Cross-sectional study on the connection between collateral status and cognitive impairment after stroke based on neural regulation and protein metabolism

Serum phosphorylation neurofilament heavy chain (p-NfH) is a marker of axonal injury, and previous research has shown an association between p-NfH and both Alzheimer’s disease and frontotemporal dementia. However, there have been no reports on its relationship with post-stroke cognitive impairment (PSCI). The purpose of this study is to investigate whether p-NfH can serve as a predictive biomarker for PSCI following acute ischemic stroke (AIS). From July 2020 to September 2021, a total of 58 cases of first-time acute ischemic stroke (AIS) patients were admitted to the Department of Neurology in the Second Hospital of Hebei Medical University. Additionally, 30 healthy volunteers were randomly selected as the control group. Demographic data, medical history, NIHSS scores, cerebral infarction volume, Fazekas scores for white matter and the serum p-NfH were collected. Follow-up assessments were conducted at 6 and 12 months after AIS. Cognitive function was evaluated using a multi-domain cognitive assessment scale, and patients were categorized into the post-stroke cognitive impairment group (PSCI) and non-post-stroke cognitive impairment group (N-PSCI). Further stratification was done into the progression group (MoCA score decline) and stable group (MoCA score unchanged or improved) based on the difference in MoCA scores between 12 and 6 months. The serum p-NfH levels in the AIS group were significantly higher than those in the control group (p < 0.01). Additionally, p-NfH levels were positively correlated with NIHSS scores and infarct volume. Furthermore, AIS patients with moderate to severe cerebral white matter lesions (Fazekas score ≥ 2) showed higher p-NfH levels compared to AIS patients with no or mild white matter lesions (Fazekas score 0 or 1) (p < 0.01). The PSCI group demonstrated higher p-NfH levels compared to the N-PSCI group, even after accounting for variables such as age, education level, NIHSS, infarct volume, and Fazekas grading (OR = 1.06, 95% CI 1.004–1.11, p = 0.03). Furthermore, the progression group exhibited significantly elevated p-NfH levels in comparison to the stable group. The ROC curve analysis revealed that the ideal cutoff point for p-NfH was determined to be at 166.03 pg/ml. This cutoff point exhibited a sensitivity of 0.774 and a specificity of 0.926 (p < 0.01). Furthermore, the area under the curve was calculated to be 0.881 (95% CI 0.791–0.97, p < 0.01). Serum p-NfH is a potential biomarker for predicting PSCI. Further investigation should explore its potential as an indicator for timely cognitive intervention in stroke patients during follow-up.

Introduction: The collateral circulation plays an important role in the dynamic process of cerebral ischemia. The aim of this study is to determine if collateral status correlates with the early ischemic changes measured by the rate of Alberta Stroke Program Early CT Scores (ASPECTS) decay in emergently transferred acute ischemic stroke patients with anterior large vessel conclusions. Material and methods: We retrospectively analyzed the data of patients referred to our comprehensive stroke center from 7 outside hospitals between January 15, 2006 and January 15, 2014. Collateral status was assessed using an initial CT angiography obtained before treatment, and graded as "Good" (the entire medial cerebral artery reconstitutes with contrast) or "Poor" (partial or no reconstitution of the distal medial cerebral artery), by two independent reviewers (CA and WD). ASPECTS decay was calculated in the following ways: 1. Absolute ASPECTS decay: (A1-A2)/T, 2. Relative ASPECTS decay: [(A1-A2)/A1]/T 3. Net ASPECTS difference: (A1-A2) and 4. Relative ASPECTS difference: (A1-A2)/A1; where A1= ASPECTS 1st CT, A2= ASPECTS 2nd CT, T= hours between 2 CT scans. Results: After reviewing 701 medical records from transferred patients, 51 patients with mean age 65±3 yrs and median initial NIHSS of 17 (IQR 14-21) were selected. In the multivariate analysis, good collateral status was independently associated with lower rates of ASPECTS decay measured by the relative rate of ASPECTS decay (0.04+/-0.01 score/h; p&lt;0.05), the net ASPECTS difference (1.10+/-0.17 score/h, p&lt;0.05) and the relative ASPECTS difference (0.12+/-0.02 score, p&lt;0.05). The relative ASPECTS difference was most strongly associated with collateral status, and an independent predictor of good outcome (p=0.047) and final infarct volume (p=0.001) after controlling for age and NIHSS in a multivariate analysis. Conclusions: Good collateral circulation status is associated with lower rates of ASPECTS decay in transferred patients, which also tend to have smaller final infarct volumes and better clinical outcome after 3 months. The analysis of the collateral circulation gives us a better understanding of the pathophysiology in acute ischemic stroke.

