Volume 03 Issue 07-2023
55
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
07
P
AGES
:
55-61
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
This article discusses the features of cognitive dysfunction in patients with ischemic stroke depending on Covid-19
status. Using the modified TOAST classification, a sample of patients with only ischemic stroke (IS) against the
background of previous COVID-19 was made. We were guided by the fact that there are a significant number of
multidirectional publications in the literature regarding views on the pathogenesis and clinic of neurological
complications in COVID-19, and in order to concretize the study, we analyzed only cases with ischemic stroke in our
work.
KEYWORDS
Features of cognitive dysfunction, ischemic stroke, Covid-19 status.
INTRODUCTION
COVID-19 increases the likelihood of developing
ischemic stroke (IS), increasing the rates of disability
and mortality in the population. It was revealed that
COVID-19 provokes a stroke even in healthy young
people, it is more severe and 5-10 times more likely to
lead to death. Thus, the average mortality from stroke
is usually 5-10%. In patients with COVID-19, it was at the
level of 42% (8.9). Observations show that SARS-CoV
and SARS-CoV-2, which leads to the frequent
development of strokes with a certain change in the
levels of neurotrophic markers, in particular BDNF, is
also characterized by the expression of certain
molecular sequences that act as ACTH mimics. Thus, a
patient’s antibodies to SARS
-CoV and SARS-CoV-2 can
Research Article
FEATURES OF COGNITIVE DYSFUNCTION IN PATIENTS WITH ISCHEMIC
STROKE DEPENDING ON COVID-19 STATUS
Submission Date:
July 20, 2023,
Accepted Date:
July 25, 2023,
Published Date:
July 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue07-10
Manzura M. Yuldasheva
Researcher Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 07-2023
56
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
07
P
AGES
:
55-61
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
destroy ACTH, decreasing its levels and increasing
cortisol levels (7,10).
That is why the problem of studying the dynamics of
neurological deficit and cognitive functions in the early
recovery period in post-COVID patients with IS and
optimizing therapy becomes of national importance
and urgent need.
THE PURPOSE OF THE STUDY
Assess cognitive deficits in patients with ischemic
stroke depending on COVID-19 status.
MATERIAL AND RESEARCH METHODS
The presented research work was carried out at the
Department of Nervous Diseases of the Regional
Vascular Center at the Federal State Budgetary
Institution NSO City Clinical Hospital No. 1 in the period
from 2020 to 2022. Based on international criteria, we
diagnosed CVA as “focal or diffuse impairment of br
ain
function of cerebrovascular origin lasting at least 24
hours or leading to death in a shorter period of time”
[3].
Using the modified TOAST classification [3], a sample
of patients with only ischemic stroke (IS) against the
background of previous COVID-19 was made. We were
guided by the fact that there are a significant number
of multidirectional publications in the literature
regarding views on the pathogenesis and clinic of
neurological complications in COVID-19, and in order to
concretize the study, we analyzed only cases with
ischemic stroke in our work.
The diagnosis of COVID-19 was made according to the
“Temporary recommendations for the management of
patients infected with a new coronavirus infection
COVID-
19” of the Ministry of Health of the Repu
blic of
Uzbekistan, version 8 [1]. This paper indicates that the
World Health Organization (WHO) in January 2020
updated the section of ICD-
10 “Codes for use in
emergencies”, adding a special code for COVID
-19 -
U07.1 [1].
The main group (MG) consisted of 165 patients with
ischemic stroke against the background of previous
COVID-19 (IS + COVID-19) (98 men and 67 women),
mean age 52.4±10.9 years. The comparison group (CG)
consisted of 85 patients with ischemic stroke without
IS and no history of COVID-19 (46 men and 39 women),
mean age 65.9±4.8 years. The control group (CG)
included relatively healthy individuals (n=20; mean age
52.4±6.5 years; gender index 1.0:1.0) (Table 1).
Table 1. Distribution of subjects by groups
Volume 03 Issue 07-2023
57
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
07
P
AGES
:
55-61
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
groups
Gender
index
men
women
total
n
%
n
%
n
%
main group
(MG)
1,46*
98
59,4%*
67
40,6%*
165
61,1%
comparison
group (GS)
1,18
46
54,1%
39
45,9%
85
31,5%
control
group (CG)
1,00
10
50,0%
10
50,0%
20
7,4%
Total
1,33
154
57,0%
116
43,0%
270
100,0%
Note: *- reliability p>0.05 between MG and CG.
