How does premorbid dementia affect your decision to offer acute stroke intervention?

I would try to engage the family, along with the patient, about goals of care, quality of life before the stroke, whether APOE status is known (E4E4 is a contraindication for tenecteplase), etc. This would lead to a decision about aggressive therapy, tenecteplase and/or endovascular therapy.

Previou...

Receiving a report on an acute stroke patient with "dementia" often feels like an umbrella term and, in my experience, tends to serve more as a label than an accurate reflection of their baseline cognitive function. Ideally, having enough clinical information to classify cognitive impairment as mild...

I still offer the acute thrombolytic treatment to the legally authorized representative and the patient. However, I do discuss risks and benefits and expected outcomes in the setting of dementia. For thrombectomy, I take the mRS (per thrombectomy trials) into account and discuss it with INR colleagu...

This question assumes that acute treatment of stroke in an ED includes the patient’s history and recognition that the patient has dementia never mind if it’s mild, moderate, or severe. I don’t think it happens generally speaking if one takes a survey of patients who present to the ED with a stroke. ...

Yes, in most cases.