Uwa-Agbonikhena I. Features of cognitive functions of patients with impaired hand motility after ischemic stroke and their correction

The dissertation work, based on complex clinico-neurological and neurophysiological research, studied the interdependence of motor function, including fine motor skills and cognitive functions. It was detected for the first time, that in right-handed patients during the period of the consequences of ischemic stroke in the left hemisphere, functional motor ability suffers to a greater extent than in right-hemispheric stroke. This applies to such domains of functional independence as "self-care" and "social cognition"; there is a probable slowdown in the speed of movement of the paretic arm in left-hemispheric stroke in contrast to right-hemispheric stroke. It was first determined that paretic arm dysfunction has a significant impact on the quality of life of patients after ischemic stroke, which is explained by the main role of dexterity in self-care and functional independence of patients. It was determined that in the period of residual effects after ischemic stroke, persons with moderate cognitive impairments dominated, and disorders primarily developed in the domains of executive functions and much less in the domain of "memory". For the first time, the frequency of cognitive impairments was established in the period of consequences of ischemic stroke, which depended on which screening scales were used: 90.5% - for evaluation by MMSE, 85.3% - for FAB, 94.8% - for MoCA. For the first time, a probable decrease in the speed of movement of the paretic arm was detected in right-handed patients with left-hemispheric stroke in contrast to right-hemispheric stroke according to the chain drawing tests; this allows their use for the diagnosis of early manifestations of cognitive impairments. Scientific data have been clarified, that impaired motility of the upper extremity, especially the hand, has a negative effect on the cognitive status of patients with the effects of ischemic stroke, in particular on executive functions. The role of cognitive auditory evoked potential P300 in the diagnosis of cognitive impairment after ischemic stroke with interhemispheric asymmetry in the posterotemporal and anterior-frontal areas was confirmed for the first time. The decision-making and memorization process in patients was significantly slowed down. For the first time, an increase in cognitive dysfunction was detected as a result of cognitive auditory evoked potential P300 depending on the degree of failure of the distal and proximal part of the upper limb. A detailed study of cognitive status using chain drawing tests, as well as the study of P300 in patients after ischemic stroke, may be recommended for early detection of initial cognitive impairment, when conventional screening scales are not sensitive enough. Patients in whom the functional capacity of the hand has not been restored in the early recovery period after ischemic stroke should undergo complexes of physical and drug therapy in the late long term. Adding exercises to improve hand function to the complex of therapeutic exercise for patients after right-hemispheric stroke promotes better overall performance. With left-hemispheric stroke, it is recommended to add exercises for the hands and choline alfoscerate 400 mg 2 t / d for 2 months to the complex of exercises for general activity. Key words: ischemic stroke; cognitive impairment; hand motility disorders; quality of life; cognitive evoked potentials; rehabilitation. Branch – medicine.