Nonlinear relationship between glycated hemoglobin and cognitive impairment after acute mild ischemic stroke

Abstract

Background Stroke is the second most common cause of morbidity and mortality. Even mild stroke survivors have an increased risk of cognitive impairment. Studies have been conducted on the relationship between glycated hemoglobin (HbA1c) and cognitive decline, but the findings have been inconsistent. Therefore, this study examined the link between HbA1c levels and cognitive impairment following acute mild ischemic stroke. Methods Data from 311 patients with acute mild ischemic stroke admitted to Suining Central Hospital, Sichuan Province, China, from January 1, 2015, to December 31, 2018, were evaluated. Fasting venous blood was taken to assess HbA1c levels on the day after admission. Cognitive function was assessed using the Chinese version of the Montreal Cognitive Assessment Scale (MoCA) 3–6 months after stroke onset. We used a generalized additive model and smooth curve fitting (penalty spline method) to assess the nonlinear relationship between HbA1c and poststroke cognitive impairment (PSCI). Results This study included 311 patients aged 23 to 96 years old (mean age: 67.37 ± 11.92 years), of whom 198 (63.67%) were men. Among the 311 stroke patients, 120 (38.59%) had PSCI. After adjusting for potential confounders, there was a nonlinear relationship between HbA1c and PSCI, with an inflection point of 8.2. To the left of the inflection point, the effect size, 95% confidence interval, and P value were 0.87, 0.58 to 1.31, and 0.5095, respectively; however, to the right of the inflection point, these numbers were 1.96, 1.08 to 3.58, and 0.0280. Conclusion We found a nonlinear relationship between HbA1c and PSCI. When HbA1c was greater than 8.2%, HbA1c was positively correlated with PSCI.

Correlation between the Cognitive Status (SIRT1) and the Metabolic Function in Geriatric Patients Using the Indonesian Version of the Montreal Cognitive Assessment (MoCA-INA)

“…It was confirmed that the HbA1c value was inversely correlated with various measures of cognitive condition; thus, high levels of blood glucose were verified as a major risk factor for cognitive impairment [25]. Interestingly, a nationwide, register-based cohort with all diabetes cases conducted by Andersen and co-workers in Denmark from January 2000 through December 2012 (n > 150,000) revealed that high HbA1c levels were correlated with lessened cognitive performance [26]. Another study of 311 patients (aged 23 to 96 years old) with acute mild ischemic stroke at the Suining Central Hospital, Sichuan Province, China, from 1 January 2015 to 31 December 2018, demonstrated almost similar results.…”

Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review

“…Post-stroke DM is associated with post-stroke cognitive decline and dementia [38,57]. A recent study suggests a potential non-linear relationship between hemoglobin A1C and post-stroke cognitive impairment [58]. However, it remains unclear if improvement in hemoglobin A1C following stroke independently improves post-stroke cognitive and functional outcomes and what, if any, is the ideal target hemoglobin A1C to mitigate the risk of post-stroke dementia.…”