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Tu R, Xia J. Stroke and Vascular Cognitive Impairment: The Role of Intestinal Microbiota Metabolite TMAO. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:102-121. [PMID: 36740795 DOI: 10.2174/1871527322666230203140805] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 02/07/2023]
Abstract
The gut microbiome interacts with the brain bidirectionally through the microbiome-gutbrain axis, which plays a key role in regulating various nervous system pathophysiological processes. Trimethylamine N-oxide (TMAO) is produced by choline metabolism through intestinal microorganisms, which can cross the blood-brain barrier to act on the central nervous system. Previous studies have shown that elevated plasma TMAO concentrations increase the risk of major adverse cardiovascular events, but there are few studies on TMAO in cerebrovascular disease and vascular cognitive impairment. This review summarized a decade of research on the impact of TMAO on stroke and related cognitive impairment, with particular attention to the effects on vascular cognitive disorders. We demonstrated that TMAO has a marked impact on the occurrence, development, and prognosis of stroke by regulating cholesterol metabolism, foam cell formation, platelet hyperresponsiveness and thrombosis, and promoting inflammation and oxidative stress. TMAO can also influence the cognitive impairment caused by Alzheimer's disease and Parkinson's disease via inducing abnormal aggregation of key proteins, affecting inflammation and thrombosis. However, although clinical studies have confirmed the association between the microbiome-gut-brain axis and vascular cognitive impairment (cerebral small vessel disease and post-stroke cognitive impairment), the molecular mechanism of TMAO has not been clarified, and TMAO precursors seem to play the opposite role in the process of poststroke cognitive impairment. In addition, several studies have also reported the possible neuroprotective effects of TMAO. Existing therapies for these diseases targeted to regulate intestinal flora and its metabolites have shown good efficacy. TMAO is probably a new target for early prediction and treatment of stroke and vascular cognitive impairment.
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Affiliation(s)
- Ruxin Tu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- Human Clinical Research Center for Cerebrovascular Disease, Changsha, China
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Sabayan B, Goudarzi R, Ji Y, Borhani‐Haghighi A, Olson‐Bullis BA, Murray AM, Sedaghat S. Intracranial Atherosclerosis Disease Associated With Cognitive Impairment and Dementia: Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032506. [PMID: 37955546 PMCID: PMC10727275 DOI: 10.1161/jaha.123.032506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Intracranial atherosclerosis disease (ICAD) alters cerebrovascular hemodynamics and brain structural integrity. Multiple studies have evaluated the link between ICAD and cognitive impairment, with mixed results. This study aims to systematically review and summarize the current evidence on this link. METHODS AND RESULTS PubMed, EMBASE, PsycInfo, and Web of Science were searched from 2000 to 2023 without language restriction. Cross-sectional and prospective cohort studies as well as postmortem studies were included. Studies containing data on the link between ICAD, defined as at least 50% stenosis in 1 intracranial vessel, and cognitive impairment and dementia were screened by 2 independent reviewers. A total of 22 (17 observational and 5 postmortem) unique studies, comprising 11 184 individuals (average age range, 59.8-87.6 years; 45.7% women; 36.5% Asian race), were included in the systematic review. Seven of 10 cross-sectional studies and 5 of 7 prospective studies showed a significant association between ICAD and cognitive impairment. In the pooled analysis, ICAD was associated with greater cognitive impairment (measure of association, 1.87 [95% CI, 1.49-2.35]). Meta-regression analyses did not show a significant impact of age, sex, and race. All postmortem studies showed that patients with Alzheimer disease and vascular dementia had a higher burden of ICAD compared with controls. CONCLUSIONS This study shows that ICAD is associated with cognitive impairment and dementia across age, sex, and race groups. Our findings may underscore the need to develop individualized dementia preventive care plans in patients with ICAD.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, Hennepin Healthcare Research InstituteHennepin County Medical CenterMinneapolisMN
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Roham Goudarzi
- Faculty of ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | | | | | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research and Geriatrics Division, Department of MedicineHennepin Healthcare Research InstituteMinneapolisMN
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
