Neural Regeneration Research ›› 2020, Vol. 15 ›› Issue (5): 922-928.doi: 10.4103/1673-5374.268928

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Serum cystatin C levels are negatively correlated with post-stroke cognitive dysfunction

Dao-Xia Guo1, Zheng-Bao Zhu1, Chong-Ke Zhong1, 2, Xiao-Qing Bu1, 2, Li-Hua Chen1, Tan Xu1, Li-Bing Guo3, Jin-Tao Zhang4, Dong Li5, Jian-Hui Zhang6, Zhong Ju7, Chung-Shiuan Chen2, Jing Chen2, 8, Yong-Hong Zhang1, Jiang He2, 8#br#   

  1. 1 Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric
    Diseases, Medical College of Soochow University, Suzhou, Jiangsu Province, China
    2 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
    3 Department of Neurology, Siping Central Hospital, Siping, Jilin Province, China
    4 Department of Neurology, the 88th Hospital of People’s Liberation Army, Taian, Shandong Province, China
    5 Department of Internal Medicine, Feicheng City People’s Hospital, Feicheng, Shandong Province, China
    6 Department of Neurology, Tongliao Municipal Hospital, Inner Mongolia Autonomous Region, China
    7 Department of Neurology, Kerqin District First People’s Hospital of Tongliao City, Inner Mongolia Autonomous Region, China
    8 Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
  • Online:2020-05-15 Published:2020-06-01
  • Contact: Yong-Hong Zhang, MD, PhD,yhzhang@suda.edu.cn.
  • Supported by:
    This study was supported by the National Natural Science Foundation of China, No. 81673263 (to YHZ), Ministry of Science and Technology of China, No. 2016YFC1307300 (to YHZ), and a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions, China (to YHZ).

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Abstract: Stroke is the leading cause of death and long-term disability worldwide, and cognitive impairment and dementia are major complications of ischemic stroke. Cystatin C (CysC) has been found to be a neuroprotective factor in animal studies. However, the relationship between CysC levels and cognitive dysfunction in previous studies has revealed different results. This prospective observational study investigated the correlation between serum CysC levels and post-stroke cognitive dysfunction at 3 months. Data from 638 patients were obtained from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Cognitive dysfunction was assessed using the Mini-Mental State Examination (MMSE) at 3 months after stroke. According to the MMSE score, 308 patients (52.9%) had post-stroke cognitive dysfunction. After adjusting for potential confounding factors, the odds ratio (95% CI) of post-stroke cognitive dysfunction for the highest quartile of serum CysC levels was 0.54 (0.30–0.98), compared with the lowest quartile. The correlation between serum CysC and cognitive dysfunction was modified by renal function status. We observed a negative linear dose-response correlation between CysC and cognitive dysfunction in patients with normal renal function (Plinearity = 0.044), but not in those with abnormal renal function. Elevated serum CysC levels were correlated with a low risk of 3-month cognitive dysfunction in patients with acute ischemic stroke, especially in those with normal renal function. The current results suggest that CysC is a protective factor for post-stroke cognitive dysfunction, and could be used to treat post-stroke cognitive dysfunction. The CATIS study was approved by the Institutional Review Boards at Soochow University from China (approval No. 2012-02) on December 30, 2012, and was registered at ClinicalTrials.gov (identifier No. NCT01840072) on April 25, 2013.

Key words: abnormal renal function, cognitive dysfunction, cystatin C, ischemic stroke, Mini-Mental State Examination, neural regeneration, neuroprotective effect, normal renal function