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<p><b>Objectives.</b> To evaluate phenotypes and identify biomarkers of cognitive impairment (CI) of different severities in patients in the acute period of ischemic stroke (IS) by analysis of clinical and paraclinical parameters. <b>Materials and methods.</b> The study included 240 patients diagnosed with IS and cognitive decline. Montreal Cognitive Assessment (MoCA) scores were used to divide patients into two groups: Group 1 consisted of 182 patients with moderate CI and Group 2 consisted of 58 patients with dementia. Investigations on admission determined the severity of stroke (National Institutes of Health Stroke Severity Scale, NIHSS) and assessed the activities of daily living on the Barthel Scale (BI) and patients’ independence on the modified Rankin Scale (mRS). Neuropsychological examination was conducted on the day 14 and included investigation of episodic memory, regulatory functions, speech, gnosis, and praxis, along with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Immunological diagnostics included determination of the concentrations of cytokines of various groups (interleukin (IL)-1b, IL-6, IL-16, granulocyte-macrophage colony-stimulating factor (GM-CSF), and chemokines CXCL10, CXCL11, and CXCL9, and tumor necrosis factor α (TNF-α)). Neuroimaging parameters were assessed from brain MRI data with verification of the STRIVE criteria and assessment on the medial temporal lobe atrophy scale (MTA). Statistical analysis was run using the standard SPSS Statistics software package and the Pandas and SciPy libraries. <b>Results.</b> Patients of group 2 had lower scores in all cognitive areas, with the greatest reductions in gnosis, constructive praxis, semantic information processing, and memory function. The analysis results revealed higher IQCODE scores and a predominance of features corresponding to the STRIVE/MTA criteria in patients of group 2; patients of the group 1 had higher NIHSS and mRS scores. Assessment of cytokine levels showed that patients of group 1 had higher concentrations of IL-1b, IL-6, GM-CSF, and TNF-α, while patients of group 2 had higher CXCL10 concentrations. <b>Conclusions.</b> The presence of pre-stroke cognitive impairment, along with initial indicators of the patient’s functional status, STRIVE/MTA parameters, and age, affect the structure and severity of cognitive deficit in the acute period of IS. Investigations of the roles of IL, GM-CSF, TNF-α, and CXCL10 in the pathogenesis of stroke and their relationship with post-stroke cognitive impairment requires further research with larger cohorts and longer observation periods.</p>

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Indicators of Cognitive Impairment of Different Severities in the Acute Period of Ischemic Stroke

  • 期刊论文

  • 发表日期：

    2025年2月1日

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  • A. M. Tynterova,
  • E. R. Barantsevich

摘要

Objectives. To evaluate phenotypes and identify biomarkers of cognitive impairment (CI) of different severities in patients in the acute period of ischemic stroke (IS) by analysis of clinical and paraclinical parameters. Materials and methods. The study included 240 patients diagnosed with IS and cognitive decline. Montreal Cognitive Assessment (MoCA) scores were used to divide patients into two groups: Group 1 consisted of 182 patients with moderate CI and Group 2 consisted of 58 patients with dementia. Investigations on admission determined the severity of stroke (National Institutes of Health Stroke Severity Scale, NIHSS) and assessed the activities of daily living on the Barthel Scale (BI) and patients’ independence on the modified Rankin Scale (mRS). Neuropsychological examination was conducted on the day 14 and included investigation of episodic memory, regulatory functions, speech, gnosis, and praxis, along with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Immunological diagnostics included determination of the concentrations of cytokines of various groups (interleukin (IL)-1b, IL-6, IL-16, granulocyte-macrophage colony-stimulating factor (GM-CSF), and chemokines CXCL10, CXCL11, and CXCL9, and tumor necrosis factor α (TNF-α)). Neuroimaging parameters were assessed from brain MRI data with verification of the STRIVE criteria and assessment on the medial temporal lobe atrophy scale (MTA). Statistical analysis was run using the standard SPSS Statistics software package and the Pandas and SciPy libraries. Results. Patients of group 2 had lower scores in all cognitive areas, with the greatest reductions in gnosis, constructive praxis, semantic information processing, and memory function. The analysis results revealed higher IQCODE scores and a predominance of features corresponding to the STRIVE/MTA criteria in patients of group 2; patients of the group 1 had higher NIHSS and mRS scores. Assessment of cytokine levels showed that patients of group 1 had higher concentrations of IL-1b, IL-6, GM-CSF, and TNF-α, while patients of group 2 had higher CXCL10 concentrations. Conclusions. The presence of pre-stroke cognitive impairment, along with initial indicators of the patient’s functional status, STRIVE/MTA parameters, and age, affect the structure and severity of cognitive deficit in the acute period of IS. Investigations of the roles of IL, GM-CSF, TNF-α, and CXCL10 in the pathogenesis of stroke and their relationship with post-stroke cognitive impairment requires further research with larger cohorts and longer observation periods.