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Low Hemoglobin Levels at Admission Are Independently Associated with Cognitive Impairment after Ischemic Stroke: a Multicenter, Population-Based Study


Data on the association between hemoglobin (Hb) levels and poststroke cognitive function are limited. We investigated the relationship between Hb concentrations at admission and poststroke cognitive function using a multicenter database. In total, 1081 patients were recruited from seven Chinese medical centers within 6 months after experiencing ischemic stroke. Cognitive status was evaluated with a series of brief neuropsychological tests. A subgroup of 439 patients from a single center was followed up for 4–6 years and was eventually reassessed with a cognitive test. The association between Hb and cognitive impairment was analyzed by multivariable Tobit regression and logistic regression. The mean age of the 920 eligible participants at study entry was 42.5 years; 311 (34%) were women, and all participants were Chinese nationals who lived locally. After adjustment for multiple covariables, Hb levels at admission remained positively associated with poststroke Mini-Mental State Examination (MMSE) scores, with a 0.37-point increase in the MMSE score for every 1-standard-deviation increase in the Hb level. Moreover, an optimal Hb level above 15.0 g/dl was proposed for preventing or alleviating the development of poststroke cognitive impairment in men. After 4–6 years of rehabilitation, the baseline Hb still correlated with MMSE scores. A significant interaction was found between baseline Hb and change in MMSE scores over time, with higher baseline Hb levels predicting faster recovery of global cognitive performance (β, 0.21; 95% confidence interval, 0.03–0.39).These findings warrant further study of anemia as a risk factor for poststroke cognitive impairment.

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We are deeply appreciative of the participants in this study and their relatives and thank all staff for their support and assistance. The study was supported by the Science and Technology Program of Zhejiang Province (NO. 2017C03011) and the Technology Project co-founded by Zhejiang Province and the Ministry of Health of China (WKJ-ZJ-1612).

Author information

FM conceived this study and wrote the manuscript. SZ designed this study and analyzed the data. BL was the project leader. JY, FH, LL, RW, HY, RJ, and HC collected information and gave a lot of useful advices on the performance of this research.

Correspondence to Benyan Luo.

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This study was approved by the Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University, and was conducted in accordance with the Declaration of Helsinki.

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The authors declare that they have no conflicts of interest.

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Meng, F., Zhang, S., Yu, J. et al. Low Hemoglobin Levels at Admission Are Independently Associated with Cognitive Impairment after Ischemic Stroke: a Multicenter, Population-Based Study. Transl. Stroke Res. (2020).

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  • Hemoglobin
  • Anemia
  • Stroke
  • Cognitive impairment
  • Dementia
  • Prevention