Inflammation is recognized as a pivotal factor in the pathophysiology of acute ischemic stroke (AIS) and has the potential to influence the collateral circulation of patients. The objective of this investigation was to explore the link between peripheral regulatory T cells (Tregs), interleukin-2 (IL-2), and the status of collateral circulation. Between September 2023 and May 2024, the study incorporated 117 AIS patients from the neurology department, with 60 identified as having good collateral status (GCS) and 57 with poor collateral status (PCS). Additionally, a control group of 46healthy individuals was included. Collateral circulation in AIS patients was assessed via computed tomography angiography. The levels of peripheral blood Tregs were quantified through flow cytometry, while IL-2 was measured by ELISA. In this investigation, patients diagnosed with PCS demonstrated reduced Tregs (5.77 ± 1.55%) and IL-2 levels (7.37 ± 2.61 pg/mL) compared to individuals with GCS (7.09 ± 1.32%, 9.95 ± 3.58 pg/mL) and healthy controls (7.17 ± 1.40%,10.33 ± 4.01 pg/mL). Logistic regression analysis identified significant associations between Tregs and IL-2 levels and collateral circulation status (p<0.05), with diminished levels of both being independent predictors of PCS when compared to GCS. A nomogram was developed to forecast risk factors for collateral circulation, further highlighting the potential of plasma Tregs and IL-2 levels as biomarkers in predicting collateral circulation among AIS patients. The diagnostic performance of Tregs and IL-2 was assessed utilizing receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) for Tregs in differentiating GCS from PCS patients was ascertained to be 0.741 (95% confidence interval [CI]: 0.652-0.830), while for IL-2, it was 0.710 (95% CI: 0.618-0.803). Moreover, the combined measurement of Tregs and IL-2 resulted in an AUC of 0.779 (95% CI: 0.695-0.863). Plasma levels of peripheral blood Tregs and IL-2 may function as promising biomarkers for the prediction of collateral circulation status, suggesting potential new therapeutic approaches aimed at enhancing cerebral collateral circulation, and providing new therapeutic targets for acute ischemic stroke.

Cognitive impairment is the major complication of acute ischemic stroke, which is a significant health concern imposing a heavy economic burden on families and society. Studies have shown that the serum uric acid (SUA) level is correlated to clinical outcomes of stroke and neurogenerative diseases. The serum uric acid to serum creatinine ratio (SUA/SCr) is an independent risk factor for poor outcomes of acute ischemic stroke and can potentially become an effective diagnostic indicator for cognitive decline. In this study, we aimed to investigate the association between SUA/SCr and early-onset post-stroke cognitive impairment. Consecutive acute ischemic stroke patients from our hospital were enrolled between June 2023 and September 2024. All blood samples were collected within 24 h after admission, and the cognitive function of patients was assessed within 2 weeks using the Chinese version of the Montreal Cognitive Assessment (MoCA). SUA/SCr was calculated by serum uric acid (umol/L)/serum creatinine (umol/L) and was split into three layers according to tertiles. The subjects were divided into a post-stroke cognitive impairment group and a non-post-stroke cognitive impairment group based on cognitive assessment. Binary logistic regression with different models, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curves were adopted to evaluate the predictive ability of SUA/SCr in early-onset post-stroke cognitive impairment. The current study showed that the post-stroke cognitive impairment group had lower SUA/SCr (p = 0.005) and the lower tertile of SUA/SCr is associated with a higher prevalence of post-stroke cognitive impairment (p = 0.008). The multivariate logistic analysis indicated that SUA/SCr (OR = 0.560, 95% CI = 0.321-0.976, p = 0.024) was independently associated with early-onset post-stroke cognitive impairment, and the lowest tertile was independently associated with a 5.903-fold increased risk of post-stroke cognitive impairment after adjusting for confounders. The optimal cutoff value of SUA/SCr to predict post-stroke cognitive impairment was 4.874, which gave a sensitivity of 72.22% and a specificity of 63.16%. Our study revealed that SUA/SCr can be a potential indicator for post-stroke cognitive impairment in the early phase, a lower level of SUA/SCr upon admission was independently correlated to cognitive dysfunction after stroke.

