ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurological Biomarkers
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1611140
This article is part of the Research TopicBlood, Cerebrospinal Fluid, and Vascular Biomarkers for DementiaView all 22 articles
Joint effects of elevated homocysteine levels and low eGFR on post-stroke cognitive impairment
Provisionally accepted
- 1Department of Neurology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
- 2School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Introduction: The correlation between serum homocysteine levels and post-stroke cognitive impairment (PSCI) remains inconsistent. This study aimed to investigate whether serum homocysteine levels are independently associated with PSCI and to assess the effects of renal function on this relationship. Methods: A retrospective analysis was conducted in 608 patients with ischemic stroke. Homocysteine levels were obtained from inpatient medical records, and global cognitive function status 1 month after discharge was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The relationship between homocysteine levels and PSCI was evaluated using univariate and multiple linear and logistic regression analyses.Results: The mean age of the patients was 66.6 ± 4.1 years, with 48% being female.The median homocysteine level was 13.8 µmol/L (interquartile range [IQR], 11.3 -17.3 µmol/L), and 39.3% of patients had total homocysteine levels above the cutoff of 15 µmol/L. After full adjustment, a stronger positive association between homocysteine levels and PSCI was observed in patients with low estimated glomerular filtration rate (eGFR), with significant interactions between eGFR and MMSE scores (P for interaction = 0.005) and between eGFR and MoCA scores (P for interaction = 0.001). Joint analyses indicated that the highest risk of PSCI was in patients with eGFR < 90 ml/min/1.73 m² and homocysteine levels ≥15 µmol/L (odds ratios [ORs] were 2.50 [95% CI: 1.49, 4.18; P < 0.001] for MMSE and 13.53 [95% CI: 6.64, 27.56; P < 0.001] for MoCA in the fully adjusted model).Conclusion: These findings highlight the additive value of hyperhomocysteinemia and lower eGFR in predicting incident PSCI risk.
Keywords: Serum homocysteine, Estimated glomerular filtration rate, post-stroke cognitive impairment, Acute ischemic stroke, Adult
Received: 19 May 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 Zhang, Cao, Liu, Meng, Gao, Bai and Xue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chunyan Zhang, Department of Neurology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
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