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COMBINED NEUROPROTECTION IN COGNITIVE RECOVERY OF PATIENTS AFTER
ISCHEMIC STROKE
Badashkeev M.
candidate of Pedagogical Sciences, psychologist Regional State Health Budget Institution Bokhansky district hospital
Shoboev A. neurologist
Regional State Health Budget Institution Bokhansky district hospital
Abstract
In modern world medicine, cerebrovascular diseases are one of the most pressing problems of modern neurology, given the high prevalence of this pathology in the population. In modern scientific works, the restorative treatment of post-stroke patients is widely used the method of combined neuroprotection. This approach is in our view the most effective and safe in the restorative treatment of patients. In our study, we prioritize in restorative treatment the combined pharmacotherapy "Citicoline" in integrated use with the drug "Cortexin." During the clinical study, we analyzed the statistics obtained, which also support the effectiveness of combined neuroprotection of cyticoline and cortexine in recovery treatment in the rehabilitation period of ischemic stroke.
Keywords: ischemic stroke, cognitive functions, restorative treatment, neuroprotection, pharmacotherapy, combined neuroprotection.
In modern medicine, vascular diseases of the brain level of disability. Every year, about 10 million people remain relevant due to the widespread and rather high in the world suffer a stroke, in Russia this figure is more
than 450 thousand [1]. Cerebrovascular mortality reaches 11-12% in developed economic countries. Every year, 250,000 people die from strokes in the Russian Federation, one of the highest deaths in the world. Speaking about the widespread incidence of stroke, we must not forget about the socio-economic aspect of this problem. Disability due to stroke, Russia ranks first among other countries and is almost 45,000 people a year [6].
According to modern scientific research, in almost every clinical case, the post-stroke state is accompanied by disorders of higher mental functions [12]. Aphasia refers to the most frequent manifestations of focal neurological deficiency in stroke, leading to disabled patients. Speech is one of the most difficult organized higher cortical functions, and its recovery is slower compared to motor, sensitive, vestibular and other disorders [12, 13]; according to various authors, speech rehabilitation takes from 2 to 6 years or more [9, 10, 14]. At the same time, speech disorders significantly worsen the quality of life of patients and are often the only obstacle to their return to work [13].
Due to the widespread and high social significance, the problem of speech recovery after a stroke has been repeatedly covered in the works of domestic and foreign authors. One of the most significant problems is the selection of adequate therapy for aphathic disorders, which would make it possible to achieve a significant improvement in speech function as soon as possible. The main methods for the rehabilitation of speech disorders are speech, reading and writing restoration classes conducted by speech therapists-aphasiologists [13], as well as the use of neuroprotective drugs capable of having an activating effect on the cognitive functions of the brain and allowing to solve the problem of rapid exhaustion during logotherapy [2, 15]. Neuroprotectors mean drugs that provide reduced damage, improved neuronal survival in the most unfavorable conditions.
Until now, the problem of using neuroprotective drugs in the recovery period of stroke has been widely discussed. Most authors are inclined to believe that the early prescription of this group of drugs allows improving prognosis, increasing the period of the "therapeutic window," reducing the size of the ischemic focus [7]. According to the prevailing mechanism of action, all neuroprotectors can be divided into the main groups: neurometabolic drugs, antioxidants and antihypoxants, neuromodulators, neurotransmitters. However, most drugs have a variety of effects on brain metabolism and microcirculation, and drugs related to secondary neuro-protectors often also affect the initial stages of brain damage in acute focal ischemia.
Today, the search for effective drugs for primary and secondary cytoprotection is actively underway, the idea of an "ideal" neuroprotector is being developed, which could simultaneously affect all key links of the ischemic cascade: impede the development of intracel-lular acidosis, oxidative stress, activate glycolysis, correct the mediatory imbalance [8, 11].
