Kotelnikova A V, Kukshina A A, Turova E A
S.I. Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2024;101(6):5-11. doi: 10.17116/kurort20241010615.
Post-stroke cognitive impairments are widespread and significantly reduce the quality of life and rehabilitation prognosis of patients. Clinical observations show a serious variability of cognitive impairments in patients after acute cerebrovascular accident. Thus, the classification of above mentioned disorders, based on which it would be possible to determine the order of individualization of a cognitive rehabilitation program, is currently not available in literature.
To scientifically establish the differentiated approach to cognitive rehabilitation by verification of patients groups, differing in the structure of post-stroke complications.
Cognitive status of 45 patients in the early rehabilitation period after ischemic stroke (26 (57.8%) women, 19 (42.2%) men aged 63.0±8.0 years), who underwent inpatient treatment stage of medical rehabilitation was studied by means of «Short neuropsychological examination of cognitive sphere (SNECS)» methodology. Indicators of neurodynamics according to the domains of the International Classification of Functioning, Disability and Health were considered as well.
The conducted neuropsychological study revealed 4 groups of patients, 3 of which had a significant cognitive functions' deficiency, manifested in the 1st group by reduced indicators of psychomotor control level (neurodynamic impairments, asthenia, exhaustion), executive functions, ability to analytical-synthetic activity, attention and working memory; in the 2nd group - by reduced ability to perform graphical test tasks on constructional praxis and reproduction of sequences' set; in the 4th group - by reduced indicators of «unfinished images» test task performance, reflecting state of visual object gnosis. Cognitive functions' state in the persons of the 3rd group was assessed as satisfactory.
The present study provides an attempt to classify cognitive disorders in patients who underwent stroke aimed at the formation of differentiated cognitive rehabilitation programs. As a result, 4 groups of patients, differing in the structure of post-stroke complications, were verified, and the directions of rehabilitation work for each of them were indicated in the cognitive functions investigation using «SNECS» methodology.
中风后认知障碍很普遍，显著降低了患者的生活质量和康复预后。临床观察表明，急性脑血管意外后患者的认知障碍存在严重变异性。因此，目前文献中尚无基于此来确定认知康复计划个体化顺序的上述障碍分类方法。
通过对中风后并发症结构不同的患者群体进行验证，科学地确立认知康复的差异化方法。
采用“认知领域简短神经心理学检查（SNECS）”方法，对45例缺血性中风后早期康复期患者（26例（57.8%）女性，19例（42.2%）男性，年龄63.0±8.0岁）进行研究，这些患者均接受了医疗康复的住院治疗阶段。同时还考虑了根据《国际功能、残疾和健康分类》领域划分的神经动力学指标。
进行的神经心理学研究揭示了4组患者，其中3组存在明显的认知功能缺陷，第1组表现为心理运动控制水平指标降低（神经动力学障碍、无力、疲惫）、执行功能、分析综合活动能力、注意力和工作记忆；第2组表现为在构建实践和序列再现方面执行图形测试任务的能力降低；第4组表现为“未完成图像”测试任务表现指标降低，反映视觉物体识别状态。第3组患者的认知功能状态评估为满意。
本研究试图对中风患者的认知障碍进行分类，以形成差异化的认知康复计划。结果验证了4组中风后并发症结构不同的患者，并使用“SNECS”方法在认知功能调查中指出了每组患者的康复工作方向。
