Association between plasma trimethylamine-N-oxide and cognitive impairment in patients with transient ischemic attack

ABSTRACT

Background

There is increasing evidence for the association of trimethylamine-N-oxide (TMAO) with cognitive impairment after minor stroke or transient ischemic attack (TIA). However, how TMAO affects cognitive function in TIA patients has seldom been studied.

Methods

A total of 310 TIA participants were retrospectively collected from our stroke register between January 2020 and July 2021. Plasma TMAO was measured by liquid chromatography‒mass spectrometry at baseline. Cognitive performance was assessed by neuropsychological evaluation at 3 months after TIA onset.

Results

A total of 310 patients were included (mean age, 74 years; male, 160 [51.6%]; mean ABCD2 score, 2.6). TMAO was positively associated with cognitive impairment after TIA (aOR, 1.423; 95% CI, 1.125–2.561). The highest quartile of TMAO was related to an almost 2-fold increased risk of cognitive decline compared to the lowest quartile. Furthermore, executive and memory function were more susceptible to impairment after TIA in groups with higher levels of TMAO. Mediation analysis revealed that the overall mediated effect was−0.347 (p < 0.001), and the intermediary effect of CRP was−0.108.

Conclusion

Plasma TMAO at baseline was independently associated with cognitive impairment at the 3-month follow-up after TIA. In addition, the inflammatory marker CRP may serve as an important mediator in this relationship. Our study may provide some insights into anti-inflammatory therapy to improve the cognitive trajectory of TIA patients with high TMAO levels.

KEYWORDS:

• cognitive impairment
• transient ischemic attack
• Trimethylamine-N-oxide
• neuroinflammation
• C-reactive protein

Acknowledgments

We thank all the participants for their cooperation during this study. The copyright to use the Montreal Cognitive assessment (MoCA) was permitted by MoCAtest.org. Transaction ID: CBJCHBCAABAAqBU_XAHBB0nq9RPHK7QKnp5x-HvH-eop.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Conceptualization, D.H. & L.W.; Methodology, L.W., J.Y., L.J., W.Z. & X.Z.; Formal analysis: H.D., Y.B., G.X. & L.W.; Writing – Original Draft Preparation, L.W. & S.Q.; Writing – Review & Editing, D.H. & L.W.; Supervision, D.H.; Project Administration, D.H.; Funding Acquisition, D.H.

Data accessibility

The data that support the findings of the current study are available from the corresponding authors on reasonable request.

Statement of ethics

This retrospective study was approved by the local Ethics Committee of Shanghai East Hospital [2020] Preliminary study No.125. The study was performed in accordance with the principles of the Declaration of Helsinki. All the participants and their relatives provided written informed consent prior to their inclusion in the study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/01616412.2023.2176632.

Additional information

Funding

The work was supported by the National Natural Science Foundation of China [81771258].