In turn, we built a combination of two drugs "Cit-icoline" and "Cortexin," while receiving positive dynamics in almost 80% of cases. We conducted a clinical
comparative analysis in the groups of patients who received Citicolin and Cortexin drugs in patients in the rehabilitation period after ischemic stroke, which were comparable in terms of disease duration, age and sex. The clinical trial was conducted with the permission of the ethics committee. All patients gave voluntary informed consent for inclusion in the study. The study included patients with mild to moderate neurocognitive deficits who suffered ischemic stroke for more than 1 year. The average age ranged from 55 to 75 years (the average age was 64.5 years). The exception to the group was patients who had gross cognitive, motor impairment (hemiplegia) and speech impairment due to the consequences of brain infarction. To study the combined effect of the drugs (Citicolin and Cortexin), patients who underwent a diagnostic study from a medical psychologist were selected. All patients were informed in detail about the safety of the clinical trial. In accordance with all criteria, 112 patients admitted to the Bochanskaya RB OGBUZ in the period 2019-2020 were treated and examined. All patients were divided into 3 groups. Group 1 - 38 patients treated with Cor-texin 20 mg w/m in combination with baseline therapy. The 2nd group was 37 patients treated with Citicolin 2000 mg in combination with basic therapy. The 3rd group was 37 patients who underwent combined neuroprotection with Citicoline drugs at a dose of 2000 mg per cap per day and Cortexin 20 mg per meter [2].
During the study, diagnosis of neurocognitive functions included the study of the dynamics of speech functions, short-term and working memory, attention, abstract and operational thinking. The Montreal Cognitive Assessment Scale (IOA) was used for this purpose. Statistical analyses between groups were used: the Mann-Whitney U-test (U-testMann-Whitney) for two independent samples and the Wilcoxonsigned-ranktest test for two dependent samples. Differences between the groups compared were considered statistically significant at p < 0.05. Statistical analysis was carried out in STATISTICA SPSS [2, 5].
In the analysis of the results of our clinical study of combined neuroprotection with the drugs "Cortexin" 20 mg in/m and "Citicoline" at a dose of 2000 mg in/per cap per day, we determined that after 10 days of restorative treatment, there is a positive dynamics of short-term memory, long-term memory, auditory memory, more efficiently perform logical-mathematical and arithmetic tasks, at the end of the course of restorative treatment of patients. Our control study of already discharged patients who underwent restorative treatment in our department after 30 and 50 days also confirmed the positive dynamics of cognitive and motor recovery, as well as socio-adaptive mechanisms.
Thus, the results of the combined use of complex neuroprotection "Citicolin" and "Cortexin" significantly increase the effectiveness of restorative treatment and the positive dynamics of cognitive recovery, which is explained in principle by complementary mechanisms in the energy cell regulation of brain neurons. Also, taking into account the diverse polypeptide and amino acid composition of the Cortexin drug, the metabolotropic effect on the central nervous system was primarily noted: increased glucose transport to
brain cells, activation and relaxation of glycolysis, "inclusion" in the cycles of amino acids: proline, leucine. The content of inhibitory amino acids (glycine, taurine, GABA, serine) in the preparation counteracts mediator imbalance, which supports trophotropic neurotransmission. Previously, neurotrophic treatment of polypep-tides in combination with the neuromediator substance cyticoline contributes to the improvement of cognitive functions.
In our study, "Citicoline" is basic in combination therapy because the pleiotropic effect of exposure to is-chemic brain damage, as well as significant efficacy in restoring neural tissue structure and function. It has been experimentally proved that "Citicoline" significantly reduces degeneration of hippocampal neurons caused by the introduction of beta-amyloid, also "Cit-icoline" reduces negative deposits of beta-amyloid in the brain, which leads to positive dynamics of cognitive recovery [3, 4].
To date, Russian medicine has quite widely introduced various approaches and technologies in the rehabilitation and rehabilitation treatment of patients who have undergone ischemic stroke, but in our opinion the combination of combined pharmacotherapy is also possible to achieve positive results. Therefore, the clinical study we conducted is relevant and proves the effectiveness of the combined pharmacotherapy Cyticolin and Cortexin in comparison with the monotherapy Cor-texin and Cyticolin in the recovery treatment after is-chemic stroke, as well as post-stroke cognitive disorders.
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