Cognitive decline after stroke: relation to inflammatory biomarkers and hippocampal volume

Stroke. 2013 May;44(5):1433-5. doi: 10.1161/STROKEAHA.111.000536. Epub 2013 Feb 26.


Background and purpose: Inflammation may contribute to cognitive impairment after stroke. Inflammatory markers are associated with hippocampal atrophy. We tested whether markers of inflammation, erythrocyte sedimentation rate (ESR), and serum levels of C-reactive protein are associated with reduced hippocampal volume and poor cognitive performance among stroke survivors.

Methods: We analyzed 368 consecutive cases from our prospective study of first-ever mild-moderate stroke patients. MRI, cognitive tests, and inflammatory markers were determined. Patients were reevaluated 6 and 12 months after the event.

Results: ESR remained unchanged in follow-up examinations, suggesting a chronic inflammation background in some patients. Higher levels of C-reactive protein and ESR were associated with worse performance in cognitive tests, particularly memory scores. This association was maintained for ESR (but not C-reactive protein) after adjustment for confounders (P=0.002). Patients with smaller hippocampi had inferior cognitive results. Moreover, in a multivariate regression model, higher ESR values (but not C-reactive protein) were related to reduced hippocampal volume (P=0.049).

Conclusions: This report shows a strong relationship between ESR and hippocampal volume, as well as with cognitive performance among poststroke patients. This could plausibly relate to incipient cognitive decline via hippocampal pathways.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Atrophy / complications
  • Atrophy / pathology
  • Biomarkers / blood
  • C-Reactive Protein
  • Cognition Disorders / blood
  • Cognition Disorders / etiology
  • Cognition Disorders / pathology
  • Cognition Disorders / psychology*
  • Female
  • Hippocampus / pathology*
  • Humans
  • Inflammation / blood
  • Inflammation / complications
  • Inflammation / pathology
  • Inflammation / psychology
  • Male
  • Middle Aged
  • Organ Size
  • Prospective Studies
  • Severity of Illness Index
  • Stroke / blood
  • Stroke / complications
  • Stroke / pathology
  • Stroke / psychology*


  • Biomarkers
  • C-Reactive Protein