Cognitive rehabilitation in cerebrovascular and neuro-oncological pathology: features of the methodological approach, comparative effectiveness

Cognitive impairment is an actual problem of patients operated on for neurosurgical pathology of the brain.

THE AIM OF THE STUDY was a comparative assessment of the severity of disorders of higher cortical functions and the effectiveness of cognitive rehabilitation in patients with neuro-oncological and cerebrovascular pathology of the brain.

MATERIALS AND METHODS: Among the studied 23 patients (14 men and 9 women, average age 60.45±7.87 years) suffered an ischemic stroke, 27 were operated on for a brain tumor: in 12 cases, meningiomas, in 12 — vestibular schwannomas, in 3 — astrocytomas (18 women, 9 men, average age 50.47±12.35 years). 30 patients received neuropsychological correction procedures in isolation, 20 — in combination with transcranial electromagnetic stimulation.

RESULTS. The test results of stroke patients on the Roschina scale were 18.0 (13.0; 22.0) points at admission, 14.0 (13.0; 22.0) points at discharge, the dynamics index was 4.0 (0; 5.0) points. The indicators of the Roschina test score in neuro–oncological patients were 19.0 (15.0; 21.0) points at admission, 11.0 (9.0; 15.5) points at discharge, the dynamics indicator was 8.0 (1.0; 11.5) points.

CONCLUSION. Thus, an integrated approach, including, in addition to neuropsychological correction, transcranial electromagnetic stimulation, makes it possible to improve the results of cognitive rehabilitation of vascular and neurooncological patients.

1. Bray F., Ferlay J., Soerjomataram I., Siegel, R.L. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492

2. Kim W.J., Novotna K., Amatya B. et al. Clinical practice guidelines for the management of brain tumours: A rehabilitation perspective. J. Rehabil. Med. 2019;51:89–96. https://doi.org/10.2340/16501977–2509

3. Rost N.S., Brodtmann A., Pase M. P. et al. Post-Stroke Cognitive Impairment and Dementia. Circ Res. 2022;130(8):1252–1271. https://doi.org/10.1161/CIRCRESAHA.122.319951

4. Anderson C.S., Huang Y., Lindley R. I. et al. ENCHANTED Investigators and Coordinators. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blindedendpoint, phase 3 trial. Lancet. 2019;393(10174):877–888. https://doi.org/10.1016/S0140–6736(19)300388

5. Fu J.B., Morishita S., Yadav R. Changing paradigms in the rehabilitation of inpatients with brain tumors. Curr. Phys. Med. Rehabil. Rep. 2018;6:115–120. https://doi.org/10.1007/s4014101801820

6. Tucha О., Smely С., Preier М. et al. Cognitive deficits before treatment among patients with brain tumors. Neurosurgery. 2000;47(2):324–334. https://doi.org/10.1097/0000612320000800000011

7. Murashko N.K., Zalesnaya Yu.D., Lipko V. G. Criteria for assessing cognitive impairment after stroke. International Medical Journal. 2012;3:13–20. (In Russ.)

8. Razumnikova O. M. Reflection of personal properties in the functional activity of the brain. Novosibirsk: Nauka; 2005.— 135 p. (In Russ.)

9. Wefel J.S., Noll K. R., Scheurer M. E. Neurocognitive functioning and genetic variation in patients with primary brain tumours. Lancet Oncol. 2016;17:97–108. https://doi.org/10.1016/S1470-2045(15)003800

10. Bashir S., Uzair M., Abualait T. et al. Effects of transcranial magnetic stimulation on neurobiological changes in Alzheimer’s disease (Review). Mol Med Rep. 2022;25(4):109. https://doi.org/10.3892/mmr.2022.12625

11. Kalloch B., Weise K., Lampe L. et al. The influence of white matter lesions on the electric field in transcranial electric stimulation. Neuroimage Clin. 2022;35:103071. https://doi.org/10.1016/j.nicl.2022.103071

12. Grigorieva V.N., Nesterova V.N. Cognitive rehabilitation of patients with focal brain lesions. Practical medicine. 2012;2(53):70–73 (In Russ.)

13. Grushina T.I. Physiotherapy in cancer patients. M.: Medicine; 2006.— 206 p. (In Russ.)]

14. Medyanik I. A., Fraerman A. P., Rubina E. A. Problems of treatment and rehabilitation of patients operated on for brain tumors. Modern technologies in medicine. 2011;3:128–133. (In Russ.)

15. Dobrushina O. R., Sidyakina I. V., Lyadov K. V. Navigational transcranial magnetic stimulation in the rehabilitation of traumatic damage to the frontal lobes of the brain. Annals of Clinical and Experimental Neurology. 2014;8(3):49–56. (In Russ.)

16. Kuznetsova S. M., Skachkova N. A. Hemispheric features of the effect of transcranial magnetic stimulation on the bioelectric activity of the brain of stroke patients. Vestn. KazNMU. 2015;2:406–411. (In Russ.)