Objective To develop a nomogram model based on the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)/caspase-1 signaling pathway to predict the value of secondary vascular dementia (VaD) after acute cerebral infarction (ACI) following thrombolytic therapy.

Methods A total of 289 patients with ACI admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from March 2021 to March 2024 were selected as study subjects, and were divided into VaD group (n=60) and non-VaD group (n=229) based on the occurrence of VaD. Relevant clinical data were compared between the two groups, and influencing factors for secondary VaD after ACI were analyzed. A nomogram prediction model was constructed and validated.

Results The proportions of patients with a history of smoking, hypertension and coronary heart disease, infarction in key areas, responsible large vessel stenosis ≥50%, leukoaraiosis, and thrombolysis benefit were higher in the VaD group than in the non-VaD group(P < 0.05). Logistic regression analysis showed that the degree of responsible vessel stenosis, infarctionin key areas, leukoaraiosis, and the expression of NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), and caspase-1, which are related to the NLRP3/caspase-1 signaling pathway, were independent influencing factors for secondary VaD after ACI (P < 0.05). Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) indicated that the nomogram model had high discrimination and predictive efficacy, with significant positive net benefit.

Conclusion The independent influencing factors for secondary VaD after ACI include the degree of responsible vessel stenosis, infarction in key areas, leukoaraiosis, and the expression of NLRP3, ASC, and caspase-1 related to the NLRP3/caspase-1 signaling pathway. The nomogram prediction model established based on these indicators has high predictive value and clinical efficacy.