Background: Post-stroke cognitive impairment (PSCI) is common and imposes a significant burden upon both families and society. There is limited information on biomarkers for PSCI. This study investigated the correlation between blood biomarkers and post-ischaemic stroke cognitive impairment, to identify potential blood biomarkers and their efficacy in predicting the disorder.
Methods: This prospective study enrolled patients who had experienced their first acute ischaemic stroke between January 2024 and March 2025. Patients underwent blood tests within 24 h of admission, which measured plasma levels of Aβ1-40, Aβ1-42, glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), p-Tau181, p-Tau217, Aβ42/40, and p-Tau217/Aβ1-42. The cognitive function of the patients was assessed at the three-month follow-up visit using the Montreal Cognitive Assessment (MOCA) scale. Participants were divided into a cognitive impairment group and a cognitively normal group with a MoCA cutoff score of 22.
Results: A total of 128 patients who had experienced a first ischaemic stroke were included in the analysis. At the three-month post-stroke follow-up, 69 patients (53.9%) were allocated to the PSCI group, with 59 patients (46.1%) in the cognitively normal group. After univariate and multivariate logistic regression analyses, plasma GFAP (OR = 1.0027, 95% CI = 1.0002-1.0053, p = 0.038) and plasma NFL (OR = 1.0046, 95% CI = 1.0006-1.0086, p = 0.025) were identified as independent risk factors for cognitive impairment following ischaemic stroke. Receiver operating characteristic (ROC) curves indicated area under the curve (AUC) values of 0.779 (95% CI = 0.700-0.858, p < 0.001) for plasma GFAP and 0.809 (95% CI = 0.733-0.885, p < 0.001) for plasma NFL, indicating good predictive performance for both parameters. The AUC for GFAP+NFL was 0.855 (95% CI = 0.792-0.918, p < 0.001), indicating superior predictive performance of the GFAP and NFL combination for PSCI post-ischaemic stroke cognitive impairment.
Conclusion: Elevated plasma GFAP and NFL levels are associated with an increased risk of post-ischaemic stroke cognitive impairment. Plasma GFAP and NFL may represent potential biological markers for PSCI. The combination of the two parameters showed superior predictive efficacy for PSCI.
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