Leukoaraiosis Mediates the Association of Total White Blood Cell Count With Post-Stroke Cognitive Impairment

So you described a problem, offered NO SOLUTION. Useless. Prevent that cognitive impairment instead of this useless shit you did. 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Leukoaraiosis Mediates the Association of Total White Blood Cell Count With Post-Stroke Cognitive Impairment

Wanying Shan^1†, Liang Xu^2†, Yuan Xu¹, Zhuoyin Qiu¹, Jie Feng¹, Jie Zhao^3* and Jingwen Wang^1*

• ¹Department of Neurology, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China
• ²Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
• ³Department of Gerontology, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China

Background and Purpose: The inflammatory response could play a key role in cognitive impairment. However, there has been limited research into the association between total white blood cell (WBC) count and post-stroke cognitive impairment (PSCI), and the significance of leukoaraiosis (LA) in this relationship is unknown. We aimed to examine the total WBC count in relation to PSCI and whether this association was mediated by LA.

Methods: Consecutive patients with first-ever ischemic stroke were prospectively enrolled from October 2020 to June 2021. The total WBC count was measured after admission. Cognitive function evaluations were performed at the 3-month follow-up using Mini-mental State Examination (MMSE). We defined the PSCI as an MMSE score <27.

Results: A total of 276 patients (mean age, 66.5 years; 54.7% male) were included in this analysis. Among them, 137 (49.6%) patients experienced PSCI. After adjustment for potential confounders, higher total WBC count was significantly correlated with an increased risk of LA [per 1-SD increase, odds ratio (OR), 1.39; 95% CI 1.06–1.82; p = 0.017] and PSCI (per 1-SD increase, OR, 1.51; 95% CI 1.12–2.04; p = 0.006). Furthermore, mediation analysis demonstrated that the association between total WBC count and PSCI was partly mediated by LA (the regression coefficient was changed by 9.7% for PSCI, and 12.4% for PSCI severity, respectively).

Conclusion: Increased total WBC count is a risk factor for PSCI. The presence of LA was partially responsible for the PSCI in patients who had a higher total WBC count.

Introduction

In China, ischemic stroke has been ranked as the first leading cause of major disability and death (1). Post-stroke cognitive impairment (PSCI) is the most common complication with a prevalence ranging from 20 to 80% (2). It involves deficits in the ability to think and remember, language, and attention that are significant enough to greatly impact daily life (3). PSCI is reported to influence the performance in daily life and at work (4) and increase the risk of long-term mortality (5). Many clinical characteristics have been linked to the advancement of cognitive impairment following a stroke, such as advanced age, female gender, education, and vascular comorbidities (2). However, the underlying mechanisms of PSCI are still unclear. Determining the exact biomarkers and potential mechanisms for PSCI is of vital importance for continuously improving the prognosis of patients with ischemic stroke.

The inflammatory response has been linked to cognitive impairment after ischemic stroke (6–9). Increased total WBC count is associated with adverse clinical outcomes in patients with acute ischemic stroke (10). In addition, a higher WBC count, even within the normal range, was found to be related to the worse psychomotor cognitive performance in the elderly (11). However, the influence of total WBC count on PSCI has not yet been clarified. Leukoaraiosis (LA) is one of the leading risk factors for vascular cognitive impairment (12), and multiple lines of evidence from clinical trials and animal studies indicated that inflammatory response may contribute to the presence and development of LA (13–17). Therefore, LA may be a mediator in the pathway between inflammation and the presence of PSCI.

We, therefore, performed this prospective study to examine: (1) the cross-sectional relationship between increased total WBC count and risk of 90-day PSCI among Chinese patients with ischemic stroke; (2) the mediating effect of LA on this potential relationship.

More at link.