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УДК: 616.8-009 DOI:10.33920/med-01-2101-01

Cognitive functions in patients in the long-term period of microsurgical treatment of cerebral aneurysms

Shetova I. M. FSBEI HE Moscow State Medical University named after A. I. Evdokimov, Moscow., ORCID 0000-0001-8975-7875
Shatokhin T. A. FSBEI HE Moscow State Medical University named after A. I. Evdokimov; N. V. Sklifosovsky Research Institute of Emergency Medicine, Moscow., ORCID 0000-0002-2864-9675
Lukyanchikov V. A. FSBEI HE Moscow State Medical University named after A. I. Evdokimov; N. V. Sklifosovsky Research Institute of Emergency Medicine, Moscow., ORCID 0000-0002-8263-1433
Krylov V. V. FSBEI HE Moscow State Medical University named after A. I. Evdokimov; N. V. Sklifosovsky Research Institute of Emergency Medicine, Moscow., 0000-0001-5256-0905

Objective: to study cognitive functions in patients in the long-term period of microsurgical treatment of cerebral aneurysms. Materials methods: on the basis of the University Clinic of the Moscow State Medical University. A.I. Evdokimov and the Department of Emergency Neurosurgery of the N.V. Sklifosovsky Research Institute for Emergency Medicine, an analysis of cognitive functions was carried out in 212 patients operated on by a microsurgical method since 2013. Results: in the long-term period of surgical treatment of cerebral aneurysms, cognitive impairments of varying severity were detected in 78 patients (37%). The main factors negatively affecting cognitive functions were the severity of the patient’s condition before surgery, corresponding to Hunt-Kosnik III–V, the age of patients over 60 years old, body mass index over 30, localization of the aneurysm in the basin of the anterior cerebral artery and vertebrobasilar basin, patients’ condition discharge according to the Glasgow Grade IV–III Outcome Scale. No significant dependence of cognitive impairment on the severity of subarachnoid hemorrhage and the gender of patients was found. On the contrary, the severity of anxiety and depression, which was assessed on the HADS scale, was twice as likely to be observed in female patients as compared with male patients. Conclusion: it is obvious that the persistence of cognitive deficit and mental disorders, in the form of anxiety and depression, in the long-term period of surgical treatment of cerebral aneurysms dictates the need for long-term dispensary observation and correction of the revealed disorders.

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I mprovement of diagnosis and treatment methods of acute cerebrovascular events (ACEs) as a part of national healthcare programs enabled to reduce the mortality rate in different forms of stroke, including one of the most severe ACE types, subarachnoid hemorrhage (SAH), to which in particular surgical activity contributed [1].

Development of the three-level resuscitation system for patients after the stroke allowed to reduce post-ACE disability; however, besides the apparent neurological symptoms that can be clinically diagnosed easily and precisely, cognitive and mental disorders have a significant adverse impact on the social, household, and labor readaptation of patients.

Pathophysiological processes in the brain resulting from aneurysmal subarachnoid and parenchymal hemorrhage as well as the delayed cerebral ischemia due to the angiospasm lead to the development of focal damage to the brain tissue. Besides cerebral ischemia foci, the disseminated ischemia damage sites develop in the brain, which leads to cognitive dysfunctions and/or focal neurological disorders in the long term.

The study of the remote findings of the cerebral aneurysm surgeries suggested that cognitive and mental disorders in patients are frequently diagnosed even if the neurological functions have reversed and there is no disability and the person is able of self-care [2].

The development of mental and psychoneurological disorders that include such common manifestations as anxiety and depression are an additional factor that triggers the cognitive dysfunction and degrades the life quality of the patients who underwent surgical intervention for cerebral aneurysm [3].

Post-stroke depression is diagnosed in a third of patients after ACE [4]. The chronization mechanisms of this syndrome are understudied. Patients with post-stroke depression that persisted for 6 months showed cortex foci more frequently and had a higher disability rate, compared with those who had resolved the depression. Post-stroke depression is associated with a more advanced age, female sex, and marital status (widowhood) [5, 6].

Для Цитирования:
Shetova I. M., Shatokhin T. A., Lukyanchikov V. A., Krylov V. V., Cognitive functions in patients in the long-term period of microsurgical treatment of cerebral aneurysms. Вестник неврологии, психиатрии и нейрохирургии. 2021;1.
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