Endothelial Dysfunction and Pre-Existing Cognitive Disorders in Stroke Patients

• Published in: Biomolecules (Basel, Switzerland) Switzerland), 2024-06, Vol.14 (6), p.721
• Main Authors: Mendyk-Bordet, Anne-Marie, Ouk, Thavarak, Muhr-Tailleux, Anne, Pétrault, Maud, Vallez, Emmanuelle, Gelé, Patrick, Dondaine, Thibaut, Labreuche, Julien, Deplanque, Dominique, Bordet, Régis
• Format: Article
• Language: English
• Subjects: Aged; Antihypertensives; Atrophy; Biomarkers; Biomarkers - blood; Blood; Cognition disorders; Cognitive ability; cognitive disorder; Cognitive Dysfunction - physiopathology; Consent; Dementia; endothelial dysfunction; Endothelium; Endothelium, Vascular - physiopathology; Female; Fenofibrate; Humans; Hyperemia; Hypotheses; inflammation; Intelligence; Ischemia; Lesions; Life Sciences; Magnetic Resonance Imaging; Male; Middle Aged; Monocyte chemoattractant protein 1; Neutrophils; Patients; Prospective Studies; Risk Factors; Stroke; Stroke - complications; Stroke - physiopathology; Stroke patients; Substantia alba
• ISSN: 2218-273X; 2218-273X
• DOI: 10.3390/biom14060721

The origin of pre-existing cognitive impairment in stroke patients remains controversial, with a vascular or a degenerative hypothesis. To determine whether endothelial dysfunction is associated with pre-existing cognitive problems, lesion load and biological anomalies in stroke patients. Patients originated from the prospective STROKDEM study. The baseline cognitive state, assessed using the IQ-CODE, and risk factors for stroke were recorded at inclusion. Patients with an IQ-CODE score >64 were excluded. Endothelial function was determined 72 h after stroke symptom onset by non-invasive digital measurement of endothelium-dependent flow-mediated dilation and calculation of the reactive hyperemia index (RHI). RHI ≤ 1.67 indicated endothelial dysfunction. Different biomarkers of endothelial dysfunction were analysed in blood or plasma. All patients underwent MRI 72 h after stroke symptom onset. A total of 86 patients were included (52 males; mean age 63.5 ± 11.5 years). Patients with abnormal RHI have hypertension or antihypertensive treatment more often. The baseline IQ-CODE was abnormal in 33 (38.4%) patients, indicating a pre-existing cognitive problem. Baseline IQ-CODE > 48 was observed in 15 patients (28.3%) with normal RHI and in 18 patients (54.6%) with abnormal RHI ( = 0.016). The RHI median was significantly lower in patients with abnormal IQ-CODE. Abnormal RHI was associated with a significantly higher median FAZEKAS score (2.5 vs. 2; = 0.008), a significantly higher frequency of periventricular lesions ( = 0.015), more white matter lesions ( = 0.007) and a significantly higher cerebral atrophy score ( < 0.001) on MRI. Vascular biomarkers significantly associated with abnormal RHI were MCP-1 ( = 0.009), MIP_1a ( = 0.042), and homocysteinemia ( < 0.05). A vascular mechanism may be responsible for cognitive problems pre-existing stroke. The measurement of endothelial dysfunction after stroke could become an important element of follow-up, providing an indication of the functional and cognitive prognosis of stroke patients.