Serum Transforming Growth Factor Beta 1 (TGF-β1) as a Biomarker of Cognitive Impairment in Acute Ischemic Stroke

Cognitive impairment is a frequent but underrecognized complication of acute ischemic stroke, significantly affecting prognosis and quality of life. Transforming Growth Factor Beta 1 (TGF-β1) is a cytokine involved in neuroinflammation, neuroprotection, and neuronal plasticity, with potential relevance to post-stroke cognitive outcomes. This quantitative observational analytic study with a case-control design was conducted across seven referral hospitals in Makassar, Indonesia, from January 2025. Adult patients with acute ischemic stroke were consecutively enrolled, cognitive function was assessed using the Montreal Cognitive Assessment–Indonesian version (MoCA-INA), and serum TGF-β1 levels were measured by immunoassay. A total of 57 patients were included, with a mean age of 58.25 ± 9.19 years; 66.7% had cognitive impairment at admission. Mean TGF-β1 levels were significantly lower in patients with cognitive impairment compared to those with normal cognition, both on day 1 (523.65 pg/mL vs. 998.32 pg/mL; p = 0.020) and day 30 (482.19 pg/mL vs. 1024.20 pg/mL; p = 0.007). No correlation was found between TGF-β1 levels and MoCA-INA scores on day 1 (r = 0.020; p = 0.884), but a significant positive correlation was observed on day 30 (r = 0.371; p = 0.005). Higher TGF-β1 levels were also associated with greater improvement in MoCA-INA scores over 30 days (MoCA-INA) (r = 0.353; p = 0.007). These findings suggest that lower serum TGF-β1 levels are associated with cognitive impairment in acute ischemic stroke patients, while higher levels predict better cognitive outcomes and greater recovery, supporting its potential role as a prognostic biomarker for post-stroke cognition.