Highlights It has been demonstrated for the first time that multitasking cognitive training reduced the density of low-frequency current sources in the frontal and temporal regions of the brain involved in encoding memories and regulating general brain activity in patients after coronary artery bypass surgery. Aim. To study the topological features of brain activity assessed using the standardized low-resolution brain electromagnetic tomography (sLORETA) method in patients with multitasking cognitive training after coronary artery bypass grafting (CABG). Methods. A prospective study enrolled 100 patients admitted to the hospital for CABG, aged 45 to 75 years. All the patients were randomly assigned to a group with multitask cognitive training (MCT) or a comparison group without training (n = 50). The MCT protocol included a postural task performed simultaneously with cognitive tasks involving mental arithmetic, verbal fluency, and the unusual use of a common object. The MCT course was conducted daily, starting 3–4 days after CABG, and lasted 5–7 days. Standardized low-resolution brain electromagnetic tomography (sLORETA) was used to localize current density sources to assess the topography of changes in brain electrical activity. Results. It was found that there was a decrease in the frontotemporal density of current sources at frequencies of 3–5 and 5–7 Hz after MCT during the early postoperative period CABG, compared to preoperative values (t > 3.43; p < 0.003 and t > 3.53; p < 0.007). Between-group differences were observed in the mediobasal regions of the brain; patients after MCT had a lower density of activity sources in the 3–5 Hz range compared to the group without training (t > -3.48; p < 0.04). Conclusion. The MCT helped to reduce low-frequency activity in patients after coronary artery bypass grafting (CABG). Topographic features were associated with the frontotemporal and medial basal regions of the brain, which are involved in memory encoding and regulating general brain activity. These findings emphasize the significance of investigating neural mechanisms underlying the effectiveness of multitasking interventions in cognitive rehabilitation. The data obtained can be utilized to develop and conduct future research aimed at enhancing cognitive rehabilitation programs.

The study investigated the changes in theta activity and localization of its sources by standardized low resolution brain electromagnetic tomography (sLORETA) in patients who have underwent two variants of multitasking cognitive training (CT) in the early postoperative period of coronary artery bypass grafting (CABG). Two groups were formed in a pseudo-random way, which differed according to the type of motor problem used: CT I (n = 27)—a postural balance task and CT II (n = 27)—a simple visual-motor reaction. Cognitive tasks were the same for both groups (counting backwards, verbal fluency, and unusual uses for common objects). Daily sessions of CT were held from the 3rd to 4th day after CABG, with a duration of 5 min on the 1st day of training and up to 20 min on the 6th to 7th day of training. The current density of theta-rhythm sources was lower before CABG than after surgery in the CT II group only. The most significant differences are in Brodmann area 31, the parietal occipital lobes, and precuneus, which may indicate damage associated with cardiac surgery. This effect was not observed in the CT I group. The results of our study demonstrated the informativeness of sLORETA indicators to determine an effective cognitive recovery option after CABG. The reduction of the severity of damaging effects of CABG during training using cognitive tasks and postural balance tasks was shown. Further research is needed to determine the optimal mode and duration of cognitive training to maximize the functional reserves of such patients.

HighlightsThe effectiveness of cognitive rehabilitation (the absence of the postoperative cognitive dysfunction (POCD) is associated with the emotional regulation of behavior and frequency-spatial organization of brain activity.The positive outcome of cognitive rehabilitation is promoted by «pre-tuning» background theta activity associated with the components of emotional intelligence: «attention to emotions» and «use of emotions in decision making». The distinctive feature of the group with unsuccessful rehabilitation is the link between empathy and high-frequency beta 2 rhythm. Aim. To study the relationship between the components of emotional intelligence (EI) and electrical activity of the brain (EEG), reflecting the effects of cognitive rehabilitation using multitasking training in cardiac surgery patients. Methods. The prospective cohort study included 83 patients who had undergone direct myocardial revascularization, 42 of whom underwent multitasking training in the early postoperative period. Physical, laboratory, and extended neurophysiological examinations were performed before cardiac surgery and 11–12 days after the intervention.Results. The effectiveness of cognitive rehabilitation (absence of postoperative cognitive dysfunction (POCD)) is related to peculiarities of emotional regulation of behavior, reflected in the ratio of components of EI and frequency-spatial organization of brain activity. The group of patients with positive cognitive rehabilitation (absence of POCD) is characterized by «pre-tuning» background theta activity associated with the components of emotional intelligence: «attention to emotions» and «use of emotions in decision making». The distinctive feature of the group with unsuccessful rehabilitation is the link between empathy and high-frequency beta 2 rhythm.Conclusion. Regional features of detected coupling patterns of EI and brain activity suggest that the effectiveness of cognitive rehabilitation using multitasking training is determined by the degree of preservation of cortical control functions during the development of cardiac artery disease, reflected in the peculiarities of emotional regulation of behavior of the patients.

