# High serum glial fibrillary acidic protein levels are associated with increased risk of post-stroke cognitive impairment

## TL;DR

High levels of a brain protein called GFAP in the blood are linked to a higher risk of cognitive problems after a stroke.

## Contribution

This study identifies serum GFAP as a potential biomarker for predicting post-stroke cognitive impairment.

## Key findings

- Higher serum GFAP levels were independently associated with post-stroke cognitive impairment.
- A linear relationship between GFAP concentrations and cognitive impairment risk was confirmed.
- 48.8% of stroke patients experienced cognitive impairment within 90 days.

## Abstract

The correlation between glial fibrillary acidic protein (GFAP) and cognitive impairment in acute ischemic stroke patients remains uncertain. We aimed to evaluate GFAP in serum as predictor of post-stroke cognitive impairment (PSCI) at 90 days.

From March 2022 to February 2023, patients with first-ever ischemic stroke were prospectively enrolled. Serum GFAP concentrations were measured within 24 h after admission using an enzyme-linked immunosorbent assay. Cognitive function measurement was performed at the 90 days follow-up using the Mini-mental state examination (MMSE). A MMSE score <27 was defined as PSCI. Multiple logistic regression and restricted cubic spline were performed to examine the association between GFAP and cognitive impairment.

A total of 336 patients (mean age: 66.3 ± 9.0 years; 58.3% male) with acute ischemic stroke were included. The median GFAP levels were 0.73 ng/mL (interquartile range, 0.38–1.09 ng/mL). During the 3-month follow-up, 164 participants (48.8%) experienced PSCI. Higher GFAP levels were independently associated with PSCI after adjusting for potential confounders (per 1-unit increase, odds ratio: 3.91; 95% confidence interval: 2.24–6.82; p = 0.001). Additionally, restricted cubic spline confirmed a linear relationship between serum GFAP concentrations and PSCI risk (P for linearity = 0.001).

This study demonstrated that higher levels of GFAP were associated with PSCI, suggesting that GFAP could be a promising and straightforward screening indicator of cognitive impairment after stroke.