Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2020; 8(1): 76-87
Published online Jan 6, 2020. doi: 10.12998/wjcc.v8.i1.76
Relationship between β-amyloid protein 1-42, thyroid hormone levels and the risk of cognitive impairment after ischemic stroke
Lei Mao, Xiao-Han Chen, Jian-Hua Zhuang, Peng Li, Yi-Xin Xu, Yu-Chen Zhao, Yue-Jin Ma, Bin He, You Yin
Lei Mao, Xiao-Han Chen, Jian-Hua Zhuang, Peng Li, Yi-Xin Xu, Yu-Chen Zhao, Yue-Jin Ma, Bin He, You Yin, Department of Neurology, Changzheng Hospital, the PLA Naval Medical University, Shanghai 200003, China
Lei Mao, Department of Neurology, Shanghai First People’s Hospital Baoshan Branch, Shanghai 200003, China
Author contributions: Mao L and Chen XH contributed equally to this study; Mao L, Chen XH, Zhuang JH and Yin Y designed the research; Mao L, Chen XH, Li P, Xu YX, Zhao YC, Ma YJ and He B performed the research; Zhuang JH, Li P and Xu YX contributed new analytic tools; Mao L, Chen XH, Ma YJ and He B analyzed the data; Mao L, Chen XH, Zhuang JH, Li P, Xu YX, Zhao YC, Ma YJ, He B and Yin Y wrote the paper.
Supported by Science and Technology Support Projects in Biomedicine Field of Shanghai Science and Technology Commission, No. 19441907500; Naval Medical University Military Medical Innovation, No. 2017JS07; Science and Technology Action Innovation Program by Science and Technology Commission of Shanghai, No. 17411950104.
Institutional review board statement: The study was approved by the Ethics Committee of Changzheng Hospital, the PLA Naval Medical University.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: You Yin, MD, PhD, Chief Doctor, Chief Physician, Department of Neurology, Changzheng Hospital, the PLA Naval Medical University, NO. 415 Fengyang Road, Huangpu District, Shanghai 200003, China. yinyou179@163.com
Received: September 8, 2019
Peer-review started: September 8, 2019
First decision: November 12, 2019
Revised: November 24, 2019
Accepted: November 27, 2019
Article in press: November 27, 2019
Published online: January 6, 2020
Processing time: 120 Days and 23.4 Hours
ARTICLE HIGHLIGHTS
Research background

Acute ischemic stroke is the second most common cause of cognitive impairment and dementia in recent years. According to statistics, more than 64% of the patients after stroke show different degrees of cognitive impairment, and about 25% of stroke survivors suffer from dementia within 12 mo after stroke. Early monitoring is very important for clinical assessment of the severity and prognosis of ischemic stroke. Recent studies and epidemiological investigations have shown that the deposition of β-amyloid protein (Aβ) is associated with vascular risk factors and plays an important role in the development of post-stroke cognitive impairment. In addition, it has the advantages of invasiveness, small variability and good stability and has a good application prospect. However, the conclusions of the relationship between Aβ and post-stroke cognitive impairment (PSCI) have not been unified, and there are few related studies.

Research motivation

The commonly used tools for detecting cognitive function include neuropsychological scales, related imaging and cerebrospinal fluid examinations. Neuropsychological scales are limited by their clinical application due to a variety of factors and the need for higher expertise. The cost of imaging examination is relatively high, and its accuracy is related to the level of medical facilities. Therefore, the discovery of effective biomarkers may increase the efficiency of diagnosis and treatment of PSCI. Aβ is considered to be the common pathway of vascular dementia induced by various causes, which can lead to a cascade reaction of neuron injury. More and more studies have shown that Aβ1-42 is associated with PSCI, but there is no direct correlation between the two.

Research objectives

The purpose of this study is to explore the relationship between serum Aβ1-42, thyroid hormone level and PSCI and its predictive effect on this disease and to understand the influence of other possible risk factors on PSCI.

Research methods

A total of 195 patients with acute cerebral infarction were followed up for 1 year and grouped according to the Montreal Cognitive Assessment score. We analyzed the difference of clinical data and Aβ1-42 and thyroid hormone between the two groups. The changes of Aβ1-42 and thyroid hormone with time after onset were analyzed by repeated measurement variance analysis, and the relationship between the above indicators and the progression of the disease was explored. COX regression and stratified analysis were used to evaluate the effects of Aβ1-42 and thyroid hormone on PSCI and other possible risk factors.

Research results

Our results showed that the prevalence of PSCI was highest at 3 mo after stroke and gradually decreased at 6 mo after stroke. We found that Aβ1-42, triiodothyronine (T3) and free thyroxin in patients with PSCI were lower than those with non-PSCI, and the above indicators were correlated with disease progression. Furthermore, Cox regression analysis revealed that Aβ1-42 and T3 were the factors influencing the development of disease, and the higher the Aβ1-42 and T3 levels, the lower the risk of disease.

Research conclusions

Aβ1-42 and T3 play an important role in the development of PSCI. Low levels of Aβ1-42 and T3 at the acute phase of ischemic stroke is the predictor of PSCI, and a higher education level may help to reduce the risk of PSCI.

Research perspectives

Currently, most of the studies on the biological markers of cognitive impairment are related to cerebrospinal fluid markers, and most of them are single predictive indicators. Therefore, there are some disadvantages in clinical practicability, sensitivity and specificity. This study analyzed the predictive ability of serum Aβ1-42 and thyroid hormone levels in cognitive impairment after ischemic stroke, improving the diagnostic rate of patients with PSCI. It provided reference for the prevention and treatment of PSCI and has potential clinical application value.