40–70% of patients after a stroke, including a mild one, may experience cognitive impairment. Brain-derived neurotrophic factor (BDNF) plays a significant role in the pathogenesis and rehabilitation of ischemic stroke and also affects the patients’ recovery prognosis. An association between cognitive impairment in the poststroke period and lower peripheral BDNF levels is known, but the prognostic significance of serum BDNF levels and clinical characteristics for the risk of developing cognitive impairment in the acute period remains uncertain. We conducted a prospective cohort study of patients in the acute phase of ischemic stroke. Clinical examination, assessment of neurological status, neuropsychological testing, and laboratory analyzes were performed on patients at 1 and 14 days after ischemic stroke. The state of cognitive functions was assessed by the Mini-Mental State Examination scale. Quantification of BDNF in blood serum was performed by solid-phaseenzyme-linked immunosorbent assay (ELISA). We found that within 14 days after an acute ischemic stroke, we found a decrease in the clinical severity of patients compared to 1 day of the onset of the disease before the start of treatment and a significant decrease in the level of BDNF in the blood serum of patients with ischemic stroke both on the first and on the 14th day. However, during the 2 weeks of the acute period, no significant changes were detected, despite the general improvement of the clinical condition. In our study, cognitive impairment was found in almost half of the patients on the first day of ischemic stroke, and there was no significant reduction in this prevalence over 2 weeks. We found that a low level of BDNF and a thrombotic subtype of ischemic stroke can be risk factors for cognitive impairment in the acute period, which can be useful in planning treatment and rehabilitation measures.
The aim: To investigate changes in motor activity and indicators of the state of the hemostasis system in the acute period of ischemic stroke during systemic thrombolytic therapy and without its use. Materials and methods: We examined 26 male and female patients with a clinical diagnosis of ischemic stroke, who were hospitalized on the first day of the disease to the neurological departments. Patients were divided into 2 groups: group 1-patients who underwent systemic thrombolytic therapy (sTLT) (n=11), group 2-patients who did not receive sTLT (n=15). To compare the coagulogram parameters, 12 healthy patients were examined (control group). Examination of patients was performed on the 1st and 14th day of the disease (clinical examination, assessment of motor activity, coagulation test). Stroke severity was determined by the overall score of the National Institutes of Health Stroke Scale. Results: The average age of patients in group 1 - 60.1±8.2 years old, in group 2 -61.3±5.5 years old. The number of points on the NIHSS scale in group 1 was 8.8±1.13 on 1st day and 3.7±0.79 on 14th day (p<0.05), in group 2 -5.7±0,94 on the 1st day and 3.1±0.93 on the 14th day(p<0.05). The results of the study of the coagulogram indicate a significantly higher level of soluble fibrin-monomer complexes on the 1st day on the 14th day of the ischemic stroke. Conclusions: In the acute period of ischemic stroke changes in the hemostasis system reflected the direction of the selected therapy. The use of systematic thrombolytic therapy in ischemic stroke led to a more severe decrease in stroke severity on the NIHSS scale, a significant increase in Barthel index.
cerebral ischemic stroke is one of the most common diseases leading to psycho-emotional, cognitive and movement disorders. Modern research is aimed at searching for biological markers of brain damage in the diagnosis of strokes, in particular physical, imaging, electrophysiological, histological, genetic and neuronal markers, the determination of which can accelerate differential diagnosis. The purpose of the study was to assess the level of brain-derived neurotrophic factor in the blood, the state of motor and cognitive functions in the acute period of ischemic stroke on days 1 and 14, as well as the possibility of using the level of blood-brain neurotrophic factor as a marker of restoration of the motor and cognitive functions in atherothrombotic and cardioembolic subtypes of ischemic stroke. The study included 34 people diagnosed with acute ischemic stroke. Depending on the results of the clinical examination, the patients were divided into 2 groups: group 1 - patients in whom ischemic stroke occurred due to atherosclerotic lesions of the vessels of the carotid system with the development of occlusion by the mechanism of atherothrombosis (17 people), group 2 - patients in whom ischemic stroke occurred against the background of damage to the vessels of the carotid system with the development of occlusion by the cardioembolic mechanism (17 people). To compare clinical and laboratory parameters, a control group was additionally identified (patients of the neurological department who did not have damage to the central nervous system - 11 people). Examination of patients was performed on 1 and 14 day of the disease. Motor functions were assessed by the degree of daily activity of life, which was determined by the Barthel index, the state of cognitive functions - by the scale of Mini-Mental State Examination Mental State Examination. The Bartel index on the 1st day of the acute period of ischemic stroke was in the range of mild dependence for the cardioembolic subtype and moderate for atherothrombotic. Within 14 days, the studied patients of both groups had the increased index to the level of complete independence in group 1 and mild dependence in group 2. Among the examined patients with ischemic stroke, average values on the MMSE scale were determined at the level of moderate cognitive deficit per day in both subtypes of ischemic stroke. Restoration of cognitive function within 14 days after ischemic stroke occurred only in the second group before mild cognitive impairment. The concentration of neurotrophic factor of the brain on the 1st day of ischemic stroke decreased sharply compared with the control group. The obtained results allow to consider the brain neurotrophic factor as a prognostic objective biomarker of the prognosis of the restoration of motor and cognitive functions and the severity of cardioembolic and atherothrombotic ischemic stroke.
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