Method of predicting clinical course of cognitive impairment in patients with ischemic stroke

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology. Risk factors are determined from history of life: family history of cardio-vascular disease, hypertension disease and in case of its presence regularity of anti-hypertensive therapy intake, marital status, age, education, psychoemotional stress, sex, also taken into account is expression of detected during first examination cognitive impairment and results of its treatment. Their gradations and numerical values are determined, prognostic coefficients F1, F2 are calculated by mathematical formulas with further comparison of their values. If F1 is higher than F2 favourable type of cognitive impairment course in patients with ischemic stroke is predicted, and if F2 is higher than F1 - unfavourable type of cognitive impairment course.

EFFECT: method ensures possibility of estimation of clinical course of cognitive impairment, thus allowing to increase efficiency and purposefulness of preventive and medicinal measures in groups of patients with risk of developing unfavourable course of cognitive impairment.

2 ex

 

The present invention relates to medicine, namely to neurology.

It is known that cognitive impairment after ischemic stroke are an important factor in the morbidity of patients.

A known method for predicting the development of cognitive impairment within the first 3 months of the disease, in which risk factors include data neuroimaging (MRI) and the results of neuropsychological testing, which establish the severity of cognitive disorders. The lower the severity of cognitive deficits, the more favorable the prognosis for recovery of cognitive functions [vakhnin in capacity, NV, Nikitina LU, Parfenov, VA and other post-stroke cognitive impairment // Journal of neurology and psychiatry. Korsakov, Application, Stroke, VIP, 2008. P.16-21.]

The disadvantages of this method include the inability to predict the development and course of cognitive impairment in late recovery period.

The closest in technical essence to the present invention is a method for predicting the course of cognitive impairment in the early recovery period after ischemic stroke, including the identification of risk factors from the history of life and of the results of neuropsychological testing. Risk factors in a known manner against the Yat: localization of the lesion, the severity of the initial condition, age, treatment of cognitive impairment. Determined the prognostic significance of the extent of cognitive impairment in patients on the 3-4th week of ischemic stroke [Bogolepov, A.N. Higher mental function in patients in the early rehabilitation period of ischemic stroke: author. dis. Kida. the honey. Sciences. - M., 1997. - P.4-5].

The disadvantages of this method include the inability to predict the course of cognitive impairment in late recovery period of ischemic stroke, and that were not taken into account such important risk factors such as arterial hypertension, emotional disorders, belonging to a professional group.

The task of the invention is to develop a method for predicting the clinical course of cognitive impairment in patients with ischemic stroke, based on the assessment of the aggregate risk factors affecting the course of cognitive disorders.

The technical result of the proposed method is to ensure the accuracy of the individual prognosis of the clinical course of cognitive impairment in a patient with ischemic stroke in the late recovery period.

The technical result of the proposed method is achieved by the fact that for predicting the clinical course of cognitive the positive disturbances in patients with ischemic stroke risk factors from the history of life and the intensity detected at the first examination of cognitive impairment and the results of their treatment.

The distinctive techniques of the proposed method is that of the history of life set the following risk factors: family history of cardiovascular disease, hypertension and if the regularity of taking antihypertensive therapy, marital status, age, education, psycho-emotional stress, Paul.

The difference lies in the fact that the established risk factors assign grades (a1...9and numeric values, where:

a1treatment of cognitive impairment: no - 0; is - 1;

a2- family history of cardiovascular disease: no - 0; is - 1;

and3- in the presence of hypertension receiving antihypertensive drugs: 0 - no hypertension; have hypertension, but did not receive treatment - 1; there is hypertension, but taking antihypertensive drugs from case to case - 2; features hypertension, regular use of antihypertensive drugs - 3;

and4- marital status: married - 1, unmarried - 2;

a5- the severity of cognitive impairment at the time of inspection: mild cognitive disorders - 1; moderate cognitive impairment - 2; severe cognitive impairment - 3;

a6- age: 44 years - 0; 45-59 years - 1; aged 60-74 year - 2;

and7/sub> - education: secondary - 1; top - 2;

a8- psycho-emotional stress: no - 0; is - 1;

and9- gender: male - 1, female - 2.

The difference also lies in the fact that the prognostic factors F1and F2determined by the formula:

F1=-1,42+3,4*a1-0,83*a2+0,87*a3-0,53*a4+1,05*a5-0,78*a6+0,58*a7-0,44*a8+0,37*a9;

F2=-5,3-6,39*a1+1,69*a2-1,77*a3+1,09*a4-2,13*a5+1,6*a6-1,18*a7+0,9*a8-0,76*a9.

The authors of the proposed method is established that when the absolute value of F1larger absolute values of F2predict favorable type of current cognitive impairment, and when F2larger F1, - adverse type of course of cognitive impairment in patients with ischemic stroke.

A comparative analysis was performed with the prototype showed that the proposed method differs from the known above-mentioned methods, and therefore meets the criterion of the invention of "novelty."

The analysis of patent and literature the authors found that the proposed method has characteristics that distinguish it not only from the prototype, but also on other technical solutions in this and related fields of medicine. In the available literature, the authors have not identified spasmoproxyvon clinical course of cognitive impairment in patients with ischemic stroke.

Clinical observations of the authors of the proposed method show that the use of the proposed solution makes it possible to predict the clinical course of cognitive impairment in patients with ischemic stroke, while the prediction accuracy was 98%. This allows to conclude that the technical solutions according to the criterion of "inventive step".

A method for predicting the clinical course of cognitive impairment in patients with ischemic stroke, comprising the invention, is intended for use in health care. The implementation of its capabilities is confirmed as described in the application techniques and equipment, therefore, the claimed invention meets the condition of patentability - "industrial applicability".

