High Neutrophil–Lymphocyte Ratio Predicts Post-stroke Cognitive Impairment in Acute Ischemic Stroke Patients

Abstract

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.

A High Neutrophil-to-Lymphocyte Ratio Predicts Higher Risk of Poststroke Cognitive Impairment: Development and Validation of a Clinical Prediction Model

“…Patient sex, age, and the NIHSS score were considered to be associated with the occurrence of PSCI in previous studies ( 29 – 31 ). Few studies have considered using the NLR as an easily available peripheral inflammatory factor, and its relationship to PSCI ( 19 ). Our results suggest that higher NLR levels at admission are associated with the presence of PSCI.…”

“…The NLR, as an inflammatory marker, is associated with cognitive impairment ( 25 , 26 ). There are few studies on the association between the NLR and PSCI, except for the study by Minwoo Lee et al ( 19 ) who found that the NLR in acute ischemic stroke was independently associated with PSCI at 3 months poststroke. Nomograms have been widely used to predict the prognosis of oncology patients, predicting patient survival based on a simple score.…”

“…Extensive studies have also shown that inflammatory pathophysiology plays a crucial role in regulating cognitive impairment (16)(17)(18). However, as an inflammatory marker, studies on the effects of the neutrophil-tolymphocyte ratio (NLR) on PSCI are limited (19).…”

Erythrocytes Are an Independent Protective Factor for Vascular Cognitive Impairment in Patients With Severe White Matter Hyperintensities

“…In addition, lymphocyte count and classification are signs of the body's immune activity. With the discovery of the value of the neutrophil-lymphocyte ratio in the long-term predictive value of post-stroke cognitive impairment (Lee et al, 2021), the damage to the vascular nerve unit and cognitive dysfunction mediated by immune responses need to be further studied.…”

Leukocyte-derived ratios are associated with late-life any type dementia: a cross-sectional analysis of the Mugello study

“…Therefore, much research effort is devoted to identify possible low cost, and highly efficient, biological markers of preclinical dementia, in order to allow a precision medicine approach. In the recent past, the importance of leukocyte counts and their derived ratios has been established [22] in several fields of clinical medicine, as markers of disease progression, predictors of outcomes, and even of cognitive impairment after acute ischemic stroke [23].…”