| Objective:Post-stroke cognitive impairment(PSCI)is one of the common complications of ischemic stroke,which refers to a series of syndromes from mild cognitive impairment to dementia caused by ischemic stroke.However,patients with ischemic stroke are often found to have intellectual impairment in the acute phase,especially executive ability and memory declining.This cognitive impairment may persist to meet the diagnostic criteria of PSCI,which significantly shortens the survival time of patients with ischemic stroke.On the other hand,it also has a considerable negative impact on the quality of daily life of patients.Early detection of cognitive impairment and intervention can effectively prevent early cognitive impairment from further developing into PSCI.The assessment of cognitive impairment often relies on neuropsychological tests,but the evaluation results of most tests are subjective,which are not enough to diagnose and clearly indicate cognitive impairment and its prognosis.In recent years,more and more studies have shown that the expression of serum biomarkers such as IL-6,Cys C and Hcy may be related to cognitive impairment,but the correlation is still controversial.In this study,the relevant data of hospitalized patients with acute ischemic stroke in our department were collected,and the cognitive function was evaluated within 14 days after the onset of the patients.The objective factors of cognitive impairment in patients with acute ischemic stroke and the relationship between serum IL-6,Cys C and Hcy levels and cognitive impairment in acute phase were explored to provide more theoretical basis for clinical diagnosis and treatment.Methods: A total of 134 patients with acute ischemic stroke hospitalized in our department from August 2021 to December 2022 were included according to the inclusion and exclusion criteria.General information,laboratory tests,imaging findings,etc.were collected,and cognitive assessment(Montreal Cognitive Assessment,Mo CA)was performed at an early stage(within 14 days).Mo CA score < 26 was defined as acute stage cognitive impairment.Based on Mo CA score results,96 cases were classified into cognitive impairment group and 38 cases were classified into normal cognitive function group.SPSS 25.0 software was used for statistical analysis.T test was used for measurement data,Chi-square test was used for counting data,non-parametric test was used for non-conformity to normality or homogeneity of variance,Spearman method was used for correlation verification,multiple Logistic regression analysis was used to explore the influencing factors of the occurrence of cognitive impairment,and ROC curve was used to analyze the sensitivity and specificity of diagnosis.Results:1.A total of 134 patients with acute ischemic stroke were included in this study,including 96 patients with cognitive impairment,accounting for 71.64%.2.The levels of age,TG,white matter osteoporosis,Hcy and IL-6 in the cognitive impairment group were higher than those in the normal cognitive function group(P <0.05);Years of education and Cys C level were significantly lower than those of normal cognitive function group(P < 0.05).There were no significant differences in sex ratio,past history and NIHSS score between the two groups.3.The scores of the impaired group in visual space,attention,language,abstract thinking and delayed recall were lower than those of the normal group.The median scores of naming ability and orientation were the same between the two groups,and statistically significant differences were found between the two groups(P < 0.05).Mo CA scores in infarcts in the thalamus were lower than those outside the thalamus,and the difference was statistically significant(P < 0.05).4.The level of serum IL-6 increased,and the degree of cognitive impairment increased.The level of serum IL-6 in the normal cognitive function group was significantly different from that in the mild,moderate and severe cognitive impairment groups(P <0.05).The level of serum Cys C decreased and the degree of cognitive impairment increased,and the difference between the normal group and the severely impaired group was statistically significant(P = 0.008).The serum Hcy level of patients with different degrees of cognitive impairment was higher than that of patients with normal cognitive function,and there was no statistical significance among all groups(P = 0.062).5.There was a very weak positive correlation between serum IL-6 level and NIHSS score,and a low negative correlation with Mo CA score.There was a very weak positive correlation between serum Cys C level and Mo CA score.6.Bivariate logistic regression equation analysis showed that the older the age,the higher the risk of cognitive impairment(OR=1.061,95%CI 1.005--1.120,P = 0.031);The higher the serum IL-6 level was,the higher the risk of cognitive impairment was(OR=1.188,95%CI 1.023--1.381,P = 0.024),indicating that age and serum IL-6 level were risk factors for the occurrence of acute cognitive impairment.7.ROC curve method showed that the area under ROC curve of serum IL-6 level to determine the occurrence of acute cognitive impairment was 0.790(95%CI 0.696--0.884,P = 0.000),the sensitivity was 83.30%,and the specificity was 76.3%.The area under ROC curve of age and serum IL-6 was 0.802(95%CI 0.714--0.889,P = 0.000),the sensitivity was 72.90%,and the specificity was 81.60%.Conclusions:1.In the sample population of this study,we found that AIS patients have a high risk of early cognitive impairment,and we should pay attention to early cognitive impairment in clinical diagnosis and treatment.2.In this study,serum IL-6 level was correlated with the degree of neurological impairment and was a risk factor for the occurrence of acute cognitive impairment.Serum Cys C level decreased and the degree of cognitive impairment increased,but it was not a protective factor for the occurrence of acute cognitive impairment.No correlation was found between serum Hcy level and early cognitive impairment.3.The serum IL-6 level in this study has a high diagnostic value in judging the risk of cognitive impairment in the acute phase. |
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