Deans' stroke musings: Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, March 19, 2022

Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

So you described something, but DID NOTHING USEFUL THAT WILL HELP STROKE PATIENTS RECOVER. Why the fuck are you in stroke anyway?

Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

Yun Zhang¹^*,

Yue Feng²,

Jiacai Zuo¹,

Jian Shi¹,

Shanshan Zhang¹,

Yao Yang¹,

Shu Xie¹ and

Zhonglun Chen¹^*

¹Department of Neurology, Mianyang Central Hospital, Mianyang, China
²Department of Medical Laboratory, Mianyang Central Hospital, Mianyang, China

Background and Purpose: The impact of serum amyloid A on cognitive impairment after ischemic stroke is unclear. We aimed to investigate the association between serum amyloid A (SAA) levels and post-stroke cognitive impairment (PSCI) at 3 months after ischemic stroke.

Methods: One hundred and ninety-eight patients were enrolled prospectively from June 2020 to April 2021. The SAA concentrations were measured using a commercially available enzyme-linked immunosorbent assay kit after admission. Cognitive function was assessed using the Montreal Cognitive Assessment score at 3 months after the symptom onset. We defined a Montreal Cognitive Assessment score <25 as cognitive impairment.

Results: During 3-month follow-up, 80 patients (40.4%) were diagnosed as having PSCI. As compared with patients with cognitively normal ischemic stroke, those with PSCI were older, more likely to have diabetes and white matter lesions, and had a higher baseline National Institutes of Health stroke score and SAA levels. After adjustment for age, the National Institutes of Health stroke score and other covariates, the OR for the highest quartile of SAA compared with the lowest quartile was 5.72 (95% CI, 2.17–15.04, P = 0.001) for PSCI. Also, ordinal logistic regression analysis showed that higher SAA concentrations were associated with increased risk of PSCI severity (OR, 4.31; 95% CI, 1.81–10.33, P = 0.001). Similar results were found when the SAA levels were analyzed as a continuous variable.

Conclusions: This present study demonstrated that increased SAA levels might be associated with PSCI at 3 months after ischemic stroke.

Introduction

Stroke is one of the major devastating diseases with high rates of mortality and long-term disability (1, 2). Post-stroke cognitive impairment (PSCI) is a common consequence of stroke affecting as high as 80% of stroke survivors (3, 4). It may reduce medication adherence and induce a poor functional outcome after stroke (5–7). Also, it has been reported that PSCI may be associated with increased risk of mortality and recurrent stroke (6, 8, 9). To date, associated factors and underlying pathophysiology of PSCI are not well-determined, which may be a contributing factor to why the mortality and long-term disability risk in ischemic stroke survivors remained high. Therefore, determining new prognostic markers is of vital importance for continuously improving the prognosis of stroke and providing insight into underlying pathophysiology of PSCI.

Serum amyloid A is one of highly conserved acute-phase proteins, which are involved in the chemotactic recruitment of inflammatory cells (10). Serum amyloid A (SAA) concentrations rise rapidly when the body is infected, wounded, or inflamed. The production of acute-phase SAA is triggered by proinflammatory cytokines, such as interleukin-1, interleukin-6, and transforming growth factor-β. Recently, it has been proved that SAA may play an important role in various central nervous system diseases (10, 11). SAA has been found to be substantially associated with the severity of senile early cognitive impairment (12). In a recent experimental study, cerebral ischemia could induce a systemic inflammatory response through SAA that might contribute to the pathological outcomes (13). Also, previous studies reported that SAA levels were significantly higher in patients with ischemic stroke who died compared with those who survived and were independently associated with early death, after adjusting for various confounders (14). However, in the cognitive impairment after ischemic stroke, the role of SAA has not yet been assessed. In this prospective cohort study, we aim to assess whether SAA levels could be an effective predictor of PSCI during a 3-month follow-up period.