The Significance of Interleukin-6 and Tumor Necrosis Factor-Alpha Levels in Cognitive Impairment among First-Ever Acute Ischaemic Stroke Patients.

BACKGROUND: Acute ischemic stroke (AIS) frequently results in the development of cognitive impairment, which quite often persists. The pathophysiological mechanisms involved in the development of cognitive impairment are only partially elucidated. The aim of this study was to evaluate the correlation between interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) serum levels with cognitive impairment in AIS patients. SUBJECTS AND METHODS: This hospital-based case-control study was performed during December 2014 - May 2018. A total number of 130 randomly selected patients were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. The study examined 100 first-ever AIS patients, while 30 comprised the non-stroke control group of patients with discogenic lumbosacral radiculopathy. All participants were evaluated using the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised. Cognitive testing and laboratory analyses were performed within the first three days of admission in all patients while AIS patients were reassessed on the 15thday of hospitalization. RESULTS: Female stroke patients with cognitive impairment had significantly higher baseline levels of IL-6 (p<0.017), and TNF-α (p<0.017) than those without cognitive impairment. In the control measurement, a significant difference in IL-6 levels (p=0.037) in male and TNF-α levels (p=0.042) in female stroke patients with cognitive impairment was observed. CONCLUSIONS: These findings indicate that pro-inflammatory cytokines are probably implicated in the pathogenesis of cognitive decline in AIS patients.

Analysis of Serum Inflammatory Markers in Cognitive Impairment among Acute Ischaemic Stroke Patients.

BACKGROUND: Previous studies have indicated that changes in the expression of certain inflammatory biomarkers are associated with cognitive impairment (CI), but only a limited number of studies were conducted in patients with acute ischemic stroke (AIS). The present study aimed to evaluate the potential association between serum levels of several inflammatory markers and cognitive impairment in AIS patients. These markers included interleukin 6 (IL-6), C-reactive protein (CRP), plasma fibrinogen, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. SUBJECTS AND METHODS: All participants were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. A total of 100 patients with first-ever AIS were included in stroke group and 30 in the non-stroke control group. Each patient underwent a comprehensive cognitive assessment and laboratory tests (IL-6, CRP, fibrinogen, ESR and WBC) within the first three days of admission. Cognitive status was assessed using cognitive instruments: the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised. RESULTS: Female stroke patients with CI had higher levels of IL-6 compared to those without CI and controls (p<0.017). AIS patients with CI had significantly higher plasma fibrinogen (p<0.001) and CRP levels (p<0.001) than controls, whereas there was no significant difference in comparison with cognitively intact patients. There were no statistical differences in ESR or WBC count between groups. CONCLUSIONS: Of the inflammatory markers, only IL-6 levels were associated with CI in AIS patients. Measuring circulating IL-6 could be used as a screening test to identify all such patients.

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients / Influência de fatores socioeconômicos e de tratamento sobre a fadiga, ansiedade e depressão autorrelatadas em pacientes com artrite reumatoide

Abstract Introduction: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). Goals: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. Method: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. Results: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. Conclusion Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.

Resumo Introdução: A fadiga, a ansiedade e a depressão são sintomas muito frequentes em pacientes com artrite reumatoide (AR). Objetivos: Neste estudo, avaliou-se a influência de características socioeconômicas, características de tratamento e comorbidades na elevação na fadiga, ansiedade e depressão autorrelatadas em pacientes com AR. Método: Este estudo transversal multicêntrico foi feito em 22 instituições de saúde na Sérvia de abril a agosto de 2014 na população de pacientes idosos com AR. O status de saúde autorrelatado dos pacientes foi medido pelos instrumentos Fatigue Assessment Scale, Patient Health Questionnaire-9 e Generalized Anxiety Disorder-7. As modalidades de tratamento foram definidas como: 1) anti-inflamatórios não esteroides (AINE) e/ou analgésicos e/ou corticosteroides; 2) fármacos antirreumáticos modificadores da doença sintéticos (DMARD) isoladamente ou em combinação com corticosteroides e/ou AINE e 3) qualquer tratamento para a AR que incluísse DMARD biológicos. Resultados: Houve preditores significativos de depressão elevada: tratamento com DMARD sintéticos em combinação com corticosteroides e/ou AINE, pagamento particular de fisioterapia, uso frequente de serviços de táxi, terapias alternativas e status ocupacional. A necessidade de assistência de outra pessoa, o tratamento suplementar com cálcio e as qualificações profissionais foram os preditores de fadiga elevada. A idade acima de 65 anos teve um efeito protetor sobre a fadiga elevada. A ansiedade foi um preditor independente de fadiga elevada. Os preditores ansiedade elevada foram: gastroproteção com inibidores da bomba de prótons e ocupação do paciente. Conclusão: Os preditores socioeconômicos de níveis elevados de depressão, ansiedade ou fadiga autorrelatadas são diferentes para cada um dos desfechos mencionados; quando acompanhados do tratamento básico para a AR, esses preditores socioeconômicos explicam exclusivamente uma depressão elevada. A ansiedade, associada às variáveis socioeconômicas e ao tratamento complementar, é um importante preditor da fadiga em pacientes com AR.

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients.

INTRODUCTION: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). GOALS: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. METHOD: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. RESULTS: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. CONCLUSION: Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients.