Shkolnyk V. M., Gudarian Yu. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The high urgency of the problem of ischemic stroke is predetermined by the breadth and continuing increase in morbidity with high rates of disability and the development of a number of complications and high mortality. Patients with the consequences of cerebral stroke constitute the heaviest contingent of neuro-rehabilitation institutions. This situation is due, according to researchers, primarily long-term preservation and insufficient regression of the main symptoms of ischemic stroke – cognitive disorders that have arisen because of acute vascular disorders of the brain. Despite the fundamental nature of research on the effects of ischemic stroke, today there is not enough clarified and sometimes contradictory information concerning factors that have a negative impact on the manifestation of cognitive disorders in the recovery period and their consequences. Most researchers unanimously recognize the negative role of manifestations of cognitive impairments of a single hypertensive illness, dyslipidemia, and increased activity of the blood coagulation system. However, in the available literature there is no information about the combined effect of these factors on cognitive functions.Comprehensive clinical, neuropsychiatric and laboratory studies using the MMSE, NIHSS scales, the Barthel scale and methods for determining the lipid and carbohydrate spectrum of the blood, the state of homeostasis were carried out in the recovery period in 103 patients who had hemispheric ischemic stroke. Analysis of the results of clinical studies and changes in the indices of neuropsychological tests of cognitive disorders in patients with ischemic stroke, in the early recovery period, made it possible not only to determine the nature of cognitive impairments and the characteristics of their manifestation, but also to establish their dependence on the number of such adverse factors as arterial hypertension, increased blood viscosity, dyslipidemia and hyperglycemia. All these risk factors were included in a single cluster that combines the main causes of the formation and further course of cognitive disorders. Conjugacy of disorders in the system of homeostasis, in the lipid spectrum of blood, carbohydrate metabolism and arterial hypertension with the severity of cognitive disorders diagnosed in the early recovery period was noted. In the recovery period, patients who have undergone hemisphere ischemic stroke, along with focal neurological symptoms, form cognitive disorders of varying severity (mild in 46.6% and moderate in 53.4% of cases), which impede social activity and livelihoods. The presence and severity of cognitive disorders in the recovery period, after suffering hemispheric ischemic stroke, is due to the completeness of a cluster of risk factors, which are based on arterial hypertension, dyslipidemia, increased activity of the blood coagulation system and hyperglycemia. In the early recovery period, the simultaneous presence of no more than two pathogenetic risk factors causes’ mild cognitive impairment, with moderate their number increases from 2 to 4. A high correlation between the severity of cognitive disorders in patients undergoing hemisphere ischemic stroke, with disorders in the hemostasis system, lipid and carbohydrate spectra of blood and blood pressure was established.

hemisphere ischemic stroke, risk factors, cognitive disorders.

1. Malakhov VO, Monastirsky VO, Lichko VS, Zagorodnya GM, Skripchenko IR, Getmanenko AV. Іshemichny insult. Obrani storinki pathogenezu ta lykuvannya [monograpia]. Harkiv: TOV “EDENA”; 2010. 154 s. [in Ukrainian].
2. Skvortsova VI, Ivanova GE, Stakhovskaya LV. Vozmognosti rashirenia reabilitacionogo potenciala bolnih s cerebralnim insultom. Rus. Med. Journ. Neurologia. Psychiatria. 2011;9:579-83. [in Russian].
3.  Kotov SV, Stakhovskaya LV, Isakova EV, redaktory. Insult: rukovodstvo dlya vrachey. Moskva: MIA; 2014. 400 s. [in Russian].
4. Melnik VS, Kuts KV, Potapovich PV. Kognitivnі rozladi pіslya gostroyogo infarktu mozku. Ukrainskiy nevrologichniy journal. 2009;3(12):16-20. [in Ukrainian].
5. Chen SY, Winstein CJ. A systematic review of voluntary hemiparetic stroke: clinical predictors for meaningful outcomes using the international classification of functioning, disability, and health. J Neurol Phys Ther. 2009;33:2-13.
6. Yepifanov VA, Yepifanov AV. Reabilitatsiya bol’nykh, perenesshikh insul’t. 2-ye izd., ispr. i dop. Moskva: MEDpressinform; 2013. 248 s. [in Russian].
7.  Pаolucci S, Bragoni M, Coiro P. Quantifi cation of the probability of reaching mobility independence at discharge from a rehabilitation hospital in nonwalking early ischemic stroke patients: a multivariate study. Cerebrovasc Dis. 2012;6(1):16-22.
8.  Yavorskaya VA, Grebenyuk AV, Mihaelyan TH. Sravnitelnaya characteristica diagnosticheskih instrumentov dlya ocenki cognitivih narusheniy v post-insultnom periode. Materiali Tretyogo naukovo-osvitnogo forumu “Academia Insults”; 2012 Nov 1-2 Kiev. Kiev: 2012. s. 40. [in Russian].
9. Sidyakina IV, Voronova MV, Snopkov PS. Sovremennie methodi rehabilitacii post-insultnih bolnich. Journal Nevrologii i Psychiatrii. S.S. Korsakova. Insult. 2014;12(2):76-80. [in Russian].
10.  Melnik VS, Shandyuk VYu, Sokolova LІ, Savchuk OM. Vpliv porushen fibrinolitichnoi lanki homeostasu na dynamicu cognitivnogo defitcitu v gostromu periodi іshemіchnogo іnsultu. Naucoviy Visnic NMU Іmenі О.О. Bogomoltsya. 2013;4:87-92. [in Ukrainian].
11. Misula MS. Osoblivosti metabolichnih procesiv u hvorih pislya perenesenogo іshemіchnogo pіvkulnogo іnsultu. Medichna himia. 2013;2:64-7. [in Ukrainian].
12.  Sidyakina IV, Voronova MV, Snopkov PS. Sovremennie methodi reabilitacii post-insultnih bolnih. Journal Neurologii i Psychiatrii. S.S. Korsakova. Insult. 2014;12(2):76-80. [in Russian].
13. Melnik VS. Stan systemi zsidanya krovi u hvorih z ishemichnim insultom z riznim stupenem viragennya nevrologichnogo defitsitu. Ukrainsky Neurologichny Journal. 2015;3:22-5. [in Ukrainian].
14.  Vakarchuk GV, Pashkovsky VM, Sidorchuk LP, Plegutsa OM, Sidorchuk RI. Dynamica pokaznikiv sistemnogo homeostasu pri іshemіnomu іnsultі. Ukr. Visnik Psychonev. 2010;18,3(64):72. [in Ukrainian].
15. Khasanova DR, Zhitkova YuV, Yausheva LM. Lecarstvennaya therapia i cognitivnoe stimulirovanie u bolnih s post-insultnimi cognitivnimi narusheniyami. Neurologsya, neuropsychiatriya, psychosomatica. 2014;2:22-7. [in Russian].

«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 201-207 pages, index UDK 616.89-008-08:616.831-005.04

10.29254/2077-4214-2019-1-2-149-201-207