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Relationship between NF-H expression and cognitive function in the serum of patients with asymptomatic carotid artery stenting
GUOLei, WANGJianhong, YANGShu, WANGDuozi, YUANXiaofan, GUOFuqiang
Chinese Journal of Alzheimer's Disease and Related Disorders ›› 2020, Vol. 3 ›› Issue (3) : 226-231.
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Abbreviation (ISO4): Chinese Journal of Alzheimer's Disease and Related Disorders
Editor in chief: Jun WANG
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Relationship between NF-H expression and cognitive function in the serum of patients with asymptomatic carotid artery stenting
Objective: To investigate the relationship between serum neurofilament protein heavy chain (NF-H) expression and cognitive function in patients with asymptomatic carotid artery stenosis before and after carotid artery stenting(CAS). Methods: From May 2018 to August 2019, 40 patients with asymptomatic carotid stenosis and mild cognitive impairment were admitted to the Department of Neurology of Sichuan Provincial People's Hospital as experimental group, and the control group was 40 health people. Blood samples in the operated patients were collected at three different points: 24 hours prior to CAS, 3 months after CAS in experimental group. Blood samples in control group were also collected. The serum concentrations of the NF-H were measured by ELISA. The cognitive function of the patients was evaluated by the mini-mental state examination(MMSE) and Montreal Cognitive Assessment(MoCA) before and 3 months after CAS.Compare the difference of serum NF-H expression level and the changes of cognitive function before and 3 months after operation. Results: Serum NF-H level of the patients in the experimental group was higher than that in the control group, with statistical difference (P< 0.01). The preoperative MMSE score in the experimental group was (26.08±1.59), which was lower than that in the control group (27.93±2.95), and the difference was statistically significant (P< 0.05). The preoperative MoCA score of the experimental group was significantly lower than that of the control group (24.48±1.89) vs (27.97±1.21), and the difference was statistically significant, (P< 0.01). Serum NF-H level decreased significantly (P< 0.01) in 3 months after operation compared with that before operation, and this is consistent with the improvement of cognitive function after 3 months--preoperative and postoperative comparison: MMSE(26.08±1.59) vs (27.48±1.95)(P< 0.05); MoCA(24.48±1.89) vs (26.83±.49)(P< 0.05). Pearson correlation analysis showed that the serum NF-H level was negatively correlated with MMSE score and MoCA score (P< 0.05). Conclusion: The patient with asymptomatic carotid artery stenosis have different degrees of brain injury and cognitive dysfunction. CAS can effectively improve the cognitive impairment associated with carotid stenosis, and the brain injury marker NF-H may be a biomarker for early recognition of cognitive impairment and may be used to monitor the cognitive function changes in patients after CAS.
Carotid artery stenosis / Carotid arterystenting(CAS) / NF-H / MMSE / MoCA / Cognitive function
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Adiponectin is an adipokine with anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing properties. Several factors may influence adiponectin levels, such as genetic polymorphisms, obesity / body fat distribution, diet and exercise as well as cardiovascular risk factors such as sleep deprivation and smoking as well as medications. Adiponectin has been proposed as a potential prognostic biomarker and a therapeutic target in patients with cardiometabolic diseases.This narrative review discusses the associations of adiponectin with obesity-related metabolic disorders (metabolic syndrome, nonalcoholic fatty liver disease, hyperuricaemia and type 2 diabetes mellitus). We also focus on the links between adiponectin and lipid disorders and with coronary heart disease and noncardiac vascular diseases (i.e. stroke, peripheral artery disease, carotid artery disease, atherosclerotic renal artery stenosis, abdominal aortic aneurysms and chronic kidney disease). Further, the effects of lifestyle interventions and drug therapy on adiponectin levels are briefly reviewed.Based on available data, adiponectin represents a multifaceted biomarker that may beneficially affect atherosclerosis, inflammation and insulin resistance pathways. However, there are conflicting results with regard to the associations between adiponectin levels and the prevalence and outcomes of cardiometabolic diseases. Further research on the potential clinical implications of adiponectin in the diagnosis and treatment of such diseases is needed.
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Retrospective studies have found a close correlation between an impaired cerebrovascular reserve capacity and the incidence of hemodynamic stroke. The present study evaluates this relation prospectively.We measured the CO2 reactivity in 85 patients with internal carotid artery occlusions by transcranial Doppler sonography (Doppler CO2 test). All patients were prospectively followed for 38 +/- 15 (mean +/- SD) months.In the group with sufficient CO2 reactivity, four of 48 (8%) developed ipsilateral transient symptoms, none a stroke. In cases with diminished or exhausted cerebrovascular reserve capacity, 12 of 37 (32%) suffered an ipsilateral event (four transient ischemic attacks, eight strokes) (p less than 0.01).The Doppler CO2 test seems to be a valuable method of estimating the risk of stroke in patients with carotid artery occlusions.
