Cognitive disorders and dementia as a complication of cerebrovascular insufficiency during the period of ischemic stroke

Dzhibilov Aslan Yurievich, Khamgokova Inna Uralovna, Tlapshokova Larisa Betalovna

The key risk factors for cerebrovascular diseases are arterial hypertension (AH), atherosclerosis and diabetes mellitus; genetic factors are also important, in particular, the polymorphism of the APOE and MTHFR genes. At the stage of the formation of non-neurological factors, processes are already taking place that determine how pronounced and how quickly the cerebrovascular pathology will develop, how pronounced and significantly the structures of the brain will be damaged and this or that clinical symptomatology will form. At the stage when the diagnosis of cerebrovascular pathology cannot yet be established, prerequisites are already being created for the brain cells to be negatively affected. The results of these studies indicate that the presence of vascular risk factors in young and middle age is a potential cause of cognitive decline in adulthood. Those who, at the age of 40-44, had a higher total score for risk factors, demonstrate the worst results in tests that assess memory, information processing speed, and verbal ability. In arteriopathy, vascular patency is impaired, blood flow decreases, focal or diffuse lesions develop, which leads to the formation of a certain neurological deficit. Simultaneously with these additional negative processes, the development of inflammatory changes, a violation of the permeability of the blood-brain barrier, and secondary autoimmune lesions occur. In general, this leads to the fact that brain cells are affected, regardless of whether they are in the zone of strategic damage to the vascular system or not. In acute disorders of cerebral circulation, neuronal damage occurs not only in the area of acute cerebral ischemia, but also in non-ischemic areas of the brain that have synaptic connections with the primary lesion focus (in the hippocampus, thalamus, substantia nigra). In the ischemic-hypoxic cascade, heterogeneous etiological agents trigger the same type of processes that cause disruption of cell functioning and its death. Today we are talking about the close relationship of vascular pathology and neurodegenerative processes. With vascular pathology, neurodegenerative disorders occur in 30-80% of cases, and vice versa, with neurodegenerative processes up to 50% of the existing phenomena of vascular damage. Therefore, this combination must also be taken into account. The clinical manifestations of cerebrovascular pathology are motor and cognitive impairments, emotional and behavioral disorders, speech impairment. It should be noted that vascular cognitive impairment is usually characterized by decreased attention, executive function and psychomotor retardation, while memory impairment may not be observed.

Keywords:cognitive impairment, ischemic stroke, failure, dementia.