Association between Osteoporosis and Cognitive Impairment during the Acute and Recovery Phases of Ischemic Stroke

The pathogenesis of post-stroke osteoporosis and the role oxidative stress plays in its development

Cardiovascular disease and osteoporotic fractures (OF) are the main diseases affecting the health of middle-aged and elderly people. With the gradual increase of population aging in China and even the world, the incidence of the two and the prevalence of high-risk groups are also showing a continuous upward trend. The relationship between the two, especially the impact of cardiovascular disease on the risk and prognosis of OF, has attracted more and more attention. Therefore, it is of great significance to fully understand the pathogenesis of cardiovascular and cerebrovascular diseases and the resulting osteoporosis and to provide targeted interventions to prevent the occurrence of diseases and fractures. This article reviews the relationship between one of the Cardiovascular disease-stroke and related therapeutic drugs and the risk of OF, and the role of oxidative stress in its pathophysiological mechanism by reviewing relevant domestic and foreign literature in recent years, in order to gain a more comprehensive understanding of the association between stroke and OF, and then provide a basis and reference for screening high-risk groups of fractures and reducing the burden on the health system caused by the disease.

Associations between cognitive impairment and computed tomography perfusion in different lobes in acute stroke of the anterior circulation

BACKGROUND

 Cognitive impairment (CI) during the acute phase of stroke should not be ignored. The present study analyzed the relationship between computed tomography perfusion (CTP) in different lobes and CI during the acute phase of stroke in patients with cerebral infarction.

METHODS

 The present study included 125 subjects: 96 in the acute phase of stroke and 29 elderly healthy subjects as a control group. The Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive status of the two groups. The CTP scans include four parameters: cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and mean transit time (MTT).

RESULTS

 The MoCA scores for naming, language and delayed recall significantly decreased only in patients with left cerebral infarctions. The MTT of the left vessels in the occipital lobe and the CBF of the right vessels in the frontal lobe were negatively related to the MoCA scores of patients with left infarction. The CBV of the left vessels in the frontal lobe and the CBF of left vessels in the parietal lobe were positively linked to the MoCA scores of patients with left infarction. The CBF of the right vessels in the temporal lobe was positively related to the MoCA scores of patients with right infarction. Finally, the CBF of the left vessels in the temporal lobe was inversely correlated with the MoCA scores of patients with right infarctions.

CONCLUSION

 During the acute phase of stroke, CTP was closely associated with CI. Changed CTP could be a potential neuroimaging biomarker to predict CI during the acute phase of stroke.

Musculoskeletal Deficits and Cognitive Impairment: Epidemiological Evidence and Biological Mechanisms

PURPOSE OF REVIEW

Cognitive impairment is associated with obesity, sarcopenia, and osteoporosis. However, no critical appraisal of the literature on the relationship between musculoskeletal deficits and cognitive impairment, focusing on the epidemiological evidence and biological mechanisms, has been published to date. Herein, we critically evaluate the literature published over the past 3 years, emphasizing interesting and important new findings, and provide an outline of future directions that will improve our understanding of the connections between the brain and the musculoskeletal system.

RECENT FINDINGS

Recent literature suggests that musculoskeletal deficits and cognitive impairment share pathophysiological pathways and risk factors. Cytokines and hormones affect both the brain and the musculoskeletal system; yet, lack of unified definitions and standards makes it difficult to compare studies. Interventions designed to improve musculoskeletal health are plausible means of preventing or slowing cognitive impairment. We highlight several musculoskeletal health interventions that show potential in this regard.

Keap1-Nrf2/ARE signal pathway activated by butylphthalide in the treatment of ischemic stroke

OBJECTIVE

To analyze the clinical efficacy and possible mechanism of butylphthalide in treatment of acute ischemic stroke.

METHODS

In this retrospective study, 127 patients with ischemic stroke, hospitalized during Jan. 2019 to Jan. 2021, were enrolled and as assigned to observation group (n=65) and control group (n=62) according to treatment methods. The control group received routine treatment, and the observation group was treated with butylphthalide injection in addition to conventional cure. The treatments lasted for 2 weeks in both groups. Subsequently, the recovery of neurological deficits (NIHSS) and Barthel index (BI) of the two groups of patients, cerebrovascular vascular reserve function (CVR) values and pulsation index (PI) before and after treatment, and the levels of brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and recombinant basic fibroblast growth factor (bFGF) were detected. The expression of Keap1-Nrf2/ARE signaling pathway related molecules was detected by ELISA.

RESULTS

The overall response rate (ORR) of observation group was remarkably superior to that of control group (P<0.05). NIHSS score obviously decreased while BI remarkably increased in both groups after treatment (all P<0.05); and the observation group showed an significantly higher BI score but significantly lower NIHSS score compared with the control group (all P<0.05). The CVR of the two groups of patients after treatment was significantly higher than that before treatment (P<0.05), while PI was significantly lower than before treatment (P<0.05); The CVR of observation-group after treatment was substantially higher than that of control-group (P<0.05), while PI was lower than control-group (P<0.05). Serum Keap1 levels of the two groups of patients after treatment were significantly higher than that before treatment (P<0.05), while serum levels of NQO1, Nrf2, and ARE were significantly lower than that before treatment (P<0.05). The serum level of Keap1 in the observation group was remarkably higher than that of the control group (P<0.05), while the serum levels of NQO1, Nrf2 and ARE were evidently lower than those in the control group (P<0.05). The two groups had insignificant difference in incidence of adverse reactions (P>0.05).

CONCLUSION

The butylphthalide can effectively improve the clinical efficacy of acute ischemic stroke, and promote patients' neurological function and activities of daily living. The mechanism may be that butylphthalide improves the CVR of patients, enhances the establishment of collateral compensatory vessels, and changes the expression of the Keap1-Nrf2/ARE signaling pathway, thereby exerting the neuroprotective effect. Clinically, butylphthalide may have good safety in adjuvant therapy of acute ischemic stroke.

Association of Bone Mineral Density to Cerebral Small Vessel Disease Burden

OBJECTIVE

To test the hypothesis that bone mineral loss is mechanistically related to cerebral small vessel disease (SVD), we investigated the relationship between bone mineral density and the prevalence and intensity of SVD among patients with stroke.

METHODS

We analyzed data of 1,190 consecutive patients with stroke who were >50 years of age and underwent both brain MRI and dual-energy x-ray absorptiometry from the stroke registry of Chung-Ang University Hospital in Seoul, Korea. The patients were categorized into 3 groups according to their bone mineral density (normal, osteopenia, and osteoporosis). White matter hyperintensities, silent lacunes, cerebral microbleeds, and extensive perivascular space were assessed from brain MRI. Multinomial logistic regression model was used to examine the association between osteoporosis and total SVD score. We also recruited 70 patients with stroke to study serum bone turnover markers and microRNAs related to both cerebral atherosclerosis and bone metabolism to understand bone and brain interaction.

RESULTS

Osteoporosis was determined among 284 patients (23.9%), and 450 patients (37.8%) had osteopenia. As bone mineral density decreased, total SVD score and the incidence of every SVD phenotype increased except strictly lobar cerebral microbleeds. Multinomial logistic regression analysis showed that osteoporosis was independently associated with severe SVD burden. The levels of microRNA-378f were significantly increased among the patients with osteoporosis and maximal total SVD score and positively correlated with parathyroid hormone and osteocalcin.

CONCLUSIONS

These findings suggest a pathophysiologic link between bone mineral loss and hypertensive cerebral arteriolar degeneration, possibly mediated by circulating microRNA.