Особливості когнітивного статусу у пацієнтів з транзиторними ішемічними атаками та малими інсультами

Abstract

Робота присвячена вивченню характеристик когнітивного статусу, а також його динаміки у пацієнтів з транзиторними ішемічними атаками (ТІА) і малими інсультами протягом тримісячного періоду після розвитку захворювання. Розповсюдженість когнітивних розладів, в залежності від нейропсихологічних шкал, у пацієнтів з ТІА складала від 23,7% до 36,8%, а у пацієнтів з малими інсультами — від 41,1% до 65,5%. У 63,6% пацієнтів з когнітивними порушеннями за шкалою МоСА на момент госпіталізації, протягом наступних трьох місяців спостерігалося когнітивне покращення. Предикторами відсутності когнітивного покращення при ТІА та малому інсульті були ступінь вираженості лейкоареозу за шкалою Fazekas та наявність гіперінтенсивного вогнища на дифузно-зважених МРТ зображеннях; Работа посвящена изучению характеристик когнитивного статуса и его динамики у пациен- тов с транзиторными ишемическими атаками (ТИА) и малыми инсультами на протяжении трехмесячного периода после развития заболевания. Распространенность когнитивных расстройств, в зависимости от использованных нейропсихологических шкал, у пациентов с ТИА составляла от 23,7% до 36,8%, а у пациентов с малыми инсультами — от 41,1% до 65,5%. У 63,6% пациентов с когнитивными нарушениями по шкале МоСА при госпитализации, на протяжении следующих трех месяцев наблюдалось когнитивное улучшение. Предикторами отсутствия когнитивного улучшения при ТИА и малом инсульте были степень выраженности лейкоареоза по шкале Fazekas и наличие гиперинтенсивного очага на диффузно-взвешенных МРТ изображениях; Cognitive impairments after stroke are common and predict dependency, institutionalization, and early mortality. Approximately 10% of patients with first-ever stroke develop new dementia and at least 30% have dementia after recurrent stroke. Up to now the cognitive profile after transient ischemic attack (TIA) as well as after minor stroke is unknown and cognitive assessment is not part of the routine work-up. Aim – to determine the cognitive characteristics of patients within first 3 months after a TIA or minor stroke. Methods. We enrolled in the study patients with TIA or minor stroke (NIHSS score at hospitalization not more than 3 points). Exclusion criteria were previous acute cerebrovascular events, alcohol abuse, severe somatic pathologies, pre-stroke cognitive impairments, intake of drugs with cognitive decline side-effects, anxious and depressive signs (according to Hospital Anxiety and Depression Scale). It had been investigated 67 patients: 38 with TIA and 29 with minor strokes. Neuropsychological testing had been performed by using of MMSE and MoCA scales consequently in definite time points: during first day after hospitalization, at 5th day, at time of hospital discharge, in 1 month and 3 months after diseases onset. Results. The rates of cognitive impairments in patients with TIA were 23,7% (according to MMSE scale) and 36,8% (according to MoCA scale). Whereas in patients with minor strokes the same values were 41,4% and 65,5%, respectively. Compared to the prevalence of cognitive impairment in the general population post-TIA and minor strokes cognitive impairment is considerably more prevalent. MoCA scale, in comparison with MMSE scale, is more sensitive for diagnostics of cognitive dysfunctions in patients with TIA and minor stroke. Univariate logistic regession analysis showed that patients with minor strokes, in comparison with TIA, had more common cognitive impairments at time of hospitalization, according to MoCA scale (odds ratio (OR), 3,26; 95% confidence interval (CI), 1,19-8,95; p=0,02). In addition, it has been demonstrated that the Fazekas scale score increment of 1 point was significantly associated with higher risk of cognitive impairments at time of hospital admission (OR, 1,59; СІ, 1,05-2,40; p=0,03). During the three-months observation period in 21 patients out of 33 (63,6%) who had cognitive impairments at the time of admission by MoCA scale, we observed cognitive improvement. The cognitive improvement was in 11 (73,3%) patients with TIA and in 10 (55,6%) patients with minor strokes. Interestingly, the likelihood of cognitive improvement significantly reduced depending on the timing after acute cerebrovascular event onset. Univariate logistic regression analysis showed that presence of hyperintensive lesions on diffuse weighted magnetic resonance imaging was significantly associated with decreased probability of cognitive improvement during first 3 months after TIA and minor stroke (OR, 5,00; СІ, 1,08-23,06; p=0,04). In a similar way, it has been demonstrated that white matter lesion severity (the Fazekas scale score increment of 1 point) was significantly associated with lower probability of cognitive improvement (OR, 2,39; СІ, 1,04-5,47; p=0,04). Conclusions 1. All patients with TIA and minor strokes should be evaluated by neuropsychological scales as soon as possible at hospital stay. 2. MoCA scale is more sensitive than MMSE scale for cognitive status evaluations in patients with TIA and minor strokes. 3. For planning the rehabilitation of patients with TIA and minor strokes neurologist should take into account some neuroimaging features (presence of hyperintense lesion on diffuse weighted magnetic resonance imaging and severity of leukoaraiosis according to Fazekas scale) that can affect the cognitive recovery