COMPOSITION (STRUCTURE) OF COGNITIVE IMPAIRMENTS IN CHRONIC CEREBRAL ISCHEMIA
Keywords:
Chronic cerebral ischemia, neuropsychological damage, cognitive impairment, psychopathological state, Spielberger-Khanin scale, DASS-21 scale, HADS scale, Beck depression scale, Montreal (MoCa) scale, Addenbrooke-III (Addenbrooke's cognitive examination III, ACE-III) scaleAbstract
Purpose. Study of the structure of neuropsychological damage depending on the stages of chronic cerebral ischemia (CCI), analysis of causes and factors.
Materials and methods. 172 (100%) patients underwent neurological and neuropsychological examination. Patients were divided into 3 groups: 1st group - 62 (36.1%) patients with hypertension without pronounced CCI, 2nd group - 57 (33.1%) patients with stage 2 CCI with mild and moderate cognitive impairment, 3rd group - 53 (30.8%) patients with vascular dementia developed against the background of CCI. Neuropsychological examination using the DASS-21 (Depression, Anxiety, Stress Scale-21), HADS (Hospital Anxiety and Depression Scale), Spilberger Ch.D. and Khanin Yu.L. scales, Beck Depression Inventory (BDI), Montreal scale (MoSA), Addenbrooke's cognitive examination III, ACE-III) scales.
Result. The study included patients aged 44 to 73 years. In the 3rd stage of CCI, in the state of dementia (3rd group), the number of men was higher, which indicates the rapid development of cognitive impairment in men compared to women, disability, and even mortality in men. According to the results of the DASS-21 scale, a low level of depression was characteristic of the 1st group, moderate and high levels were characteristic of the 2nd group, and in patients of the 3rd group, it was difficult to determine the cognitive state due to the presence of a degree of dementia. According to the HADS scale, the absence of anxiety in patients of group 1 was revealed, subclinical anxiety was almost equally distributed in all three groups, and severe anxiety was observed in almost half of the patients of group 2, which differed from both groups. According to the Spielberger and Khanin scale, the distribution of the average level of STAI-SHX and STAI-HX/RX in all three groups was practically the same, the strong level of STAI-SHX was less prevalent in group 3 than in group 1 (P<0.05), the strong level of STAI-HX/RX was more prevalent in group 2 than in group 1 (P<0.001). According to the BDI scale, mild, pronounced, and severe depressive states were identified in the main groups. When assessing the cognitive characteristics of patients according to the Montreal (MoCa) scale, mild, moderate, and severe cognitive impairment was observed in all three groups. We witnessed a decrease in the cognitive state depending on the stage of CCI.
Conclusion. In chronic cerebral ischemia, which belongs to the category of cerebrovascular diseases, the cognitive and psychopathological state deepens with the development of the disease, these cognitive and psychopathological changes increase the possibility of determining the stage of the disease, in what and under what conditions to treat, which drugs to choose and provide adequate medical care, carrying out early prevention of the development of severe complications, and directing relatives of the patient for their care.
References
Амелина И.П., Романенко А.В., Соловьева Э.Ю. Этиопатогенетические и терапевтические аспекты церебральной микроангиопатии. Трудный пациент. 2019; 17 (11–12): 15-23. DOI: 10.24411/2074-1995-2019-10081.
Боголепова А.Н. Когнитивные и эмоциональные нарушения у больных с хронической цереброваскулярной недостаточностью. Медицинский совет. 2020; 8: 29–37. DOI: 10.21518/2079-701X-2020-8-29-37.
Варако Н.А., Архипова Д.В., Ковязина М.С., Юсупова Д.Г., Зайцев А.Б., Зимин А.А., Соломина А.В., Бундхун П., Рамчандани Н.М., Супонева Н.А., Пирадов М.А. Адденбрукская шкала оценки когнитивных функций III (Addenbrooke’s cognitive examination III – ACE-III): лингвокультурная адаптация русскоязычной версии//Анналы клинической и экспериментальной неврологии. 2022. Т. 16, № 1. DOI: https://doi.org/10.54101/ACEN.2022.1.7. – С. 53-58.
Захаров В.В., Слепцова К.Б., Мартынова О.О. Хроническая ишемия мозга: взгляд из ХХI века. РМЖ. 2021; 5: 45–49.
