these data argue against routine IV tenecteplase despite attractive early imaging and NIHSS responses. 3