Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients
Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associ...
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MDPI AG
2021-05-01
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| Online Access: | https://www.mdpi.com/2076-3425/11/5/612 |
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| author | Minwoo Lee Jae-Sung Lim Yerim Kim Ju Hun Lee Chul-Ho Kim Sang-Hwa Lee Min Uk Jang Mi Sun Oh Byung-Chul Lee Kyung-Ho Yu |
| author_facet | Minwoo Lee Jae-Sung Lim Yerim Kim Ju Hun Lee Chul-Ho Kim Sang-Hwa Lee Min Uk Jang Mi Sun Oh Byung-Chul Lee Kyung-Ho Yu |
| author_sort | Minwoo Lee |
| collection | DOAJ |
| description | Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, <i>p</i>-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions. |
| first_indexed | 2024-03-10T11:32:28Z |
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| language | English |
| last_indexed | 2024-03-10T11:32:28Z |
| publishDate | 2021-05-01 |
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| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-2b8d799656884ca5a749e64238a355242023-11-21T19:08:29ZengMDPI AGBrain Sciences2076-34252021-05-0111561210.3390/brainsci11050612Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke PatientsMinwoo Lee0Jae-Sung Lim1Yerim Kim2Ju Hun Lee3Chul-Ho Kim4Sang-Hwa Lee5Min Uk Jang6Mi Sun Oh7Byung-Chul Lee8Kyung-Ho Yu9Department of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, KoreaAsan Medical Center, Department of Neurology, Seoul 05505, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chunchon 24253, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chunchon 24253, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong 18450, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, KoreaDepartment of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, KoreaBackground: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, <i>p</i>-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.https://www.mdpi.com/2076-3425/11/5/612glycemic gaphemoglobin A1cstrokecerebral infarctioncognitive impairment |
| spellingShingle | Minwoo Lee Jae-Sung Lim Yerim Kim Ju Hun Lee Chul-Ho Kim Sang-Hwa Lee Min Uk Jang Mi Sun Oh Byung-Chul Lee Kyung-Ho Yu Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients Brain Sciences glycemic gap hemoglobin A1c stroke cerebral infarction cognitive impairment |
| title | Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients |
| title_full | Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients |
| title_fullStr | Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients |
| title_full_unstemmed | Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients |
| title_short | Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients |
| title_sort | effects of glycemic gap on post stroke cognitive impairment in acute ischemic stroke patients |
| topic | glycemic gap hemoglobin A1c stroke cerebral infarction cognitive impairment |
| url | https://www.mdpi.com/2076-3425/11/5/612 |
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