Correlation between neuroimaging, neurological deficits, and neurotrophic proteins in predicting rehabilitation potential in ischemic stroke patients

Abstract

Background: Ischemic stroke (IS) is a major contributor to global morbidity and mortality, responsible for over 5 million deaths and 15 million survivors annually, the majority of whom experience long-term disability. The growing burden of IS, driven by aging populations and the increasing prevalence of hypertension, diabetes, and cardiovascular disease, underscores the urgent need for reliable prognostic biomarkers and personalized rehabilitation strategies. While current clinical assessments guide acute management, they often fall short in predicting neurological outcomes and the potential for functional recovery. This study aimed to evaluate the prognostic value of serum nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels in the acute phase of IS and to develop a predictive model for rehabilitation potential (RP) by integrating these biomarkers with standardized clinical scales. Methods: The study involved clinical-neurological evaluations, brain magnetic resonance imaging (MRI) imaging, serum biomarker quantification, and standardized neuropsychological assessments. Results: Quantitative analysis revealed that NGF and BDNF serum concentrations were significantly lower in IS patients compared to healthy controls, with NGF reduced by 6.9-fold and BDNF by 2.9-fold (P<0.01). Statistical correlation analyses demonstrated a strong inverse relationship between NGF and National Institute of Health Stroke Scale (NIHSS) scores (P<0.01), and a moderate inverse relationship for BDNF (P<0.05), indicating that lower neurotrophic factor levels are associated with greater neurological impairment. Furthermore, significant correlations were found between NGF levels and functional outcome measures, including the Barthel Index (P<0.01), reinforcing the hypothesis that reduced neurotrophic support contributes to impaired recovery of daily living activities. These neurotrophins are known to support neuronal survival, synaptic plasticity, and neurogenesis, and their deficiency may exacerbate ischemiainduced apoptosis and glial dysfunction, thus impeding neurovascular unit restoration. A three-factor linear regression model was developed to predict RP based on NGF and BDNF levels in combination with clinical scale scores. This predictive tool could aid clinicians in stratifying patients by recovery potential and tailoring rehabilitation interventions accordingly. Conclusions: These findings substantiate the clinical utility of NGF and BDNF as biomarkers for early outcome prediction and functional prognosis in acute IS. By establishing a measurable link between neurotrophic factor levels and structural-functional recovery indices, this study provides a scientific basis for incorporating serum biomarkers into stroke rehabilitation protocols.