Research on the risk factors for cognitive impairment and their interactions in acute ischemic stroke patients_West China Medical Journal

Authors：

DUAN Yuanyuan ¹ , LIU Shenggang ¹ , XIAO Lei ¹ , DENG Xiaohong ¹ , WANG Yajun ¹ ,  LIU Hua ^1,2

1. Department of Neurology, Mianyang People’s Hospital, Mianyang, Sichuan 621000, P. R. China;
2. Department of Neurology, the Third People’s Hospital of Chengdu & the Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan 610031, P. R. China;

Corresponding author：

LIU Hua, Email: hxliumedidoctor@163.com

Keywords：

Ischemic stroke; cognitive impairment; risk factor; interaction

DOI：

10.7507/1002-0179.202303193

Video：

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Objective To evaluate the risk factors for cognitive impairment and their interactions in acute ischemic stroke (IS) patients. Methods IS patients admitted to the Department of Neurology, the People’s Hospital of Mianyang between January 2019 and January 2022 were selected. Patients were divided into a cognitive impairment group and a cognitive normal group. The demographic characteristics and clinical data of the subjects were collected, and the traditional risk factors for cognitive impairment were determined by univariate and multivariate logistic regression analysis. The multifactor dimensionality reduction test was used to detect the possible interactions between risk factors. Results A total of 255 patients were included. Among them, 88 cases (34.5%) in the cognitive impairment group and 167 cases (65.5%) in the cognitive normal group. The results of factor logistic regression analysis showed that after adjusting for covariates, big and medium infarction volume, severe IS, moderate to severe carotid artery stenosis as well as high hypersensitive C-reactive protein (hs-CRP) were associated with post-IS cognitive impairment (P<0.05). The cognitive impairment increased by 22.632 times [odds ratio=22.632, 95% confidence interval (5.980, 85.652), P<0.001] in patients with big and medium infarction volume, severe IS and high hs-CRP. Conclusions The cognitive impairment is common in acute IS. Patients with big and medium infarction volume, non-mild stroke, carotid artery stenosis, high hs-CRP, and non-right sided infarction are prone to cognitive impairment, and there are complex interactions among these risk factors.

Citation： DUAN Yuanyuan, LIU Shenggang, XIAO Lei, DENG Xiaohong, WANG Yajun, LIU Hua. Research on the risk factors for cognitive impairment and their interactions in acute ischemic stroke patients. West China Medical Journal, 2023, 38(5): 688-693. doi: 10.7507/1002-0179.202303193 Copy

