From the Guidelines
For a patient with memory loss and ischemia on MRI, neurology consultation should be obtained promptly, ideally within 1-2 weeks, though urgent consultation (within 24-48 hours) is warranted if symptoms are rapidly progressing or severe. This recommendation is based on the importance of early evaluation and management of vascular cognitive impairment, as highlighted in the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 1.
The key aspects of management include:
- Addressing vascular risk factors, such as hypertension, which can reduce the risk of dementia, with antihypertensive therapy considered for average diastolic blood pressure readings ≥90 mmHg and for average systolic blood pressure readings ≥140 mmHg 1
- Considering a systolic BP treatment target of <120 mmHg in middle-aged and older persons being treated for hypertension who have associated vascular risk factors, as it may be associated with a decreased risk of developing mild cognitive impairment 1
- Guideline-recommended treatments to prevent first-ever or recurrent stroke, as appropriate, should be provided to all patients with cognitive symptoms or impairment 1
- The use of aspirin is not recommended for patients with MCI or dementia who have brain imaging evidence of covert white matter lesions of presumed vascular origin without history of stroke or brain infarcts, but its use in patients with covert brain infarcts detected on neuroimaging without history of stroke is reasonable, although the benefit is unclear 1
- Cholinesterase inhibitors and the N-methyl-D-aspartate (NMDA) receptor antagonist memantine may be considered for the treatment of vascular cognitive impairment in selected patients 1
Early neurological intervention is crucial because prompt treatment of vascular risk factors can slow cognitive decline progression and potentially prevent further ischemic damage. Neurologists can effectively evaluate the extent and cause of ischemic changes, distinguish between vascular cognitive impairment and other dementia types, and develop appropriate management plans. Lifestyle modifications, including Mediterranean diet, regular exercise, smoking cessation, and limited alcohol consumption, are also essential, and cognitive rehabilitation may benefit some patients.
From the Research
Ischemia per MRI Results
- MRI results can help identify ischemia in patients with memory loss, and neurology consults can be effective in managing the condition 2.
- Non-contrast MRI sequences, such as T1-weighted imaging, T2-weighted imaging, and fluid-attenuated inversion recovery, can be used to evaluate ischemic stroke 2.
Effectiveness of Neurology Consults
- Neurology consults can be effective in reducing the risk of recurrent stroke in patients with acute ischemic stroke or transient ischemic attack 3, 4.
- Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA) 4.
- Prestroke concomitant statin and aspirin use is associated with lower neurological deterioration and platelet activity in patients with acute ischemic stroke 5.
Timing of Neurology Consults
- The golden hour is critical in managing acute ischemic stroke, and prompt diagnosis and treatment can improve patient outcomes 6.
- Neurology consults should be conducted as soon as possible after the patient presents with symptoms of ischemic stroke, ideally within the first hour of arrival at the hospital 6.
- Advanced MRI techniques, such as arterial spin labeling and MR spectroscopy, can provide valuable information for guiding treatment and predicting patient prognosis 2.