The Impact of Homocysteine, Vitamin B12, and Vitamin D Levels on Functional Outcome after First-Ever Ischaemic Stroke

Abstract

We explored the relationship between acute ischaemic stroke (IS) early functional outcome and serum levels of homocysteine, vitamin B12, and D in a noninterventional prospective clinical study. We enrolled 50 patients with first-ever IS and performed laboratory tests and functional assessment at three time points: on admission and three and six months after stroke. Modified Rankin Scale (mRS), NIHSS scale, and Barthel index (BI) scores were assessed in all participants by trained examiner blinded to laboratory data. Patients did not receive treatment that might alter laboratory data. Admission NIHSS correlated with homocysteine levels (r = 0.304, p < 0.05), B12 level (r = −0.410, p < 0.01), and vitamin D levels (r = −0.465, p < 0.01). Functional outcome measures (BI and mRS) did not significantly correlate with homocysteine and vitamin D3 levels at 3 and 6 months. However, a positive correlation with vitamin B12 levels was detected for BI both at 3 and 6 months and mRS at 6 months. Higher serum vitamin B12 levels were associated with better functional outcome at follow-up.

Vitamin D and Rehabilitation after Stroke: Status of Art

“…At admission, the NIH Stroke Scale (NIHSS) negatively correlated with vitamin D, suggesting that major impairment after stroke correlated with lower levels of vitamin D; adjusting for age and the baseline NIHSS values, a trend in correlations were found between functional outcomes at all timepoints (Barthel index and modified ranking scale) and vitamin D levels. Authors highlighted that they included only surviving patients in the final analysis, so no data about vitamin D levels in dead patients were reported, not allowing a correct evaluation [14]. Moreover, a noteworthy aspect of this study [14] was that vitamin D level increased during the follow-up, whereas no supplementations were administered; authors properly suggested that secondary dietary changes could have contributed to these results which they did not evaluate.…”

“…Vitamin D and risk of stroke [16,[57][58][59][60][61][62][63][64][65][66] Vitamin D and outcome of stroke [3,[11][12][13][14][15][67][68][69][70][71] Supplementation of Vitamin D and post-stroke recovery [67,72,73] Vitamin D and rehabilitation after stroke [3,[12][13][14][15]74] Appl. Sci.…”

“…Markisic et al [14] analyzed the influence of Vitamin D levels on functional outcomes after first-ever ischemic stroke, at 3 months and 6 months from stroke. The functional outcomes were evaluated and measured with the Barthel index and Modified Ranking Scale, including scale of performance in ability of daily living, and neurological disability, respectively.…”

“…Therefore, further studies are necessary on stroke patients undergoing rehabilitation treatment, including: (a) the measurement of the 25(OH) vitamin D serum concentrations at admission and post rehabilitation treatment; (b) the identification of the presence/absence of CYP2R1, CYP27B1, CYP24A1 and VDR polymorphisms, and (c) analysis of the methylation levels of these genes pre-and post-rehabilitation treatment.In a recent meta-analysis, a relationship between vitamin D deficiency and stroke severity at onset, risk of stroke, and functional outcome at the follow-up was reported [11]. Few studies evaluated patients undergoing rehabilitation treatment, or vitamin D levels before and after rehabilitation treatment [12][13][14][15]. Therefore, we believe that the relationship between vitamin D levels and rehabilitation outcome is topic that needs to be explored.This literature review, shows: (a) an overview of the metabolism and the genetic/epigenetic aspects of vitamin D, (b) the relationship between vitamin D deficiency and stroke as risk, severity, and outcome, and (c) the influence of vitamin D levels and recovery in post-stroke patients undergoing rehabilitation treatment.…”

“…In a recent meta-analysis, a relationship between vitamin D deficiency and stroke severity at onset, risk of stroke, and functional outcome at the follow-up was reported [11]. Few studies evaluated patients undergoing rehabilitation treatment, or vitamin D levels before and after rehabilitation treatment [12][13][14][15]. Therefore, we believe that the relationship between vitamin D levels and rehabilitation outcome is topic that needs to be explored.…”