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Serological biomarkers which enable quick and reliable diagnosis or measurement of the extent of irreversible brain injury early in the course of stroke are eagerly awaited. Neurofilaments (Nf) are a group of proteins integrated into the scaffolding of the neuronal and axonal cytoskeleton and an established biomarker of neuro-axonal damage. The Nf heavy chain (NfH(SMI35)) was assessed together with brain-specific astroglial proteins GFAP and S100B in hyperacute stroke (6 and 24 h from symptom onset) and daily for up to 6 days. Twenty-two patients with suspected stroke (median NIHSS 8) were recruited in a prospective observational study. Evidence for an ischaemic or haemorrhagic lesion on neuroimaging was found in 18 (ischaemia n = 16, intracerebral haemorrhage n = 2). Serum NfH(SMI35) levels became detectable within 24 h post-stroke (P < 0.0001) and elevated levels persisted over the study course. While GFAP was not detectable during the entire course, S100B levels peaked at the end of the observation period. The data indicate that significant in vivo information on the pathophysiology of stroke may be obtained by the determination of NfH(SMI35). Further studies are required to evaluate whether NfH(SMI35) in hyperacute stroke reflects the extent of focal ischaemic injury seen on neuroimaging or is a consequence of more diffuse neuro-axonal damage.
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Stroke is the second leading cause of death and a major cause of disability worldwide. Its incidence is increasing because the population ages. In addition, more young people are affected by stroke in low- and middle-income countries. Ischemic stroke is more frequent but hemorrhagic stroke is responsible for more deaths and disability-adjusted life-years lost. Incidence and mortality of stroke differ between countries, geographical regions, and ethnic groups. In high-income countries mainly, improvements in prevention, acute treatment, and neurorehabilitation have led to a substantial decrease in the burden of stroke over the past 30 years. This article reviews the epidemiological and clinical data concerning stroke incidence and burden around the globe.Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Cerebral hypoperfusion has previously been associated with mild cognitive impairment and dementia in various cross-sectional studies, but whether hypoperfusion precedes neurodegeneration is unknown. We prospectively determined the association of cerebral perfusion with subsequent cognitive decline and development of dementia.Between 2005 and 2012, we measured cerebral blood flow by 2-dimensional phase-contrast magnetic resonance imaging in participants of the population-based Rotterdam Study without dementia. We determined the association of cerebral perfusion (mL/100mL/min) with risk of dementia (until 2015) using a Cox model, adjusting for age, sex, demographics, cardiovascular risk factors, and apolipoprotein E genotype. We repeated analyses for Alzheimer disease and accounting for stroke. We used linear regression to determine change in cognitive performance during 2 consecutive examination rounds in relation to perfusion. Finally, we investigated whether associations were modified by baseline severity of white matter hyperintensities.Of 4759 participants (median age 61.3 years, 55.2% women) with a median follow-up of 6.9 years, 123 participants developed dementia (97 Alzheimer disease). Lower cerebral perfusion was associated with higher risk of dementia (adjusted hazard ratio, 1.31; 95% confidence interval per standard deviation decrease, 1.07-1.61), similar for Alzheimer disease only, and unaltered by accounting for stroke. Risk of dementia with hypoperfusion was higher with increasing severity of white matter hyperintensities (with severe white matter hyperintensities; hazard ratio, 1.54; 95% confidence interval, 1.11-2.14). At cognitive reexamination after on average 5.7 years, lower baseline perfusion was associated with accelerated decline in cognition (global cognition: β=-0.029, =0.003), which was similar after excluding those with incident dementia, and again most profound in individuals with higher volume of white matter hyperintensities ( value for interaction=0.019).Cerebral hypoperfusion is associated with accelerated cognitive decline and an increased risk of dementia in the general population.© 2017 American Heart Association, Inc.
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Intraoperative blood flow assessments during cerebral bypass would ideally assess vessel patency, downstream perfusion, and risk of postoperative hyperperfusion syndrome (HPS). Previous studies using indocyanine green-based flow analyses (ICG-BFA) have identified multiple parameters that can intraoperatively track bypass-related changes in cerebral perfusion and potentially predict postoperative risk of HPS. Herein, we determine the most robust parameter and anatomic location for intraoperative ICG-BFA assessment of bypass-related perfusion changes and prediction of postoperative risk of HPS.Retrospective analysis of an institutional review board-approved prospective database identified patients undergoing superficial temporal artery-to-middle cerebral artery bypass. Demographic and clinical information, as well as manually calculated and automated pre- and postbypass intraoperative ICG-BFA data from cortical, arterial, and venous regions of interest were recorded and analyzed.Seven patients underwent superficial temporal artery-to-middle cerebral artery bypass (4 Moyamoya, 3 carotid occlusions). Average age was 48.2 ± 13.9 years (3 female, 4 male). Although all parameters measured showed trends toward improvement postbypass, only changes in arterial and venous automated ICG-BFA slope (also known as blood flow index [maximum intensity/rise time]) reached significance. None of the patients experienced symptomatic HPS, despite 5 of 7 (71.4%) having an increased HPS risk based on previously published ICG-BFA data.ICG-BFA has utility for the intraoperative assessment of bypass-related changes in cerebral perfusion, with automated blood flow index being the most robustly affected parameter. Although previously published ICG-BFA indices did not predict the development of symptomatic postoperative HPS, larger-scale studies correlating observed ICG-BFA changes with risk of HPS are warranted.Copyright © 2018 Elsevier Inc. All rights reserved.
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