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COGNITIVE DYSFUNCTION IN PATIENTS WITH ISCHEMIC STROKE:
CLINICAL AND NEUROPSYCHOLOGICAL EVALUATION
¹Maxammadiyeva Nargiz
²Holbòtayev Sardor
³Norbekov Rayimjon
¹'²'³1st-year Residents, Department of Neurology, Samarkand State Medical University
Affiliation: Department of Neurology, Samarkand State Medical University, Uzbekistan.
https://doi.org/10.5281/zenodo.15511979
Research Objective
: To assess the nature and severity of cognitive dysfunction in
patients who have suffered an ischemic stroke, using standardized clinical and
neuropsychological tools. The study aims to identify correlations between stroke location,
severity, and specific cognitive domains affected, and to support the need for integrated
neurorehabilitation strategies.
Introduction
: Ischemic stroke, a leading cause of death and long-term disability
worldwide, often leaves survivors with cognitive deficits that impair daily functioning and
quality of life. Post-stroke cognitive impairment (PSCI) includes a wide spectrum of deficits
affecting attention, executive function, memory, language, and visuospatial abilities. Although
motor recovery is often prioritized, cognitive rehabilitation is critical for comprehensive
recovery. Understanding the pattern, severity, and predictors of PSCI is essential for
individualized therapeutic strategies.
The brain's vulnerability to ischemia is not uniform; different territories, depending on
vascular supply, yield distinct cognitive sequelae. Lesions in the left hemisphere typically affect
language and verbal memory, while right hemisphere strokes impair visuospatial processing
and attention. The prefrontal cortex, hippocampus, and thalamus are particularly important for
cognitive function and are frequently affected in cerebrovascular accidents. Moreover, factors
like age, comorbidities (e.g., hypertension, diabetes), and time to rehabilitation influence
outcomes.
Materials and Methods
: A hospital-based observational study was conducted at the
Neurology Department of Samarkand State Medical University over a 14-month period. The
study involved 120 patients aged 45–80 years with a confirmed diagnosis of ischemic stroke
(via CT or MRI).
Inclusion criteria
:
a.
First-ever ischemic stroke within the past 3 months
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b.
Age 45–80 years
c.
Conscious and able to complete cognitive testing
Exclusion criteria:
a.
History of prior stroke, traumatic brain injury, or dementia
b.
Severe aphasia or psychiatric disorders interfering with assessment
c.
Hemorrhagic stroke
Study tools and assessments
:
1. Demographic and clinical data collection
2. National Institutes of Health Stroke Scale (NIHSS) for stroke severity
3. Montreal Cognitive Assessment (MoCA) for cognitive screening
4. Frontal Assessment Battery (FAB) for executive dysfunction
5. Rey Auditory Verbal Learning Test (RAVLT) for memory assessment
6. Clock Drawing Test (CDT) for visuospatial function
7. Hospital Anxiety and Depression Scale (HADS)
Patients were grouped based on stroke territory involvement:
a.
Group A: Left hemispheric stroke
b.
Group B: Right hemispheric stroke
c.
Group C: Subcortical infarcts
Results
: Of the 120 patients included, 102 (85%) demonstrated cognitive impairment.
The mean age was 65.3 ± 7.1 years. MoCA scores indicated that 58% had mild cognitive
impairment (MCI), while 27% exhibited moderate-to-severe dysfunction. The most affected
cognitive domains were executive function (82%), memory (76%), and visuospatial skills
(69%).
Group A patients had significantly lower scores on language and verbal memory tasks
(p<0.001), while Group B had greater deficits in visuospatial and attention domains (p<0.005).
Group C exhibited moderate deficits across all domains, particularly affecting processing speed
and executive control.
Strong correlations were observed between MoCA scores and stroke severity (r = -0.68),
age (r = -0.53), and delayed rehabilitation onset (r = -0.59). Patients with NIHSS scores >8 had
a 3.1-fold increased risk of developing moderate cognitive impairment.
Functional status, as measured by the modified Rankin Scale (mRS), also aligned with
cognitive outcomes. Patients with higher cognitive scores were more likely to regain
independence (p<0.01).
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Discussion
: The findings underscore the high prevalence and heterogeneity of post-
stroke cognitive dysfunction. Left hemispheric strokes are predominantly associated with
impaired language, verbal fluency, and sequential memory processing. In contrast, right
hemispheric lesions impair non-verbal domains, including spatial awareness and visual
memory. These cognitive profiles reflect localized cortical and subcortical ischemic injury.
Early detection through structured tools like MoCA and FAB provides critical insight
for initiating cognitive rehabilitation. Many patients with normal Mini-Mental State
Examination (MMSE) scores still exhibited significant dysfunction on MoCA, affirming its
superior sensitivity in post-stroke populations.
Executive dysfunction, frequently seen in subcortical and frontal strokes, impairs
planning, goal-setting, and problem-solving abilities, making it harder for patients to comply
with medication or therapy. Such dysfunctions may not be easily detected unless specifically
tested.
Neuroplasticity and recovery potential are highest in the early post-stroke period,
underscoring the importance of prompt rehabilitation. Multimodal therapy, including cognitive
training, physical exercise, and pharmacologic intervention (e.g., cholinesterase inhibitors), can
enhance outcomes. Integration of mental health screening is also vital, as anxiety and
depression exacerbate cognitive decline.
Conclusion
: Post-stroke cognitive dysfunction is a prevalent, multifaceted consequence
of ischemic stroke that significantly hinders recovery and independence. This study illustrates
the importance of early, domain-specific cognitive evaluation and personalized rehabilitation
strategies. Cognitive assessment should be integrated into standard stroke care protocols to
facilitate holistic recovery and prevent long-term disability.
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