颈动脉内膜切除术后 6 个月患者认知功能动态变化的预测因素

R. Y. Kalinin, A. S. Pshennikov, I. Suchkov, R. Zorin, N. A. Solyanik, A. O. Burshinov, G. A. Leonov, V. A. Zhadnov, M. R. Afenov
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引用次数: 0

摘要

背景。由于发生缺血性中风和认知障碍的风险很高,颈动脉粥样硬化是亟待解决的问题之一。颈动脉狭窄患者临床疾病的动态变化由神经生理学、血管学、组织和生物分子反应的复合体决定,其特征可作为病理过程的预测因子。确定接受颈动脉内膜切除术患者的神经生理参数和认知功能障碍的预测因素。研究纳入了59名颈动脉粥样硬化症患者。所有患者均接受了颈动脉内膜切除术。我们使用FAB(额叶评估电池)量表和MoCA(蒙特利尔认知评估)测试评估了颈内动脉的狭窄程度和认知状况,并记录了不同时期(手术前、手术后6个月)患者的脑电图(EEG)、P300认知诱发电位和心率变异性。通过聚类分析(k-means)将患者根据认知测试的动态分为不同的组别,并对组别中包含的元素进行识别:第1组患者的认知状况为 "保留";第2组患者为中度认知功能障碍。结果显示,第 1 组患者的额叶前导β振荡功率较高,P300 电位的 P3 分量振幅较高,R-R 间期的总指标和高频功率变异性较大。我们提出了一个模型,可以根据认知功能评分的动态变化将患者分为不同的组别。根据获得的数据,对认知状态动态最重要的预测因素是脑电图的初始特征和 P300 认知诱发电位。我们确定了认知功能障碍的临床和神经生理学相关性:与脑电图的激活效应、大脑皮层联想区的识别和决策过程以及较不明显的压力实施机制的活动有关联。脑电图频谱分析指标和 P300 认知诱发电位的特征是认知状态动态的预测指标。
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Predictors of the dynamics of changes in cognitive functions in patients 6 months after carotid endarterectomy
Background. Carotid atherosclerosis is one of the urgent problems due to the high risk of developing ischemic stroke and cognitive impairment. The dynamics of clinical disorders in patients with carotid stenosis is determined by a complex of neurophysiological, angiological, tissue and biomolecular reactions, the characteristics of which can act as predictors of the course of the pathology.The aim of the work. To determine the neurophysiological parameters and predictors of cognitive dysfunction in patients who underwent carotid endarterectomy.Materials and methods. The study included 59 people with carotid atherosclerotic disease. All included patients underwent carotid endarterectomy. We assessed the degree of stenosis of the internal carotid artery and cognitive status using the FAB (Frontal Assessment Battery) scale and MoCA (Montreal Cognitive Assessment) Test and recorded electroencephalogram (EEG), P300 cognitive evoked potentials and heart rate variability in patients at various terms (before surgery, 6 months after the surgery). Patients were divided into groups based on the dynamics of cognitive tests using cluster analysis (k-means) with identification of elements included in the clusters: patients of cluster 1 had a “preserved” profile of cognitive status; patients of cluster 2 – moderate cognitive dysfunction.Results. Patients of cluster 1 had a higher power of beta oscillations in the frontal lead, a higher amplitude of the P3 component of the P300 potential, and a greater variability of R-R intervals in terms of the total indicator and high-frequency power. We proposed a model that allows us to classify patients into groups according to the dynamics of cognitive function scores. According to the data obtained, the most significant predictors of the dynamics of cognitive status were the initial characteristics of the EEG and the P300 cognitive evoked potential.Conclusions. We determined the clinical and neurophysiological correlates of cognitive dysfunction: an association with greater preservation of activating effects on the EEG, processes of recognition and decision-making in the associative zones of the cortex, and less pronounced activity of stress-implementing mechanisms. Indicators of EEG spectral analysis and characteristics of the P300 cognitive evoked potential are predictors of the cognitive status dynamics.
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