Цель работы. Оценить прогрессирование стенозов сонных артерий, их связь с цереброваскулярными событиями и нарушениями липидного метаболизма у пациентов в отдаленном периоде коронарного шунтирования. Материалы и методы. В проспективное исследование включены 152 пациента, все мужчины, медиана возраста – 57 лет, из них у 37% выявлены стенозы сонных артерий < 50%. Перед коронарным шунтированием и через 5-7 лет после операции всем пациентам проводился нейропсихологический скрининг, дуплексное сканирование брахиоцефальных артерий с цветным допплеровским картированием кровотока и исследование показателей липидного обмена. Статистический анализ выполнялся в программе Statistica 10 (StatSoft, Inc., США). Результаты. Установлено, что через 5-7 лет после коронарного шунтирования число пациентов со стенозами сонных артерий увеличилось до 57%, при этом ишемические инсульты развились в 5% случаев, деменция – у 2,6% больных. В группе пациентов со стенозами сонных артерий число случаев умеренного когнитивного расстройства увеличилось с 18% до 23%. Целевых значений концентраций липидов достигла лишь малая часть больных, а среди пациентов со стенозами сонных артерий целевого уровня липопротеинов низкой плотности не смог достичь никто. Треть всех обследованных пациентов в течение 5-7 лет после коронарного шунтирования отказались от приема статинов. Заключение. В отдаленном послеоперационном периоде коронарного шунтирования (через 5-7 лет) возросло число пациентов, имеющих стенозы сонных артерий, у части пациентов развились ишемические инсульты и деменция. При этом оптимальных значений концентраций липидов, рекомендованных для пациентов, перенесших коронарное шунтирование, достигла лишь малая часть больных, а пациенты со стенозами сонных артерий не смогли достичь целевых значений концентраций холестерина липопротеинов низкой плотности. Objective. To assess the progression of carotid artery (CA) stenoses, the relationship to cerebrovascular events and lipid metabolism disorders in patients in the long-term period of coronary artery bypass surgery (CABG). Materials and methods. The prospective study included 152 patients, males, median age 57 years, of whom 37% had identified < 50% СA stenosis. Neuropsychological screening, duplex scanning of brachiocephalic arteries with colored Doppler blood flow mapping and lipid metabolism parameters evaluation were performed in all patients before and at 5-7 years after surgery. Statistical analysis was performed using the Statistica 10 program (StatSoft, Inc., USA). Results. It was found that the number of patients with CA stenosis increased to 57%, the incidence of acute ischemic stroke was 5% cases, dementia – 2.5% at 5-7 years after CABG. Also, in the group of CA stenoses, the number of cases of mild cognitive impairment increased from 18% to 23%. Only a small proportion of patients reached the target lipid concentrations, and none of patients with CA stenoses reached the target level of LDL. One-third of all patients examined at 5-7 years after CABG refused to take statins. Conclusion. In the long-term postoperative period of CABG (after 5-7 years) there was an increase in the number of patients with CA stenoses, some patients had ischemic strokes and dementia. At the same time, only a small proportion of patients with lipid was able to reach the optimal values recommended for CABG patients, and patients with CA stenoses were unable to reach the target cholesterol LDL concentrations.