Association of statin pretreatment with collateral circulation and final infarct volume in acute ischemic stroke patients: A meta-analysis

Neuronal pentraxin 2 (NPTX2) is associated with cognitive impairment in some neurodegenerative diseases. However, few studies focused on the association between NPTX2 and poststroke cognitive impairment (PSCI). Hence, this study aimed to investigate the association between serum NPTX2 levels and PSCI. A total of 134 participants with acute ischemic stroke (AIS) and 42 normal controls were enrolled in this study. Admission baseline information was collected, and serum NPTX2 levels were determined within 24h using enzyme-linked immunosorbent assay (ELISA) at hospital admission. All subjects were evaluated for cognitive function using the MoCA (Montreal Cognitive Assessment) scale at 3 months after stroke onset, and patients with AIS were divided into PSCI and PSNCI (poststroke no cognitive impairment) groups, with a total MoCA score < 26 defined as PSCI. This study analyzed the relationship between serum NPTX2 and MoCA score and the risk factors of PSCI. The receiver operating characteristic (ROC) curve was to evaluate the diagnostic value of serum NPTX2 levels on PSCI. Among the 134 AIS participants, 53 (38.8%) patients suffered from PSCI at 3 months after stroke onset. The serum levels of NPTX2 in the PSCI group, PSNCI group, and normal controls group were significantly different (p <0.05). The serum NPTX2 levels in the PSCI and PSNCI groups were higher than normal control group, and the serum NPTX2 levels in the PSCI group were lower than PSNCI group (p <0.05). Serum NPTX2 levels were positively correlated with the total score of MoCA (r = 0.329, p <0.01), and also positively correlated with some subcognitive domains of MoCA (visuospatial and executive functions, naming, delayed memory, and attention). ROC curve indicated that serum NPTX2 predicted cognitive impairment in AIS patients. Multivariate Logistic regression analysis indicated serum NPTX2 was an independent protective factor for PSCI (odds ratio [OR] = 0.075, 95% CI 0.010-0.812, p <0.01). Lower serum NPTX2 levels were associated with PSCI within 3 months in patients with first-episode AIS. Lower levels of serum NPTX2 may be associated with impairment in visuospatial and executive functions, naming, delayed memory, and attention, while a further larger-scale study is needed to verify our findings.

Acute ischemic stroke (AIS) accounts for the majority of all stroke, globally the second leading cause of death. Due to its rapid development after onset, its early diagnosis is crucial. We aim to identify potential highly reliable blood-based biomarkers for early diagnosis of AIS using quantitative plasma lipid profiling via a machine learning approach. Lipidomics was used for quantitative plasma lipid profiling, based on ultra-performance liquid chromatography tandem mass spectrometry. Our samples were divided into a discovery and a validation set, each containing 30 AIS patients and 30 health controls (HC). Differentially expressed lipid metabolites were screened based on the criteria VIP > 1, p < 0.05, and fold change > 1.5 or < 0.67. The least absolute shrinkage and selection operator (LASSO) and random forest algorithms in machine learning were used to select differential lipid metabolites as potential biomarkers. Three key differential lipid metabolites, CarnitineC10:1, CarnitineC10:1-OH and Cer(d18:0/16:0), were identified as potential biomarkers for early diagnosis of AIS. The former two, associated with thermogenesis, were down-regulated, whereas the latter, associated with necroptosis and sphingolipd metabolism, was upregulated. Univariate and multivariate logistic regressions showed that these three lipid metabolites and the resulting diagnostic model exhibited a strong ability in discriminating between AIS patients and HCs in both the discovery and validation sets, with an area under the curve above 0.9. Our work provides valuable information on the pathophysiology of AIS and constitutes an important step toward clinical application of blood-based biomarkers for diagnosing AIS.

