Dynamics of cognitive functions in post-stroke patients under the influence of physical and pharmacological rehabilitation complex of the paretic arm
Summary. The aim was to determine the efficacy of complex physical and pharmacological rehabilitation of the paretic arm in recovery of cognitive functions in patients after ischemic stroke with the use of cognitive evoked potentials parameters (CEP) monitoring. Object and methods. 66 patients (63.6% males, the mean age 63 (54–72) years) in the period of 12–24 months after ischemic stroke were examined. Depending on the therapeutic tactics, patients were randomized into 3 groups: patients of group 1 (n=21) performed the exercise complex for general muscle function improvement, group 2 (n=21) also performed the exercise complex for paretic hand function improvement, group 3 (n=24) were additionally prescribed choline alfoscerate 400 mg twice a day. The control group consisted of 20 apparently healthy individuals of the appropriate age. The treatment lasted 2 months. The CEP P300 was investigated. Patients were examined before and after 2 months of treatment. Statistical analysis of the results was used. Results. The latent period of the CEP P300 was 1.3 times prolonged compared to the apparently healthy individuals (p<0.001), and the P300 wave amplitude was decreased by 1.7 times (p<0.001). In the period of 19–24 months after stroke, the P300 amplitude significantly differed from the indices of patients in the period of 2–18 months (p=0.008). The correlation between cognitive functions according to P300 data, hand function (ARAT scale) and the entire upper extremity function (Fugl-Meyer scale) was observed (r=0.77; p<0.001 and r=0.32; p=0.029, respectively). After 2 months of treatment, patients in group 3 showed a statistically significant difference between latent period (444 [415; 469] vs. 474 [440; 500] in apparently healthy individuals, p=0.022) and amplitude P300 [6 [5; 6] vs. 5 [4; 6], p=0.024). In group 2, a significant increase in the amplitude of P300 was observed (p=0.050), and latent period tended to decrease (p=0.471 vs. p=0.780). Conclusions. Cognitive impairment according to the CEP P300 data is observed patients with arm paresis in the period of 12–24 months after stroke. The ARAT scale is a more effective tool than the Fugl-Meyer scale, which assesses arm function in general, in determination of the cognitive function of patients with arm paresis in the post-stroke period. Patients who have not recovered the arm functional ability within the first months after stroke should receive physical and pharmacological therapy in the residual stroke period.
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