Background: Increased aortic stiffness has been found to be associated with cognitive function decline, but the evidence is still under debate. It is of great significance to elucidate the evidence in this debate to help make primary prevention decisions to slow cognitive decline in our routine clinical practice.Methods: Electronic databases of PubMed, EMBASE, and Cochrane Library were systematically searched to identify peer-reviewed articles published in English from January 1, 1986, to March 16, 2020, that reported the association between aortic stiffness and cognitive function. Studies that reported the association between aortic pulse wave velocity (PWV) and cognitive function, cognitive impairment, and dementia were included in the analysis.Results: Thirty-nine studies were included in the qualitative analysis, and 29 studies were included in the quantitative analysis. The aortic PWV was inversely associated with memory and processing speed in the cross-sectional analysis. In the longitudinal analysis, the high category of aortic PWV was 44% increased risk of cognitive impairment (OR 1.44; 95% CI 1.24–1.85) compared with low PWV, and the risk of cognitive impairment increased 3.9% (OR 1.039; 95% CI 1.005–1.073) per 1 m/s increase in aortic PWV. Besides, meta-regression analysis showed that age significantly increased the association between high aortic PWV and cognitive impairment risk.Conclusion: Aortic stiffness measured by aortic PWV was inversely associated with memory and processing speed and could be an independent predictor for cognitive impairment, especially for older individuals.

Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

Leptomeningeal collateral flow (LMF) is associated with infarct area and clinical outcome for ischemic stroke patients. Although LMF can be detected by multiple imaging methods, but their diagnostic performance is uncertain. The aim of this study was to evaluate the diagnostic validity or reliability of noninvasive image methods in assessing LMF. Databases included PubMed, Web of Science, Embase, and Cochrane Library. Original observational cohort studies. Ischemic stroke patients. Different noninvasive image methods to assess LMF. Newcastle–Ottawa Scale to evaluate the quality of the studies; forest plot to show pooled results; I 2 and Egger test to evaluate the heterogeneity and publication bias. Thirty of the 126 selected studies were eligible. For CT angiography, the interobserver agreement ranged from 0.494 to 0.93 and weighted kappa was 0.888; for patients receiving thrombolysis or endovascular treatment, 0.68 to 0.91; 0.494 to 0.89 for the 2-point system, 0.60 to 0.93 for the 3-point system, 0.68 to 0.87 for the system of >4 points; area under the curve (AUC) was 0.78. For perfusion computed tomography (CTP), the interobserver agreement ranged from 0.724 to 0.872; for patients receiving thrombolysis or endovascular treatment, 0.74 to 0.872; 0.724 for the 2-point system, 0.783 to 0.953 for the 3-point system; the intraobserver agreement was 0.884; AUC was 0.826. For MRI-fluid attenuated inversion recovery (FLAIR), the interobserver agreement ranged from 0.58 to 0.86; for patients receiving thrombolysis or endovascular treatment, 0.75 to 0.86; 0.86 for the two-point system, 0.77 to 0.87 for the system of more than 5 points; AUC was 0.82. No pooled data of CTP and FLAIR. The difference cohort study had difference bias. The unpublished data were not included. CT angiography is a good tool for assessing LMF. CTP shows a good validity and reliability, but its diagnostic value needs more evidence. FLAIR is a good modality to assess LMF. These image methods had better validity and reliability to evaluate LMF of patients receiving thrombolysis or endovascular treatment than all ischemic stroke patients.

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Background: People with migraine experience cognitive decline more often than healthy controls, resulting in a significant functional impact. Early identifying influencing factors that contribute to cognitive decline in migraineurs is crucial for timely intervention. Although migraine may onset early in childhood and early onset migraine is related to significant disability, there is no research investigating the association between age of migraine onset and migraineurs’ cognitive decline. Therefore we aim to explore possible factors that correlate to cognitive function of migraineurs, especially focus on age of migraine onset. Method: 531 patients with migraine were included. Data on demographics and headache-related characteristics were collected and evaluated using face-to-face interviews and questionnaires. We used the Montreal Cognitive Assessment scale to assess cognitive function. In addition, we analyzed independent correlations between cognitive decline and the age of migraine onset in patients with migraine. And all patients completed the Headache Impact Test-6 to evaluate their quality of life. Results: Migraineurs with cognitive decline showed significant differences from those without in age (OR=1.26, P<0.0001), years of education (OR=0.89, P=0.0182), intensity of headache (OR=1.03, P=0.0217), age of onset (OR=0.92, P<0.0001) and anxiety scores (OR=1.09, P=0.0235). Furthermore there was no interaction in the age of onset between subgroups. Multivariate linear regression analyses of HIT-6 scores showed that the intensity of headache (β=0.18, P<0.0001) and depression scores (β=0.26, P=0.0009) had independent effects on decreased quality of life. Conclusion: Our findings suggest that younger age of migraine onset is independently related to migraineurs’ cognitive decline, and migraine accompanying anxiety symptoms significantly related to decreased quality of life in migraineurs.