Dynamics of cognitive functions in post-stroke patients under the influence of physical and pharmacological rehabilitation complex of the paretic arm

Gryb V.A.,Gerasymchuk V.R.,Uwa-Agbonikhena I.F.,Tkachuk N.P.,Doroshenko O.O.,Henyk S.I.

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Dynamics of cognitive functions in post-stroke patients under the influence of physical and pharmacological rehabilitation complex of the paretic arm

April 23, 2021

946

Neurology and Psychiatry

Therapy, General practice

Keywords :

cognitive evoked potentials,

cognitive impairment,

post-stroke period,

rehabilitation,

upper extremity function

Specialities :

Neurology and Psychiatry

Therapy, General practice

Resume

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.

References:

1. Pendlebury S.T., Rothwell P.M. (2019) Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol., 18(3): 248–258. DOI: 10.1016/S1474-4422(18)30442-3
2. Pendlebury S.T., Chen P.J., Bull L. et al. (2015) Methodological factors in determining rates of dementia in transient ischemic attack and stroke: (I) impact of baseline selection bias. Stroke, 46: 641–646. DOI: org/10.1161/STROKEAHA.114.008043
3. Kishimoto H., Ohara Т., Hata J. (2016) The longterm association between physical activity and risk of dementia in the community: the Hisayama Study. Eur. J. Epidemiol., 31(3): 267–274. DOI: 10.1007/ s10654-016-0125-y
4. Corbetta D., Imeri F., Gattic R. (2015) Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. J. Phisiother., 61(3): 117–124. DOI: 10.1016/j.jphys. 2015.05.017
5. Shi Y.X., Tian J.H., Yang K.H., Zhao Y. (2011) Modified Constraint-Induced Movement Therapy Versus Traditional Rehabilitation in Patients With Upper-Extremity Dysfunction After Stroke: A Systemic Review and Meta-Analysis. Arch. Phys. Med. Rehab., 92(6): 972–982. DOI: 10.1016/j.apmr.2010.12. 036
6. Tan S., Hong C.T., Chen J.-H., Chan L. (2020) Hand Fine Motor Skill Disability Correlates with Cognition in Patients with Moderate-to-Advanced Parkinson’s Disease. Brain Sci., 10(6): 337. DOI:10.3390/brainsci10060337
7. Baker L.D., Frank L.L., Foster-Schubert K. et al. (2010) Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch. Neurol., 67(1): 71–79. DOI: 10.1001/archneurol.2009.307
8. Blondell S.J., Hammersley-Mather R., Veerman J.L. (2014) Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies. BMC Public Health, 14(1): 510 р.
9. Morgan G.S., Gallacher J., Bayer A. et al. (2012) Physical activity in middle-age and dementia in later life: findings from a prospective cohort of men in caerphilly, South Wales and a meta-analysis. J. Alzheimer’s Dis., 31(3): 569–580. DOI: 10.3233/JAD-2012-112171
10. Guire C.B., Ibrahim N.A., Adam M.B., Said S.M. (2017) Impact of physical activity on cognitive decline, dementia and its subtypes: meta-analysis of prospective studies. Biomed. Res. Int. DOI: 10.1155/2017/9016924
11. Vasilyeva N.Yu., Zharinov O.J., Stolyarov G.S. et al. (2013) Usage of the cerebral evoked potentials for study of the cognitive functions. UMJ, 4(96): 171–175. (In Rus.).
12. Fugl-Meyer A.R., Jääskö L., Leyman I. et al. (1975) The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand. J. Rehabil. Med., 7(1): 13–31.
13. Duncan C.C., Barry R.J., Connolly J.F., Fischer C. (2009) Event-related potentials in clinical research: Guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400. Clin. Neurophisiol., 120(11): 1883–1908. DOI: 10.1016/j.clinph.2009.07.045
14. Dejanovic M., Ivetic V., Nestorovic V., Eric M. (2015) The role of P300 event-related potentials in the cognitive recovery after the stroke. Acta Neurol. Belg., 115: 589–595. DOI: 10.1007/s13760-015-0428-x
15. Faraci F.M. (2011) Protecting against vascular disease in brain. Am. J. Physiol. Heart. Circ. Physiol., 300(5): 1566–1582. DOI: 10.1152/ ajpheart.01310.2010
16. Clouston S.A.P., Brewster P., Kuh D. et al. (2013) The dynamic relationship between physical function and cognition in longitudinal aging cohorts. Epidemiol. Rev., 35: 33–50. DOI: 10.1093/epirev/mxs004
17. Hordacre B., Austin D., Brown K.E. et al. (2021) Evidence for a Window of Enhanced Plasticity in the Human Motor Cortex Following Ischemic Stroke. Neurorehabil. Neural. Repair., 10(6): 337. DOI: 10.3390/brainsci10060337