PECULIARITIES OF THE RELATIONSHIPS OF POSTINSULAR COGNITIVE DISORDERS WITH DISTURBANCES IN THE SYSTEM OF HEMOSTASIS, LIPID AND CARBOHYDRIC SPECTRUM OF THE BLOOD AND ARTERIAL HYPERTENSION

Abstract

Objective - study of the effects of disorders in the hemostasis system, blood lipid spectrum,carbohydrate metabolism and blood pressure on the clinical manifestations of theneuropsychological state in patients with post-stroke consequences, which remainedafter the transferred ischemic stroke.Materials and methods. In accordance with the purpose of the work, the data of clinicaland laboratory examination of 109 patients who underwent hemisphere ischemic strokewere analyzed. The study included 74 (67.9%) men and 35 (32.1%) women. The averageage of patients was 58.6 ± 4.9 years. Since the onset of acute ischemic stroke, 64 (58, 7%)had passed from 2 to 3 months, and the remaining 45 (41.3%) patients had up to four months. Arterial hypertension (in 14.7%), dyslipidemia (in 68, 8%) and theircombination (in 16.5%) of cases was the presumed causes of cerebral ischemic stroke.Comprehensive clinical, neuropsychiatric and laboratory studies using the MMSE,NIHSS scales, the Barthel scale and methods for determining the lipid and carbohydratespectrum of the blood, the state of homeostasis was carried out in the early recoveryperiod in patients who had hemispheric ischemic stroke. Statistical processing of theobtained results was carried out using the STATISTICA 6.0 program. The test wascarried out according to the criterion of Shapiro-Wilks. For comparison of qualitativefeatures and independent samples, the Pearson's criterion (x2) and Fisher's exact testwere used; in dependent samples, the Mac-Nemar criterion was used.Results. The analysis of the results of clinical studies and changes in the complex ofneuropsychic tests of cognitive disorders in patients with ischemic stroke in the earlyrecovery period made it possible not only to identify the special nature of cognitiveimpairments and their manifestations, but also to establish their dependence on thequantitative detection of such adverse factors as arterial hypertension, increased bloodviscosity, dyslipidemia and hyperglycemia. All of these risk factors were included in asingle cluster that combines the main causes of the formation and further course ofcognitive disorders. Conjugacy of disorders in the system of homeostasis, in the lipidspectrum of blood, carbohydrate metabolism and arterial hypertension with the severityof cognitive disorders diagnosed in the early recovery period was noted. It has beenestablished that the presence of one or two of the listed aggravating factors is associated with mild cognitive impairment, and more than two contribute to the appearanceof moderate neuropsychiatric disorders.Conclusions. 1. The recovery period in patients with ischemic stroke is characterized bythe presence of mild cognitive impairment in 36.7% of cases and moderate in 63.3% ofcases. 2. The development of cognitive disorders in the post-stroke period is due to thecompleteness of the cluster of risk factors, the basis of which is arterial hypertension,dyslipidemia, increased activity of the blood coagulation system and hyperglycemia. 3.In the formation and further manifestation of mild cognitive disorders, no more than twopathogenetic risk factors are simultaneously involved; in moderate cases, their numberincreases from 2 to 4. 4. A high correlation was found between the severity of cognitivedisorders and disorders in the hemostasis system, lipid and carbohydrate spectra ofblood and blood pressure.