Abstract
Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.
Highlights
Post-stroke cognitive impairment (PSCI) is one of the major disabilities encountered by post-stroke survivors
The baseline characteristics between no cognitive impairment (NCI) group and post-stroke cognitive impairment (PSCI) group are presented in the Table 1
In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI, after adjusting for age, sex, education level, initial stroke severity, TOAST classification, and presence of a left hemispheric lesion
Summary
Post-stroke cognitive impairment (PSCI) is one of the major disabilities encountered by post-stroke survivors. Hyperglycemia should be considered along with the pre-existing glycemic control status to reflect acute physiological stress For this purpose, previous studies have utilized the glycemic gap as a surrogate marker for stress-induced hyperglycemia (SIH) by subtracting the HbA1c-derived estimated average glucose (eAG) from the initial serum glucose [5,6,7,8]. The study showed that the association between them remained significant only in non-diabetic patients and diabetic patients with good glycemic control status They suggested that an elevated glycemic gap during the acute stage better reflects stress-induced hyperglycemia (SIH) and is a better prognostic factor than hyperglycemia itself without considering the glycemic control status. It is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions
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