OBJECTIVE:To compare biomarkers of neurovascular unit (NVU) - S100β, NSE, BDNF and indicators of the brain electrical activity in patients who underwent coronary artery bypass grafting (CABG) depending on the use of different versions of multi-tasking cognitive training (CT). MATERIAL AND METHODS:The study included 89 people, of whom 47 completed the CTI (postural and three cognitive tasks (counting backwards, verbal fluency and the open-ended task «Unusual use of an ordinary object») and 42 patients, who underwent CTII (visuomotor reaction and the same cognitive tasks) in the early postoperative CABG period. The patients of both groups underwent complex testing of psychomotor, executive functions, attention, short-term memory and EEG study in the perioperative period of CABG. Concentrations of NVU markers in peripheral blood serum were also analyzed. RESULTS:The highest values of S100β protein concentration in both patients with CTI and CTII were observed on the 1st-2nd days after CABG, followed by a significant decrease on the 10th-12th days to preoperative values only in the CTII group. Also, during CTI, low concentrations of S100β and NSE protein were associated with higher indicators of cognitive status, such as short-term memory and general integral index. In patients with CTI, the concentration of BDNF on days 10-12 of CABG was significantly higher compared to patients with CTII, and its higher levels were associated with higher levels of attention. Only if the training was successful, the patients with CTI had greater preoperative levels of EEG alpha-1 and alpha-2 activity compared to patients with CTII. CONCLUSION:The version of multitasking CT using the postural motor component more actively triggered the processes of neuroplasticity due to the expression of BDNF and its success was due to the greater presence of alpha-activity in the preoperative period of CABG. Further research is needed to study the neurophysiological mechanisms of recovery of cognitive functions after cardiac surgery.

HighlightsFor the first time it was demonstrated that changes in the neurophysiological parameters and markers of the neurovascular unit in cardiac surgery patients under the influence of multitask training in a three-dimensional environment result in optimization of the attention and short-term memory domains, the absence of significant dynamics of low-frequency theta activity and a pronounced activation of BDNF synthesis in contrast to patients without training. AbstractAim. To study the changes in a complex index of cognitive status in the neurodynamic, attention and short-term memory domains, electroencephalogram (EEG) indices and neurovascular unit (NVU) markers in cardiac surgery patients under the influence of multitask training in a three-dimensional environment.Methods. The prospective randomized study included 100 patients who were divided into two groups using the envelope method: 47 patients underwent a course of multitask training in a three-dimensional environment and 53 patients received no training. In addition to a standard clinical examination, all patients underwent an extended study of cognitive status, EEG parameters, and NVU markers in peripheral blood.Results. The complex indicators of attention and short-term memory improved at 11–12 days after CABG compared to preoperative values, but only in patients who underwent training. There were no significant changes in complex indicators of cognitive domains in patients without training. Analysis of the EEG total power revealed that theta 1 rhythm indicators did not statistically differ from preoperative values in patients who underwent training. In the group without training, the increase in theta activity (theta1 and theta2) was significant, as was beta 1–2 activity. The dynamics of changes in the BDNF indicator demonstrated that in patients with training, who had an increase in BDNF concentrations in the peripheral blood on the 1st day after CABG, there was no development of early POCD at 11–12 days after cardiac surgery.Conclusion. The multitask trainings in a three-dimensional environment contributed to a decrease in the incidence of POCD at the end of the in-hospital stage of CABG due to optimization of the activity of the attention and short-term memory domains. The positive effect of the training was the absence of significant dynamics of low-frequency theta activity and a more pronounced activation of BDNF compared to patients without training, which may indicate a reorganization of brain activity and NVU, but this effect requires confirmation in further studies.

Aim. To compare the incidence of postoperative cognitive dysfunction and neuropsychological changes in the early postoperative period of coronary artery bypass grafting (CABG) in patients who underwent two versions of multitask cognitive training, which involved various cognitive and motor tasks, as well as in a control group.Material and methods. The study included 100 patients after elective CABG. All patients were randomly divided into three following groups: cognitive training (CT) 1 (postural balance combined with mental arithmetic, verbal fluency, and unusual object use tasks) (n=30), CT 2 (simple visual-motor response combined with task on mental arithmetic, verbal fluency and unusual object use) (n=35) and without training (standard postoperative therapy) (n=35). All patients underwent extensive neuropsychological testing before CABG. Reexamination with assessment of postoperative cognitive dysfunction (POCD) was carried out on days 2-3 and upon completion of 5-7 days of training or on days 11-12 after CABG.Results. The presence of POCD on days 2-3 was found in 100% of patients in the study groups. On days 11-12 of CABG, POCD persisted in 17 people (56,7%) from the CT 1 group, in 24 (68,6%) from the CT 2 group, and in 28 (80%) patients in the control group. Significant differences were obtained in the POCD prevalence in the CT 1 and control groups (odds ratio =3,06; 95% confidence interval: 1,02-9,18, p=0,04), but not CT 2 and control groups (odds ratio =1,83; 95% confidence interval: 0,64-5,47, p=0,28).Conclusion. Multitask training using a combination of postural balance and mental arithmetic tasks, verbal fluency, and unusual object use had a greater effect in reducing the POCD incidence in patients after CABG compared with standard postoperative care. The results of this study may be used to develop cognitive rehabilitation programs in cardiology and cardiac surgery.

