Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke

Abstract

Acute cerebrovascular disease  is a global medical and social problem of the modern angioneurology, occupying leading positions in the structure of morbidity and mortality among  adult population of the world. Ischemic stroke – is one of the most common pathology. Today this disease took out the world pandemic. More than 16 million new cases of cerebral infarction   recorded in the world each year and it “kills”  about 7 million of people.

About 111,953 cases of cerebral stroke were registered in 2013 in Ukraine. Cognitive impairment, t hat significantly disrupt daily activities and life of the patient, is one of the most significant post-stroke complications that have social, medical and biological significance.

Aim. The purpose of this investigation was to study features and dynamics of cognitive impairments in patients with primary and recurrent cerebral hemispheric ischemic stroke (CHIS ) in the acute stage of the disease.

Materials and methods. To achieve the aim, and the decision of tasks in the clinic of nervous diseases Zaporozhye State Medical University (supervisor - Doctor of Medicine, Professor Kozelkin A.) based on the department  of acute cerebrovascular disease were performed  comparative, prospective cohort study, which included comprehensive clinical and paraclinical examinations of 41 patients (26 men and 15 women) aged 45 to 85 years (mean age 66,4 ± 1,4 years) with acute left-hemispheric (2 patients) and right - hemispheric (39 patients) CHIS . First up was a group of 28 patients (19 men and 9 women, mean age 65,6 ± 1,6 years), who suffered from primary  CHIS. The second group consisted of 13 patients (7 men and 6 women, mean age 68,1 ± 2,5 years) with recurrent CHIS. The groups were matched by age, sex, localization of the lesion  and the initial level of neurological deficit.

All patients underwent physical examination, neurological examination. Dynamic clinical neurological examination assessing the severity of stroke was conducted using a NIHS scale. Neuropsychological examination included verification of the existence and structure of the cognitive impairments  using scales Montreal Cognitive Assessment (MoCA), Mini-Menthal State Examination (MMSE), Frontal Assessment Battery (FAB) on the 1st -3rd and 10 - 13th day of the acute period of the disease. Outcome of the acute period of the disease was assessed by the modified Rankin scale .

All patients underwent a CT scan (Siemens Somatom Spirit, Germany) of the brain and  laboratory investigations. The obtained data were processed using the program Statistica 6.0 (StatSoft., USA ) and software package  Microsoft Excel.

It was detected that patients with recurrent ischemic supratentorial stroke are characterized with lower summary score by Mini-Menthal State Examination, Montreal Cognitive Assessment and Frontal Assessment Battery scales than those with first stroke episode. It was revealed that moderate cognitive disturbances are prevailed in the structure of cognitive disorders in primary stroke, while in recurrent brain ischemia mild and moderate dementia is dominated.  Transitory type of perception-gnostic field violations in primary ischemic supratentorial stroke was established.  The leading cognitive domains which are associated with expressed cognitive disfunction in patients with recurrent brain ischemia were detected.

Conclusions. The patients with recurrent CHIS were characterized by more severe cognitive impairment in the acute period of the disease, so  a primary CHIS  we can  considered as a main risk factor for the progression of cognitive disorders  in a specified group of patients.