Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации7112Conference ProceedingsPREVALENCE AND SEVERITY OF COGNITIVE AND PSYCHOEMOTIONAL DISORDERS IN HYPERTENSIVE PATIENTS WHO HAVE SUFFERED ACUTE CEREBRAL CIRCULATORY DISORDERSKharkovskayaElenalenhar.elf@yandex.ruhttps://orcid.org/0000-0001-9799-2912N. N. Burdenko VSMU of the Ministry of Health of the Russian Federation30062022111551582901202211032022Copyright © 2022, Kharkovskaya E.2022<p>Relevance. Vascular diseases of the brain occupy a leading place in the hierarchy of medical and social problems at the present stage. Being the most common chronic disease, arterial hypertension is the most common cause of acute cerebrovascular accident. A significant proportion of post-infarction disorders account for cognitive disorders and disorders of the psycho-emotional sphere. The purpose of the work. To study the prevalence and severity of cognitive and psychoemotional disorders in hypertensive patients who have suffered acute cerebral circulatory disorders.Materials and methods. A group of patients was selected 36 people, average age 65.163.2. The study used the following methods of clinical examination of patients, analysis of outpatient charts, the following scales were used: MMSE (M. Folstein, 1975), geriatric depression scale (GDS-15), VAS. The Statistica 6.0 program was used for statistical processing of the material.</p>
<p>Results. According to the results of the study, the target blood pressure was achieved in both groups, but to control blood pressure in patients of group 1, the use of three-stage or more antihypertensive therapy is required, and for patients of group 2, a combination of two drugs was sufficient, and only a quarter of patients in this group needed a triple combination. According to the MMSE scale, moderate cognitive impairment was detected in group 1 patients. The indicators of group 2 did not reveal significant cognitive impairments. In group 1 patients, according to the Geriatric depression Scale, probable depression was established, in group 2 patients there were no signs of depression. The scores of both groups on the VASH scale indicate a periodic feeling of dissatisfaction with their lives. Disorders of the psycho-emotional sphere can be a significant obstacle in achieving compliance with therapy. Conclusion. The results of this study can be used to plan neurorehabilitation programs for patients with hypertension who have suffered acute cerebrovascular accident.</p>hypertensionpsychoemotional disorderscognitive disordersгипертоническая болезньпсихоэмоциональные нарушениякогнитивные нарушения<p>The relevance of research: Vascular diseases of the brain in the hierarchy of medical and social problems at the present stage occupy a leading place. More than 65% of the population over 60 suffer from hypertension [4]. Being the most common chronic disease, arterial hypertension is the most common cause of acute cerebrovascular accident, increasing the risk in patients with uncontrolled hypertension to develop a vascular "catastrophe" every year by more than 4.7% of the total in the population. The share of post-stroke disability accounts for 3.2 cases per 10,000 population, which puts it in first place in relation to other causes [2]. Only 1/5 of stroke patients can return to a full life [1]. More often this is due to young age and the effectiveness of neurorehabilitation programs [5]. In the structure of post-infarction disorders, a significant proportion of the consequences falls on cognitive disorders, which manifest themselves in a decrease in memory and attention, as well as in the intellectual capabilities of the individual [3]. A special role should be given to the psychological state of the patient, because it is the emotional status in this somatic pathology that is in the most labile state [1]. According to studies, it is known that in persons who have undergone acute cerebrovascular accident, cognitive abilities decrease, the emotional background changes, in the most severe cases, leading to depression and the patient's refusal to rehabilitate and cooperate with doctors. Thus, significantly reducing the possibility of one's own recovery after a vascular "catastrophe". Objective: To study the prevalence and severity of cognitive and psycho-emotional disorders in hypertensive patients with acute cerebrovascular accident. Tasks: 1. To determine the prevalence and severity of cognitive impairment in patients with hypertension and a history of stroke. 2. To study the emotional state in patients with hypertension and a history of stroke. 3. Assess the quality of life in patients with hypertension and a history of stroke. Materials and methods. Object of study: Patients of the outpatient department of VGP No. 10, building 6 with GB - 36 people, mean age 65.163.2. The number of men and women who took part in the study was 18 (50%) and 18 (50%), respectively. The patients were divided into 2 groups. The first group (12 people) with hypertension and stroke in history. The average age in the group was 65.163.23 years. The number of men and women (6 (50%) men and 6 (50%) women. The second group of patients with hypertension without a history of stroke (24 people) (65.23.26 years). The number of men and women (12 (50%) and 12 (50%), respectively.In patients of the first group with a history of stroke not more than 3 years old, the course of hypertension in both groups was at least 5 years from the moment of diagnosis. Hypertension was established on the basis of Clinical guidelines: Arterial hypertension in adults, year of approval: 2020. The patients were clinically examined, outpatient records were analyzed, the following scales were used: MMSE, geriatric depression scale, VAS. 1) Mini-MentalStateExamination (MMSE) (M. Folstein, 1975) is a short 30-point analysis used to assess the state of cognitive functions and the degree of their impairment (the maximum number of points is 30). The results were interpreted as follows: 0-10 points - severe dementia, 11-19 points - moderate dementia, 20-23 points - mild dementia, 24-27 points - moderate cognitive impairment, 28-30 points - no impairment cognition or mild cognitive impairment. 2) Geriatric Depression Scale (GERIATRICDEPRESSIONSCALE, GDS-15) is a 15-element test aimed at self-assessment of the presence of depression in geriatric patients (the maximum score is 15). The interpretation of the results was carried out as follows: less than 4 points on this scale do not give grounds for diagnosing depression, from 5 or more points - depression is likely. The Visual Analogue Scale (VAS) of the subjective assessment of the quality of life is a continuous scale on which there are two extreme points: "happiness, complete satisfaction with one's life" and "grief, complete dissatisfaction with one's life."</p>
