Increased blood-brain barrier permeability in the left hippocampal CA4 region is associated with post-stroke cognitive impairment

doi:10.3969/j.issn.1006-7795.2026.01.007

Abstract

Abstract: Objective To investigate the association between blood-brain barrier (BBB) permeability in the left hippocampal cornu ammonis 4 (CA4) subregion and post-stroke cognitive impairment (PSCI). Methods This multicenter prospective cohort study consecutively enrolled 97 patients with transient ischemic attack (TIA) or minor ischemic stroke. Within 7 d of admission, all participants underwent dynamic contrast-enhanced magnetic resonance imaging, and BBB permeability parameters volume transfer constant(Ktrans) of hippocampal subregions were calculated using the Patlak model. According to Montreal Cognitive Assessment (MoCA) scores at 6-month follow-up, patients were divided into the PSCI group and the post-stroke non-cognitive impairment (PSNCI) group. Multivariate Logistic regression analysis was performed to examine the independent association between BBB permeability in the left hippocampal CA4 region and cognitive outcomes. Results A total of 65 patients completed the follow-up, including 13 (20.0%) in the PSCI group. Patients in the PSCI group were older, had fewer years of education, and lower baseline MoCA scores (all P < 0.05). Increased BBB permeability in the left hippocampal CA4 region was associated with lower total MoCA scores, and negatively correlated with executive and naming function scores. Multivariate Logistic regression analysis indicated that elevated BBB permeability in the left hippocampal CA4 region was an independent risk factor for PSCI. Conclusion Increased BBB permeability in the left hippocampal CA4 subregion is independently associated with lower cognitive scores at 6 months in patients with TIA or minor ischemic stroke. It may serve as a potential imaging biomarker for predicting PSCI.

Key words: post-stroke cognitive impairment, transient ischemic attack, minor ischemic stroke, blood-brain barrier, hippocampal CA4 subregion, dynamic contrast-enhanced magnetic resonance imaging

CLC Number:

R743

Wang Shuaiguo, Wang Zihao, Jing Jing, Lin Jinxi, Meng Xia. Increased blood-brain barrier permeability in the left hippocampal CA4 region is associated with post-stroke cognitive impairment[J]. Journal of Capital Medical University, 2026, 47(1): 54-61.

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