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Xu L, Ouyang QR, Xiong Q, Huang LW, Yu M. Elevated serum uric acid is associated with cognitive impairment in acute minor ischemic stroke patients. Heliyon 2023; 9:e21072. [PMID: 37886747 PMCID: PMC10597847 DOI: 10.1016/j.heliyon.2023.e21072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/26/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Background Acute minor ischemic stroke (AMIS) has been proven to be strongly associated with post-stroke cognitive impairment (PSCI). Few studies have reported that uric acid (UA) levels are linked to PSCI in patients with AMIS, and those results are debatable. We investigated the relationship between serum UA levels and cognitive impairment in patients with AMIS. Methods A total of 318 patients who were diagnosed with AMIS were recruited from Suining Central Hospital. Fasting serum samples were collected the day after admission for UA measurement. Cognitive function was evaluated at admission and 3 months after stroke using the Montreal Cognitive Assessment (MoCA). The relationship between UA and PSCI was examined using a multivariate binary logistic regression model. The optimal cut-off point for UA levels to predict PSCI was determined using the receiver operating characteristic (ROC) curve. Results A total of 197 (61.9 %) of the 318 participants in this study exhibited cognitive impairment at 3 months. Serum UA was strongly linked with PSCI after adjusting for confounding factors (OR = 1.82, 95 % CI: 1.56 to 2.11, P < 0.0001). The ROC curve revealed a cut-off of 363.58 μmol/L serum UA, and the predicted sensitivity and specificity for PSCI were 67.5 % and 83.5 %, respectively. Subgroup analysis showed that confounding factors had no impact on the association between serum UA and PSCI risk. Conclusions Higher baseline serum UA levels might be an independent risk factor for cognitive impairment in AMIS patients. Serum UA levels above 363.58 μmol/L may have clinical implications in predicting PSCI.
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Affiliation(s)
- Lei Xu
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
| | - Qing-rong Ouyang
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
| | - Qin Xiong
- Department of Internal Medicine, The Third People's Hospital of Suining, Suining, 629099, China
| | - Lu-wen Huang
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
| | - Ming Yu
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
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Seyman EE, Sadeh-Gonik U, Berman P, Blum I, Shendler G, Nathan B, Rothschild O, Molad J, Ben Assayag E, Hallevi H. Association between intracranial vessel calcifications, structural brain damage, and cognitive impairment after minor strokes: a prospective study. Front Neurol 2023; 14:1218077. [PMID: 37533476 PMCID: PMC10393263 DOI: 10.3389/fneur.2023.1218077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Background Vascular calcifications are a hallmark of atherosclerosis, and in the coronary arteries are routinely used as a prognostic marker. Calcifications of intracranial vessels (ICC) are frequently observed on non-contrast CT (NCCT) and their effect on post-stroke cognitive impairment (PSCI) remains unclear. Our aim was to explore the association of ICC with prospective long-term cognitive function and advanced MRI-measures in a large prospective cohort of cognitively intact mild stroke survivors. Methods Data from the Tel-Aviv brain acute stroke cohort (TABASCO) study [ClinicalTrials.gov #NCT01926691] were analyzed. This prospective cohort study (n = 575) aimed to identify predictors of PSCI, in cognitively intact mild stroke survivors. A quantitative assessment of the intracranial calcium content - The ICC score (ICCS) was calculated semi-automatically on NCCT using a validated calcium quantification application. Participants underwent a 3 T-MRI and prospective comprehensive cognitive clinical and laboratory assessments at enrollment, 6, 12, and 24-months. Results Data were available for 531 participants (67.4 years, 59.5% males). The incidence of PSCI at two-years doubled in the high ICCS group (26% vs. 13.7%, p < 0.001). The high ICCS group had significantly greater small-vessel-disease (SVD) tissue changes and reduced microstructural-integrity assessed by Diffusion-Tensor-Imaging (DTI) maps (p < 0.05 for all). In multivariate analysis, a higher ICCS was independently associated with brain atrophy manifested by lower normalized white and gray matter, hippocampal and thalamic volumes (β = -0.178, β = -0.2, β = -0.137, β = -0.157; p < 0.05) and independently predicted PSCI (OR 1.83, 95%CI 1.01-3.35). Conclusion Our findings suggest that the ICCS, which is a simple and readily available imaging marker on NCCT, is associated with brain atrophy, microstructural damage, the extent of SVD, and may predict PSCI. This finding has implications for identifying individuals at risk for PSCI and implementing targeted interventions to mitigate this risk.
