Serum BDNF’s Role as a Biomarker for Motor Training in the Context of AR-Based Rehabilitation after Ischemic Stroke

Abstract

Background: brain-derived neurotrophic factor (BDNF) may play a role during neurorehabilitation following ischemic stroke. This study aimed to elucidate the possible role of BDNF during early recovery from ischemic stroke assisted by motor training. Methods: fifty patients were included after acute recovery from ischemic stroke: 21 first received classical rehabilitation followed by ‘motor rehabilitation using motion sensors and augmented reality’ (AR-rehabilitation), 14 only received AR-rehabilitation, and 15 were only observed. Serum BDNF levels were measured on the first day of stroke, on the 14th day, before AR-based rehabilitation (median, 45th day), and after the AR-based rehabilitation (median, 82nd day). Motor impairment was quantified clinically using the Fugl–Meyer scale (FMA); functional disability and activities of daily living (ADL) were measured using the Modified Rankin Scale (mRS). For comparison, serum BDNF was measured in 50 healthy individuals. Results: BDNF levels were found to significantly increase during the phase with AR-based rehabilitation. The pattern of the sequentially measured BDNF levels was similar in the treated patients. Untreated patients had significantly lower BDNF levels at the endpoint. Conclusions: the fluctuations of BDNF levels are not consistently related to motor improvement but seem to react to active treatment. Without active rehabilitation treatment, BDNF tends to decrease.

Biomarkers of Angiogenesis and Neuroplasticity as Promising Clinical Tools for Stroke Recovery Evaluation

“…[35] BDNF Useful post-stroke recovery marker due to its broad neurotrophic activity and changes in its plasma concentration during recovery. [46,47,54,55] The level of BDNF does not differ between sex, age and the initial severity of stroke. [55] The correlation between low serum BDNF levels in the first day after stroke correlates with the poorer long-term functional prognosis.…”

“…[46,47,54,55] The level of BDNF does not differ between sex, age and the initial severity of stroke. [55] The correlation between low serum BDNF levels in the first day after stroke correlates with the poorer long-term functional prognosis. [50][51][52] The positive correlation between serum BDNF level with function and mental status in post-stroke patients.…”

“…On the other hand, Stanne et al found that a decreased BDNF level after hospital admission was associated with a poor functional outcome in both two years (score 3–6 on the mRS scale) and seven years (3–5 mRS) after stroke [ 52 ]. Moreover, it has been shown that the level of BDNF increases significantly after physical rehabilitation, regardless of the type of therapy [ 54 , 55 ]. Koroleva et al demonstrated that active rehabilitation favored the increase of BDNF and functional improvement of patients; while in patients without rehabilitation, the BDNF concentration tended to decrease [ 55 ].…”

“…Moreover, it has been shown that the level of BDNF increases significantly after physical rehabilitation, regardless of the type of therapy [ 54 , 55 ]. Koroleva et al demonstrated that active rehabilitation favored the increase of BDNF and functional improvement of patients; while in patients without rehabilitation, the BDNF concentration tended to decrease [ 55 ]. Moreover, it has also been shown that an increase in BDNF levels was conducive to the improvement of post-stroke depression, including estrogen therapy [ 56 ] and physical rehabilitation [ 57 ].…”

Are Sarcopenia and Cognitive Dysfunction Comorbid after Stroke in the Context of Brain–Muscle Crosstalk?

“…An integrative review has reported lower BDNF levels in patients with stroke [ 49 ]; in one data-driven study, stroke patients with low levels of serum BDNF had significantly higher prevalence of cognitive dysfunction than healthy controls. Another study found that BDNF levels increased during motor rehabilitation following ischemic stroke [ 50 ]. A randomised controlled trial (RCT) in Taiwan compared the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training on serum BDNF and other outcomes in stroke patients.…”