Neopterin, kynurenine metabolites, and indexes related to vitamin B6 are associated with post-stroke cognitive impairment: The Nor-COAST study

Brain Behav Immun. 2024 May:118:167-177. doi: 10.1016/j.bbi.2024.02.030. Epub 2024 Feb 28.


Background and aims: We have previously shown that systemic inflammation was associated with post-stroke cognitive impairment (PSCI). Because neopterin, kynurenine pathway (KP) metabolites, and B6 vitamers are linked to inflammation, in our study we investigated whether those biomarkers were associated with PSCI.

Material and methods: The Norwegian Cognitive Impairment After Stroke study is a prospective multicenter cohort study of patients with acute stroke recruited from May 2015 through March 2017. Plasma samples of 422 participants (59 % male) with ischemic stroke from the index hospital stay and 3 months post-stroke were available for analyses of neopterin, KP metabolites, and B6 vitamers using liquid chromatography-tandem mass spectrometry. Mixed linear regression analyses adjusted for age, sex, and creatinine, were used to assess whether there were associations between those biomarkers and cognitive outcomes, measured by the Montreal Cognitive Assessment scale (MoCA) at 3-, 18-, and 36-month follow-up.

Results: Participants had a mean (SD) age of 72 (12) years, with a mean (SD) National Institutes of HealthStroke Scale score of 2.7 (3.6) at Day 1. Higher baseline values of quinolinic acid, PAr (i.e., an inflammatory marker based on vitamin B6 metabolites), and HKr (i.e., a marker of functional vitamin B6 status based on selected KP metabolites) were associated with lower MoCA score at 3, 18, and 36 months post-stroke (p < 0.01). Higher baseline concentrations of neopterin and 3-hydroxykynurenine were associated with lower MoCA scores at 18 and 36 months, and higher concentrations of xanthurenic acid were associated with higher MoCA score at 36 months (p < 0.01). At 3 months post-stroke, higher concentrations of neopterin and lower values of pyridoxal 5́-phosphate were associated with lower MoCA scores at 18- and 36-month follow-up, while lower concentrations of picolinic acid were associated with a lower MoCA score at 36 months (p < 0.01).

Conclusion: Biomarkers and metabolites of systemic inflammation, including biomarkers of cellular immune activation, indexes of vitamin B6 homeostasis, and several neuroactive metabolites of the KP pathway, were associated with PSCI.

Trial registration: NCT02650531.

Keywords: B6 vitamin; Biomarker; Ischemic stroke; Kynurenine pathway; Neopterin; Plasma; Post-stroke cognitive impairment; Quinolinic acid.

Publication types

  • Clinical Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Cognitive Dysfunction* / complications
  • Cohort Studies
  • Female
  • Humans
  • Inflammation / complications
  • Kynurenine / metabolism
  • Male
  • Middle Aged
  • Neopterin
  • Prospective Studies
  • Pyridoxal Phosphate
  • Stroke* / complications
  • Vitamin B 6 / metabolism


  • Biomarkers
  • Kynurenine
  • Neopterin
  • Pyridoxal Phosphate
  • Vitamin B 6

Associated data