Analysis of the Mediating Role of Cytokines in the Relationship Between Nonalcoholic Fatty Liver Disease and Cognitive Impairment After Ischemic Stroke

OBJECTIVE: To explore whether nonalcoholic fatty liver disease (NAFLD) is associated with poststroke cognitive impairment (PSCI) and to investigate the mediating role of cytokine levels. RESEARCH METHODS: This study included 247 patients with ischemic stroke. The subjects were divided into no-to-mild and moderate-to-severe groups according to the severity of NAFLD. The levels of peripheral blood cytokines and the scores of the Montreal cognitive assessment scale (MoCA) were measured for all subjects. The scale scores and cytokine levels were compared between the two groups, and the correlations among NAFLD, cytokines, and cognitive function were analyzed. RESULTS: Compared with those in the no-to-mild group, the levels of IL-1β, IL-6, IL-10, and TNF-α in the moderate-to-severe group were significantly higher, while the MoCA score was significantly lower. Multivariate linear regression analysis indicated that the NAFLD grade could significantly affect the MoCA score and the levels of IL-1β and TNF-α. Mediation analysis revealed that the level of TNF-α significantly mediated the relationship between NAFLD and cognitive function, with a mediation effect size of 0.36. CONCLUSION: Elevated TNF-α levels may be a key intermediate factor in the development of PSCI in patients with NAFLD. The prevention and treatment of NAFLD and the inhibition of the peripheral inflammatory response may lead to new targets for early screening and intervention in PSCI.