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2.	Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
3.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in china: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
4.	Rost NS, Brodtmann A, Pase MP, et al. Post-stroke cognitive impairment and dementia. Circ Res, 2022, 130(8): 1252-1271.
5.	Hill J, Fillit H, Shah SN, et al. Patterns of healthcare utilization and costs for vascular dementia in a community-dwelling population. J Alzheimers Dis, 2005, 8(1): 43-50.
6.	Quinn TJ, Richard E, Teuschl Y, et al. European stroke organisation and European academy of neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol, 2021, 28(12): 3883-3920.
7.	Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med, 2014, 2(8): 80.
8.	史悦, 高小夏, 谈笑, 等. 中文版认知障碍简要测试量表与简易精神状态检查量表在脑卒中患者认知评估中的比较分析. 重庆医科大学学报, 2021, 46(11): 1310-1314.
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11.	Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
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13.	Kelly TN, Gu D, Chen J, et al. Cigarette smoking and risk of stroke in the Chinese adult population. Stroke, 2008, 39(6): 1688-1693.
14.	中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南(2016 年修订版). 中国循环杂志, 2016, 31(10): 937-953.
15.	Chen C, Lu FC; Department of Disease Control Ministry of Health, PR China. The guidelines for prevention and control of overweight and obesity in Chinese adults. Biomed Environ Sci, 2004, 17(Suppl 1): 1-36.
16.	North American Symptomatic Carotid Endarterectomy Trial Collaborators; Barnett HJM, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med, 1991, 325(7): 445-453.
17.	Pullicino P, Nelson RF, Kendall BE, et al. Small deep infarcts diagnosed on computed tomography. Neurology, 1980, 30(10): 1090-1096.
18.	Hahn LW, Ritchie MD, Moore JH. Multifactor dimensionality reduction software for detecting gene-gene and gene-environment interactions. Bioinformatics, 2003, 19(3): 376-382.
19.	Makin SD, Turpin S, Dennis MS, et al. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry, 2013, 84(8): 893-900.
20.	Droś J, Klimkowicz-Mrowiec A. Current view on post-stroke dementia. Psychogeriatrics, 2021, 21(3): 407-417.
21.	Li P, Quan W, Lu D, et al. Association between metabolic syndrome and cognitive impairment after acute ischemic stroke: a cross-sectional study in a Chinese population. PloS One, 2016, 11(12): e0167327.
22.	Yu S, Cui W, Han J, et al. Longitudinal change of Th1, Th2, and Th17 cells and their relationship between cognitive impairment, stroke recurrence, and mortality among acute ischemic stroke patients. J Clin Lab Anal, 2022, 36(7): e24542.
23.	Shang T, Ma B, Shen Y, et al. High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: a single-center retrospective study in China. Front Neurol, 2022, 13: 907486.
24.	Chibber S, Alexiou A, Alama MN, et al. A synopsis on the linkage between age-related dementias and vascular disorders. CNS Neurol Disord Drug Targets, 2016, 15(2): 250-258.
25.	Shen J, Tozer DJ, Markus HS, et al. Network efficiency mediates the relationship between vascular burden and cognitive impairment: a diffusion tensor imaging study in UK Biobank. Stroke, 2020, 51(6): 1682-1689.
26.	Pendlebury ST, Rothwell PM; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based oxford vascular study. Lancet Neurol, 2019, 18(3): 248-258.
27.	Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 1993, 43(2): 250-260.
28.	Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol, 2009, 8(11): 1006-1018.
29.	Zheng F, Xie W. High-sensitivity C-reactive protein and cognitive decline: the English longitudinal study of ageing. Psychol Med, 2018, 48(8): 1381-1389.
30.	Alexandrova ML, Danovska MP. Cognitive impairment one year after ischemic stroke: predictors and dynamics of significant determinants. Turk J Med Sci, 2016, 46(5): 1366-1373.
31.	Zhang X, Bi X. Post-stroke cognitive impairment: a review focusing on molecular biomarkers. J Mol Neurosci, 2020, 70(8): 1244-1254.
32.	Lal BK, Dux MC, Sikdar S, et al. Asymptomatic carotid stenosis is associated with cognitive impairment. J Vasc Surg, 2017, 66(4): 1083-1092.
33.	Yue W, Wang A, Zhu R, et al. Association between carotid artery stenosis and cognitive impairment in stroke patients: a cross-sectional study. PLoS One, 2016, 11(1): e0146890.
34.	Wang Y, Li C, Ding M, et al. Carotid atherosclerotic calcification characteristics relate to post-stroke cognitive impairment. Front Aging Neurosci, 2021, 13: 682908.
35.	Shabir O, Berwick J, Francis SE. Neurovascular dysfunction in vascular dementia, Alzheimer’s and atherosclerosis. BMC Neurosci, 2018, 19(1): 62.
36.	Girouard H, Iadecola C. Neurovascular coupling in the normal brain and in hypertension, stroke, and Alzheimer disease. J Appl Physiol (1985), 2006, 100(1): 328-335.
37.	Jefferson AL, Cambronero FE, Liu D, et al. Higher aortic stiffness is related to lower cerebral blood flow and preserved cerebrovascular reactivity in older adults. Circulation, 2018, 138(18): 1951-1962.

