Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack

Abstract

Purpose To investigate the associations among homocysteine (Hcy), inflammation and cognitive impairment in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). Patients and Methods Patients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). We used a Chinese version of Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. We used high-sensitivity C-reactive protein (hsCRP) level to reflect the inflammatory status, which was assessed at baseline together with Hcy concentration. The primary outcome was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after AIS and TIA. Multivariable logistic regression analysis was used to evaluate the correlation between Hcy and hsCRP, and their effects on cognition. Results We enrolled 1466 patients with a median age of 62 (54–70) years old, including 895 (61.05%) patients with elevated Hcy levels, 466 (31.79%) with increased hsCRP concentrations, and 755 (51.50%) with PSCI. In the group of patients with hyperhomocysteinemia (HHcy), higher hsCRP levels were related to cognitive impairment, whether or not adjusted for multiple potential confounders (crude OR: 1.71,95% CI: 1.29–2.27, p < 0.01; adjusted OR: 1.42, 95% CI: 1.04–1.93, p = 0.03). No significant interactions for the impact on PSCI were observed in subgroups stratified by age, sex or Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (P interaction > 0.05 for all). Conclusion High inflammatory levels increase the risk of cognitive impairment in HHcy patients after AIS and TIA.

Examining the Associations between Post-Stroke Cognitive Function and Common Comorbid Conditions among Stroke Survivors

“…While we found that no singular comorbid condition was associated with post-stroke cognitive decline, as measured by MoCA or MMSE, the total scores were associated with cognitive decline and, therefore, may be indicative of a cumulative, rather than singular, burden. This is not an entirely novel finding in the literature [ 24 , 25 ]; however, the perspective in the literature, when it comes to correlations between disease states and cognitive function, is quite narrow. For example, studies often illustrate the differences in cognitive outcomes, depending on singular inflammatory conditions, such as diabetes [ 26 ], metabolic syndrome [ 27 ], obstructive sleep apnea [ 28 ], and hypertension [ 14 , 29 ], rather than a collective burden of multiple comorbid conditions.…”

Systemic immune-inflammation index upon admission correlates to post-stroke cognitive impairment in patients with acute ischemic stroke

“…Previous studies have revealed that systemic inflammation processes are closely related to endothelial dysfunction, cell death, blood-brain barrier (BBB) disruption, cerebral blood flow autoregulation disorder and platelet aggregation [ 5 , 13 ]. Studies consecutively showed that PSCI was associated with some inflammatory biomarkers and cytokines [ 14 , 15 ]. Otherwise, as important primary immune mediators that can release inflammatory signals, infiltrating leukocytes, including neutrophils, monocytes, and lymphocytes, have been reported to be related to stroke and dementia [ 16 , 17 ].…”

Analysis of risk factors for the development of cognitive dysfunction in patients with cerebral small vessel disease and the construction of a predictive model

“…Hcy is a sulfur-containing amino acid produced during methionine metabolism, which generates oxygen radicals with strong oxidative effects on vascular endothelial cells and is defined as a reactive vascular damage amino acid ( 32 ). High Hcy can cause endothelial dysfunction in the body and plays an important role in the pathogenesis of neurological disorders such as stroke and cognitive impairment.…”