Cognitive Functions in Acute Ischemic Stroke Period

Aim: to assess the dynamics of the state of cognitive functions in the acute period of ischemic stroke.

Design: prospective study.

Material and methods. The study included a group of observation of patients in the acute period of ischemic stroke in the amount of 26 people. The cognitive sphere was assessed twice: on admission to the hospital on days 2-3, and on discharge on days 8-10. Scales used to assess the cognitive sphere: Mini Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), The Clock-drawing Test (CDT). The emotional-volitional sphere was assessed using the Hospital Anxiety and Depression Scale (HADS). Data were considered statistically significant at p < 0.05.

Results. In a dynamic assessment, cognitive disorders in the observed group were most pronounced upon admission to the hospital. By discharge on days 8-10, according to the MMSE test, there was a positive trend, the increase was by 2b, MoCA by 2b, FAB by 1b, respectively, the results were significant (p < 0.001, p < 0.001, p = 0.001). In the analysis of subscales according to the MMSE test, improvements to the extract were according to word reproduction (p = 0.005), speech functions (p = 0.04). According to MoCA, the improvement in total scores was due to subscales: memory (p = 0.01), attention (p = 0.05), speech (p = 0.04), abstraction (p = 0.005). Changes in the FAB test were driven by the conceptualization function (p = 0.04) and the simple choice response (p = 0.008). Anxiety and depression were not detected in the studied patients.

Conclusion. During the acute period of ischemic stroke, the degree of cognitive impairment significantly decreases by 8-10 days against the background of ongoing treatment.

1. Antipenko E.A., Erokhina M.N., Fatkina D.A. Post-stroke cognitive and emotional impairment: therapeutic management options. Nervous Diseases. 2020;4:58–62. (in Russian). DOI: 10.24412/2226-0757-2020-12246

2. Zhao Q., Wang X., Wang T., Dmytriw A.A. et al. Cognitive rehabilitation interventions after stroke: protocol for a systematic review and metaanalysis of randomized controlled trials. Syst. Rev. 2021;10(1):66. DOI: 10.1186/s13643-021-01607-7

3. Klochihina О.А., Shprakh V.V., Stakhovskaya L.V., Polunina Е.А. Prevalence of recurrent stroke in different age groups. Siberian Medical Review. 2020;6(126):51–6. (in Russian). DOI: 10.20333/2500136- 2020-6-51-56

4. Emelin A.Yu., Lobzin V.Yu., Salimkhanova Yu.R. Сognitive impairment after stroke: features and sequences of development. Bulletin of the Russian Military Medical Academy. 2020;suppl.3(71):32–4. (in Russian). DOI: 10.32863/1682-7392-2020-3-71-32-34

5. Rost N.S., Brodtmann A., Pase M.P., van Veluw S.J. et al. Post-stroke cognitive impairment and dementia. Circ. Res. 2022;130(8):1252– 71. DOI: 10.1161/CIRCRESAHA.122.319951

6. Gaynor E., Rohde D., Large M., Mellon L. et al. Cognitive impairment, vulnerability, and mortality post ischemic stroke: A five-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Cohort. J. Stroke Cerebrovasc. Dis. 2018;27(9):2466–73. DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.002

7. Serebrova E.V. The influence of sleep apnoea syndrome on cognitive functions in patients with cerebral infarction. Siberian Medical Review. 2022;3:34–9. (in Russian). DOI: 10.20333/25000136-2022-3-34-39

8. Emelin A.Yu., Kolmakova K.A., Kashin A.V., Kostina E.V. Vascular dementia as variant of rapidly progressive dementia. Russian Military Medical Academy Reports. 2021;40(S4):32–6. (in Russian).

9. Parfenov V.A. Poststroke cognitive impairment. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):22–7. (in Russian). DOI: 10.14412/2074-2711-2019-4-22-27

10. Lobzin V.Yu, Kolmakova K.A, Emelin A.Yu., Yanishevskiy S.N. Arterial hypertension and Alzheimer’s disease. Prologue to neurodegeneration. Arterial Hypertension. 2019;25(2):122–33. (in Russian). DOI: 10.18705/1607-419X-2019-25-2-122-133

11. Ostapchuk Ye.S., Myakotnykh V.S., Borovkova T.A. The formation and dynamics of cognitive disordersin acute period of stroke in representatives different ages. Advances in Gerontology. 2017;30(6):893–900. (in Russian).

12. Barba R., Martínez-Espinosa S., Rodríguez-García E., Pondal M. et al. Poststroke dementia: clinical features and risk factors. Stroke. 2000;31(7):1494–501. DOI: 10.1161/01.str.31.7.1494 13. Verdelho A., Wardlaw J., Pavlovic A., Pantoni L. et al. Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee. Eur. Stroke J. 2021;6(1):5–17. DOI: 10.1177/23969873211000258

13. Drozdowska B.A., McGill K., McKay M., Bartlam R. et al. Prognostic rules for predicting cognitive syndromes following stroke: A systematic review. Eur. Stroke J. 2021;6(1):18–27. DOI: 10.1177/2396987321997045

14. Kuźma E., Lourida I., Moore S.F., Levine D.A. et al. Stroke and dementia risk: A systematic review and meta-analysis. Alzheimers Dement. 2018;14(11):1416–26. DOI: 10.1016/j.jalz.2018.06.3061

15. Kozelkin A.A., Kuznetsov A.A., Novikova L.V. Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke. Zaporozhye Medical Journal. 2014;4(85):56–9 (in Russian).

16. Prokopenko S.V., Mozheyko Ye.YU., Levin O.S., Koryagina T.D. et al. Cognitive disorders and its correction in the acute period of ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2012;112(8–2):35–9. (in Russian).