Tynterova Anastasia, Perepelitsa Svetlana, Golubev Arкady
Immanuel Kant Baltic Federal University, 14 Alexander Nevsky St., 236041 Kaliningrad, Kaliningrad Oblast, Russia.
V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25 Petrovka Str., Build. 2, 107031 Moscow, Moskovskaya Oblast, Russia.
Brain Sci. 2022 Apr 26;12(5):554. doi: 10.3390/brainsci12050554.
The leading factors of post-stroke disability are motor disorders and cognitive dysfunctions. The aim of the study was to identify and provide a rationale for the variable early cognitive dysfunction in right and left hemispheric damage in patients with acute stroke. The study included 80 patients diagnosed with ischemic stroke. All patients were assessed for cognitive status, depression, fatigue and anxiety. For objectification, the method of evoked potentials (P300) and neuroimaging were used. Our findings revealed distinguishing features of cognitive dysfunction and identified a combination of the most informative markers characteristic of right and left hemispheric damage in patients with acute ischemic stroke. In patients with damage to the left hemisphere, a predominance of dysregulation syndrome (decrease in executive function and attention) was revealed, accompanied by various disorders such as severe anxiety and fatigue. The causes of this cognitive dysfunction may be directly related to stroke (damage to subcortical structures), as well as to a preexisting reduction in higher mental functions associated with age and vascular conditions. Cognitive impairments in patients with lesions of the right hemisphere were characterized by polymorphism and observed in the mental praxis, speech (with predominant semantic component) and abstract thinking domains. They are closely linked to each other and are more related to the lateralization of the lesion and preexisting neurodegeneration than to the localization of the ischemic lesion. The study of P300-evoked potentials is a good tool for confirming cognitive dysfunction. The latent period of the P300 wave is more sensitive to neurodegeneration, while the amplitude factor characterizes vascular pathology to a greater extent. The results of the study provide a rationale for a comprehensive assessment of lateralization, stroke localization, underlying diseases, neurophysiological parameters and identified cognitive impairments when developing a plan of rehabilitation and neuropsychological measures aimed at cognitive and emotional recovery of patients both in the acute phase of ischemic stroke and when selecting further personalized rehabilitation programs.
中风后残疾的主要因素是运动障碍和认知功能障碍。本研究的目的是确定急性中风患者左右半球损伤后早期认知功能障碍的差异，并给出其原因。该研究纳入了80例被诊断为缺血性中风的患者。对所有患者的认知状态、抑郁、疲劳和焦虑情况进行了评估。为了使评估更客观，采用了诱发电位（P300）方法和神经影像学检查。我们的研究结果揭示了认知功能障碍的显著特征，并确定了急性缺血性中风患者左右半球损伤最具信息价值的标志物组合。在左半球损伤的患者中，发现以调节障碍综合征为主（执行功能和注意力下降），同时伴有严重焦虑和疲劳等各种障碍。这种认知功能障碍的原因可能与中风直接相关（皮层下结构损伤），也与年龄和血管状况导致的先前存在的高级心理功能下降有关。右半球损伤患者的认知障碍具有多态性，见于心理实践、言语（主要是语义成分）和抽象思维领域。它们相互紧密关联，更多地与损伤的偏侧化和先前存在的神经退行性变有关，而非与缺血性病变的定位有关。对P300诱发电位的研究是确认认知功能障碍的良好工具。P300波的潜伏期对神经退行性变更敏感，而波幅因素在更大程度上表征血管病变。研究结果为在制定旨在缺血性中风急性期患者认知和情感恢复以及选择进一步个性化康复方案的康复和神经心理措施计划时，对偏侧化、中风定位、基础疾病、神经生理参数以及已确定的认知障碍进行综合评估提供了依据。
