Neurofilament Light Chain Predicts Cognitive Decline After Cardiac Arrest | News-Medical.net
A simple blood test measuring levels of neurofilament light chain (NfL) shows promise in predicting long-term cognitive impairment in patients following out-of-hospital cardiac arrest, according to research presented today at the European Society of Cardiology’s (ESC) Acute CardioVascular Care 2026 congress.
Following a cardiac arrest outside of a hospital setting, the brain is particularly vulnerable to damage. Clinicians currently rely on tests to assess the extent of brain injury in survivors, often utilizing neuron-specific enolase (NSE) as a biomarker. However, concerns exist regarding the reliability of NSE, as elevated levels can be triggered by factors unrelated to brain injury.
The study, led by Dr. Martin Meyer of Rigshospitalet – Copenhagen University, Denmark, investigated whether NfL, a biomarker increasingly recognized for its potential in diagnosing neurological conditions, could offer a more accurate prediction of long-term cognitive function compared to NSE. “Currently, we measure neuron-specific enolase in the blood as a marker of brain injury but there are concerns about its reliability as factors other than brain damage can lead to high levels. Another blood biomarker, neurofilament light chain, has potentially better diagnostic performance than neuron-specific enolase,” Dr. Meyer explained.
Researchers analyzed blood samples collected from participants in the Blood Pressure and Oxygenation Targets after Cardiac Arrest (BOX) trial. These individuals had been successfully resuscitated from out-of-hospital cardiac arrest and were in a comatose state upon hospital admission. Blood samples were taken 48 hours post-arrest to measure both NfL and NSE levels.
Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) score, administered months after the initial cardiac event. MoCA scores were available for a subset of survivors who had undergone both NfL and NSE testing.
The key finding revealed a clear inverse correlation between NfL levels and MoCA scores: higher levels of NfL in the blood, measured 48 hours after the cardiac arrest, were indicative of poorer long-term cognitive performance. Conversely, no significant association was found between NSE levels at 48 hours and subsequent cognitive function.
“Neurofilament light chain levels measured early after cardiac arrest, while patients were still admitted to hospital, were related to long-term cognitive function,” Dr. Meyer stated. “This association with cognitive function was not observed with neuron-specific enolase testing.”
Dr. Meyer suggests that the introduction of routine early NfL measurement could assist identify patients at higher risk of cognitive impairment, allowing for more informed decisions regarding further testing, targeted rehabilitation strategies, and more realistic expectations for patients and their families. He cautioned, however, that further validation and standardization of NfL assays are necessary before widespread clinical implementation.