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Guo X, Liu Z, Yuan W, Wei A, Luo G. Electroencephalographic power spectrum changes in cerebral small vessel disease combined with cognitive dysfunction and its relationship with neutrophil/lymphocyte ratio and its clinical value - a pilot study. Front Neurol 2024; 14:1300240. [PMID: 38283675 PMCID: PMC10820721 DOI: 10.3389/fneur.2023.1300240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Objective The study aimed to explore the changes in the electrical power spectrum of the brain and its correlation with neutrophil/lymphocyte ratio (NLR) in patients with cognitively impaired cerebral small vessel disease (CSVD) and to explore its clinical application. Methods A total of 61 patients with CSVD who attended the People's Hospital of Shaanxi Province from September 2021 to September 2022 were divided into the group with cognitive impairment (cerebral small vascular with cognitive impairment, CSVCI group, n = 29) and the group without cognitive impairment (CSVD group, n = 32) based on the Montreal Cognitive Assessment Scale (MoCA) score, while 20 healthy subjects were recruited as the control group (healthy control, HC group). EEG was performed in the three groups, and the difference in whole brain quantitative EEG power spectral density (PSD) was calculated and compared between the three groups. Results The PSD values in the δ and θ bands of the CSVCI group were higher than those of the CSVD group, while the PSD values in the α band were lower than those of the CSVD and HC groups. In addition, PSD values in the δ-band in the CSVD group were lower than those in the HC group (all p < 0.05). Multifactorial logistic regression showed that reduced α-band global average PSD and low years of education were independent risk factors for cognitive impairment in patients with CSVD (p < 0.05). In patients with cerebral small-vessel disease, α-band PSD was positively and δ-band PSD negatively correlated with MoCA score, and paraventricular, deep white matter, and total Fazekas scores were negatively correlated with MoCA score. Furthermore, θ-band PSD is positively correlated with NLR (all p < 0.05). Conclusion EEG activity was slowed down in patients with CSVD with cognitive impairment. The α-band global mean PSD values independently affected the occurrence of cognitive impairment in CSVD patients beyond the Fazekas score. NLR may be one of the mechanisms leading to the slowing down of the EEG, which can be used as an objective indicator for the early prediction of cognitive impairment but still needs to be clarified by further studies.
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Affiliation(s)
- Xiaomin Guo
- Department of Neurology, The People’s Hospital of Shaanxi Province, Xi’an, China
| | - Zongwei Liu
- First Institute of Oceanography, Ministry of Natural Resources, Qingdao, China
| | - Weishuai Yuan
- First Institute of Oceanography, Ministry of Natural Resources, Qingdao, China
| | - Aiqin Wei
- Department of Neurology, The People’s Hospital of Shaanxi Province, Xi’an, China
| | - Guogang Luo
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Hung KC, Liu CC, Wu JY, Ho CN, Lin MC, Hsing CH, Chen IW. Association between the neutrophil-to-lymphocyte ratio and cognitive impairment: a meta-analysis of observational studies. Front Endocrinol (Lausanne) 2023; 14:1265637. [PMID: 38089627 PMCID: PMC10715314 DOI: 10.3389/fendo.2023.1265637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Background Systemic inflammation is one of the underlying mechanisms of cognitive impairment. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a systemic inflammation indicator. This meta-analysis aimed to evaluate the association between high NLR and cognitive impairment (CI) risk. Method A comprehensive systematic search was conducted to identify eligible studies published until May 30, 2023. The reference group comprised patients with the lowest NLR level, whereas the exposure group comprised those with the highest NLR level. The main outcome was to examine the relationship between NLR and CI risk. The secondary outcome included the association between patient characteristics or comorbidities and CI risk. Results This meta-analysis included 11 studies published between 2018 and 2023, involving 10,357 patients. Patients with CI had a higher NLR than those without (mean difference=0.35, 95% confidence interval [CI]: 0.26-0.44, p < 00001, I2 = 86%). Consistently, pooled results revealed an association between high NLR and CI risk (odds ratio [OR]=2.53, 95% CI:1.67-3.82, p<0.0001, I2 = 84%). Furthermore, aging (mean difference =4.31 years, 95% CI:2.83-5.8, p < 0.00001, I2 = 92%), diabetes (OR=1.59, 95% CI:1.35-1.88, p < 0.00001, I2 = 66%), and hypertension (OR=1.36, 95% CI:1.19-1.57, p < 0.00001, I2 = 0%) were significant risk factors for CI. However, no significant associations were observed between CI and male gender (OR = 0.84, 95% CI:0.64-1.11, p = 0.22, I2 = 81%), body mass index (mean = -0.32 kg/m2, 95% CI: -0.82, 0.18, p = 0.2, I2 = 82%), alcohol consumption (OR = 1.11, 95% CI:0.95-1.3, p = 1.35, I2 = 0%), and smoking (OR = 0.99, 95% CI:0.87-1.13, p = 0.86, I2 = 0%). Meta-regression found that diabetes and hypertension, but not age, significantly moderated the association between NLR and CI. Conclusion This meta-analysis showed a significant association between high NLR and increased CI risk. Moreover, meta-regression identified diabetes and hypertension, but not age, as significant moderating factors in the relationship between NLR and CI. To validate and strengthen these findings, further large-scale studies are required. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023430384, identifier CRD42023430384.
