Prediction of Post-Stroke Cognitive Impairment Based on Iron Metabolism Parameters: Results From A Prospective Study

Abstract

Disruption of iron homeostasis is associated with the pathogenesis of neurological disorders. This study aims to elucidate the correlation between serum iron metabolism profiles and the occurrence of post-stroke cognitive impairment (PSCI). Acute ischemic stroke (AIS) patients (n = 500) were enrolled, and serum iron metabolism parameters were collected at baseline. Cognitive abilities, including global cognition, episodic memory, language proficiency, attention, and executive function, were successfully assessed in participants six months after the AIS event (n = 224, mean age = 62). Multivariate logistic regression analysis was employed to screen for iron metabolism indicators influencing PSCI. A general linear model was used to analyze the correlation between total iron-binding capacity (TIBC) and overall cognitive function as well as performance in various cognitive domains. Additionally, we constructed a nomogram model to predict PSCI risk and validated its performance. The results revealed that the TIBC levels were significantly lower in the PSCI group. Elevated TIBC levels may represent a potential protective factor against PSCI development (OR = 0.940, 95% CI = 0.894-0.989, p = 0.018). Furthermore, higher serum TIBC levels were associated with better overall cognitive function, episodic memory, and language proficiency. The nomogram model constructed using age, gender, education level, National Institutes of Health Stroke Scale (NIHSS) score, and TIBC variables demonstrated good predictive performance for PSCI risk (AUC = 0.761, 95%CI = 0.696-0.825). In conclusion, serum TIBC is a potential biomarker for PSCI and is closely associated with cognitive ability.

Keywords: Acute ischemic stroke; Iron metabolism; Post-stroke cognitive impairment; Total iron binding capacity.