Journal Article

Endothelial Dysfunction and Pre-Existing Cognitive Disorders in Stroke Patients

Bordet, Régis, Labreuche, Julien, Dondaine, Thibaut, Pétrault, Maud, Deplanque, Dominique, Mendyk-Bordet, Anne-Marie, Gelé, Patrick, Ouk, Thavarak, Vallez, Emmanuelle, Muhr-Tailleux, Anne

2024

Overview

Background: The origin of pre-existing cognitive impairment in stroke patients remains controversial, with a vascular or a degenerative hypothesis. Objective: To determine whether endothelial dysfunction is associated with pre-existing cognitive problems, lesion load and biological anomalies in stroke patients. Methods: Patients originated from the prospective STROKDEM study. The baseline cognitive state, assessed using the IQ-CODE, and risk factors for stroke were recorded at inclusion. Patients with an IQ-CODE score >64 were excluded. Endothelial function was determined 72 h after stroke symptom onset by non-invasive digital measurement of endothelium-dependent flow-mediated dilation and calculation of the reactive hyperemia index (RHI). RHI ≤ 1.67 indicated endothelial dysfunction. Different biomarkers of endothelial dysfunction were analysed in blood or plasma. All patients underwent MRI 72 h after stroke symptom onset. Results: A total of 86 patients were included (52 males; mean age 63.5 ± 11.5 years). Patients with abnormal RHI have hypertension or antihypertensive treatment more often. The baseline IQ-CODE was abnormal in 33 (38.4%) patients, indicating a pre-existing cognitive problem. Baseline IQ-CODE > 48 was observed in 15 patients (28.3%) with normal RHI and in 18 patients (54.6%) with abnormal RHI (p = 0.016). The RHI median was significantly lower in patients with abnormal IQ-CODE. Abnormal RHI was associated with a significantly higher median FAZEKAS score (2.5 vs. 2; p = 0.008), a significantly higher frequency of periventricular lesions (p = 0.015), more white matter lesions (p = 0.007) and a significantly higher cerebral atrophy score (p < 0.001) on MRI. Vascular biomarkers significantly associated with abnormal RHI were MCP-1 (p = 0.009), MIP_1a (p = 0.042), and homocysteinemia (p < 0.05). Conclusions: A vascular mechanism may be responsible for cognitive problems pre-existing stroke. The measurement of endothelial dysfunction after stroke could become an important element of follow-up, providing an indication of the functional and cognitive prognosis of stroke patients.

• Publisher: MDPI AG,MDPI
• Subject: Aged / Antihypertensives / Atrophy / Biomarkers / Biomarkers - blood / Blood / Cognition disorders / Cognitive ability / cognitive disorder / Cognitive Dysfunction - physiopathology / Consent / Dementia / endothelial dysfunction / Endothelium / Endothelium, Vascular - physiopathology / Female / Fenofibrate / Humans / Hyperemia / Hypotheses / inflammation / Intelligence / Ischemia / Lesions / Life Sciences / Magnetic Resonance Imaging / Male / Middle Aged / Monocyte chemoattractant protein 1 / Neutrophils / Patients / Prospective Studies / Risk Factors / Stroke / Stroke - complications / Stroke - physiopathology / Stroke patients / Substantia alba