Association Between Serum Uric Acid Levels and Cognitive Function in Patients with Ischemic Stroke and Transient Ischemic Attack (TIA): A 3-Month Follow-Up Study

Abstract

Purpose Cognitive impairment is a common complication after stroke and transient ischemic attack (TIA). The relationship between serum uric acid (SUA) and post-stroke cognitive impairment (PSCI) is controversial. This study evaluated the association of different SUA levels in the normal range and PSCI at 3 months. Patients and Methods A total of 1523 patients with ischemic stroke/TIA were recruited from the Impairment of Cognition and Sleep (ICONS) subgroup of the China National Stroke Registry-3 (CNSR-3). SUA concentration was assessed at baseline. Global cognitive status was evaluated using the Montreal Cognitive Assessment (MoCA). The main clinical outcome was the incidence of PSCI assessed at 3 months after stroke/TIA. The association between SUA status and the risk of PSCI was assessed with multiple regression models adjusted for potential covariates. Results Among the 1523 patients (1391 (91.33%) stroke patients and 132 (8.67%) TIA patients), 747 (49.05%) patients had PSCI at 3 months. Compared to the reference group, there was an increased risk of PSCI in males with SUA levels in the first (OR=1.76) and fourth quartiles (OR=1.47). A U-shaped association between SUA levels and the incidence of PSCI with an inflection point of 297 mmol/L was also found in males. However, there was no association between SUA levels and PSCI in females. Conclusion The association between SUA and PSCI differed between males and females. In males, both low and high SUA levels were associated with relatively higher incidences of PSCI, supporting a U-shaped association between SUA levels and PSCI.

Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis

“…Evaluation of cognitive function after AIS was performed during the hospitalization in six studies 20 22 24 25 26 27 , and during follow-up after discharge in the other five studies 21 23 28 29 30 . Diagnosis of PSCI was based on the Mini-mental State Examination (MMSE) in two studies 20 28 , the Montreal Cognitive Assessment (MoCA) in seven studies 21 22 24 25 26 29 30 , and MMSE or MoCA in one study 27 . The other study reported two datasets of serum UA values for PSCI diagnosed with MMSE and MoCA, separately 23 .…”

“…Five studies 25 26 27 29 30 with 2679 patients with AIS reported the risk of PSCI comparing between AIS patients with higher versus lower serum UA at admission. Pooled results showed that higher serum UA was associated with PSCI in patients with AIS (OR: 1.33, 95% CI: 1.02 to 1.73, p=0.04; I 2 =72%; Fig.…”

“…UA after AIS may be associated with PSCI [19]. However, results of previous studies comparing the serum level of US between patients with and without PSCI showed inconsistent results [20][21][22][23][24][25][26][27][28][29][30], and the association between serum UA and PSCI in patients with AIS remains to be determined. Therefore, in this study, we performed a meta-analysis to systematically evaluate the association between serum UA and PSCI in patients with AIS.…”

“…1. Finally, eleven observational studies [20][21][22][23][24][25][26][27][28][29][30] were available for the meta-analysis.…”

“…As shown in ▶table 1, a total of 11 observational studies, including five case-control studies [20,22,[24][25][26], five prospective studies [21,23,[27][28][29], and one retrospective study [30] were included in the meta-analysis. These studies were all performed in China, and published between 2018 and 2011.…”