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Plasma neurofilament light chain levels predict improvement in late phase after stroke.

BACKGROUND: Although functional recovery is most pronounced in the first 6 months after stroke, improvement is possible also in the late phase. We explored the value of plasma neurofilament light chain (NfL), a biomarker of axonal injury and secondary neurodegeneration, for the prediction of functional improvement in late phase after stroke.

METHODS: We measured baseline plasma NfL levels in 115 participants of a trial on the efficacy of multimodal rehabilitation in late phase after stroke. We determined the association between NfL levels, impairment in balance, gait and cognitive domains, and improvement 3 and 9 months later.

RESULTS: Plasma NfL levels were associated with the degree of impairment in all three domains. Individuals with meaningful improvement in balance and gait capacity had higher plasma NfL levels compared with non-improvers (P=0.001 and P=0.018, respectively). Higher NfL levels were associated with improvement in balance (OR 2.34, CI: 1.35-4.27, P=0.004) and gait (OR 2.27, CI: 1.25-4.32, P=0.009). Elevated plasma NfL levels showed a positive predictive value for cognitive improvement, and this effect was specific for the intervention targeting the cognitive domain. The association of NfL levels with cognitive improvement withstood correction for baseline impairment, age and total years of schooling (OR 7.54, CI: 1.52-45.66, P=0.018).

CONCLUSIONS: In addition to its established role as a biomarker in the acute phase, elevated circulating NfL levels may predict functional improvement in late phase after stroke. Our results should prompt further studies into the use of plasma NfL as a biomarker in late phase after stroke.

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