The Effects of Enriched Rehabilitation on Cognitive Function and Serum Glutamate Levels Post-stroke

Abstract

AimThis study aimed to explore the effect of enriched rehabilitation (ER) on cognitive function and serum glutamate levels in patients with stroke.MethodsForty patients diagnosed with post-stroke cognitive impairment (PSCI), according to the inclusion criteria, and undergoing inpatient rehabilitation were enrolled in the study. Patients were randomly assigned to receive 8 weeks of ER treatment (ER group; n = 20) or conventional medical treatment (CM group; n = 20). In addition, 20 age-matched healthy subjects who were outpatients in our hospital during the same period formed the healthy control (HC) group. In- and between-group differences in cognitive function were assessed during pre-intervention and post-intervention based on the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT). The serum levels of glutamate, tumor necrosis factor (TNF), and malondialdehyde (MDA) levels were also detected pre-intervention and post-intervention.ResultsPre-intervention cognitive function and the levels of all the serum parameters assessed significant difference between the HC group and the PSCI group (both ER and CM groups) (p < 0.05), but not between the two groups of patients with PSCI (p > 0.05). Significant improvements were observed in cognitive function in both the ER and the CM groups post-intervention compared with pre-intervention, as evidenced by the measured improvement in MoCA, SDMT, and TMT scores. Similar improvements were seen for serum glutamate, the degree of oxidative damage, and the level of inflammation in both the treatment groups (p < 0.05). More enhancements in cognitive function, including MoCA, SDMT, TMT scores, and the serum levels of glutamate, the degree of oxidative damage, and the level of inflammation were shown in the ER group compared with the CM group post-intervention (p < 0.05).ConclusionsER can improve cognitive function in patients with PSCI. The associated mechanism may be related to the negative regulatory effect of ER on serum glutamate, TNF, and MDA levels, which is likely to enhance synaptic plasticity and alleviate oxidative stress- and inflammation-related damage, at least to some extent.

Post-stroke cognitive impairment: exploring molecular mechanisms and omics biomarkers for early identification and intervention

“…IDO leads to increased production of kynurenine, while kynurenine (Sapko et al, 2006) and quinolinic acid (Santamaría et al, 2001;Stone and Darlington, 2002) are involved in the induction of synaptic plasticity, and changes in these two substances' concentrations and ratios have been considered accurate indicators of PSCI (Cogo et al, 2021). Serum glutamate levels in PSCI patients further support the idea (Wang X. et al, 2022) that although glutamate is an excitatory neurotransmitter linked to cognitive function, excessive quantities might cause severe excitotoxicity that can aggravate ROS and inflammation (Liu et al, 2020b). Meng et al (2016) found that PSCI patients had a considerably lower N-acetylaspartic acid/creatine ratio in their hippocampal regions, whereas Liu et al (2015) also discovered an increase in serum creatine.…”

Biomarkers associated with functional improvement after stroke rehabilitation: a systematic review and meta-analysis of randomized controlled trials

“…Furthermore, the concentration of brain-derived neurotrophic factor (BDNF) significantly increased in the treatment group, and this was significantly correlated to the functional improvement after stroke ( 10 , 14 , 15 , 28 , 34 , 36 , 41 , 47 , 48 ) ( Figure 2 ; Table 1 ). Compared to the control group, the low-quality evidence in the treatment group revealed that the concentration of serum noradrenaline (NE) increased ( 27 , 28 , 36 ), while the concentrations of serum endothelin (ET) ( 39 , 44 , 46 ) and glutamate ( 36 , 40 , 42 ) decreased, and these were significantly associated with the functional improvement after stroke ( Supplementary Figures S2–S4 ; Table 1 ).…”