To study auditory-
speech memory, the Luria test “10
words” was used, the Schulte method was used to
assess the stability of attention and performance, and
the MMSE scale was used to determine cognitive
deficit.
Statistical processing of clinical and instrumental
materials in accordance with the recommendations for
processing the results of biomedical research at a
significance level of p<0.05 was carried out using the
practical statistical package STATISTICA.
Research results. Complaints about memory disorder
in the form of forgetfulness were presented by 58.0%
of patients, while an objective study revealed memory
loss in 84.8% of cases. Memory impairments were
predominantly modal-nonspecific in nature and were
primarily due to pathological inhibition of traces by
interfering influences. The degree of impairment
varied from mild (71.6%) to moderate (20.0%) severity.
Mild disturbances were found only with the use of
sensitized samples. The absence of mnestic disorders
was recorded in 8.4% of cases.
In
the study of memory according to the Luria test “10
words”, a significant difference was revealed between
the number of reproduced words between groups -
CG, OG and GS in the time period of 10 and 20 minutes
(Table 2).
Table 2
The average number of words on the test for memorization is 10 words (according to Luria A.R.)
Volume 03 Issue 07-2023
58
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
07
P
AGES
:
55-61
SJIF
I
MPACT
FACTOR
(2021:
5.
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)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Test “10 words”
Luria
MG
CG
CG
AT
CE
LI
AT
CE
LI
1
st
attempt
4,9±2,1
5,0±1,0
5,1±1,0
5,2±0,3
5,4±1,0
5,8±1,25
6,2±0,25
2
nd
attempt
5,0±1,8
6,5±0,6
7,0±0,9
4,7±0,29
7,1±1,9
7,2±0,8
7,5±0,9
3
rd
attempt
6,1±1,3
7,1±0,8
8,4±0,5
4,0±0,29
7,4±0,5
8,0±0,5
6,3±0,24
4
th
attempt
5,7±1,5
7,5±1,4
8,2±0,4
6,1±0,21
8,2±0,4
8,0±0,7
8,1±0,8
5
th
attempt
5,2±1,1
6,3±2,2
7,1±1,7
5,1±0,26
7,1±1,7
7,6±0,8
7,1±1,2
Delayed playback
4,0±1,3
6,0±1,5
6,8±1,3
4,3±0,28
6,8±1,3
7,0±0,5
6,7±1,8
When conducting a test for memorization of 10 words,
a slight decrease in memorization productivity was
noted compared to the control, the patients reach the
maximum results after 5-6 repetitions, while the
persons of the control group - after 3-4 repetitions
(Table 2).
In 98.0% of cases, modal-nonspecific disorders of
voluntary attention were also detected. The
memorization curve in the 10-word test reflected the
insufficiency of activation support, a decrease in the
concentration of voluntary attention, and its increased
exhaustion.
Noteworthy is the relative preservation of the volume
of short-term memory in the GS with a slight decrease
in long-term memory, which indicates the absence of
pronounced disturbances in the phase of direct
reproduction. The number of errors is comparable to
the control group.
The reproduction of numerical series in the control
group was better compared to patients who
underwent COVID-19, this difference was significantly
significant (p=0.04). Reproduction of numerical series
in direct order in patients with CG and MG was
impaired to a greater extent than in CG, these
differences were more pronounced in patients with AT
subtype IS. The revealed changes in patients with
different groups had a statistically significant
difference when comparing some indicators.
Table 3
Test results according to the Schulte method
Volume 03 Issue 07-2023
59
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
07
P
AGES
:
55-61
SJIF
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FACTOR
(2021:
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(2022:
5.
893
)
(2023:
6.
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)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Schulte table
MG
CG
CG
AT
CE
LI
AT
CE
LI
1
67±11,8
63±8,7
42,6±5,3
56,8±1,6
57,8±2,3
41,6±9,0
42±5,7
2
66±8,5
71±9,0
46,8±2,7
52,7±2,3
53,7±1,8
40,0±6,4
45±2,4
3
68±10,3
76±9,3
49,3±3,8
51,6±2,8
56,9±2,3
48±10
47±3,5
4
73±12,5
75±16,4
54,2±2,1
50,0±1,9
58,1±1,6
55±5,7
52±2,8
5
70±7,9
79±10,8
53,5±2,7
58,1±1,3
62,7±2,4
48±4,5
50±2,2
After analyzing the assessment of the stability of attention and performance according to the Schulte method (Table
3), we found a fairly large variability in the data. The studied groups of patients who underwent COVID-19 significantly
differed in the efficiency of work with the control group (p = 0.001). The scatter in the time of passing the Schulte
tables in patients of the MG and CG increased with the increase in the complexity of the task.
