Association Between Plasma L-Carnitine and Cognitive Impairment in Patients with Acute Ischemic Stroke

Article type: Research Article

Authors: Che, Bizhong^{a; 1} | Chen, Haichang^{a; 1} | Wang, Aili^a | Peng, Hao^a | Bu, Xiaoqing^b | Zhang, Jintao^c | Ju, Zhong^d | Xu, Tan^a | He, Jiang^e | Zhong, Chongke^{a; e; *} | Zhang, Yonghong^{a; *}

Affiliations: [a] Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China | [b] Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China | [c] Department of Neurology, The 88th Hospital of PLA, Shandong, China | [d] Department of Neurology, Kerqin District First People’s Hospital of Tongliao City, Tongliao, China | [e] Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

Correspondence: [*] Correspondence to: Chongke Zhong, MD, PhD, or Yonghong Zhang, MD, PhD, Department of Epidemiology, School of Public Health and JiangsuKey Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China. Tel.: +86 512 6588 0078; Fax: +86 512 6588 0052. E-mail: ckzhong@suda.edu.cn; E-mail: yhzhang@suda.edu.cn.

Note: [1] These authors contributed equally to this work.

Abstract: Background:L-carnitine has been shown to exert neuroprotective effects on cerebral ischemia, mainly by improving mitochondrial function and reducing inflammation. L-carnitine supplementation has also been promoted to enhance cognitive function. However, the relationship between L-carnitine and cognitive impairment after ischemic stroke has seldom been studied. Objective:We aimed to evaluate the association between plasma L-carnitine and poststroke cognitive impairment. Methods:The study sample population was drawn from the China Antihypertensive Trial in Acute Ischemic Stroke. Plasma L-carnitine were measured at baseline in 617 patients with ischemic stroke using ultrahigh-performance liquid chromatography-tandem mass spectrometry. Cognitive function was evaluated using the Montreal Cognitive Assessment at 3-month follow-up after ischemic stroke. Results:Plasma L-carnitine were inversely associated with cognitive impairment at 3 months after ischemic stroke, and the adjusted odds ratio (95% CI) for the highest versus lowest quartiles of L-carnitine was 0.60 (0.37, 0.98; p for trend = 0.04). Each 1-SD increase in log-transformed L-carnitine concentration was significantly associated with a 15% (95% CI: 1%, 29%) reduction in the risk of cognitive impairment after stroke. The addition of L-carnitine to the model including conventional risk factors significantly improved the risk reclassification for cognitive impairment (net reclassification improvement: 17.9%, integrated discrimination improvement: 0.8%; both p < 0.05). Furthermore, joint effects of L-carnitine and inflammation markers were observed, and patients with higher L-carnitine and a lower inflammatory status simultaneously had the lowest risk of poststroke cognitive impairment. Conclusion:The present study provided prospective evidence on the inverse association between plasma L-carnitine and cognitive impairment after ischemic stroke.

Keywords: Acute ischemic stroke, cognitive impairment, inflammation, L-carnitine

DOI: 10.3233/JAD-215376

Journal: Journal of Alzheimer's Disease, vol. 86, no. 1, pp. 259-270, 2022