The Study Of Cognitive Function,MTHFR Gene Polymorphism And Plasma Homocysteine Levels In Patients With Post-stroke Depression

BackgroundPost-Stroke Depression(PSD) is a mood disorder that manifested after stroke, the main symptoms of depression, decreased interest and sleep disorders.Which are often associated with cognitive function,both to each other effects the rehabilitation of stroke patients and quality of life. Homocysteine (Hcy) is an important product in cysteine and methionine metabolic pathway and its impact on levels of PSD and cognitive function. N5, N10-Methylenetetrahydrofolate Reductase (MTHFR) gene polymorphism is key enzyme in homocysteine metabolism loop its genotype have an important impact on Hcy levels.Objectives1. Understanding cognitive function, MTHFR gene polymorphism and plasma Hcy levels, analyze their correlation in patients with post-stroke depression and cerebral infarction.2. To explore the influence of Hcy,MTHFR genotype and other common risk factors for cerebrovascular disease,in order to provide an objective basis for post-stroke depression etiology, clinical diagnosis and treatment.Methods1. Divided into post-stroke depression group159cases and purely cerebral infarction group160cases according to diagnosis standard of national fourth session of cerebrovascular disease academic conference and adopt twenty-fourth item Hamilton’s depression scale, selectig healthy volunteer140cases as control group. 2. As assessment indicators of cognitive function in patients using the Mini Mental State Examination (MMSE).3.Using the analytical techniques of Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to detect the MTHFR genotype in PSD group and cerebral infarction group.4. Determination of the three groups of Hcy, serum total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), high-sensitivity C-reactive protein (hsCRP) levels, the National Institute Hospital States stroke Scale (NIHSS). activities of daily living rating scale (Barthel), the patient’s age, sex, hypertension, diabetes, family history of cardiovascular disease, a history of smoking and drinking history.Results1. Cognitive dysfunction in Post-stroke depression group and cerebral infarction(CI) group was significantly higher than the normal control group difference was statistically significant (P<0.05); the PSD groups MMSE score was significantly lower than the cerebral infarction group difference was statistically significant (P<0.05):attention computing power and memory PSD group was significantly lower than the cerebral infarction group and the normal control group difference was statistically significant (P <0.05).2. Hcy,TC. hsCRP,NIHSS in Post-stroke depression group significantly higher than the cerebral infarction group and normal control group were statistically significant (P <0.05); the score of Barthel in Post-stroke depression group was below cerebral infarction group and the normal control group difference was statisticallysignificance (P<0.05); hypertension history, history of smoking, and the proportion with a family history of cardiovascular and cerebrovascular disease, PSD group was significantly higher than the CI group, the difference was statistically significant (P<0.05).3. Correlation studies have shown that the the PSD group with a history of hypertension, family history of cardiovascular and cerebrovascular diseases, smoking history, history of diabetes, history of alcohol consumption, TG, TC, HDL, LDL and plasma have no correlation with PSD. PSD was positively correlated with NIHSS score, negatively correlated with MMSE score results. The degree of neurological deficit and Hey, TG, activities of daily living and cognitive function difference was statistically significant (P<0.05), and patients with activities of daily living with Hey, TG, degree of neurological deficits and cognitive function difference was statistically significant (P<0.05), the cognitive function in patients with Hey, TG, daily living skills and nerve function defect extent difference was statistically significant (P<0.05).4. Three genotypes in Post-stroke depression group and cerebral infarction group difference was statistically significant (χ2=12.064,P=0.000);The comparison of C, T allele frequency distribution, the difference was statistically significant (χ2=10.484, P=0.000). The number of cases with Post-stroke depression group CC genotype was significantly lower than the CI group, the TT genotype cases was significantly higher than the number of cases of cerebral infarction group, the PSD Group C allele frequency was significantly lower than the frequency of T allele difference statistically significant (P<0.05); cerebral infarction group C, T allele frequency was no difference (P>0.05).5. Hey values in Post-stroke depression group CC genotype below the cerebral infarction group, the difference was statistically significant (t=-3.067,P=0.003); Hey values in Post-stroke depression group TT genotypes higher than the CI group, the difference was statistically significance (t=3.927, P=0.000).6. MMSE score in Post-stroke depression group CC genotype higher than the CI group, the difference was statistically significant (t=2.653, P=0.011); MMSE score in Post-stroke depression group CT and TT genotypes lower than the CI group, the difference was statistically significant(t=-3.232, P=0.002; t=-5.984, P=0.000).Conclusions1. There has the cognition function lesion in post-stroke depression patients.2. Post-stroke depression in patients with The higher the level of blood Hey, the more serious cognitive impairment. 3. History of hypertension, smoking history, cardiovascular and cerebrovascular disease, family history may be risk factors for PSD, Hyperhomocysteinemia, neurological and cognitive impairment with the high prevalence of PSD.4. C allele may be a protective factor for patients with post-stroke depression T allele may be a pathogenic factor in patients with post-stroke depression.5. CC genotype may be a protective factor for Post-stroke depression in patients with hyperhomocysteine TT genotype may be a risk factor.6. CC genotype may be a protection factor for Post-stroke depression in patients with cognitive impairment, the TT genotype may be a risk factor for PSD with cognitive impairment.