Abstract
This study aimed to explore the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) and cognitive dysfunction risk in patients with acute ischemic stroke (AIS). This cross-sectional study enrolled 583 AIS patients. Biochemical markers and lipid profile were collected after admission. AIS patients were classified into high group (non-HDL-C ≥3.4 mM) and normal group (non-HDL-C <3.4 mM). Mini-Mental State Examination scale (MMSE), Montreal Cognitive Assessment scale (MoCA), Activities of Daily Living (ADL) scale, Neuropsychiatric Inventory (NPI), and Hamilton Depression scale 21 version (HAMD-21) were applied on the third day after admission. Compared with the control group, patients of the high group had higher body mass index and higher frequency of intracranial artery stenosis, and exhibited higher levels of non-HDL-C, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, fasting blood glucose, and glycosylated hemoglobin (HbA1c), and lower levels of high-density lipoprotein cholesterol (all P<0.05). Compared with the control group, patients of the high group had significantly lower MMSE and MoCA scores (MMSE: 26.01±4.17 vs 23.12±4.73, P<0.001; MoCA: 22.28±5.28 vs 20.25±5.87, P<0.001) and higher scores on the NPI and HAMD-21 (both P<0.001). MMSE (r=-0.306, P<0.001) and MoCA scores (r=-0.251, P<0.001) were negatively associated with non-HDL-C level. Multivariate regression analysis revealed that non-HDL-C level (OR=1.361, 95%CI: 1.059-1.729, P=0.016) was independently associated with the presence of cognitive dysfunction after adjusting for confounding factors. High serum non-HDL-C level might significantly increase the risk of cognitive dysfunction after AIS.
Highlights
Vascular cognitive impairment is one of the most common complications in patients with acute ischemic stroke (AIS) [1]
The exclusion criteria were: 1) patients with disturbance of consciousness, hemiplegia or severe aphasia, and could not complete neuropsychological testing; 2) patients with depression, Lewy body dementia, Alzheimer’s disease, frontotemporal dementia, or dementia induced by other reasons such as intracranial infections, malignant tumors, traumatic brain injury, neurodegenerative diseases, etc.; 3) patients with other severe organ dysfunction; 4) patients with a history of mental illness or abnormal behavior; 5) patients who had ischemic stroke history combined with cognitive dysfunction before the onset of the present AIS; and 6) usage of nootropics or antipsychotics within 4 weeks
AIS patients who were hospitalized at the Department of Neurology, Weifang People’s Hospital between January 2013 and December 2018 were included in the final analysis
Summary
Vascular cognitive impairment is one of the most common complications in patients with acute ischemic stroke (AIS) [1]. Dyslipidemia has been considered to be a vital risk factor for cardiovascular disease (CVD), and its roles in the occurrence and development of ischemic stroke are still unknown. Dyslipidemia may result in the insidious, progressive decline of vital organ function, and influence the cognitive function of AIS patients through accelerating systemic atherosclerosis. It has been regarded as a risk factor for inducing cognitive impairment and vascular dementia [2]. Previous consensus and guidelines have recommended low-density lipoprotein cholesterol (LDL-C) as the primary target of lipid-lowering therapy for primary prevention of CVD [3]. Non-HDL-C contains all of the potentially atherogenic lipid particles, it is more likely to reflect the risk of atherosclerotic disease [4]
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