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Affiliation(s)
- Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Liu
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Chung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Chuang SY, Hsu YC, Chou KW, Chang KS, Wong CH, Hsu YH, Cheng HM, Chen CW, Chen PY. Neutrophil-Lymphocyte Ratio as a Predictor of Cerebral Small Vessel Disease in a Geriatric Community: The I-Lan Longitudinal Aging Study. Brain Sci 2023; 13:1087. [PMID: 37509017 PMCID: PMC10377025 DOI: 10.3390/brainsci13071087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Cerebral Small Vessel Disease (CSVD) frequently affects the elderly, with inflammation playing a crucial role in related health complications, including dementia, stroke, and SVD. Studies, including animal experiments, indicate a strong link between inflammation and SVD progression. The Neutrophil-Lymphocyte Ratio (NLR) serves as a possible biomarker for ongoing inflammatory risks. A total of 720 adults aged 50 years or older from the community-based I-Lan Longitudinal Aging Study were included in this study. General linear regression and ordinally logistic regression analyses were performed to evaluate the association between NLR and CSVD. We further examined the presence of lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. The NLR was positively associated with WMH (adjusted r = 0.109, p = 0.003), microbleed (adjusted r = 0.102, p = 0.006), and lacune (adjusted r = 0.100, p = 0.008). After adjustments for smoking, drinking, and physical activity in the ordinal logistic regression analysis, age, gender, brachial Systolic Blood Pressure (SBP), fasting glucose, LDL-cholesterol, and Hs-CRP were compared among subjects with low tertile (T1), medium tertile (T2) and high tertile (T3) NLR. The results showed that T2 vs. T1 had an odds ratio of 1.23 (0.86-1.77); and T3 vs. T1 had an odds ratio of 1.87 (1.29-2.71) of CSVD scores in four groups (zero (reference group), one, two, and three or more). NLR could be used to assess the state of inflammation in cerebral vessels. A significant and positive correlation between NLR and CSVD was verified in this study. However, the practical clinical application of NLR in CSVD patients and prognosis prediction should be validated through more scientific attempts.
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Affiliation(s)
- Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institute, Miaoli 36001, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University School of Medicine, Taipei 30010, Taiwan
| | - Yin-Chen Hsu
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Kuang-Wei Chou
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 11008, Taiwan
| | - Kuo-Song Chang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 11008, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei 11260, Taiwan
| | - Chiong-Hee Wong
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 11008, Taiwan
| | - Ya-Hui Hsu
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 11008, Taiwan
| | - Hao-Min Cheng
- Institute of Public Health, National Yang Ming Chiao Tung University School of Medicine, Taipei 30010, Taiwan
- Department of Internal Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 31254, Taiwan
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Pang-Yen Chen
- Institute of Public Health, National Yang Ming Chiao Tung University School of Medicine, Taipei 30010, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 11008, Taiwan
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Tondo G, Aprile D, De Marchi F, Sarasso B, Serra P, Borasio G, Rojo E, Arenillas JF, Comi C. Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment. J Clin Med 2023; 12:4298. [PMID: 37445333 DOI: 10.3390/jcm12134298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Growing evidence suggests that neuroinflammation plays a critical role in the pathogenesis of neurodegenerative diseases. Peripheral markers of inflammation, including blood cell counts and their ratios, such as the neutrophil-to-lymphocyte ratio (NLR), have been reported as an easily accessible and reliable proxy of central nervous system inflammation. However, the role of peripheral inflammation in dementia and Mild Cognitive Impairment (MCI) still needs to be clarified. In the current study, we aimed to assess the prognostic role of the NLR and other peripheral markers of inflammation in a sample of 130 amnestic MCI, followed up for two to five years. The Mini-Mental state examination (MMSE) score at baseline and follow-up visits was used to assess global cognitive status at each visit and the degree of cognitive decline over time. Baseline peripheral markers of inflammation included blood cell counts and ratios, specifically the NLR, the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), and the systemic immune inflammation index (SII). After classifying subjects into CONVERTERS and non-CONVERTERS (respectively, patients converting to dementia and subjects showing stability at the last available follow-up), we compared peripheral markers of inflammation among groups ed correlated them with cognitive measures, testing the ability of significant factors to predict conversion to dementia. In our cohort, CONVERTERS showed lower baseline MMSE scores (p-value = 0.004) than non-CONVERTERS. In addition, CONVERTERS had statistically elevated NLR (p-value = 0.005), PLR (p-value = 0.002), and SII levels (p-value = 0.015), besides a lower number of lymphocytes (p-value = 0.004) compared with non-CONVERTERS. In a logistic regression analysis, baseline MMSE scores and NLR predicted conversion to dementia. Tertiles analysis showed that MCI with the highest NLR values had a higher conversion risk. Our study supports the hypothesis that a dysregulation of peripheral inflammation involving both lymphocytes and neutrophils may play a role in the pathogenesis of dementia, even at the early stages of neurodegeneration, as in the MCI condition.