Table 4. MMSE results, %
IO degrees
Lungs IO
Moderate IO
total
AT
22
52,4%
20
47,6%
42
MG
CE
24
66,7%
12
33,3%
36
LI
35
77,8%
10
22,2%
45
Total MG
81
65,9%
42
34,1%
123
AT
17
68,0%
8
32,0%
25
CG
CE
13
68,4%
6
31,6%
19
LI
10
76,9%
3
23,1%
13
Total CG
40
70,2%
17
29,8%
57
Note: hereinafter * - significant differences between the CG and groups.
# - difference between MG and CG groups.
The exhaustion of attention according to the method
of Schulte's tables in LI in MG and CG and in healthy
people fluctuated in the same ranges, while in patients
with AT of both groups, a dependence was observed,
in which exhaustion increased as the test was
performed. Patients with AT MG also had a tendency
to exhaustion of attention during the test, but not as
pronounced as in AT MG. The work efficiency of
patients with HC was 57.3%, MG - 49.5%.
The severity of IO on the MMSE scale in patients was
studied depending on the subtype of IS. As can be seen
from Table 4.10, in the MG and CG of patients with
moderate IO, it was significantly higher compared to
Volume 03 Issue 07-2023
60
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
07
P
AGES
:
55-61
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
the CG. Also, significant differences in the score
severity of MCI according to the MMSE scale was
significantly higher in patients with MG compared with
CG (Table 4).
According to the results of other researchers,
moderate cognitive impairment (MCD) was more
common in patients with MG compared with CG - 34.1%
and 29.8%, respectively (p<0.05). Patients with AT of
both groups had MCI more often in comparison with
CE and LI (v.4.10). Distinctive characteristics of MCI in
different subtypes of IS can be explained by damage to
different areas of the cerebral cortex [2,4,5].
When conducting a correlation analysis, the following
was revealed - the severity of the severity of COVID-19
correlated
with
more
pronounced
cognitive
impairment. The results of neuropsychological testing
of patients who underwent COVID-19 were compared
with modern criteria for pre-dementia disorders
[6,7,8]. The structure of cognitive disorders (CG) in
patients with COVID-19 was significantly dominated by
MCI, which, according to the study with changes in
severity, were more pronounced (p<0.05).
CONCLUSION
According to the results of neuropsychological testing,
the overall severity of CR in COVID-19 (according to the
MMSE scales and the 10-word test according to Luria)
was significantly higher in groups II and III. Moreover,
in patients with AT, MCI was detected more often than
in patients with CE or LI (p<0.05).
From the foregoing, it follows that the identified
intergroup differences are statistically significant.
Recovery of long-term memory is more intense with
mild COVID-19.
Changes in the cognitive status were of a wave-like
nature: improvement - worsening - improvement with
an increase in positive dynamics, which subsequently
consolidated and acquired a stable character. Given
that the process of transferring information from
short-term memory to long-term memory is
accompanied by functional and structural changes
supported by the acetylcholinergic system. When
conducting a correlation analysis, the following was
revealed - the severity of the severity of COVID-19
correlated
with
more
pronounced
cognitive
impairment. The results of neuropsychological testing
of patients who underwent COVID-19 were compared
with modern criteria for pre-dementia disorders [9,10].
The structure of cognitive disorders (CD) in patients
with COVID-19 was significantly dominated by MCI,
which, according to the study with changes in severity,
were more pronounced (p<0.05).
In conclusion, we can confidently say that
neuropsychological examinations are important
methods for assessing the state of higher mental
functions in patients who have undergone COVID-19
Volume 03 Issue 07-2023
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International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
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P
AGES
:
55-61
SJIF
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MPACT
FACTOR
(2021:
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(2022:
5.
893
)
(2023:
6.
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)
OCLC
–
1121105677
Publisher:
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and allow assessing the degree of involvement of the
affected parts of the brain in the pathological process,
as well as the functional state of the brain as a whole.
The study showed differences in neuropsychological
parameters depending on the subtypes of IS;
significantly more pronounced SI was observed in AT,
in contrast to patients with CE and LI. Moreover, the
indicators on the MMSE scale in AT were also
significantly lower than the corresponding indicators
of those examined with CE and LI. It should be assumed
that patients with atherosclerosis are at risk for
developing CR with COVID-19.
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