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Affiliation(s)
- Estelle Emanuelle Seyman
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Sadeh-Gonik
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Phillip Berman
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itay Blum
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Genady Shendler
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Bornstein Nathan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Brain Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ofer Rothschild
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeremy Molad
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einor Ben Assayag
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hen Hallevi
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Xu L, Xiong Q, Du Y, Huang LW, Yu M. Nonlinear relationship between glycated hemoglobin and cognitive impairment after acute mild ischemic stroke. BMC Neurol 2023; 23:116. [PMID: 36949414 PMCID: PMC10031995 DOI: 10.1186/s12883-023-03158-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Stroke is the second most common cause of morbidity and mortality. Even mild stroke survivors have an increased risk of cognitive impairment. Studies have been conducted on the relationship between glycated hemoglobin (HbA1c) and cognitive decline, but the findings have been inconsistent. Therefore, this study examined the link between HbA1c levels and cognitive impairment following acute mild ischemic stroke. METHODS Data from 311 patients with acute mild ischemic stroke admitted to Suining Central Hospital, Sichuan Province, China, from January 1, 2015, to December 31, 2018, were evaluated. Fasting venous blood was taken to assess HbA1c levels on the day after admission. Cognitive function was assessed using the Chinese version of the Montreal Cognitive Assessment Scale (MoCA) 3-6 months after stroke onset. We used a generalized additive model and smooth curve fitting (penalty spline method) to assess the nonlinear relationship between HbA1c and poststroke cognitive impairment (PSCI). RESULTS This study included 311 patients aged 23 to 96 years old (mean age: 67.37 ± 11.92 years), of whom 198 (63.67%) were men. Among the 311 stroke patients, 120 (38.59%) had PSCI. After adjusting for potential confounders, there was a nonlinear relationship between HbA1c and PSCI, with an inflection point of 8.2. To the left of the inflection point, the effect size, 95% confidence interval, and P value were 0.87, 0.58 to 1.31, and 0.5095, respectively; however, to the right of the inflection point, these numbers were 1.96, 1.08 to 3.58, and 0.0280. CONCLUSION We found a nonlinear relationship between HbA1c and PSCI. When HbA1c was greater than 8.2%, HbA1c was positively correlated with PSCI.
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Affiliation(s)
- Lei Xu
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
| | - Qin Xiong
- Department of Internal Medicine, the Third People's Hospital of Suining, Suining, 629000, China
| | - Yang Du
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
| | - Lu-Wen Huang
- Department of Neurology, Suining Central Hospital, Suining, 629000, China
| | - Ming Yu
- Department of Neurology, Suining Central Hospital, Suining, 629000, China.
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Nahas NE, Zaki A, Zakaria M, Naser AAE, Bassiony AE, Abdeldayem E, Shokri H, Bokl AE. Cognitive impairment in asymptomatic cerebral arterial stenosis: a P300 study. Neurol Sci 2023; 44:601-609. [PMID: 36258105 PMCID: PMC9842544 DOI: 10.1007/s10072-022-06442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cerebral arterial stenosis (CAS), in the absence of a structural lesion, can result in cognitive impairment that represents an ongoing contention among studies. Accordingly, we investigated cognitive functions in asymptomatic patients with CAS, using P300 which is a neurophysiological tool. We also compared cognition in intracranial stenosis (ICS) and extracranial stenosis (ECS). METHODS Asymptomatic patients with CAS (≥ 70%) in the absence of structural brain lesions were categorized into ICS and ECS groups of 15 patients each, in addition to 15 normal controls. MRI, MRA, CT angiography, P300 analysis, Mini-Mental State examination (MMSE), Wisconsin Card Sorting Test (WCST), and Wechsler Memory Scale Test-Revised (WMST) were performed to all patients. RESULTS Impairment on all cognitive scales ranged from 70 up to 100% among CAS group. Prolonged p300 latency and reaction time correlated with worse performance on WMST (p = 0.02), while lower amplitude and decreased accuracy correlated with more errors on WCST (p = 0.01). ICS scores on WCTS were lower than those of ECS group (p = 0.001), while ECS had a longer reaction time (p = 0.02) and lower scores on MMS and WMST than those of ICS group (p = 0.03). CONCLUSION Patients with asymptomatic CAS had a high prevalence of cognitive dysfunction which places them at risk of higher morbidity. ICS group showed impairment on executive functions, while the ECS group showed predilection to memory and information processing dysfunction.