HighlightsThe effectiveness of cognitive rehabilitation in reducing the incidence of early postoperative cognitive dysfunction in patients who have undergone coronary artery bypass grafting has been demonstrated for the first time by optimizing neurodynamics and memory parameters. AbstractAim. To study the effectiveness of cognitive training (CT) using a combination of simple visual-motor reactions with a set of arithmetic and verbal tasks to reduce the frequency of early postoperative cognitive dysfunction (POCD) in patients who underwent coronary artery bypass grafting (CABG), and to evaluate the dynamics of the neurovascular unit markers (NVU).Methods. The prospective randomized study included 81 patients: group with CT (n = 43) and the comparison group without CT (n = 38). All patients underwent general clinical, laboratory and instrumental examinations as well as extended neuropsychological examination and determination of concentrations in the plasma of peripheral blood of NVU markers.Results. Patients who underwent CT with a combination of vision-motor task and cognitive components in the early post-operative period of CABG showed better psychomotor and executive functions (faster reaction time, a smaller number of errors and missed signals), as well as attention (more processed symbols in the 4th minute of Burdon’s test) compared to patients without training. The patients with CT also had a decrease in the concentration of S100β protein in peripheral blood at 11–12 days after CABG and a tendency towards higher the concentration of BDNF. The comparison group had an increase in the concentration of S100β protein at 1st day after surgery and maintained an elevated level until 11–12 days after CABG.Conclusion. Thus, the cognitive rehabilitation as the combinations of simple visual-motor reactions with a set of arithmetic and verbal tasks in the early postoperative period of CABG contributed to a decrease in the incidence of early POCD and the maintenance of the cognitive status of patients to a greater extent due to the optimization of the activity of the neurodynamic and short-term memory domains. The decrease in the concentration of S100β protein in the peripheral blood at 11–12 days after CABG and the tendency towards higher concentration of BDNF, observed in patients with CT in comparison to patients without CT, may indicate NVU reorganization.

Aim. Approbation of a course of cognitive rehabilitation using multitasking cognitive training in the early postoperative period of coronary artery bypass grafting (CABG).Materials and Methods. The study involved 10 cardiac surgery patients who underwent a course of multitasking cognitive training in the early postoperative period of CABG. All patients underwent neurological and advanced neuropsychological testing before the intervention and upon completion of cognitive rehabilitation. The results of cognitive rehabilitation of two study participants are described as clinical cases.Results. Most patients (7 out of 10) responded positively to the course. It was also possible to achieve a reduction in the frequency of postoperative cognitive dysfunction (POCD) to 40 %. The individual relative change (Δ) index showed that 5 patients (50 %) improved by 20 % or more, or did not change their executive and psychomotor functions, attention scores in 3 patients (30 %), short-term memory improvement − 7 patients (70 %). Successful completion of cognitive rehabilitation course (no POCD) was observed in a man, 60 years old, with initial lack of cognitive impairment with sufficient level of motivation to undergo training. Whereas for a 68-year-old patient with preoperative cognitive impairment and reduced motivation, the training course was unsuccessful.Conclusion. Seven out of 10 patients showed satisfactory results in individual transferability of the multitask training course, as well as transfer of the training effect to other cognitive functions not trained. Two clinical cases demonstrated that the initial cognitive status, level of motivation and even gender of patients can affect the effectiveness of cognitive rehabilitation in the early postoperative period of coronary artery bypass grafting.

