Cognitive impairment in the acute period of cardioembolic stroke

Background. Acute disorders of cerebral circulation are one of the most urgent problems of modern clinical neurology. Its significance is due to both the high frequency of occurrence and a large number of unsatisfactory outcomes, as well as the significant impact on the quality of life. Cognitive disorders are one of the main syndromes that manifest in post-stroke period and are associated with the rehabilitation potential, as well as opportunities for social and household adaptation. Our objective was to study the profile of cognitive impairment in a continuous sample of patients with cardioembolic stroke in the acute period of stroke, as well as to determine the correlations between their occurrence and the factors determining the course of the disease. Design and methods. The study involved 46 patients of both sexes in the acute stage of ischemic stroke (average age was 69 ± 11 years). The selection of patients was carried out in accordance with the diagnostic criteria of the International Association of Vascular Behavioral and Cognitive Disorders VASCOG. The results of the Hachinski scale were also considered. All patients underwent interview for history, complaints, as well as the assessment of the neurological status. Risk factors for stroke were evaluated. We also assessed the results of computer and magnetic resonance imaging, standard “stroke” scales and performed a neuropsychological examination aimed at a comprehensive study of cognitive functions. All studies were conducted at the end of 10-14 days from the development of focal neurological symptoms. Results. Cognitive disorders in patients with cardioembolic ischemic stroke turned out to be quite heterogeneous. Their severity in the majority of our patients was considered as mild cognitive impairment. Changes at dementia level were much less common and were characteristic of patients with extensive lesions or in the case of disorders in the field of cognitively significant “strategic” foci. Neurodynamic disorders predominated in the profile of disorders of higher cortical functions. Memory impairment was expressed slightly and was of a secondary nature. With the aggravation of cognitive disorders, mnestic disorders progressed. In addition, regulatory disorders began to be detected. The most significant correlations were found between the results of neurocognitive tests on the one hand and the assessment on the Bartel scales, the assessment of changes in white matter, as well as the volume of the necrosis focus, the presence of heart failure and dyscirculatory encephalopathy in the anamnesis. Conclusions. Cognitive impairment is a significant component of the clinical picture of cardioembolic stroke. Their severity is largely determined by the volume and topical localization of the ischemic focus, as well as the presence and severity of previous chronic cerebrovascular pathology. This determines the need to develop methods to assess the state of cognitive functions before the development of stroke.

1. Brainin M, Feigin VL, Norrving B, Martins SCO, Hankey GJ, Hachinski V. Declaration on the Global Primary Prevention of Stroke and Dementia of the World Stroke Organization. Annals Clin Experiment Neurol. 2020;14(3):5-10. doi:10.25692/ACEN.2020.3.1. In Russian.

2. Gusev EI, Martynov MY, Kamchatnov PR, Yasamanova AN, Shchukin IA, Kolesnikova TI. Cerebral stroke. Consilium Medicum. 2014;16(12):13-17. In Russian.

3. Fedin AI, Badalyan KR. Review of clinical recommendations for the treatment and prevention of ischemic stroke. Zhurnal Nevrologii i Psikhiatrii Imeni S. S. Korsakova. 2019;119(8/2):95-100. doi:10.17116/jnevro201911908295. In Russian.

4. Zakharov VV. Cognitive impairment after stroke: medical and social significance and approaches to therapy. Nervous Diseases. 2015;2:2-9. In Russian.

5. Barbay M, Taillia H, Nedelec-Ciceri C, Bompaire F, Bonnin C, Varvat J et al. Prevalence of poststroke neurocognitive disorders using national institute of neurological disorders and stroke — Canadian stroke Network, VASCOG Criteria (Vascular Behavioral and Cognitive Disorders), and optimized criteria of cognitive deficit. Stroke. 2018;49(5):1141-1147. doi:10.1161/STROKEAHA.117.018889

6. Makin SD, Turpin S, Dennis MS, Wardlaw JM. Cognitive impairment after lacunar stroke: systematic review and metaanalysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry. 2013;84(8):893-900. doi:10.1136/jnnp-2012-303645

7. Moliis H, Jokinen H, Parkkonen E, Kaste M, Erkinjuntti T, Melkas S. Post-stroke cognitive impairment is frequent after infratentorial enfarct. J Stroke Cerebrovasc Dis. 2021;30(12):106108. doi:10.1016/j.jstrokecerebrovasdis.2021.106108

8. Sachdev P, Kalaria R, O'Brien J, Skoog I, Alladi S, Black SE et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28(3):206-218. doi:10.1097/WAD.0000000000000034

9. Triumfov AV. Topical diagnostics of diseases of the nervous system. Moscow: TOO Tekhlit, 1996. 248 p. In Russian.

10. Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology. 1993;43(9):1683-1689.

11. Yahno NN, Zaharov VV, Lokshina AB, Koberskaya NN, Mhitaryan EA. Dementia. Moscow: MEDpress-inform, 2011. 272 p. In Russian.

12. Petersen RC, Touchon J. Consensus on mild cognitive impairment. Research and practice in AD. EADS-ADCS Joint Meeting. 2005;10:24-32.

13. International statistical classification of diseases and health-related problems. Tenth revision (ICD-10). Geneva: WHO. 1995;1(1):698. In Russian.

14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-V). Arlington: American Psychiatric Association. 2013. 947 p.

15. Reisberg B, Ferris SH, de Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139(9):1136-1139.

16. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH et al. Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology. 1993;43(2):250-260. doi:10.1212/wnl.43.2.250

17. Emelin AYu, Lobzin VYu Modified criteria for the diagnosis of vascular cognitive disorders. Vestnik Rossijskoj Voenno-medicinskoj Akademii = Bulletin of the Russian Military Medical Academy. 2020; S 3:25-28. doi:10.32863/1682-7392-2020-3-71-25-28. In Russian.

18. Kulesh AA, Shestakov VV. Vascular non-dement cognitive disorders: diagnosis, prognosis, treatment and prevention. Nevrologia, Nejropsihiatria, Psihosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3):68-75. doi:10.14412/2074-2711-2017-3-68-75. In Russian.

19. Emelin AYu, Lobzin VYu, Vorob'ev SV. Cognitive disorders: a guide for doctors. Moscow: T8 Izdatel'skie Tekhnologii, 2019. 416 s. In Russian.

20. Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta. 2016;1862(5):915-25. doi:10.1016/j.bbadis.2016.01.015

21. Rendon J, Zuluaga Y, Velilla L, Ochoa J, Arboleda-Velasquez JF, Budson A et al. Event-related potential correlates of recognition memory in asymptomatic individuals with CADASIL. Brain Res. 2019;1707:74-78. doi:10.1016/j.brainres.2018.11.016