# Preexisting cognitive impairment in patients with acute stroke

## TL;DR

Preexisting cognitive impairment in stroke patients leads to worse outcomes and less access to treatments, highlighting the need for better care strategies.

## Contribution

The paper emphasizes the underappreciated impact of preexisting cognitive impairment on stroke management and outcomes.

## Key findings

- Patients with preexisting cognitive impairment have less access to stroke units and revascularization therapies.
- Prestroke cognitive impairment is linked to greater clinical severity, complications, and poorer survival.
- These patients face reduced rehabilitation access and higher institutionalization needs due to comorbidities and frailty.

## Abstract

Preexisting cognitive impairment is a significant but often overlooked factor in the management and outcome of stroke patients. Patients with prior cognitive impairment suffering a stroke have less access to stroke units, and less administration of acute revascularization therapies, as a possible consequence of limited research on the benefits of these treatments in this specific population, with most data coming from observational studies. Prestroke cognitive impairment is associated with a greater clinical severity at onset, increased complications, and poorer survival and functional outcome, with a reduced access to rehabilitation services, and a greater need for institutionalization. Patients with preexisting cognitive impairment have more prevalent comorbidities and frailty, which contribute to their increased vulnerability to adverse health outcomes. Further research is needed to better understand how these factors may influence clinical outcomes and decision-making in stroke care in patients with neurocognitive disorders. More inclusive clinical trials and standardized assessment strategies to guide optimal care for this vulnerable population are required. This will be crucial in adapting healthcare systems to meet the needs of a growing and aging population.