Study On The Risk Factors Of Cognitive Impairment After Ischemic Stroke

Background With the improvement of people’s living standard in China,the incidence of ischemic stroke(IS)is increasing year by year.Cerebral infarction accounts for 70%to80%of the total stroke.Post-stroke cognitive impairment(PSCI)is one of the most common complications and has become an important health problem in China.PSCI is the type of CI that can be prevented cognitive decline through early intervention.Therefore,to study on the risk factors of ischemic PSCI and analyze the correlation between ischemic PSCI and serum insulin-like growth factor-1(Insulin-like growth factor 1,IGF-1),Soluble Intercellular adhesion molecule-1(Soluble Intercellular adhesion molecule-1,sICAM-1)is the hot spot of the present study.Objective To investigate the risk factors of ischemic PSCI and the changes of serum levels of IGF-1 and sICAM-1 in patients with ischemic PSCI,so as to provide clinical evidence for the prevention and treatment of ischemic PSCI.Methods 204 patients with first onset cerebral infarction were selected.General data of the patients were collected on admission and the levels of serum IGF-1 and sICAM-1were detected by ELISA.The Chinese version of the simple intelligent scale(Mini-Mental State Examination,MMSE)and Montreal Cognitive Assessment Scale(MoCA)were used for cognitive evaluation at 3 months.The patients were divided into two groups.According to the evaluation results,they were divided into observation group(105 cases)and control group(99 cases).The data were statistically processed byχ~2 test,t test,non-parametric rank sum test,Spearman correlation analysis,ROC curve and multivariate Logistic regression analysis.Results1.The incidence of ischemic PSCI in all enrolled patients was 51.47%.2.There were not statistically significant differences in two groups those of age,gender,history of alcohol consumption and hyperlipidemia(P>0.05).There were statistically significant differences in two groups those of hypertension,diabetes,coronary heart disease,infarction site,carotid artery plaque,years of education,NIHSS score,smoking history,serum IGF-1 and sICAM-1 levels(P<0.05).3.There was a significant positive correlation between serum IGF-1 level and cognitive scale score,and a significant negative correlation between serum sICAM-1 level and cognitive scale score,which was analyzed by Spearman correlation analysis.The AUC value of the IGF-1 was 0.853,the sensitivity was 77.8%,and the specificity was87.6%,and the AUC value of the sICAM-1 was 0.895,the sensitivity was 98.1%,and the specificity was 70.7%,which were analyzed by ROC curve.4.Carotid artery plaque[OR=4.681(95%CI:1.918,11.426),P=0.001],essential hypertens ion[OR=2.940(95%CI:1.172,7.372),P=0.022],serum IGF-1 level decreased[OR=1.077(95%CI:1.050,1.105),P=0.000],and serum sICAM-1 level increased[OR=1.003(95%CI:1.002,1.004),P=0.000]were independent risk factors of ischemic PSCI,respectiv ely,which were analyzed by multivariate Logistic regression.Conclusions1.Orientation,language ability,writing ability,memory,attention and computational ability,abstract thinking,and executive ability all have gone down significantly in the clinical manifestations of ischemic PSCI patients.2.Carotid plaque,essential hypertension,the decrease of serum IGF-1 level and the increase of serum sICAM-1 level are all independent risk factors of ischemic PSCI.3.IGF-1 and sICAM-1 in serum are important biomarkers of ischemic PSCI,and their changes in serum level could be conducive to early identification of potential PSCI in patients with ischemic stroke.