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Section 3. Medical science
https://doi.org/10.29013/ESR-20-1.2-23-25
Badashkeev Mikhail Valeryevich, candidate of pedagogical sciences, psychologist OGBUZ "Bokhansky RB" E-mail: [email protected] Shoboev Andrey Eduardovich, neurologist, OGBUZ "Bokhansky RB" E-mail: [email protected]
MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF COGNITIVE DYSFUNCTIONS FOLLOWING STROKE
Abstract. This research work examines the effectiveness of a multidisciplinary approach in the restorative treatment of stroke patients. Features of restoration of cognitive functions of patients, increase of their level of household adaptation, achievement of independence in performance of individual household skills, as well as normalization of psychological and sensual-emotional state. The degree of recovery of cognitive functions was determined using the Montreal Cognitive Assessment Scale (MoCA).
Keywords: stroke, psychological rehabilitation, neuroprotection, multidisciplinary team.
To date, cerebrovascular pathology has continued day more than one million people who had a stroke
to be one ofthe most pressing and significant problems live in our country, at the same time about a third
of modern Russian medicine for many years, largely make faces of working-age of them, however less
due to the constant increase in the number ofpatients, than 15% of patients continue the work [1, 2-7].
as well as the severity of the medical, economic and Clinical practice shows that the possibilities of
social consequences of the disease, both for patients recovery of functions lost in patients due to stroske
and their relatives and for society as a whole. are very variable, and are largely determined by the
In our opinion, the most severe manifestation of nature and severity of the stroke suffered, the age of
cerebrovascular pathology is stroke. At present, many the patient, the presence of concomitant diseases
complex issues of diagnosis and treatment of cerebral and the severity of complications of the main dis-
stroke have been solved, which has significantly re- ease. Along with it, the volume, adequacy and cor-
duced the level of fatality, but other indicators char- rectness of the choice of tactics of performing treat-
acterizing the outcome of the disease remain very ment, coordination coherence of activity of doctors
disappointing. So, in the Russian Federation among ofvarious specialties participating in medical process
all reasons of primary disability, disability owing to [2, 26-31] also in no small measure have an impact
a cerebral stroke with firmness is high on the list. To- on final result of rehabilitation.
Section 3. Medical science
There is evidence in the scientific literature that demonstrates the high impact of the multidisciplinary approach in the management and early rehabilitation of patients in the acute period of cerebral stroke. At the same time, it has been proved that the termination or suspension of specialized medical care at the subsequent stages of treatment is a direct factor causing an unfavourable prognosis for the restoration of lost functions of the post-insult patient [4; 5; 6].
Thus, in our view, there is no single generally accepted, scientifically sound system of measures for carrying out a multidisciplinary team of rehabilitation and treatment of patients who have suffered a stroke in relation to the subsequent stages of medical rehabilitation - in particular at the stage of the primary vascular department of the hospital. Neither foreign nor Russian theory and practice rank rehabilitation and treatment activities, which initially complicates the task at the initial stage. In turn, we focus on the systemic approach of neuroprotection and hypnotherapy, which for our clinical study is a hypothetical moment to increase the effectiveness of rehabilitation and treatment of stroke patients [7, 29-32].
To study the effectiveness and portability of drugs ("Citicoline" and "Cortexin"), patients who had undergone psychological diagnosis were selected, as well as informed in detail about the tactics and strategies of the process of recovery of cognitive functions. In strict compliance with the criteria, 70 patients were examined and treated for treatment in the neurological department. The blind randomization method divided the patients into 2 groups.
The first group - 30 patients who received basic therapy in combination with the preparation "Cortexin" 20 mg/m.
The second group - 40 patients who were treated with basic therapy, combination therapy with preparations "Cortexin" 20 mg v/m and "Citicoline" at a dose of 1000 mg v/kap per day, as well as additional work of the multidisciplinary team including hypnotherapy.
The diagnosis and evaluation of the patient 's cognition functions included the study of language
functions, short-term and working memory, attention, abstract thinking. The Montreal Cognitive Assessment Scale (MoSA) was used for this purpose. Non-parametric methods were used to determine differences between groups: U-test Mann-Whitney for two independent samples and Wilcoxton signed-rank test for two dependent samples. The differences between the compared groups were considered statistically significant at p < 0.05. Statistical analysis was done by SPSS10, Excel.
In the analysis of the assessment of intellectual impairment evaluated by the Montreal Scale of Cognitive Functions on the day of arrival, no reliable differences between the groups were identified. The duration of hospital treatment was 12 days.
Age list of patients: 30-39 years - 1.8%, 40-49 years - 12.7%, 50-59 years - 38.18%, 60 years are also more senior - 47.2%.
Clinical studies conducted in Group 1, patients who were treated with cortexin in combination, showed that the average results of the MoCA scale, although statistically significant after treatment, remained below the standard of 26 points (Wilcoxton Z-criterion = 2.73; p < 0.006. In the experimental group, the averages reached the norm (Wilcoxton Z-criterion = 5.12; p < 0.00001).
Thus, the results of the differences in the distribution of scales between groups of patients treated with different approaches showed that the criteria for recovery of cognitive impairment after treatment by the multidisciplinary team were significantly higher than in the standard method (U-criterion = 194.5; p-level = 0.01).
Thus, our study fully confirms the effectiveness of the multidisciplinary approach in restoring cognitive functions in the rehabilitation period of stroke. The findings indicate the effectiveness of the complex therapy of these drugs in conjunction with hypnotherapy, which may be recommended for introduction into clinical practice of the treatment of cognitive disorders in patients who have suffered a stroke in the rehabilitation period.
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