1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update: a report from the American heart association. Circulation, 2022, 145(8): e153-e639.
2. Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
3. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in china: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
4. Rost NS, Brodtmann A, Pase MP, et al. Post-stroke cognitive impairment and dementia. Circ Res, 2022, 130(8): 1252-1271.
5. Hill J, Fillit H, Shah SN, et al. Patterns of healthcare utilization and costs for vascular dementia in a community-dwelling population. J Alzheimers Dis, 2005, 8(1): 43-50.
6. Quinn TJ, Richard E, Teuschl Y, et al. European stroke organisation and European academy of neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol, 2021, 28(12): 3883-3920.
7. Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med, 2014, 2(8): 80.
8. 史悦, 高小夏, 谈笑, 等. 中文版认知障碍简要测试量表与简易精神状态检查量表在脑卒中患者认知评估中的比较分析. 重庆医科大学学报, 2021, 46(11): 1310-1314.
9. 中国高血压防治指南修订委员会. 中国高血压防治指南 2010. 中华心血管病杂志, 2011, 39(7): 579-616.
10. 中华医学会内分泌学分会. 中国高尿酸血症与痛风诊疗指南(2019). 中华内分泌代谢杂志, 2020, 36(1): 1-13.
11. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
12. Chalmers J, MacMahon S, Mancia G, et al. 1999 World Health Organization-international society of hypertension guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens., 1999, 21(5/6): 1009-1060.
13. Kelly TN, Gu D, Chen J, et al. Cigarette smoking and risk of stroke in the Chinese adult population. Stroke, 2008, 39(6): 1688-1693.
14. 中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南(2016 年修订版). 中国循环杂志, 2016, 31(10): 937-953.
15. Chen C, Lu FC; Department of Disease Control Ministry of Health, PR China. The guidelines for prevention and control of overweight and obesity in Chinese adults. Biomed Environ Sci, 2004, 17(Suppl 1): 1-36.
16. North American Symptomatic Carotid Endarterectomy Trial Collaborators; Barnett HJM, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med, 1991, 325(7): 445-453.
17. Pullicino P, Nelson RF, Kendall BE, et al. Small deep infarcts diagnosed on computed tomography. Neurology, 1980, 30(10): 1090-1096.
18. Hahn LW, Ritchie MD, Moore JH. Multifactor dimensionality reduction software for detecting gene-gene and gene-environment interactions. Bioinformatics, 2003, 19(3): 376-382.
19. Makin SD, Turpin S, Dennis MS, et al. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry, 2013, 84(8): 893-900.
20. Droś J, Klimkowicz-Mrowiec A. Current view on post-stroke dementia. Psychogeriatrics, 2021, 21(3): 407-417.
21. Li P, Quan W, Lu D, et al. Association between metabolic syndrome and cognitive impairment after acute ischemic stroke: a cross-sectional study in a Chinese population. PloS One, 2016, 11(12): e0167327.
22. Yu S, Cui W, Han J, et al. Longitudinal change of Th1, Th2, and Th17 cells and their relationship between cognitive impairment, stroke recurrence, and mortality among acute ischemic stroke patients. J Clin Lab Anal, 2022, 36(7): e24542.
23. Shang T, Ma B, Shen Y, et al. High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: a single-center retrospective study in China. Front Neurol, 2022, 13: 907486.
24. Chibber S, Alexiou A, Alama MN, et al. A synopsis on the linkage between age-related dementias and vascular disorders. CNS Neurol Disord Drug Targets, 2016, 15(2): 250-258.
25. Shen J, Tozer DJ, Markus HS, et al. Network efficiency mediates the relationship between vascular burden and cognitive impairment: a diffusion tensor imaging study in UK Biobank. Stroke, 2020, 51(6): 1682-1689.
26. Pendlebury ST, Rothwell PM; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based oxford vascular study. Lancet Neurol, 2019, 18(3): 248-258.
27. Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 1993, 43(2): 250-260.
28. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol, 2009, 8(11): 1006-1018.
29. Zheng F, Xie W. High-sensitivity C-reactive protein and cognitive decline: the English longitudinal study of ageing. Psychol Med, 2018, 48(8): 1381-1389.
30. Alexandrova ML, Danovska MP. Cognitive impairment one year after ischemic stroke: predictors and dynamics of significant determinants. Turk J Med Sci, 2016, 46(5): 1366-1373.
31. Zhang X, Bi X. Post-stroke cognitive impairment: a review focusing on molecular biomarkers. J Mol Neurosci, 2020, 70(8): 1244-1254.
32. Lal BK, Dux MC, Sikdar S, et al. Asymptomatic carotid stenosis is associated with cognitive impairment. J Vasc Surg, 2017, 66(4): 1083-1092.
33. Yue W, Wang A, Zhu R, et al. Association between carotid artery stenosis and cognitive impairment in stroke patients: a cross-sectional study. PLoS One, 2016, 11(1): e0146890.
34. Wang Y, Li C, Ding M, et al. Carotid atherosclerotic calcification characteristics relate to post-stroke cognitive impairment. Front Aging Neurosci, 2021, 13: 682908.
35. Shabir O, Berwick J, Francis SE. Neurovascular dysfunction in vascular dementia, Alzheimer’s and atherosclerosis. BMC Neurosci, 2018, 19(1): 62.
36. Girouard H, Iadecola C. Neurovascular coupling in the normal brain and in hypertension, stroke, and Alzheimer disease. J Appl Physiol (1985), 2006, 100(1): 328-335.
37. Jefferson AL, Cambronero FE, Liu D, et al. Higher aortic stiffness is related to lower cerebral blood flow and preserved cerebrovascular reactivity in older adults. Circulation, 2018, 138(18): 1951-1962.

West China Medical Journal

Research on the risk factors for cognitive impairment and their interactions in acute ischemic stroke patients

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