Plasma Neurofilament Light Chain Is Associated with Cognitive Impairment after Posterior Circulation Stroke

Abstract

Background. Neurofilament light chain (NfL) is a biomarker for large-caliber axonal degeneration in the subcortex. The purpose of this research was to examine the relationship between plasma neurofilament light chain (pNfL) and cognitive impairment following a posterior circulation stroke. Methods. Patients over the age of 18 with their first-ever acute ischemic stroke (AIS) of the posterior cerebral circulation within 24 h of symptom onset were included from July 1, 2017, to December 31, 2019. Blood samples were collected within 48 h after the stroke. The Montreal Cognitive Assessment (MOCA) (MOCA < 26) was adopted to define poststroke cognitive impairment (PSCI) 90 days after stroke onset. Results. A total of 264 patients were analyzed in this research 101 (38.30%) patients were clinically diagnosed with PSCI. The PNfL concentration was significantly higher in the PSCI group compared with the non-PSCI group ( $p<0.001$ ). The pNfL concentration (OR 1.044; $p<0.001$ ) remained to be a significant predictor for PSCI after a multivariable logistic regression analysis, even after adjusting for factors including age, sex, education background (OR 1.044; $p<0.001$ ), baseline NIHSS, infarct volume, and TOAST classification (OR 1.035; $p<0.001$ ). The diagnostic efficacy of pNfL concentration for PSCI was then explored with a ROC analysis. The optimum pNfL concentration threshold was 38.12 pg/ml, with a sensitivity of 78.20%, a specificity of 66.9%, and an AUC of 0.782 ( $p<0.001$ ). Conclusion. This research showed that pNfL concentration, independent of established conventional risk factors, could predict the cognitive impairment in 90 days following posterior circulation stroke.