Objective To investigate the predictive role of cerebral white matter lesions (WML) and subcortical atrophy on cognitive function in patients with acute ischemic stroke (AIS) after 3 months. Methods 233 cases of AIS patients admitted to hospital continuously from September 2016 to March 2018 were enrolled and all of them underwent brain MRI.The degree of WML on FLAIR was evaluated according to the Fazekas grading standard.The linear measurement of subcortical atrophy on T1WI was carried out on the subcortical brain atrophy index, including EVANS ratio (ER), inverse cella media index (iCMI), caudate head index (CHI) and basal cistern index (BCI). Demographic, clinical and imaging data of all patients were also recorded.Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were conducted at 3 months after AIS.The patients were divided into normal cognitive function (NCI) group and post stroke cognitive impairment (PSCI) group according to evaluation results of MMSE and MoCA.Multivariate logistic regression analysis was used to screen the independent risk factors of cognitive impairment. Results Univariate analysis showed that age (t=-4.233, P=0.000), sex (χ2=7.501, P=0.006), education (H=21.188, P=0.000), NHISS score (H=5.791, P=0.016), history of atrial fibrillation (χ2=6.484, P=0.011), TIA (χ2= 9.015, P=0.003), smoking history (χ2=6.943, P=0.008), Fazekas WML score (χ2=27.885, P=0.000), EVANS ratio (H=31.129, P=0.000), inverse cella media index (H=9.434, P=0.002), caudate head index (H=15.148, P=0.000), basal cistern index (t=-1.979, P=0.049) and baseline cognitive function (χ2=136.994, P=0.000) were related to cognitive impairment in patients with AIS after 3 months (P<0.05). Multivariate logistic regression analysis showed that WML score (OR=3.416, P=0.047, 95%CI: 1.017-11.482), EVANS ratio (OR=1.245, P=0.038, 95%CI: 1.012-1.531) and caudate head index (OR=1.187, P=0.040, 95%CI: 1.008-1.397) were risk factors for cognitive impairment in AIS patients after 3 months adjusting for age, education, disease severity and baseline cognitive function. Conclusion WML, EVANS ratio and caudate head index can predict short-term cognitive function in patients with AIS. Key words: White matter lesions; Subcortical atrophy; Acute ischemic stroke; Cognitive impairment

Introduction and Hypothesis: Multiple studies have demonstrated no statistically significant association between time after stroke onset and initial infarct volume. Factors other than time may play a role in infarct growth. We sought to investigate association between collateral status and infarct growth rate in acute ischemic stroke (AIS) patients. Methods: We included 130 consecutive patients with CTA showing ICA and/or proximal MCA occlusions who had DWI within 8 hours of stroke onset. Collateral status was categorized into three groups: poor (none or minimal), intermediate (present but &lt; contralateral side) and good (≥ contralateral side). DWI lesion volumes were measured and infarct growth rate was calculated using MRI time after stroke onset. Mann-Whitney test and correlation coefficient were used for statistical analysis. Results: In our 130 patients, 62 female (48%), the average values (mean±SD) were: age 70 ± 17 years, NIHSS 16 ± 6, DWI volume 59 ± 65 mL, time after stroke onset 4 ± 2 hours, and infarct growth rate 17 ± 23 mL/hour. 19 (14.6%) had poor, 75 (57.7%) had intermediate, and 36 (27.7%) had good collaterals. Infarct growth rate and DWI lesion volume were significantly increased with decreased collateral quality (p&lt;0.0004 for all group comparisons). Patients with good collaterals were younger (p=0.004 and p=0.018 compared to poor and intermediate groups respectively) and had lower NIHSS scores (p&lt; 0.001). Time after stroke onset, gender, or occlusion site (ICA vs MCA) were not significantly different among different collateral groups. There was no correlation between time and DWI volume (r2=0.02, p=0.8) or collateral status (r2=0.05, p=0.6). There was significant correlation between collateral status and infarct growth (r2=-0.6,p&lt;0.0001). Conclusion: AIS patients with good collaterals have small initial DWI lesion volumes and slower infarct growth rates. These patients may be candidates for treatment options outside traditional time windows.

