COMORBIDITY NEUROLOGY
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
ABSTRACT
INTRODUTION. The widespread and insufficiently studied structure of post-stroke cognitive impairment makes it urgent to conduct studies with the use of extensive neuropsychological testing and monitoring of post-stroke cognitive impairment at different time periods from the development of ischemic stroke, which will make it possible to assess the degree of progression and phenotype of cognitive deficit in stroke patients.
AIM. To assess the structure of cognitive deficit in patients in the acute and early recovery periods of ischemic stroke and the degree of post-stroke cognitive impairment progression in 6 months since the development of cerebrovascular disease.
MATERIALS AND METHODS. 192 patients who underwent an ischemic stroke in period from 2020 to 2023 were examined. Neuropsychological testing was performed on the 14th day (baseline) and in 6 months (endpoint) after ischemic stroke development using tests to evaluate the general status and severity of impairments in perception functions, memory, attention, cognitive flexibility, speech and constructive praxis.
RESULTS AND DISCUSSION. A positive trend was found for cognitive flexibility by reducing patients with severe impairment (by 16.7%) and increasing the overall score at the study endpoint. A negative dynamics was demonstrated for the perception functions and attention by reducing the amount of patients with normal initial scores (by 10% and 14% respectively) and neuropsychological testing scores after 6 months. For episodic memory, an increase in the number of patients with severe impairments was found (by 15.7%). During assessing changes in speech dysfunction, an increase in the total index and the number of patients with mild disorders (by 10.1%) was revealed against the background of a decrease in the percentage of patients with severe disorders, which indicates positive dynamics. Correlation analysis at baseline revealed the most significant relationship of the cognitive flexibility score with the functions of memory (r = 0.480), perception (r = 0.440), and constructive praxis (r = 0.370). The endpoint results revealed correlations of the cognitive flexibility score with attention (r = 0, 320), perception, and memory (r = 0, 310); perceptual function with memory (r = 0, 360) and attention (r = 0, 350).
CONCLUSION. The obtained data allow us to evaluate the main trends in the development and course of post-stroke cognitive impairment, as well as to determine the role of individual cognitive impairment in the formation of the phenotype of cognitive disorder at different time periods after ischemic stroke.
KEYWORDS: cognitive impairment, ischemic stroke, cognitive functions
For citation: Tynterova A.M., Shusharina N.N., Khoimov M.S. Dynamics of Cognitive Impairment in the Recovery Period of Ischemic Stroke. Comorbidity Neurology. 2025; 2 (2): 6-12. https://doi.org/10.62505/3034-185x-2025-2-2-6-12
*For correspondence: Anastasia M. Tynterova, Ph.D. Sci. (Med.), Senior Researcher of Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, Kaliningrad, Russia, e-mail: antynterova@mail.ru
REFERENCES
1.El Husseini N., Katzan I.L., Rost N.S., Blake M.L., Byun E., Pendlebury S.T., Aparicio H.J., Marquine M.J., Gottesman R.F., Smith E.E. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Hypertension; and Council on Lifestyle and Cardiometabolic Health. Cognitive Impairment After Ischemic and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2023 Jun; 54 (6): e272-e291. https://doi.org/10.1161/STR.0000000000000430
2.Parfenov V.A. Poststroke cognitive impairment. Neurology, Neuropsychiatry, Psychosomatics. 2019; 11 (4): 22-27. https://doi.org/10.14412/2074-2711-2019-4-22-27 (In Russ.)
3.Rost N.S., Brodtmann A., Pase M.P., van Veluw S.J., Biffi A., Duering M., Hinman J.D., Dichgans M. Post-Stroke Cognitive Impairment and Dementia. Circ Res. 2022 Apr 15; 130 (8): 1252-1271. https://doi.org/10.1161/CIRCRESAHA.122.319951
4.Barbay M., Diouf M., Roussel M., Godefroy O. GRECOGVASC study group. Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies. Dement Geriatr Cogn Disord. 2018; 46 (5-6): 322-334. https://doi.org/10.1159/000492920
5. Levin O.S., Bogolepova A.N. Poststroke motor and cognitive impairments: clinical features and current approaches to rehabilitation. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2020; 120 (11): 99-107. https://doi.org/10.17116/jnevro202012011199 (In Russ.)
6.Pendlebury S.T., Rothwell P.M. Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019 Mar; 18 (3): 248-258. https://doi.org/10.1016/S1474-4422(18)30442-3
7.Cherdak M.A. Mixed dementia in stroke patient. Russian Journal of Geriatric Medicine. 2020; (3): 236-242. https://doi.org/10.37586/2686-8636-3-2020-236-242 (In Russ.)
