Leukoaraiosis Mediates the Association of Total White Blood Cell Count With Post-Stroke Cognitive Impairment

Shan, Wanying; Xu, Liang; Xu, Yuan; Zhuo-yin, Qiu; Jiang, Feng; Zhao, Jie; Wang, Jingwen

doi:10.3389/fneur.2021.793435

Cited by 2 publications

(2 citation statements)

References 39 publications

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“…Both positive and null associations with PSCI acutely and at 6 months have been reported for CRP 18 , 19 and WCC. 51 , 52 Elevated NLR has been shown to be associated with global impairment at 3 months and visuospatial and memory domain impairment (NLR ≥3.80) 17 and executive dysfunction (Montreal Cognitive Assessment) (NLR ≥4.05). 53 However, the sample characteristics and type/timing of cognitive assessment differed among studies.…”

Section: Discussionmentioning

confidence: 99%

Infection, Inflammation, and Poststroke Cognitive Impairment

Milosevich,

Demeyere,

Pendlebury

2024

JAHA

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Background Infection and inflammation are dementia risk factors in population‐based cohorts; however, studies in stroke are scarce. We determined the prevalence of infection after stroke and routinely measured inflammatory biomarkers during hospitalization and their associations with acute and 6‐month cognitive impairment. Methods and Results A prospective stroke cohort completed the Oxford Cognitive Screen at ≤2 weeks and 6 months after stroke. Infection, inflammatory markers (C‐reactive protein, white cell count, and neutrophil/lymphocyte ratio), and systemic inflammatory response syndrome were ascertained throughout admission with electronic patient records supplemented by hand searches. Associations with acute and 6‐month global and domain‐specific cognitive impairment were analyzed using multivariable regression, adjusting for demographic/vascular factors and stroke severity. Among 255 patients (mean age, 73.9 [SD, 12.6] years; 46.3% women; mean education, 12.6 [SD, 3.7] years; median National Institutes of Health Stroke Scale score 5 [range, minimum‐maximum, 0–30]), infection was present in 90 patients (35.3%) at mean 4.4 (SD, 6.9) days after stroke, consisting predominantly of pneumonia (47/90; 52%) and urinary tract infection (39/90; 43%). Admission white cell count was elevated in 25.1% (n=64; mean, 9.5×10 9 /L [SD, 3.2×10 9 /L]), C‐reactive protein in 41.2% (n=105; mean, 27.5 [SD, 50.9 mg/L]), neutrophil/lymphocyte ratio in 55.7% (n=97; mean, 5.5 [SD, 4.5]), and systemic inflammatory response syndrome in 26.6% (n=53 [45.2%] positive during hospitalization). Infection was associated with acute and 6‐month poststroke cognitive impairment ( P <0.05 adj ) with stronger associations acutely for severe infection (infection+systemic inflammatory response syndrome; P =0.03 adj ). Acute language, executive function and attention domain impairments, and 6‐month number processing impairment were associated with infection ( P <0.05 adj ). No significant relationships were found for any biomarker and cognitive impairment. Conclusions Infection and elevations in routinely measured inflammatory biomarkers are common following stroke; however, only infection is associated with poststroke cognitive impairment, suggesting that increases in these biomarkers may be nonspecific. Infection may present a tractable target for reducing poststroke cognitive impairment.

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Section: Discussionmentioning

confidence: 99%

Infection, Inflammation, and Poststroke Cognitive Impairment

Milosevich,

Demeyere,

Pendlebury

2024

JAHA

View full text Add to dashboard Cite

show abstract

“…Both positive and null associations with PSCI acutely and at 6-months have been reported for CRP [18][19] and WCC. 52,53 Elevated NLR has been shown to be associated with global impairment at 3-months and visuospatial and memory domain impairment (NLR≥3.80), 17 and executive dysfunction (MoCA) (NLR≥4.05). 54 However, the sample characteristics and type/timing of cognitive assessment differed between studies.…”

Section: Discussionmentioning

confidence: 99%

Infection, inflammation and post-stroke cognitive impairment

Milosevich

Demeyere

Pendlebury

2023

Preprint

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Background Infection and inflammation are risk factors for dementia in population-based cohorts, however studies in stroke are scarce. We determined the prevalence of stroke-associated infection and routinely measured inflammatory biomarkers during hospitalization for stroke, and their associations with global and domain-specific cognition acutely and at 6-months. Methods A prospective stroke cohort completed the Oxford Cognitive Screen ≤2 weeks and at 6 months. Global post-stroke cognitive impairment (PSCI) was defined as proportion of domains impaired and domain-specific impairment was binarized as present/absent. Infection, inflammatory markers (C-reactive protein-CRP, white cell count-WCC, and neutrophil/lymphocyte ratio-NLR), and systemic inflammatory response syndrome-SIRS, were ascertained throughout admission through linkage to electronic patient records-EPRs supplemented by hand-searches. Associations of infection, inflammatory markers, and SIRS, with acute and 6-month global and domain-specific cognitive impairment were analyzed using multivariable regression adjusting for demographic/vascular factors and stroke severity. Results Among 255 patients (mean/SD age=73.9/12.6 years, 46.3% female, mean/SD education=12.6/3.7 years, median NIHSS=5, range 0-30), infection was present in 90 (35.3%) patients at mean/SD 4.4/6.9 days post-stroke, most commonly pneumonia (47/90, 52%) and urinary tract infection (39/90, 43%). Admission WCC was elevated in 64 (25.1%, mean/SD=9.5/3.2x109/L), CRP in 105 (41.2%, mean/SD=27.5/50.9 mg/L), NLR in 97 (55.7%, mean/SD=5.5/4.5) and SIRS in 53 (26.6% with 45.2% positive overall during admission). Infection was associated with acute and 6-month PSCI (p<0.05adj) with stronger associations acutely for severe infection (infection+SIRS,p=0.02adj). Acute impairments in language, executive function and attention domains and 6-month impairment in number processing (allp<0.05adj) were associated with infection. No significant relationships were found for any biomarker and cognitive impairment. Conclusion Infection and elevations in routinely measured inflammatory biomarkers are common after stroke, however only infection is a risk factor for PSCI, suggesting that the rise in these biomarkers may be non-specific. Infection may present a tractable target for reducing PSCI.

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Leukoaraiosis Mediates the Association of Total White Blood Cell Count With Post-Stroke Cognitive Impairment

Cited by 2 publications

References 39 publications

Infection, Inflammation, and Poststroke Cognitive Impairment

Infection, Inflammation, and Poststroke Cognitive Impairment

Infection, inflammation and post-stroke cognitive impairment

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