Background: Post stroke cognitive impairment (PSCI) can be as high as 15-70% after stroke depending on the patient population and diagnostic tool. Few studies on PSCI have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI in the current population. Methods: We analyzed Cerner Health Facts® EMR database, which is comprised of de-identified EHR data from over 700 hospitals and clinics in the US from 2000-2018. We evaluated patients ≥40 years of age with a first time acute ischemic stroke (AIS) diagnosis using ICD9/10 codes. PSCI was defined as pts with ICD 9/10 codes for dementia, mild cognitive impairment, or on medications for dementia. Pts with first stroke in the Cerner database and no pre-existing cognitive impairment were included; those with no follow-up visits in the system were excluded. We compared hazard ratios for developing PSCI for patient characteristics. Results: A total of 211,622 AIS pts were evaluated, of which 153,078 had follow-up data in the system and no prior diagnosis of PSCI. Among these, the rate of PSCI was 9.29%. Most pts qualified under PSCI using dementia ICD codes (15,280) compared to mild cognitive impairment codes (4,321) or medication usage (1,032). Median time to PSCI diagnosis was at their first follow-up visit within the first year after stroke. Pts ≥65 years of age at time of stroke (HR 2.95, 95% CI 2.83,3.07) and of African American race (HR 1.37, 95% CI 1.31,1.46) were more likely to develop dementia. There were no disparities for developing PSCI between Hispanic and non-Hispanic pts (HR 0.89, 95% CI 0.69, 1.16). Male pts were less likely to develop PSCI than female counterparts (HR 0.84, 95% CI 0.81,0.87). Conclusion: Our analyses highlight the viability of utilizing large administrative databases to assess trends in PSCI diagnosis. The number of pts with PSCI may be underestimated however, given the importance of EHR records in patient care, this suggests PSCI is under-diagnosed in the community. Previously described racial disparities for black survivors persisted but male patients had less PSCI. Further study into other administrative databases is necessary to assess if these data are consistent in other EHR systems and to evaluate new trends in PSCI diagnosis and treatment.

Introduction: Four-dimensional computed tomography (CT) angiography (4D-CTA) can visualize time sequential changes of bilateral internal carotid (ICA) and middle cerebral arteries (MCA). Therefore, 4D-CTA could find ICA or MCA occlusion and visualize collateral circulation in case of intracranial artery occlusion. Hypothesis: Four-dimensional CTA covering only 4-cm width with a focus on the intracranial ICA and the MCA can early visualize them because of small volumetric data and evaluate collateral development status to identify candidates of thrombectomy. Methods: We included acute ischemic stroke patients who 1) were admitted from August 2018 to July 2019 due to ICA or MCA occlusion, 2) underwent 4D-CTA covering only 4-cm width on admission and 3) underwent endovascular thrombectomy. We classified collateral status into good, moderate and poor collateral according to opacification of M2 and M3 branches distal to occlusion and evaluated successful recanalization of thrombolysis in cerebral infarction (TICI) grade 2b or 3 and improvement of NIHSS score 7 days after thrombectomy. Results: During the study period, 337 acute ischemic stroke patients were admitted, 92 patients suffered from ICA or MCA occlusion and 23 patients met our inclusive criteria. Median age was 81 years and median ASPECTS was 10. Image reconstruction time of 1,000 images was only 69 seconds and 4D-CTA with only 4-cm width demonstrated MCA occlusion in 14 patients, IC occlusion in 9 patients and collateral status as good in 4 patients, moderate in 13 patients and poor in 6 patients. Median onset-to-recanalization time was 5.2 hours, successful recanalization was achieved in 21 patients (91.3%), median NIHSS score on admission was 20, median 7-day NIHSS score decreased to 6 (p&lt;0.0001) and median decrease of NIHSS score was 13. Two patients without successful recanalization had no early improvement of NIHSS score, whereas 20 of 21 patients with successful recanalization obtained early neurological improvement. Conclusion: Four-dimensional CTA with only 4-cm width rapidly and appropriately evaluated collateral status to identify candidates of thrombectomy for ICA or MCA occlusion and achieved early neurological improvement following successful recanalization.

It is still controversial whether peripheral blood biomarkers have the potential to be diagnostic, prognostic, and therapeutic targets for post-stroke cognitive impairment (PSCI). All studies reporting the correlation between peripheral blood biomarkers and PSCI in Chinese acute ischemic stroke (AIS) patients were screened in eight databases and meta-analyses were performed to explore their predictive value for PSCI. The results showed that the levels of C-reactive protein (CRP), fasting bloodglucose (FBG), homocysteine (Hcy), and cystatin C (CysC) were significantly higher in the PSCI group than in the post-stroke cognitive impairment no dementia (PSNCI) group. However, the differences in glycosylated hemoglobin (HbA1c), creatinine (Cr), blood urea nitrogen (BUN), and uric acid (UA) levels were not significant. The correlation between Hcy and PSCI applies to all AIS patients, whereas the correlation between CRP (p < 0.001), FBG (p = 0.005), CysC (p = 0.005), and PSCI is generalizable only to first-onset AIS. CRP may be a biomarker of cognitive impairment 3-6months after AIS (3months: p < 0.001; 6months: p = 0.030) and does not appear to have a correlation in the long term. However, the correlation between FBG and PSCI may be significant 6months to 1year after AIS (6months: p = 0.032; 1year: p = 0.004), whereas the correlation between Hcy and PSCI may be significant 3months to 1year after AIS (3months: p = 0.002; 6months: p = 0.004; 1year: p = 0.004). CRP, FBG, Hcy, and CysC may be potential biomarkers for PSCI, whereas the correlation between Cr, BUN, UA, and PSCI has not been confirmed.

