Relationship Among Homocysteine, Inflammation and Cognitive Impairment in Patients with Acute Ischemic Stroke and Transient Ischemic Attack

PURPOSE: To investigate the associations among homocysteine (Hcy), inflammation and cognitive impairment in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). PATIENTS AND METHODS: Patients included were enrolled from a subgroup of China National Stroke Registry-III (CNSR-III). We used a Chinese version of Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment. We used high-sensitivity C-reactive protein (hsCRP) level to reflect the inflammatory status, which was assessed at baseline together with Hcy concentration. The primary outcome was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after AIS and TIA. Multivariable logistic regression analysis was used to evaluate the correlation between Hcy and hsCRP, and their effects on cognition. RESULTS: We enrolled 1466 patients with a median age of 62 (54-70) years old, including 895 (61.05%) patients with elevated Hcy levels, 466 (31.79%) with increased hsCRP concentrations, and 755 (51.50%) with PSCI. In the group of patients with hyperhomocysteinemia (HHcy), higher hsCRP levels were related to cognitive impairment, whether or not adjusted for multiple potential confounders (crude OR: 1.71,95% CI: 1.29-2.27, p < 0.01; adjusted OR: 1.42, 95% CI: 1.04-1.93, p = 0.03). No significant interactions for the impact on PSCI were observed in subgroups stratified by age, sex or Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (P interaction > 0.05 for all). CONCLUSION: High inflammatory levels increase the risk of cognitive impairment in HHcy patients after AIS and TIA.