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Affiliation(s)
- Nevine El Nahas
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Zaki
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Magd Zakaria
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Azza Abd El Naser
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed El Bassiony
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Abdeldayem
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam Shokri
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed El Bokl
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Wang Y, Li C, Ding M, Lin L, Li P, Wang Y, Dong Q, Yang Y, Cui M. Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment. Front Aging Neurosci 2021; 13:682908. [PMID: 34113247 PMCID: PMC8185032 DOI: 10.3389/fnagi.2021.682908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Together with cerebral small vessel disease (CSVD), large vessel atherosclerosis is considered to be an equally important risk factor in the progression of vascular cognitive impairment. This article aims to investigate whether carotid atherosclerotic calcification is associated with the increased risk of post-stroke cognitive impairment (PSCI). Methods: A total of 128 patients (mean age: 62.1 ± 12.2 years, 37 women) suffering from ischemic stroke underwent brain/neck computer tomography angiography examination. The presence and characteristic of carotid calcification (size, number and location) were analyzed on computer tomography angiography. White matter hyperintensity (WMH) was assessed using Fazekas scales. PSCI was diagnosed based on a battery of neuropsychological assessments implemented 6−12 months after stroke. Results: Among 128 patients, 26 developed post-stroke dementia and 96 had carotid calcification. Logistic regression found carotid calcification (odds ratio [OR] = 7.15, 95% confidence interval [CI]: 1.07–47.69) and carotid artery stenosis (OR = 6.42, 95% CI: 1.03–40.15) both significantly increased the risk for post-stroke dementia. Moreover, multiple, thick/mixed, and surface calcifications exhibited an increasing trend in PSCI (Ptrend = 0.004, 0.016, 0.045, respectively). The prediction model for post-stroke dementia including carotid calcification (area under curve = 0.67), WMH (area under curve = 0.67) and other covariates yielded an area under curve (AUC) of 0.90 (95% CI: 0.82–0.99). Conclusion: Our findings demonstrated that the quantity and location of carotid calcifications were independent indicators for PSCI. The significant role of large vessel atherosclerosis in PSCI should be concerned in future study.
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Affiliation(s)
- Yingzhe Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chanchan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengyuan Ding
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Lin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Peixi Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yizhe Wang
- Department of Medicine, Nanchang University, Nanchang, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,The State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yanmei Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,The State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Gong L, Wang H, Zhu X, Dong Q, Yu Q, Mao B, Meng L, Zhao Y, Liu X. Nomogram to Predict Cognitive Dysfunction After a Minor Ischemic Stroke in Hospitalized-Population. Front Aging Neurosci 2021; 13:637363. [PMID: 33967738 PMCID: PMC8098660 DOI: 10.3389/fnagi.2021.637363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
An easily scoring system to predict the risk of cognitive impairment after minor ischemic stroke has not been available. We aimed to develop and externally validate a nomogram for predicting the probability of post-stroke cognitive impairment (PSCI) among hospitalized population with minor stroke. Moreover, the association of Trimethylamine N-oxide (TMAO) with PSCI is also investigated. We prospectively conducted a developed cohort on collected data in stroke center from June 2017 to February 2018, as well as an external validation cohort between June 2018 and February 2019. The main outcome is cognitive impairment defined as <22 Montreal Cognition Assessment (MoCA) score points 6 – 12 months following a minor stroke onset. Based on multivariate logistic models, the nomogram model was generated. Plasma TMAO levels were assessed at admission using liquid chromatography tandem mass spectrometry. A total of 228 participants completed the follow-up data for generating the nomogram. After multivariate logistic regression, seven variables remained independent predictors of PSCI to compose the nomogram included age, female, Fazekas score, educational level, number of intracranial atherosclerotic stenosis (ICAS), HbA1c, and cortical infarction. The area under the receiver-operating characteristic (AUC-ROC) curve of model was 0.829, C index was good (0.810), and the AUC-ROC of the model applied in validation cohort was 0.812. Plasma TMAO levels were higher in patients with cognitive impairment than in them without cognitive dysfunction (median 4.56 vs. 3.22 μmol/L; p ≤ 0.001). In conclusion, this scoring system is the first nomogram developed and validated in a stroke center cohort for individualized prediction of cognitive impairment after minor stroke. Higher plasma TMAO level at admission suggests a potential marker of PSCI.