Elevated serum uric acid is associated with cognitive impairment in acute minor ischemic stroke patients

Stroke ranks first among disease fatalities, and those who do survive stroke are prone to cognitive impairment. The aim of this study was to explore the clinical characteristics of post stroke cognitive impairment (PSCI) and the risk factors of PSCI using multivariate logistic regression. January 2018 to January 2021, the clinical data of 120 patients treated for cerebral ischemic stroke (CIS) at Chengde Central Hospital were retrospectively analyzed. In this study, patients were divided into 2 groups: a control group and a cognitive impairment group. The clinical characteristics of cognitive impairment following CIS were determined using multivariate logistic regression analysis to examine the risk factors and identify clinical implications. This study included the assessment of overall cognitive function and daily living activities of 120 participants, 68 of whom experienced cognitive impairment, representing an incidence of 57%, while 43% patients represented no cognitive impairment after CIS. After the careful analysis of the data, there were remarkable differences in age, sex, education level, stroke history, infarction area, and infarction location (P<0.05). There was no remarkable difference in the history of hypertension, diabetes, atrial fibrillation, carotid intima thickness, smoking, or drinking (P>0.05). The degree of white matter degeneration, brain atrophy, and dominant hemisphere involvement was higher in the cognitive impairment group (P<0.05). The results of multivariate logistic regression analysis indicated that sex, age, education level, stroke history, infarction size, and infarction location were the main risk factors for cognitive impairment after CIS (P<0.05). Patients with cognitive impairment after CIS have imaging features of white matter degeneration, brain atrophy, and involvement of dominant hemispheres. The results of multivariate logistic regression analysis indicated that sex, age, education level, stroke history, infarct size, and infarct location were main risk factors of cognitive impairment after CIS.

Background and Aims: Systemic inflammation is associated with an increased risk of cognitive impairment and dementia, but the associations between them in stroke patients are less clear. We examined the impact of systemic inflammation represented as the neutrophil-lymphocyte ratio (NLR) on the development of post-stroke cognitive impairment (PSCI) and domain-specific cognitive outcomes 3-month after ischemic stroke.Methods: Using prospective stroke registry data, we consecutively enrolled 345 participants with ischemic stroke whose cognitive functions were evaluated 3-month after stroke. Their cognition was assessed with the Korean version of the Vascular Cognitive Impairment Harmonization Standards and the Korean-Mini Mental Status Examination. PSCI was defined as a z-score of < -2 standard deviations for age, sex, and education adjusted means in at least one cognitive domain. The participants were categorized into five groups according to the quintiles of NLR (lowest NLR, Q1). The cross-sectional association between NLR and PSCI was assessed using multiple logistic regression, adjusting for age, sex, education, vascular risk factors, and stroke type.Results: A total of 345 patients were enrolled. The mean age was 63.0 years and the median NIHSS score and NLR were 2 [1–4] and 2.26 [1.65–2.91], respectively. PSCI was identified in 71 (20.6%) patients. NLR was a significant predictor for PSCI both as a continuous variable (adjusted OR, 1.14; 95% CI, 1.00–1.31) and as a categorical variable (Q5, adjusted OR, 3.26; 95% CI, 1.17–9.08). Patients in the Q5 group (NLR ≥ 3.80) showed significantly worse performance in global cognition and in visuospatial and memory domains.Conclusions: NLR in the acute stage of ischemic stroke was independently associated with PSCI at 3 months after stroke, and high NLR was specifically associated with cognitive dysfunction in the memory and visuospatial domains. Thus, systemic inflammation may be a modifiable risk factor that may influence cognitive outcomes after stroke.