Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Dec 19, 2023; 13(12): 985-994
Published online Dec 19, 2023. doi: 10.5498/wjp.v13.i12.985
Diagnostic and prognostic implications of non-high-density lipoprotein cholesterol and homocysteine levels for cognitive impairment in thalamic infarction
Shan-Yao Zhu, Wei Ge, Huan Zhang
Shan-Yao Zhu, Wei Ge, Huan Zhang, Department of Internal Medicine-Neurology, Chaohu Hospital Affiliated to Anhui Medical University, Hefei 238000, Anhui Province, China
Author contributions: Zhu SY and Zhang H conceived and designed the study; Zhu SY and Ge W guided the study; Zhu SY and Zhang H collected the clinical date; Zhu SY and Zhang H analyzed the data; All authors drafted and revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chaohu Hospital Affiliated to AnhuiMedical University, Approval No. KYXM-202208-011.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shan-Yao Zhu, Doctor, Chief Physician, Department of Internal Medicine-Neurology, Chaohu Hospital Affiliated to Anhui Medical University, No. 64 Chaohu North Road, Hefei 238000, Anhui Province, China. zsydoc@126.com
Received: September 14, 2023
Peer-review started: September 14, 2023
First decision: October 8, 2023
Revised: November 6, 2023
Accepted: December 2, 2023
Article in press: December 2, 2023
Published online: December 19, 2023
Processing time: 96 Days and 3.2 Hours
Abstract
BACKGROUND

Patients with thalamic infarction experience abnormal blockages of multinucleated vessels, affecting the body and thereby the thalamus. Most patients with thalamic infarction have an adverse prognosis, which seriously affects their safety. Therefore, it is essential to analyze the independent risk factors that influence the prognosis of patients with thalamic infarction and develop corresponding preventive measures.

AIM

To explore the effect of non-high-density lipoprotein cholesterol (non-HDL-C) and Homocysteine (Hcy) levels in cognitive impairment in thalamic infarction.

METHODS

From March 2019 to March 2022, 80 patients with thalamic infarction were divided into a group with cognitive impairment [Montreal Cognitive Assessment (MoCA) score < 26; 35 patients] and a group with normal cognitive function (MoCA score of 26-30; 45 patients) according to the MoCA score. In addition, 50 healthy people in the same period were selected as the control group. A correlation between the non-HDL-C and Hcy levels and the MoCA score and receiver operating characteristic curve was observed, and the serum non-HDL-C and Hcy levels were analyzed for the diagnosis of cognitive impairment in patients with thalamic infarction. According to the Modified Rankin Scale (MRS) score, 80 patients with thalamic infarction were divided into a good prognosis group (MRS score ≤ 2) and a poor prognosis group (MRS score >2).

RESULTS

The non-HDL-C and Hcy levels were significantly higher in the group with cognitive impairment than in the group with normal cognitive function (P < 0.05). There was no significant difference in the non-HDL-C level between the control group and the group with normal cognitive function (P > 0.05). The MoCA scores of the group with cognitive impairment were significantly lower than those of the group with normal cognitive function and the control group (P < 0.05). There was a significant difference between the control group and the group with normal cognitive function (P < 0.05). The non-HDL-C and Hcy levels were correlated with the MoCA score (P < 0.05), cognitive impairment [areas under the curve (AUC) = 0.709, 95% confidence interval (95%CI): 0.599-0.816], the non-HDL-C level, and could predict cognitive impairment in patients with thalamic infarction (AUC = 0.738, 95%CI: 0.618-0.859). Hcy combined with non-HDL-C levels can predict cognitive impairment in patients with thalamic infarction (AUC = 0.769, 95%CI: 0.721-0.895).

There were 50 patients in the good prognosis group and 30 patients in the poor prognosis group. Compared with the good prognosis group, in the poor prognosis group, the National Institutes of Health Stroke Scale (NIHSS) score, non-HDL-C level, Hcy level, large-area cerebral infarction, atrial fibrillation, and activated partial prothrombin time were statistically significant (P < 0.05). The non-HDL-C level, the Hcy level, the NIHSS score, extensive cerebral serum, and atrial fibrillation may all be independent risk factors for poor prognosis in patients with thalamic infarction (P < 0.05).

CONCLUSION

Non-HDL-C and Hcy levels are positively correlated with cognitive impairment in patients with thalamic infarction. Non-HDL-C and Hcy levels can be used in the diagnosis of cognitive impairment in patients with thalamic infarction, and the combined detection effect is better. The main factors affecting the prognosis of patients with thalamic infarction are the non-HDL-C level, the Hcy level, the NIHSS score, large-area cerebral infarction, and atrial fibrillation. Clinically, corresponding preventive measures can be formulated based on the above factors to prevent poor prognosis and reduce mortality.

Keywords: Thalamic infarction; Cognitive impairment; Non-high-density lipoprotein cholesterol; High homocysteine level; Diagnostic value; Prognosis; Influencing factors; Correlation

Core Tip: This study explored the diagnostic and prognostic implications of non-high-density lipoprotein cholesterol (non-HDL-C) and Homocysteine (Hcy) levels for cognitive impairment in patients with thalamic infarction. Both non-HDL-C and Hcy levels were found to be useful for the diagnosis of cognitive dysfunction in patients with thalamic infarction, with their combined detection being more effective. In addition, clinical precautions can be formulated based on their levels to prevent poor prognosis and reduce mortality.