Endothelial Dysfunction and Pre-Existing Cognitive Disorders in Stroke Patients.

Area of Science:

• Neurology
• Vascular Medicine
• Cognitive Science

Background:

• The origins of cognitive impairment preceding stroke are debated, with vascular and degenerative theories proposed.
• Understanding these origins is crucial for effective patient management and prognosis.

Purpose of the Study:

• To investigate the association between endothelial dysfunction and pre-existing cognitive problems in stroke patients.
• To explore the relationship between endothelial dysfunction, lesion load on MRI, and specific biological markers.

Main Methods:

• Utilized data from the prospective STROKDEM study, assessing baseline cognitive state (IQ-CODE) and stroke risk factors.
• Measured endothelial function via reactive hyperemia index (RHI) 72 hours post-stroke onset.
• Analyzed vascular biomarkers and performed MRI to evaluate lesion load and cerebral atrophy.

Main Results:

• Abnormal RHI, indicating endothelial dysfunction, was significantly associated with lower baseline IQ-CODE scores (p=0.016).
• Endothelial dysfunction correlated with increased white matter lesions, periventricular lesions, and cerebral atrophy on MRI (p<0.001).
• Elevated MCP-1, MIP_1a, and homocysteinemia levels were significantly linked to abnormal RHI.

Conclusions:

• Findings suggest a vascular mechanism contributes to cognitive impairment present before stroke.
• Post-stroke endothelial dysfunction assessment may serve as a valuable prognostic indicator for functional and cognitive recovery.