What Determines the Prognosis of Motor and Cognitive Functions in Patients with Vascular Diseases of the Nervous System: Clinical and Imaging Examples

In the modern paradigm, cerebrovascular diseases are classified depending on the caliber of arteries in which circulatory disorders occur and the rate of development of clinical symptoms. The purpose of this work was to analyze our own clinical and neuroimaging data of patients with various types of cerebral ischemia (after a stroke and those suffering from small cerebral vessel disease) to identify factors that influence motor or cognitive functions. Material and methods. The study included data from 417 patients (178 of whom were cerebral stroke survivors) from middle to old age according to the WHO classification. All of them underwent clinical and neuroimaging (computed tomography or magnetic resonance imaging) studies with tractography and morphometry of strategic areas of the brain. As clinical methods, we used neurological examination results, including those measured with different scales recommended for assessing motor and cognitive deficits in Russian official clinical guidelines and E. Heim scale for diagnosing coping strategies. Results and conclusions. To predict outcomes and more effectively build individual rehabilitation programs for patients with vascular diseases of the brain, it is important to use a combination of the results of clinical and neuroimaging techniques. For the functional independence of a patient who has suffered an ischemic stroke, the integrity of cerebral structures plays an important role: a decrease in fractional anisotropy below a threshold value of 0.963 or radial diffusivity below 0.776 according to magnetic resonance tractography are unfavorable prognostic factors for the restoration of motor functions to the level of functional independence (model sensitivity – 95.8% and specificity – 87.7%). Of the planimetric indicators according to computed tomography for cognitive recovery after a cerebral stroke, the large transverse sizes of the thalamuses turned out to be an unfavorable prognostic factor. In chronic cerebral ischemia caused by small cerebral vessel disease, the use of maladaptive coping strategies for psychological protection in stressful situations associated with postural instability was a negative prognostic factor for motor status. These parameters, along with those previously known, should be taken into account for the selection of effective methods of pharmacotherapy, physical therapy and psychological care for patients with diseases of the cerebral vessels.