8. Kotelnikova A.V., Pogonchenkova I.V., Kostenko E.V., Petrova L.V., Khaustova A.V. Psychometric Approbation of Screening Methods for the Diagnosis of Cognitive Status in a Sample of Ischemic Stroke Patients: an Observational Cohort Study. Bulletin of Rehabilitation Medicine. 2023; 22 (2): 32-41. https://doi.org/10.38025/2078-1962-2023-22-2-32-41 (In Russ.)
9. Kovalenko E.A., Bogolepova A.N., Katunin D.A. The role of pre-stroke cognitive disorders in the formation of post-stroke cognitive impairment. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2017; 117 (12-2): 19-24. https://doi.org/10.17116/jnevro201711712219-24 (In Russ.)
10. Skidmore E.R., Eskes G., Brodtmann A. Executive Function Poststroke: Concepts, Recovery, and Interventions. Stroke. 2023 Jan; 54 (1): 20-29. https://doi.org/10.1161/STROKEAHA.122.037946
11.Teissier T., Boulanger E., Deramecourt V. Normal ageing of the brain: Histological and biological aspects. Rev Neurol (Paris). 2020 Nov; 176 (9): 649-660. https:// doi.org/ 10.1016/j.neurol.2020.03.017
12.Dobrynina L.A., Gadzhieva Z.S., Kremneva E.I., Shamtieva K.V., Tsypushtanova M.M., Makarova A.G., Trubitsyna V.V Bitsieva E.T., Filatov A.S., Byrochkina A.A., Krotenkova M.V. Survival, cognitive functions, and brain MRI in patients with cSVD: 5-year observation . Annals of Clinical and Experimental Neurology. 2022; 16 (4): 18-28 https://doi.org/ 10.54101/ACEN.2022.4.3 (In Russ.)
13.Kim K.A., Lee J.S., Chang W.H., Kim D.Y., Shin Y.I., Kim S.Y., Kim Y.T., Kang S.H., Choi J.Y., Kim Y.H. Changes in Language Function and Recovery-Related Prognostic Factors in First-Ever Left Hemispheric Ischemic Stroke. Ann Rehabil Med. 2019 Dec; 43 (6): 625-634. https:// doi.org/ 10.5535/arm.2019.43.6.625
ADDITIONAL INFORMATION
Anastasya M. Tynterova, Ph.D. Sci. (Med.), Senior Researcher, Baltic Center for Artificial Intelligence and Neurotechnology, Immanuel Kant Baltic Federal University, Kaliningrad, Russia. E-mail: antynterova@mail.ru. ORCID: https://orcid.org/0000-0003-1743-4713
Natalia N. Shusharina, Ph.D. Sci. (Pedag.), Head of Development and Innovation Department, senior Researcher. Baltic Center for Artificial Intelligence and Neurotechnology, Immanuel Kant Baltic Federal University, Kaliningrad, Russia. E-mail: nnshusharina@gmail.com. ORCID: https://orcid.org/0000-0002-8848-6134
Matvei S. Khoimov, Junior Researcher of Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University. E-mail: matthewkhoimov@gmail.com; ORCID: 0000-0001-8056-2019
Author contributions. All authors confirm that their authorship complies with the international ICMJE criteria (all authors made a significant contribution to the development of the concept, the conduct of the study and the preparation of the article, read and approved the final version before publication). Special contributions: Tynterova A.M. – conceptualization, methodology, investigation, data curation, writing – original draft, visualization, supervision; Shusharina N.N. – resources, writing – review & editing, project administration, funding acquisition; Khoimov M.S. – validation, formal analysis, software.
Funding. This work was performed within the scope of the of the “Priority 2030” program and State assignment FZWM-2024-0013 (Immanuel Kant Baltic Federal University).
Disclosure. The authors declare no apparent or potential conflicts of interest related to the publication of this article.
Ethics Approval. The study was approved by the Independent Ethics Committee of the Independent Ethics Committee of the Center for Clinical Research of Immanuel Kant Baltic Federal University (Kaliningrad, Russia) (protocol № 2 of April 27, 2021, protocol № 46 of March 04, 2024).
Informed consent for publication. All patients, and if it is impossible to review and sign, persons responsible for the patients (relatives, social workers, etc.) on behalf of the patients undergoing examination and participating in this study, signed informed consent.
The content is available under the Creative Commons Attribution 4.0 License.
©2025. Anastasya M. Tynterova, Natalia N. Shusharina, Matvei S. Khoimov