The effect of atherosclerotic lesions of the carotid arteries (CA) on the success of the cognitive function recovery procedures in cardiac patients has not been sufficiently studied. This study aims to evaluate the effects of cognitive rehabilitation depending on the presence of CA stenosis in patients after coronary artery bypass grafting (CABG) using neurophysiological indicators.Material and methods. The cohort prospective study involved 85 patients (16 of them women), aged 45 to 75 years, admitted for elective CABG. All patients underwent standard clinical and instrumental, neurological, extended neuropsychological and neurophysiological examination.Results. After multi-task training, the patients with CA stenosis had higher levels of high-frequency beta power (13-30 Hz), while the spectral power of the alpha1 rhythm (8-10 Hz) in this group was lower compared to patients without stenosis. In the case of successful cognitive rehabilitation (absence of POCD) at 11–12 days after CABG, compared with the group with POCD, patients without stenoses had higher total power of alpha 1 power and lower — beta power than patients with stenoses CA.Conclusion. The absence of CA stenosis in the patients with successful completion of multi-tasking training contributed to the optimization of brain activity with an increase of alpha power. Whereas the patients with CA stenosis were characterized by an increase in high-frequency brain activity, both in the case of successful multi-tasking training and in its absence, in the early postoperative period of CABG. This study may serve as a basis for the development of special cognitive rehabilitation programs for patients with atherosclerotic lesions of the carotid system.

Цель исследования – оценка когнитивных функций в послеоперационном периоде у пациентов, перенесших симультанное вмешательство на коронарном и каротидном бассейнах.

OBJECTIVE:To identify the features of the cognitive status in patients with cardiac surgery profile with senile asthenia syndrome (SAS) and preasthenia.MATERIAL AND METHODS:A study included 272 patients admitted for coronary artery bypass grafting (CABG). Screening for preasthenia and SAS in patients before surgery was performed using the Brief Battery of Physical Functioning Tests. SAS and preasthenia were detected in 15% of patients (n=41). Seventy-five patients were selected in the comparison group without asthenia. Assessment of the state of cognitive functions was carried out using screening neuropsychological scales - the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).RESULTS:The median of the MMSE score (27 [26; 28] and 28 [27; 29], p=0.04), and the MoCA score (23 [19; 25] and 25 [23; 27], p=0.0085) was significantly lower in patients with asthenia and pre-asthenia compared to patients without asthenia. According to the MoCA, about 60% of patients in the pre-asthenia-asthenia group had severe cognitive impairment, while in the group without asthenia, more than 30% of cases had normal cognitive functions (p=0.003). Significant intergroup differences were found in MoCA subtests, reflecting visuospatial skills, abstraction, verbal fluency and working memory (p=0.01-0.04). Regression analysis showed that age and physical functioning index (severity of asthenia) most significantly contributed to the basic cognitive status assessed by MoCA.CONCLUSION:Features of the cognitive status in patients of cardiac surgery with the SAS and preasthenia are impairments of visuospatial thinking, verbal fluency, abstract thinking and working memory. The MoCA was shown to be informative in determining the basic cognitive status of cardiac surgical patients. At the same time, the greatest contribution to the basic cognitive status is made by age and the indicator of physical functioning, which characterizes the degree of asthenia.

The effect of dual-task cognitive training on neurophysiological parameters of patients with postoperative cognitive dysfunction (POCD) in the early postoperative period of coronary artery bypass grafting (CABG) under cardiopulmonary bypass was examined. The study involved 96 male patients who underwent CABG. All patients underwent a detailed neuropsychological and electroencephalogram (EEG) analysis before and after CABG. On day 2 or 3 after surgery, all patients were diagnosed with POCD and randomly divided into two groups: a group who received training (n = 54) and a group with no training (n = 42). From days 3–4 of the postoperative period, a daily course of dual-task training (simultaneous performance of cognitive and physical tasks) was carried out. Repeated diagnostics for POCD was carried out at the end of the training course, on days 8–11. It was demonstrated that patients who successfully completed the training course (with no POCD on days 8–11) showed a postoperative power decrease in θ1-rhythm, while in all patients with POCD, these indices increased compared to preoperative data. Topographic changes in θ1 rhythm were detected in the left parietal areas, which may be indicative of the impaired perfusion in these regions of the brain.