Котова О.В., Зуйкова Н.Л., Палин А.В., Фролова В.И., Гушанская Е.В., Салынцев И.В., Медведев В.Э. Психопатологические расстройства при хронической ишемии мозга: возможности профилактики // Лечащий Врач. 2021; 5 (24): 22-26. DOI: 10.51793/OS.2021.15.98.005.
Коценко Ю.И. Нейропсихологические особенности у пациентов с хронической ишемией мозга в разных возрастных группах при сахарном диабете 2 типа // Журнал психиатрии и медицинской психологии № 3 (59), 2022; - С. 78-84.
Кулеш А.А., Емелин А.Ю., Боголепова А.Н. и др. Клинические проявления и вопросы диагностики хронического цереброваскулярного заболевания (хронической ишемии головного мозга) на ранней (додементной) стадии. Неврология, нейропсихиатрия, психосоматика. 2021;13(1):4–12. DOI: 10.14412/2074-2711-2021-1-4-12.
Федорова Н.В. Когнитивные нарушения на фоне хронической ишемии мозга. Фокус на энергетический обмен // Современная терапия в психиатрии и неврологии № 1–2 / 2023, - С. 54-57.
Череващенко Л.А., Серебряков А.А. Когнитивные и психоэмоциональные нарушения у пациентов с хронической ишемией головного мозга и их коррекция в условиях курорта // Вестник физиотерапии и курортологии №3, 2018, - С. 68-72.
Aizenstein H.J., Baskys A., Boldrini M., et al. Vascular depression consensus report – a critical update. BMC Med. 2016 Nov 3;14(1):161. doi: 10.1186/s12916-016-0720-5 32.
Arvanitakis Z, Shah RC, Bennett DA. Diagnosis and Management of Dementia: Review. JAMA. 2019;322(16):1589-99. DOI:10.1001/jama.2019.4782.
Brainin M. Cognitive deterioration following stroke: a growing, heavy burden for patients, families, and society. M.: Buki-Vedi, 2017. [in Russian]
Charidimou A., Shams S., Romero J.R., et al. Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1). Int J Stroke. 2018;13(5):454-68. doi: 10.1177/1747493017751931
Clinical guidelines. Senile asthenia. ICD-10: R-54. Age group: 60 and over. Moscow; 2018. 106 p. (In Russ.).
Debette S., Schilling S., Duperron M.G., et al. Clinical significance of magnetic resonance imaging markers of vascular brain injury: a systematic review and metaanalysis. JAMA Neurol. 2019;1;76(1):81-94. doi: 10.1001/jamaneurol.2018.3122.
Erhardt EB, Pesko JC, Prestopnik J, Thompson J, Caprihan A, Rosenberg GA. Biomarkers identify the Binswanger type of vascular cognitive impairment. Journal of Cerebral Blood Flow & Metabolism. 2018;0(00):1-11. https://doi.org/10.1177/0271678X18762655.
Francis F., Ballerini L., Wardlaw J.M. Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: A systematic review and meta-analysis. Int J Stroke. 2019 Jun;14(4):359-71. doi: 10.1177/1747493019830321.
Gude H. POS-Psychoorganic Syndrome. Endocrinol Metab Syndr. 2021; 10:328. doi: 10.4172/2161-1017.21.10.328.
Jie W., Lin G., Liu Z., et al. The Relationship Between Enlarged Perivascular Spaces and Cognitive Function: A Meta-Analysis of Observational Studies. Front Pharmacol. 2020; 11:715.
Johnson RJ, Tolan DR, Bredesen D, et al. Could Alzheimer's disease be a maladaptation of an evolutionary survival pathway mediated by intracerebral fructose and uric acid metabolism? Am J Clin Nutr. 2023;117(3):455-66. DOI:10.1016/j.ajcnut.2023.01.002.
Информация об авторах/ Information about the authors
КОНТАКТНАЯ ИНФОРМАЦИЯ:
Саноева Матлюба Жахонкуловна – доктор медицинских наук (DSc), доцент кафедры неврологии Бухарского государственного медицинского института им. Абу Али ибн Сино, г.Бухара, Узбекистан
Адрес: ул. Гиждуванская 24, Бухара, 102000, Республика Узбекистан
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E-mail: matlyubadoct70@mail.ru
Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
Финансирование. Исследование не имело спонсорской поддержки (собственные ресурсы).
