Association between fibrinogen and cognitive impairment in patients with ischemic cerebrovascular disease

Objectives: Fibrinogen has been reported as a potential risk factor for vascular dementia (VaD). However, the association between fibrinogen and cognition in patients with ischemic cerebrovascular disease (ICVD) has not been studied adequately. We aimed to examine the association of fibrinogen with cognitive impairment among patients with ICVD and to test whether white matter hyperintensities (WMH) and brain atrophy play a role under the association. Methods: In this case-control study, ICVD patients were recruited from the Neurology Department. Cognitive function was assessed using the Montreal Cognitive Assessment. WMH and brain atrophy were quantified by brain magnetic resonance imaging (MRI). The associations of fibrinogen with cognition and MRI markers were investigated by conditional logistic regression models and generalized additive models. Results: The risk of cognitive impairment increased with each unit increase in fibrinogen (AOR = 1.92, 95 % CI = 1.06 - 3.48). Individuals with fibrinogen levels > 4 g/L presented a substantially higher risk of cognitive impairment than those with fibrinogen levels of 2-4 g/L (AOR = 5.72, 95 % CI = 1.22- 26.82). Fibrinogen was negatively correlated with global cognitive function (r(s) = -0.235) and visuospatial/executive function (r(s) = -0.251). A negative correlation between fibrinogen and normal-appearing white matter (NAWM) volume was observed (r(s) = -0.282). Conclusions: Fibrinogen is associated with cognitive impairment among patients with ICVD, and significantly negatively impacts global cognitive function and visuospatial/executive function. Furthermore, the negative correlation between fibrinogen and NAWM volume supports further exploration of potential mechanistic paths.