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Affiliation(s)
- Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Davide Aprile
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Fabiola De Marchi
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy
| | - Barbara Sarasso
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Paola Serra
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Giordana Borasio
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Esther Rojo
- Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Juan Francisco Arenillas
- Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, 28100 Novara, Italy
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Yao S, Ding K, Liu S, Zhang Q, Li W, Tang L, Yu S, Pang L, Yin X, Cheng H. The Managing Cancer and Living Meaningfully (CALM) Intervention Alleviates Chemotherapy-Related Cognitive Impairment in Patients with Breast Cancer by Modulating Pan-Immune-Inflammation Values. Integr Cancer Ther 2022; 21:15347354221140498. [DOI: 10.1177/15347354221140498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The number of patients with breast cancer is increasing worldwide, resulting in a growing number of patients with chemotherapy-related cognitive impairment (CRCI), which seriously affects their quality of life. CRCI is associated with inflammatory factors and systemic inflammatory markers such as pan-immune-inflammation value (PIV) and monocyte-to-lymphocyte ratio (MLR), which can reflect the level of inflammation in the body. While the Managing Cancer and Living Meaningfully (CALM) intervention has been demonstrated to alleviate CRCI in patients with breast cancer, the specific mechanism remains unclear. Objective: This study evaluated the impact of the CALM intervention on systemic inflammation. Methods: Ninety patients with breast cancer with CRCI were enrolled and randomized into care as usual (CAU) and CALM intervention groups. All patients were assessed using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), Mini-Mental State Exam (MMSE), and Functional Assessment of Cancer Therapy-Breast (FACT-B) before and after the CAU/CALM intervention. The blood levels of inflammatory markers were also analyzed before and after the intervention. Results: Compared to the CAU group, the CALM group showed significantly improved cognitive function and significantly decreased PIV ( P < .05). PIV was significantly negatively correlated with FACT-Cog ( P < .05). The levels of other inflammatory markers, including MLR, neutrophil-to-lymphocyte ratio (NLR), granulocyte-to-lymphocyte ratio (GLR), and systemic immune-inflammation index (SII), were also reduced in the CALM group. Conclusion: PIV is an important marker of inflammation. The CALM intervention may improve the cognitive function of patients by regulating the systemic inflammation marker PIV through the neuroimmune axis.
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Affiliation(s)
- Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ke Ding
- Department of Radiation Oncology, Fuyang Cancer Hospital, Fuyang, Anhui, China
| | - Shaochun Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qianqian Zhang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lingxue Tang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Sheng Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lulian Pang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiangxiang Yin
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Li C, Wan S, Li W, Wang Y, Li B, Chen Y, Sun P, Lyu J. Higher Neutrophil to Lymphocyte Ratio at Admission is Association with Post-PCI Depressive Symptoms in Patients with ACS. Neuropsychiatr Dis Treat 2022; 18:2981-2990. [PMID: 36578901 PMCID: PMC9792112 DOI: 10.2147/ndt.s387582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression and elevated blood biomarkers of inflammation are common in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Neutrophil to lymphocyte ratio (NLR) is an indicator of peripheral inflammation and has been proved to be associated with both ACS and depression. PURPOSE Our aim was to evaluate the possible association between NLR at admission and post-PCI depressive symptoms at 1 month. PATIENTS AND METHODS A total of 224 patients with ACS who underwent PCI for the first time were recruited and completed 1-month follow-up. The 24-item Hamilton Depression Scale (HAMD-24) was used to measure depressive symptoms at 1 month after PCI. Logistic regression was used to analyze the relationship between different NLR levels and post-PCI depressive symptoms. A receiver operating characteristic (ROC) curve analysis was performed to assess the value of NLR for predicting post-PCI depressive symptoms and to determine its critical value. RESULTS Of the 224 enrolled patients, 52 (23.2%) patients were diagnosed with depressive symptoms at 1 month after PCI. Patients with depressive symptoms showed significantly higher level of NLR at admission than patients without depressive symptoms (4.33 (3.26, 7.01) vs 2.57 (1.72, 3.91), P < 0.001). The proportion of depressive symptoms in post-PCI patients increases progressively along with NLR quartile. In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of post-PCI depressive symptoms was 12.028 (95% CI, 2.642-54.752) for the lowest quartile of NLR compared with the highest quartile. According to the receiver operating characteristic curve (ROC), the area under the curve (AUC) for predicting post-PCI depressive symptoms was 0.716 (95% CI, 0.641-0.791; P < 0.001), and the optimal cutoff of NLR levels was 3.235 (sensitivity: 76.9%, specificity: 66.9%). CONCLUSION Higher NLR levels at admission were associated with post-PCI depressive symptoms at 1 month, suggesting that NLR might be useful inflammatory markers to predict post-PCI depressive symptoms at 1 month.
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Affiliation(s)
- Cexing Li
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Shaozhi Wan
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Wenqian Li
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Yue Wang
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Bingqing Li
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Yuwen Chen
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Peiyuan Sun
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Jianfeng Lyu
- Affiliated Renhe Hospital of China Three Gorges University, Department of Cardiology, Yichang, People's Republic of China
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