Residual Inflammatory Risk Is Associated with Cognitive Impairment After Acute Ischemic Stroke

Acute ischemic stroke (AIS) may lead to varying degrees of cognitive impairment, while the inflammatory response plays a significant role in this process. This study aims to examine the relationship between residual inflammation risk (RIR) and the development of post-stroke cognitive impairment (PSCI) in patients with acute ischemic stroke.

This prospective cohort study enrolled a total of 172 patients diagnosed with AIS over the study period from January 2024 to December 2024. They were divided into four groups: RIR only [low-density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L and high-sensitivity CRP (hsCRP) ≥ 2 mg/L], residual cholesterol risk (RCR) only (LDL-C ≥ 2.6 mmol/L and hsCRP < 2 mg/L), both risk or residual cholesterol and inflammatory risk (RCIR) (LDL-C ≥ 2.6 mmol/L and hsCRP ≥ 2 mg/L), and neither risk (LDL-C < 2.6mmol/L and hsCRP < 2 mg/L). PSCI is defined as a Montreal Cognitive Assessment (MoCA) score below 22 at 6 months after stroke. The final analysis included 172 patients who completed the follow-up. The association between RIR and PSCI was analyzed by multivariable logistic regression analyses.

Among the 172 enrolled patients, 58 (33.7%) developed PSCI. The proportion of patients with neither risk, RIR, RCR, and RCIR was 23.8% (n=41),18.6% (n=32), 32.0% (n=55) and 25.6% (n=44), respectively. Compared to those without PSCI, patients with PSCI had a higher prevalence of hyperlipidemia (P = 0.026), a greater proportion of RIR (P = 0.015), and higher white blood cell count (P = 0.042) and neutrophil count (P = 0.016). Logistic regression analysis, adjusting for major confounding factors, identified RIR as an independent factor associated with PSCI occurrence (OR 4.496, 95% CI 1.571-17.477, P = 0.030; RCIR: OR 7.357, 95% CI 2.081-26.006, P = 0.002).

This study presents what is, to our knowledge, the first evidence that RIR is associated with PSCI among acute ischemic stroke patients.