Highlights We estimated theta current sources density changes in patients who received cognitive multitasking training in the early postoperative period of cardiac surgery. Patients with cognitive multitasking training had a significantly lower theta current source density (t<–3.89; p<0.002) before surgery compared to baseline. The strongest differences were localized in Brodmann areas 7, 19 and 31 which related to the structures of the parieto-occipital lobes of the brain, cuneus and precuneus. Abstract Aim. The effect of cognitive recovery techniques on brain activity remains a significant issue in modern health care. The aim of this study was to estimate theta current sources density changes using standardized low resolution electromagnetic tomography – sLORETA – (standardized low resolution brain electromagnetic tomography) in patients who have received cognitive multitasking training (CMT) in the postoperative period of coronary artery bypass grafting (CABG). Methods . The study included 30 patients aged between 45 and 75 years who underwent routine CABG. Clinical and neurophysiological examinations were carried out 2–3 days before surgery and 11–12 days after CABG. The cognitive training started 3–4 days after CABG and lasted until discharge and consisted of a motor task - a keypress in response to an object appearing on the screen and three consecutive cognitive tasks (counting backwards, verbal fluency and unusual use of an ordinary object). Results. Patients with CMT had lower theta current source density (t<–3.89; p<0.002) before CABG as compared to postoperative data, the most significant differences were noted in parieto-occipital lobes of the brain, cuneus and precuneus (Brodmann areas 7, 19 and 31). Conclusion. The results of our research contribute to a better understanding of the pathogenetic mechanisms underlying postoperative cognitive impairments in cardiac surgery patients.

Highlights The presence of preoperative mild cognitive impairment (MCI) in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting is associated with an increased theta activity at the frontal and parieto-occipital regions of both hemispheres after surgery. Abstract Aim. To study the impact of preoperative cognitive impairment on changes in electrical activity of the brain in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting. Methods. Sixty-three patients undergoing combined carotid endarterectomy (CAE) and coronary artery bypass grafting (CABG) were included in the study. The patients were divided into three groups, depending on the preoperative cognitive functions: without cognitive impairment (n = 17), with MCI (n = 29), and with severe cognitive impairment (n = 17). High-resolution electroencephalography (EEG) (62 channels, bandpass filtered between 0.1–50.0 Hz, sampling rate of 1000 Hz) was performed 3–5 days before and 7–10 days after surgery. Results. Patients with severe cognitive impairment at baseline presented with higher theta activity at the frontal region of the left hemisphere compared to patients without cognitive impairment and patients with MCI (p = 0.048). At the same time, patients with MCI showed the most pronounced theta activity increase after surgery compared to preoperative levels at the frontal and parieto-occipital cortical regions of both the left and right hemispheres (p≤0.05). Postoperative changes of theta activity in patients with severe cognitive impairment were minimal and statistically insignificant. Conclusion. Patients without severe preoperative cognitive impairment presented with higher grade brain dysfunction in the form of increased theta activity at the frontal and parieto-occipital regions after combined CAE and CABG. A smaller decrease in theta power after surgery in patients with severe preoperative cognitive impairment, on the one hand, can indicate compensation after cerebral ischemia and resistance to hypoperfusion during on-pump cardiac surgery, and on the other, can be a manifestation of the ceiling effect and insufficiency of brain functional reserves.

