The Correlation Between Telomere Length And Post-stroke Cognitive Impairment With First-episode Ischemic Stroke

Objective To investigate the relationship between Leukocyte telomere length(LTL)in peripheral blood of patients with first-episode ischemic stroke and cognitive impairment after stroke.Methods This study is a prospective study,By following up the 120 patients with first ischemic stroke who were admitted to the treatment center from July 2014 to July 2015,they were divided into the case group(including 60 patients in the post-stroke cognitive impairment PSCI group,60 patients in the post-stroke Non-cognitive impairment PSNCI group)and 120 patients in the healthy control group.The scores of the cognitive function assessment scale(MMSE)and the Montreal cognitive assessment scale(MOCA),the detection results of the telomere length of peripheral blood leukocytes,and the general clinical data of all the selected subjects were collected and classified.The selected subjects were followed up again from October 2018 to October 2019,the subjects were excluded who include lost visitors and deaths and a new disease in the exclusion criteria.The subjects who met the inclusion criteria were again given MMSE and MOCA for cognitive function score and telomere length of peripheral white blood cells.The changes in cognitive impairment and telomere length of the subjects before and after 4 years were compared.To study the correlation between the telomere length of peripheral blood leukocytes in patients with ischemic stroke and Post-stroke cognitive impairment.Results1.In the design of this study,two groups of subjects whose general clinical datasuch as gender,age and education level were matched were selected,includeding 120first-episode ischemic stroke patients and 120 healthy controls at the same time,There was no statistical difference between the two groups(P > 0.05).At the end of follow-up,a total of 19 patients in the healthy control group and 26 patients in the case group were excluded.2.Compared with the healthy control group,the telomere length of the case group was shortened,and the telomere length of the post-stroke cognitive impairment group was shortened more significantly.There were statistically significant differences in telomere length between the healthy control group,the post-stroke non-cognitive impairment group and the post-stroke cognitive impairment group(P=0.032),and statistically significantdifferences in MMSE and MOCA cognitive function scale scores between the three groups(P=0.020,P=0.031).3.Telomere length of the healthy control group,the stroke non-cognitive impairment group and the post-stroke cognitive impairment group all decreased with age(r=-0.655,P<0.001).r = 0.197,P = 0.037;r =-0.234,P=0.004).Among them,telomere length shortening was more significant in the post-stroke cognitive impairment group,with a statistical difference.4.The MMSE and MOCA cognitive function scores of the healthy control group andthe case group all decreased with the increase of age.25.7% of the healthy control group and75.5% of the case group had cognitive impairment,which was statistically significant(P <0.001).5.After 4 years,Telomere length was shortened in the healthy control group,the stroke non-cognitive impairment group and the post-stroke cognitive impairment group.Before and after 4 years,the telomere length between each group was statistically significant(P=0.013,P < 0.01,P < 0.001).There was a statistical difference in telomere length between the three groups 4 years ago(P=0.045).After 4 years,there was a statistically significant difference in telomere length between the three groups(P < 0.001).Among them,the telomere length shortening was the most significant in the post-stroke cognitive impairment group.6.According to the severity of cognitive impairment,there were four groups: normal,mild,moderate and severe.Comparison of telomere length of healthy control group and case group after 4 years showed that the severity of cognitive impairment increased and the telomere shortening was more significant(P < 0.01).Telomere length in the case group decreased more significantly with the severity of cognitive impairment(P < 0.001).There were statistical differences.7.According to telomere length,the patients were divided into long telomere group,medium telomere group and short telomere group.Comparing the scores of MMSE and MOCA before and after 4 years,The results showed that MMSE and MOCA scores of the short telomere group and the medium telomere group were lower than those of the long telomere group.The cognitive scores of the short telomeres group decreased significantly.The MMSE and MOCA scores of the three groups were statistically different 4years ago(P < 0.001,P =0.041).After 4 years,there were statistically significant differences in MMSE and MOCA scores between the three groups(P=0.012,P < 0.001).8.With the decrease of MMSE,telomere length increased,and the difference was statistically significant(r=0.957,P=0.041).Conclusion1.With the development of follow-up time,the length of white blood cell telomeres in patients with ischemic stroke was significantly shortened,and the cognitive dysfunction after stroke was significantly increased.2.Shortening of leukocyte telomere length in patients with ischemic stroke was positively correlated with cognitive impairment and its aggravation after stroke.This suggests that changes in relative telomere length can be used as a predictor of cognitive impairment and its severity after stroke.It is of great significance to improve theprognosis of patients with post-stroke cognitive dysfunction by early clinical intervention.