<p><span class="VIiyi" lang="en"><span class="JLqJ4b" data-language-for-alternatives="en" data-language-to-translate-into="ru" data-phrase-index="0" data-number-of-phrases="1">3) To determine satisfaction with their lives, the VAS scale was used (maximum score 10). The interpretation of the results was carried out as follows: 0-2 points - "I am dissatisfied with my life", 3-4 - "sometimes I am satisfied with my life", 5-6 - "I am periodically dissatisfied with my life", 7-8 - "I satisfied with my life, problems happen, but everything is solved, 9-10 - I am happy and satisfied with my life. Statistica 6.0 software was used for statistical processing of the material. The mean value (M) was used as the most typical value for the sample, and the standard deviation (s) was used as a dispersion measure. Statistical significance was considered significant at p0.05. Results. Mean systolic blood pressure (SBP) in patients of the first group was: 130.88.21 mm Hg. The mean diastolic blood pressure (DBP) recorded during the examination reached 73.334.44 mm Hg. The results of measuring the pulse 69.168.58 beats per minute. The average SBP in patients of the second group was: 130.547.4 mm Hg. The mean DBP recorded during the examination reached 74.65.3 mm Hg. The results of measuring the pulse 74.09.3 beats per minute. Based on the obtained data, the target level of SBP and DBP was achieved in both groups. The average number of antihypertensive drugs taken by one patient in patients of the first group was: 2.380.7; in patients of the second group was: 1.750.3.</span></span></p>
<p><span class="VIiyi" lang="en"><span class="JLqJ4b" data-language-for-alternatives="en" data-language-to-translate-into="ru" data-phrase-index="0" data-number-of-phrases="1">The average score on the MMSE brief mental status study scale in patients of the first group was: 27.080.99, which corresponded to moderate cognitive impairment. In patients of the second group, this indicator was: 29.370.82, which characterizes the absence of cognitive impairment or mild cognitive impairment. The average score on the "Geriatric Depression Scale" in patients of the first group was: 4.08+1.08, which indicated in favor of probable depression; in patients of the second group, this indicator was: 0.50.66, which characterized the absence of depression. The average score on the Visual analog scale of satisfaction with their lives in patients of the first group corresponds to: 5.50.79; in patients of the second group, this indicator was: 6.50.66. The Vash score in both groups indicated that patients periodically experience dissatisfaction with their lives. Discussion. Target BP was achieved in both groups, but 2.380.7 antihypertensive drugs were used to control BP in group 1, and 1.750.3 drugs were used to control BP in group 2. This suggests that BP control in patients with a history of stroke requires the use of three or more stages of therapy. Whereas for patients of group 2, a combination of two drugs was sufficient, and only for 25% of patients in this group, a triple combination was necessary to achieve the target BP figures. According to the MMSE (Mini-MentalStateExamination) scale (M. Folstein, 1975), patients of the 1st group had moderate impairments in cognitive functions, the largest shift was found in the subscales: "attention concentration", "memory". Indicators of group 2 did not reveal significant cognitive impairment. In patients of group 1, according to the Geriatric Depression Scale, probable depression was fixed, while in patients of group 2, signs of depression were not observed. The scores of both groups on the VAS scale indicate a periodic feeling of dissatisfaction with their lives. Psychoemotional disorders can be a significant barrier to achieving therapy compliance.</span></span></p>
<p><span class="VIiyi" lang="en"><span class="JLqJ4b" data-language-for-alternatives="en" data-language-to-translate-into="ru" data-phrase-index="0" data-number-of-phrases="1">Conclusion. Based on the results of the study, the following conclusions can be drawn: 1. Patients with hypertension and stroke had a history of mild cognitive impairment, most pronounced in the functions of concentration and memory. 2. In the group of patients with hypertension and a history of stroke, the data obtained support the presence of probable depression. 3. The results on the VAS scale indicate that patients in both groups periodically experience dissatisfaction with their lives. The results of this scientific work can be used to plan neurorehabilitation programs for patients with hypertension who have undergone acute cerebrovascular accident.</span></span></p>[Гуреева И.Л., Голикова К.В., Гомзякова Н.А. Когнитивные и эмоциональные нарушения у пациентов с острым нарушением мозгового кровообращения. – Москва: Медицинская психология в России: электрон. Науч. Журн. – 2017. – Т. 9, №2 (43). – С. 9.][Гуреева И.Л., Гомзякова Н.А., Селькин М.Д. Нейропсихологические изменения у пациентов с острым нарушением мозгового кровообращения. - Вестник ЮУрГУ. Серия «Психология». - 2017. -Т. 10, № 4. - С. 28-36.][Дамулина А.И., Коновалов Р.Н., Кадыков А.С. Постинсультные когнитивные нарушения. ФГБНУ «Научный центр неврологии». – Москва: Неврологический журнал. – 2015. - С. 12-19.][Кадыков А.С., Шахпаранова Н.В. Нейропластичность и восстановление нарушенных функций после инсульта. – Москва: Физическая и реабилитационная медицина, медицинская реабилитация. – 2019. – С. 32-34.][Климов А. В. Артериальная гипертензия и ее распространенность среди населения. – Москва: Молодой ученый. - 2018. - № 50 (236). - С. 86-90.]