The relationship between inflammatory markers and post stroke cognitive impairment.
OBJECTIVE
To determine whether there is a relationship between inflammatory markers (serum C-reactive protein (CRP) and cytokines) and post stroke cognitive impairment (PSCI).


METHODS
This was a cross-sectional observational study. Patients were recruited from 4 sources: (1) the acute stroke unit of a general hospital, (2) an outpatient stroke prevention clinic, (3) a stroke rehabilitation unit in a specialized geriatric hospital, or (4) a stroke rehabilitation unit of a rehabilitation hospital. Patients meeting National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) project criteria for stroke were invited to participate in this study within the first 5 to 31 days post stroke. Patients with subarachnoid or intracranial hemorrhage, decreased level of consciousness, severe aphasia or dysarthria, or a significant acute medical, neurological, or psychiatric illness were excluded. Clinical assessments included the Mini-Mental State Examination (MMSE) for cognition, the National Institutes of Health Stroke Scale (NIHSS) for stroke severity, and the Center for Epidemiological Studies-Depression Scale (CES-D) for depressive symptoms. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum concentrations of CRP, interleukin 6 (IL-6), and interferon gamma (IFN-gamma).


RESULTS
A total of 48 patients with ischemic stroke (age [mean +/- SD] 71.6 +/- 13.2 years, 54.2% male, MMSE 26.4 +/- 3.8, NIHSS 6.8 +/- 4.0) were recruited within their first month post stroke. Backward stepwise elimination linear regression showed that higher concentrations of serum CRP (beta(CRP) = -0.46, p( CRP) = 0.002) predicted lower post stroke global cognition ([MMSE], F1,44 = 11.31, P = .002), with age (P = .92), level of education (P = .22), infarct side (P = 0.49), IL-6 (P = 0.36), and IFN-gamma (P = .57) removed from the final model.


CONCLUSIONS
A post stroke inflammatory response may be important in subacute, PSCI.
Rothenburg
Lana S
LS
Neuropsychopharmacology Research Group, Toronto, Ontario, Canada.
Herrmann
Nathan
N
Swardfager
Walter
W
Black
Sandra E
SE
Tennen
Gayla
G
Kiss
Alexander
A
Gladstone
David J
DJ
Ween
Jon
J
Snaiderman
Abraham
A
Lanctôt
Krista L
KL
D000203:Activities of Daily Living; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D003072:Cognition Disorders / Q000097:blood / Q000209:etiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications*; D007371:Interferon-gamma / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications* / Q000523:psychology*; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D015850:Interleukin-6; D007371:Interferon-gamma; D002097:C-Reactive Protein