Serum Rheumatoid Factor Levels at Acute Phase of Ischemic Stroke are Associated with Poststroke Cognitive Impairment

J Stroke Cerebrovasc Dis. 2019 Apr;28(4):1133-1140. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.049. Epub 2019 Jan 17.


Background: The effect of serum rheumatoid factor (RF) on poststroke cognitive impairment remains unknown. We aimed to investigate the association of serum RF in the acute phase with cognitive impairment at 3 months after ischemic stroke onset.

Methods: Our study was based on a random sample from the China Antihypertensive Trial in Acute Ischemic Stroke, a total of 582 patients from 7 of 26 participating sites of the trial with serum RF levels were included in this analysis. Cognitive impairment was defined as Mini-Mental State Examination less than 27 or Montreal Cognitive Assessment less than 25.

Results: According to Mini-Mental State Examination score, the multivariate-adjusted odds ratio and 95% confidence interval of cognitive impairment for the highest tertile of serum RF was 1.79 (1.08-2.99) compared with the lowest tertile. Each standard deviation increase of log-transformed RF was associated with 33% (95% confidence interval: 7%-66%) increased risk of cognitive impairment, and a linear association between serum RF and risk of poststroke cognitive impairment was observed (P for linearity < .01). Adding log-transformed RF to a model containing conventional risk factors improved the predictive power for poststroke cognitive impairment (net reclassification improvement: 26.21%, P < .01; integrated discrimination index: 1.24%, P = .02). Similar significant findings were observed when cognitive function was defined by Montreal Cognitive Assessment score.

Conclusions: Elevated serum RF levels in the acute phase were independently associated with 3-month cognitive impairment among ischemic stroke patients. Further studies are needed to replicate our findings and to clarify the potential mechanisms.

Keywords: Rheumatoid factor; cognitive impairment; ischemic stroke; prognosis; risk factors.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Brain Ischemia / blood*
  • Brain Ischemia / complications
  • Brain Ischemia / diagnosis
  • Brain Ischemia / psychology
  • China
  • Cognition Disorders / blood
  • Cognition Disorders / diagnosis
  • Cognition Disorders / etiology*
  • Cognition Disorders / psychology
  • Cognition*
  • Female
  • Humans
  • Male
  • Mental Status and Dementia Tests
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Rheumatoid Factor / blood*
  • Risk Factors
  • Stroke / blood*
  • Stroke / diagnosis
  • Stroke / etiology*
  • Stroke / psychology
  • Time Factors
  • Up-Regulation


  • Biomarkers
  • Rheumatoid Factor