ФИЗИОЛОГИЯ. ПАТОФИЗИОЛОГИЯ. ДИАГНОСТИКА ■Цель -изучение клинических и нейрофизиологических показателей пациентов, перенесших транскатетерную имплантацию аортального клапана (ТИАК).Материал и методы.В настоящее исследование, согласно критериям включения, вошли 30 пациентов (из них 26 женщин), медиана возраста 75 лет.Помимо стандартного клинического обследования, всем пациентам за 1-2 дня до вмешательства и на 5-7-е сутки после ТИАК проводилось нейрофизиологическое обследование с использованием Монреальской шкалы когнитивной дисфункции (MoCA), расширенного нейропсихологического тестирования и цифровой электроэнцефалографии (ЭЭГ).Результаты.При проведении ТИАК в 10% случаев (n=3) в аортальную позицию имплантировался транскатетерный баллон-расширяемый клапан (Sapien XT), тогда как у 90% пациентов использовались самораскрывающиеся протезы (Acurate, EvolutR, Portico).Большинство пациентов (n=29) оперировались с использованием локальной анестезии (1 случайобщая анестезия с искусственной вентиляцией легких).Длительность госпитального периода и нахождения пациентов в отделении реанимации не превысили 10 и 2 дней соответственно.На протяжении периода наблюдения в госпитальном периоде ТИАК не отмечено неблагоприятных кардиоваскулярных событий.В 3 случаях (10%) в госпитальном периоде ТИАК потребовалась имплантация постоянного электрокардиостимулятора в связи с развитием значимых нарушений атриовентрикулярной проводимости.Расширенное нейропсихологическое тестирование позволило выявить послеоперационную когнитивную дисфункцию (ПОКД) в 80% случаев (n=24).Ухудшение исполнительных функций наблюдалось у 26 (87%) пациентов, комбинация снижения исполнительных функций и кратковременной памяти -у 18 (60%).По данным ЭЭГ пациенты демонстрировали признаки корковой дисфункции после проведения ТИАК с увеличением показателей тета (4-8 Гц) и низкочастотной альфа-активности (8-10 Гц) по сравнению с предоперационным уровнем.Заключение.В настоящем исследовании, несмотря на удовлетворительные клинические результаты процедуры ТИАК, выявлена высокая частота ПОКД с преимущественным ухудшением исполнительных функций и кратковременной памяти, а также проявления корковой дисфункции в виде увеличения медленноволновой ЭЭГ-активности.Полученные данные указывают на необходимость дальнейшего изучения особенностей работы мозга под воздействием факторов, сопровождающих ТИАК, и повышения ее безопасности для когнитивного функционирования пациентов.Финансирование.Исследование выполнено при финансовой поддержке Министерства науки и высшего образования

Irina D. Syrova, Irina V. Tarasova, Olga A. Trubnikova, Darya S. Kupriyanova, Anastasia S. Sosnina, Tatyana B. Temnikova, Olga L. Barbarash

Aim. To determine the relationship between perioperative factors and cognitive function in patients after coronary bypass grafting (CABG) in combination with unilateral carotid endarterectomy (CE).Material and methods. We examined 56 men in the perioperative period with CABG combined with unilateral CE (mean age, 64,0±7,1 years). Cognitive assessment was performed before and 5-7 days after surgery with Status PF program. An advanced psychometric examination included an assessment of voluntary attention (Bourdon test), short-term memory (tests on memorizing 10 numbers, 10 words, and 10 syllables), neurodynamics (visual-motor reaction time, level of functional mobility of nervous processes, brain performance, as well as the number of errors in these tasks and missed positive signals). The concentration of neuron-specific enolase (NSE) and S100β protein in the blood serum of patients before surgery, 24 hours and 5-7 days after surgery was determined using enzyme immunoassay.Results. In the early postoperative period, an increase in reaction time (p=0,031) was accompanied by an increase in errors in this test (p=0,042) and a decrease in the number of memorized numbers (p=0,022). Twenty four hours and 5-7 days after surgery, there were no differences between the perioperative NSE level (p1-2-3>0.05). Twenty four hours after CABG surgery, the level of S100β protein increased by 9,0% (p=0,001), while regression of S100β protein to the preoperative level was observed 5-7 days after operation.Conclusion. A relationship was found between the CABG factor and the attention level (r=-0,518; p=0,031), functional mobility reaction time (r=0,476; p=0,041), and the number of errors (r=0,449; p=0,032). A correlation was found between the factor of neurochemical markers, the number of processed letters on the 1st minute of Bourdon test (r=-0,642; p=0,014), the total number of processed letters in Bourdon test (r=-0,617; p=0,017). The combined factor of perioperative period was associated with functional mobility reaction time (r=0,609; p=0,041), the number of processed letters at 4 min (r=-0,490; p=0,017), and the total number of processed letters in the Bourdon test (r=-0,334; p=0,006).

ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнительная оценка когнитивных показателей в периоперационном периоде изолированного коронарного шунтирования (КШ) и его сочетания с каротидной эндартерэктомией (КЭЭ). МАТЕРИАЛ И МЕТОДЫ Выполнен сравнительный анализ когнитивного статуса 56 пациентов с мультифокальным атеросклерозом коронарных и прецеребральных артерий, подвергшихся симультанному вмешательству КШ и КЭЭ (средний возраст 64,8±7,1 года), и 67 пациентов с изолированной ишемической болезнью сердца (ИБС), перенесших прямую реваскуляризацию миокарда в условиях искусственного кровообращения (средний возраст 57,1±5,8 года). Нейропсихологическое исследование включало Минимальную шкалу оценки когнитивного статуса (Mini-Mental State Examination), батарею лобной дисфункции (Frontal Assessment Battery). Оценку памяти, внимания и нейродинамики проводили на программно-аппаратном комплексе Status-PF за 2—3 дня до вмешательства и через 5—7 дней после вмешательства. Послеоперационную когнитивную дисфункцию (ПОКД) диагностировали при снижении от исходных показателей памяти, внимания и нейродинамики на 20% в 20% пройденных тестов. Статистическую обработку результатов исследования проводили при помощи статистического пакета Statistica 10.0. РЕЗУЛЬТАТЫ В дооперационном периоде умеренные когнитивные расстройства имели 24 (36%) пациента группы изолированного КШ и 31 (55%) пациент группы сочетанной операции (p=0,01). Пациенты с показаниями к сочетанной операции имели лучшие показатели кратковременной памяти, а именно воспроизводили большее количество из десяти запоминаемых бессмысленных слогов по сравнению с пациентами группы изолированного КШ. Показатели внимания и нейродинамики до операции были лучше у пациентов группы изолированного КШ. Так, они перерабатывали большее количество знаков на четвертой минуте корректурной пробы Бурдона, имели более высокие скорость при выполнении теста сложной зрительно-моторной реакции, уровень функциональной подвижности (УФП) нервных процессов и работоспособность головного мозга, тратили меньше времени на выполнение теста УФП и имели более высокий коэффициент внимания. Анализ градации уровней когнитивного статуса показал, что большая часть пациентов обеих групп обладала исходно низким уровнем когнитивного статуса (38 (68%) и 30 (44,7%) человек соответственно, p<0,0001). Уровень когнитивного статуса ниже среднего имели 11 (19,5%) пациентов группы симультанного вмешательства и 23 (34,3%) пациента группы изолированного КШ (p<0,0001). Также в группе изолированного КШ преобладали лица со средним уровнем когнитивного статуса (12 (18%) и 5 (9%) больных соответственно, p<0,0001). Количество пациентов с уровнем когнитивного статуса, соответствующим здоровым лицам, в группах не различалось. ВЫВОД Пациенты с мультифокальным атеросклерозом имеют худший когнитивный фон по сравнению с пациентами с изолированной ИБС до операции и в раннем послеоперационном периоде, а также высокий риск периоперационных событий. Однако частота ранней ПОКД после сочетанной операции сопоставима с таковой после изолированного КШ. Оба оперативных вмешательства способствуют развитию ранней ПОКД и не подтвердили свою безопасность с позиции профилактики вторичных цереброваскулярных осложнений.

Aim. To evaluate the effectiveness of dual-task computerized cognitive training (CCT) in the prevention of postoperative cognitive dysfunction in patients after on-pump coronary artery bypass grafting (CABG).Material and methods. This cohort prospective study included 68 patients (median age, 64 years [54; 69]) admitted for elective on-pump CABG. In addition to the standard preoperative examination, all patients underwent advanced neuropsychological and neurophysiological examination. Starting from 3-4 days of the postoperative period, all patients underwent dual-task CCT.Results. After 8-10 days, early postoperative cognitive dysfunction was observed in 37 (54,4%) patients from CCT group, while in patients without training in 69,3% of cases (n=79). The best results of cognitive functioning were achieved in neurodynamics and short-term memory. In addition, in patients who completed the training course, a postoperative increase in the frontooccipital gradient of theta rhythm was observed.Conclusion. Neuropsychological and neurophysiological assessment have demonstrated the limited effectiveness of a short-term dual task CCT using in the prevention of early postoperative cognitive dysfunction in patients after on-pump CABG. The dual task method can be an additional preventive intervention in the development of a personalized approach to cognitive rehabilitation therapy in cardiac surgery patients.