During the work, a comprehensive clinical and laboratory examination and neuropsychological testing were carried out in 109 patients between the ages of 45 and 65 years, with a history of cerebral infarction and one or another neurological deficit, including neuropsychological disorders, which reduced physical and social capabilities. For a comprehensive assessment of the quality of life, the SF-36 questionnaire generally recognized as valid was used.
Neuropsychological testing of patients with cerebral infarction during the recovery period revealed disorders of the psychoemotional status with a predominance of changes in the main domains of cognitive functions: spontaneous activity, memory impairment and control over task performance, temporal and spatial orientation, mental activity, emotional lability. Mild cognitive disorders were diagnosed in 42.2% of patients; dementia - in 57.8% of the subjects.
It was found that the development of cognitive disorders in the recovery period of cerebral infarction is due to the completeness of the cluster of risk factors, which are based on arterial hypertension, dyslipidemia, increased activity of the blood coagulation system and hyperglycemia. No more than two pathogenetic risk factors are simultaneously involved in the formation and further manifestation of mild cognitive disorders; at moderate levels, their number increases from 3 to 4, which gives grounds to assert the presence of a high combination of the severity of cognitive disorders with disorders in the hemostasis system, lipid and carbohydrate spectra of blood and blood pressure.
It has been proven that in patients with uncorrected risk factors, such as AH, altered hemostasis indices, hypercholesterolemia and hyperglycemia, there are more severe hemodynamic changes in the form of a decrease in the blood circulation rate, its asymmetry, and an increase in resistance indices.
A correlation was established between the degree of cognitive impairment and hemodynamics (with a resistive index r = + 0.79). Mild neuropsychological disorders on the MMSE, are combined with less LBFV impairments.
The possibility of increasing the effectiveness of complex medical rehabilitation of patients with ischemic cerebral disorders due to an individual approach to the choice of uncorrected risk factors correction was established. With the use of the proposed, on this basis, a treatment and rehabilitation complex, a faster and more stable regression of neurological, cognitive and emotional disorders was noted.
The data obtained in the course of the research indicate that the use of instrumental, laboratory, neuropsychological tests makes it possible to track the effectiveness of the application of the rehabilitation strategy in dynamics, not to resort to other treatment, which is essential in assessing the effectiveness of rehabilitation measures in patients with the consequences of myocardial infarction. that Bartela.
The effectiveness of the use in medical practice of indicators of the state of homeostasis, lipid and carbohydrate metabolism, blood pressure for the prediction of the recovery process and the development of rational tactics of managing patients, including medication, with the consequences of cerebral infarction (ischemic stroke)
The high efficiency of using the assessment of the quality of life in patients in the recovery period of cerebral infarction has been proven, since the decrease in indicators is due to disorders in the psychoemotional and social spheres, which arose against the background of changes in physical functioning, somatic pain and deterioration in general health. The use of the technique allows monitoring the effectiveness of the applied individualized rehabilitation, including medication, according to the data of changes in the dynamics of psychological emotional health.
The use of the proposed concept of medical rehabilitation in patients with the consequences of cerebral infarction makes it possible to achieve a reduction of neurological, cognitive, emotional disorders in the recovery period in patients with a more severe primary condition to the level of patients with milder manifestations of myocardial infarction, which has not only a positive effect on the patient's quality of life with the consequences of myocardial infarction, but also ensures a decrease in the degree of disability in the future, due to the targeted correction of the main risk factors for the development of cerebral infarction and a decrease in the negative impact of cognitive disorders and depression on the recovery period of rehabilitation.