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Affiliation(s)
- Li Gong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Haichao Wang
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaofeng Zhu
- Department of Nursing, Huashan Hospial North, Fudan University, Shanghai, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qiuyue Yu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Bingjie Mao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.,Nanjing Medical University, Nanjing, China
| | - Longyan Meng
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
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Wei B, Wang Z, Wu S, Orgah J, Zhu J, Song W. Improving Collateral Circulation: A Potential Adjunctive Strategy to Prevent or Slow the Progression of Vascular Dementia. Neuropsychiatr Dis Treat 2021; 17:3061-3067. [PMID: 34675517 PMCID: PMC8502063 DOI: 10.2147/ndt.s328446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Vascular dementia (VaD), a cognitive disorder caused by cerebrovascular pathologies, is the most common cause of dementia in the elderly, being second only to Alzheimer's disease. Researches have shown that adequate cerebral blood flow (CBF) is the first condition for maintaining the structural integrity and normal function of the brain, and VaD is generally considered to be resulted from neuronal loss due to reduced CBF. Collateral circulation, a compensation mechanism for CBF, provides an alternative vascular pathway for blood to reach ischemic tissues, which has been confirmed to be associated with better clinical outcomes of ischemic diseases. At present, considerable effort has been devoted to enhancing the functional prognosis of acute ischemic stroke by improving collateral circulation. Since ischemic stroke is the primary contributor to VaD, it is necessary to explore whether improving collateral circulation is beneficial to prevent or slow the progression of VaD. This article reviews the compensatory characteristics of different levels of cerebral collateral circulation, addresses the relationship between collateral circulation and VaD, and highlights that improving collateral circulation may be a potential adjunctive strategy in preventing and slowing the progression of VaD.
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Affiliation(s)
- Baoyu Wei
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Zhaoqi Wang
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Shihao Wu
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - John Orgah
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Jinqiang Zhu
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China
| | - Wanshan Song
- Department of Acupuncture and Cerebropathy, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, People's Republic of China
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Nomogram to Predict Poor Outcome after Mechanical Thrombectomy at Older Age and Histological Analysis of Thrombus Composition. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8823283. [PMID: 33381271 PMCID: PMC7765717 DOI: 10.1155/2020/8823283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023]
Abstract
An easy scoring system to predict the risk of poor outcome after mechanical thrombectomy among the elderly is currently not available. Therefore, we aimed to develop a nomogram for predicting the probability of negative prognosis in aged patients with acute ischemic stroke undergoing thrombectomy. In addition, we sought to investigate the association between histological thrombus composition and stroke characteristics. To this end, we prospectively studied a developed cohort using data collected from a stroke center from November 2015 to December 2019. The main outcome was functional independence, defined as a modified Rankin Scale score ≤ 2 at 90 days following a mechanical thrombectomy. A nomogram model based on multivariate logistic models was generated. The retrieved thrombi were stained with hematoxylin and eosin and assessed according to histological composition. Our results demonstrated that age ≥ 72 years was independently associated with poor outcome. A total of 304 participants completed the follow-up data to generate the nomogram model. After multivariate logistic regression, five variables remained independent predictors of outcome, including older age, hemorrhagic transformation, thrombolysis in cerebral infarction score, National Institute of Health Stroke score, and neutrophil-to-lymphocyte ratio, and were used to generate the nomogram. The area under the receiver-operating characteristic curve of the model was 0.803. The clots from elderly subjects with large-artery atherosclerosis, anterior circulation, and successful recanalization groups had a higher percentage of fibrin compared to those of younger patients. This is the first nomogram to be developed and validated in a stroke center cohort for individualized prediction of poor outcome in elderly patients after mechanical thrombectomy. Clot composition provides valuable information on the underlying pathogenesis of oxidation in older patients.
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