The proposed method is as follows.

The patient suffered an ischemic stroke, based on the results of the General clinical examination, anamnestic data and neuropsychiatric testing, identify risk factors, which assign appropriate grades and numeric values.

Then by the above formulas to determine the prognostic value of the coefficients of F1and F2compare their numerical characteristics, and predict the course of cognition the x violations.

When the value of F1more F2predicts favorable type of course of cognitive impairment in patients with ischemic stroke, treatment continue.

If F2more F1then the individual(Oh) predict adverse type currents cognitive impairment, which allows reasonable to assign more intensive treatment and preventive measures.

The proposed method for predicting the clinical course of cognitive impairment is illustrated by examples of specific performance.

Example 1. Patient K., born in 1952 Diagnosis: Ischemic stroke in the basin of the right middle cerebral artery (12.07.07). Cerebral atherosclerosis. Hypertension Art. III, risk IV. Easily pronounced left-side hemiparesis. Moderate cognitive impairment.

In this patient retrospectively using data from the patient card, identified the following indicators of risk factors: family history of cardiovascular disease (0), hypertension, regular use of antihypertensive drugs (3), marital status - married (1), age in 2007, 55 (1), higher education (2), psychological stress (1), Paul (2), mild cognitive impairment (2), treatment of cognitive impairment receives (1).

F1=-1,42+3,4*(1)-0,83*(0)+0,87*(3)-0,53*(1)+1,05*(2)-0,78*(1)+0,58*(2)-0,44*(1)+0,37*(2)=6,07;

F2=-5,3-6,39*(1)+1,69*(0)-1,77*(3)+1,09*(1)-2,13*(2)+1,6*(1)-1,18*(2)+0,9*(1)-0,76*(2)=-19,9.

Therefore, F1more F2. The patient predicts favorable type currents cognitive impairment. By year-end observations of cognitive disorders, the patient was not recorded.

Example 2. Patient I., born in 1945 Diagnosis: Ischemic stroke in the basin of the left middle cerebral artery (05.04.07). Cerebral atherosclerosis. Hypertension Art. III, risk IV. Easily pronounced left-side hemiparesis. Moderate cognitive impairment.

In the patient retrospectively using data from the patient card, identified the following indicators of risk factors: family history of cardiovascular disease (1), hypertension, antihypertensive drugs does not accept (1), married (1), age in 2007, 62 (2), secondary education (1), psychological stress (1), floor (1), mild cognitive impairment (2), treatment of cognitive impairment does not receive (0).

F1=-1,42+3,4*(0)-0,83*(1)+0,87*(1)-0,53*(1)+1,05*(2)-0,78*(2)+0,58*(1)-0,44*(1)+0,37*(1)=-7,92;

F2=-5,3-6,39*(0)+1,69*(1)-1,77*(1)+1,09*(1)-2,13*(2)+1,6*(2)-1,18*(1)+0,9*(1)-0,76*(1)=8,07.

Therefore, F1less F2. The patient is predicted adverse type currents cognitive impairment. By the end of the year of observation (10.04.2008 g) the patient has been identified heavy cognitiveneuroscience: low rates neuropsychological testing, can not do without help.

Clinical studies of the proposed method was conducted at the city clinical hospital №1, №8, №10, NFM IAPO since 2005. The sample of 134 people, including 69 women, 65 men. The main group consisted of 94 patients with ischemic stroke with cognitive impairment. Patients of the main group and the control group was under surveillance during the years since the development of ischemic stroke.

To conduct discriminant analysis in the study sample included 94 patients. The control group forecast amounted to 40 people. The accuracy of the prediction in the late recovery period of the disease was 98%.

Thus, the proposed method for predicting the clinical course of cognitive impairment will improve the efficiency and targeting of preventive and therapeutic measures in patients at risk of developing adverse currents cognitive impairment.

A method for predicting the clinical course of cognitive impairment in patients with ischemic stroke, including the identification of risk factors from the history of life and the intensity detected at the first examination of cognitive impairment, and the results of their treatment, characterized in that reveal a family history of cardiovascular diseases essential hypertension and if the regularity of taking antihypertensive therapy, marital status, age, education, psycho-emotional stress, gender, set their grades and numeric values, then the prognostic factors F1and F2determined by the formula:
F1=-1,42+3,4·a1-0,83·a2+0,87·a3-0,53·a4+1,05·a5-0,78·a6+0,58·a7-0,44·a8+0,37·a9;
F2=-5,3-6,39·a1+1,69·a2-1,77·a3+1,09·a4-2,13·a5+1,6·a6-1,18·a7+0,9·a8-0,76·a9where
a1treatment of cognitive impairment: no - 0; is - 1;
and2- family history of cardiovascular disease: no - 0; is - 1;
and3- in the presence of hypertension receiving antihypertensive drugs: 0 - no hypertension; have hypertension, but did not receive treatment - 1; there is hypertension, but taking antihypertensive drugs from case to case - 2; features hypertension, regular use of antihypertensive drugs - 3;
and4- marital status: married - 1, unmarried - 2;
and5- the severity of cognitive impairment at the time of inspection: mild cognitive disorders - 1; moderate cognitive impairment - 2; severe cognitive impairment - 3;
and6- age: 44 years - 0; 45-59 years - 1; aged 60-74 year - 2;
and7- education: secondary - 1; top - 2;
asub> 8- psycho-emotional stress: no - 0; is - 1;
and9- gender: male - 1, female - 2,
and when F1more F2predicts favorable type for cognitive impairment, and when F2more F1- adverse type of course of cognitive impairment in patients with ischemic stroke.



 

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