Zuo Lijun, Dong Yanhong, Pan Yuesong, Yan Hongyi, Meng Xia, Li Hao, Zhao Xingquan, Wang Yilong, Wang Yongjun, Liao Xiaoling
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore, 117597, Singapore.
Neuropsychiatr Dis Treat. 2023 Jul 5;19:1543-1554. doi: 10.2147/NDT.S412825. eCollection 2023.
Cognitive impairment after stroke/transient ischemic attack (TIA) has a high prevalence. Cystatin C (CysC) has been found as a novel biomarker of neurodegenerative diseases, such as dementia and Alzheimer's disease. We aimed to explore the possible correlations of serum CysC level with cognitive impairment in patients who had mild ischemic stroke and TIA after 1 year.
We measured serum CysC level in 1025 participants with a minor ischemic stroke/TIA from enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were divided into four groups according to quartiles of baseline CysC levels. Patients' cognitive functions were assessed by Montreal Cognitive Assessment (MoCA)-Beijing at day 14 and at 1 year. Multiple logistic regression models were performed to evaluate the relationship between CysC and post-stroke cognitive impairment (PSCI) at 1-year follow-up.
Cognitive impairment was defined as MoCA-Beijing ≤22. Most patients were in 60s (61.52±10.97 years old) with a median (interquartile range) National Institute of Health Stroke Scale(NIHSS) score of 3.00 (4.00) and greater than primary school level of education, and 743 participants (72.49%) were male. Among the 1025 participants, 331 participants (32.29%) patients suffered PSCI at 1-year follow-up. A U-shaped association was observed between CysC and 1-year PSCI [quartile (Q)1 vs Q3: adjusted odds ratio (aOR) 2.69, 95% CI 1.67-4.34, p < 0.0001; Q2 vs Q3: aOR 1.63, 95% CI 1.03-2.57, p = 0.0354; Q4 vs Q3: aOR 1.83, 95% CI 1.16-2.87, p = 0.009]. Moreover, the U-shaped trends were also found between CysC level and the subscores of attention, recall, abstraction and language in MoCA.
CysC showed a U-shaped correlation with 1-year overall cognitive function. It is probable that measurement of the serum CysC level would aid in the early diagnosis of PSCI.
中风/短暂性脑缺血发作（TIA）后认知障碍的患病率很高。胱抑素C（CysC）已被发现是神经退行性疾病（如痴呆和阿尔茨海默病）的一种新型生物标志物。我们旨在探讨轻度缺血性中风和TIA患者1年后血清CysC水平与认知障碍之间的可能相关性。
我们在中国国家卒中登记-3（CNSR-3）的认知与睡眠障碍（ICONS）研究中，对1025例轻度缺血性中风/TIA参与者的血清CysC水平进行了测量。根据基线CysC水平的四分位数将他们分为四组。在第14天和1年时，通过蒙特利尔认知评估（MoCA）-北京版对患者的认知功能进行评估。采用多元逻辑回归模型评估1年随访时CysC与中风后认知障碍（PSCI）之间的关系。
认知障碍定义为MoCA-北京版评分≤22分。大多数患者年龄在60多岁（61.52±10.97岁），美国国立卫生研究院卒中量表（NIHSS）评分中位数（四分位间距）为3.00（4.00），受教育程度高于小学水平，743名参与者（72.49%）为男性。在1025名参与者中，331名参与者（32.29%）在1年随访时患有PSCI。观察到CysC与1年PSCI之间呈U型关联[四分位数（Q）1与Q3：调整优势比（aOR）2.69，95%置信区间1.67-4.34，p<0.0001；Q2与Q3：aOR 1.63，95%置信区间1.03-2.57，p=0.0354；Q4与Q3：aOR 1.83，95%置信区间1.16-2.87，p=0.009]。此外，并在CysC水平与MoCA中的注意力、回忆、抽象和语言子分数之间也发现了U型趋势。
CysC与1年总体认知功能呈U型相关性。血清CysC水平的测量可能有助于PSCI的早期诊断。
