ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA

İlk ve Tekrarlayan İnmeli Hastalarda Bilişsel Bozuklukların Prediktörleri
Predictors of Cognitive Impairments in Patients with First-Ever and Recurrent Stroke
Received Date : 01 Feb 2022
Accepted Date : 12 May 2022
Available Online : 23 May 2022
Doi: 10.31609/jpmrs.2022-88639 - Makale Dili: EN
J PMR Sci. 2022;25(3):315-23
ÖZET
Amaç: İnme sonrası genellikle bilişsel bozukluklar ortaya çıkar. Bu çalışmanın birincil amacı, ilk ve tekrarlayan inmeli hastalarda bilişsel bozuklukların prediktörlerini belirlemek; ikincil amacı, bu hastalarda 4-haftalık geleneksel ve bilişsel rehabilitasyon programı sonrası fiziksel, emosyonel ve bilişsel fonksiyonlarda, uyku ve yaşam kalitesinde oluşan gelişmeleri ortaya koymak ve karşılaştırmaktır. Gereç ve Yöntemler: Hastalar, ilk inme (n=21) ve tekrarlayan inme (n=18) olarak 2 gruba ayrıldı. Bilişsel işlevsellik; anlık ve gecikmeli hatırlama, dikkat, sözel olmayan akıl yürütme, apraksi bileşenlerini kapsayan bir nöropsikolojik test bataryası ve Mini Mental Test (MMT) ile ölçüldü. Fiziksel fonksiyon, duygudurum, uyku kalitesi ve yaşam kalitesi sırasıyla Fonksiyonel Bağımsızlık Ölçeği (FBÖ), Beck Depresyon Ölçeği, Pittsburgh Uyku Kalitesi İndeksi ve Nottingham Sağlık Profili ile değerlendirildi. Hastalara, hem geleneksel hem de bilişsel rehabilitasyon programı uygulandı. Başlangıçta (T0) ve 4 haftalık programdan sonra (T1) değerlendirildi. Bulgular: Yaş, MMT ile her iki grupta, sözel çağrışım çiftleri-1 ve Raven Standart Progresif Matrisler Testi ile sadece Grup-2’de negatif ilişkili idi. Her iki grupta da sol hemiplejik taraf ile sözel çağrışım çiftleri-1 ve sözel çağrışım çiftleri-2 arasında pozitif bir ilişki vardı. Sayı dizisi testi, motor, toplam FBÖ puanları, duygusal reaksiyonlar ve sosyal izolasyon alt grupları T1’de Grup 1 lehine daha iyi gelişti. Sonuç: Yaş ve hemiplejik taraf kognitif bozuklukların güçlü prediktörleridir. Genç hastalarda kognitif durum daha iyiyken, sağ hemisferik lezyonu olan hastalar daha iyi sözel sonuçlara sahiptir. Bilişsel programların dikkat becerilerini içermesi, ilk inmeli hastalarda rehabilitasyonun etkinliğini artırabilir.
ABSTRACT
Objective: Cognitive impairments usually occur after stroke. The primary aim of this study was to determine the predictors of cognitive impairments in patients with first-ever and recurrent stroke, and the secondary aim was to reveal and compare the improvements in physical, emotional and cognitive functions, sleep quality and quality of life after 4-week traditional and cognitive rehabilitation programs. Material and Methods: Patients were assigned into two groups: first-ever stroke (n=21) and recurrent stroke (n=18). Cognitive functioning was measured with a neuropsychological test battery comprising immediate and delayed memory, attention, non-verbal reasoning, and apraxia components; and Mini-Mental Status Examination (MMSE). Physical function, emotional status, sleep quality, and quality of life were evaluated by Functional Independence Measure (FIM), Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Nottingham Health Profile, respectively. Patients received both conservative and cognitive rehabilitation and assessed at baseline (T0) and after the 4-week program (T1). Results: Age was negatively related to MMSE in both groups and verbal paired associates (VPA)-1 and Raven’s Standard Progressive Matrices test in Group 2. There was a positive relationship between left-hemiplegic side and VPA-1 and VPA-2 tests in both groups. Number sequencing test, motor, total FIM scores, emotional reactions and social isolation subgroups improved better in favor of Group 1, at T1. Conclusion: Age and hemiplegic side are strong predictors of cognitive impairment. Young patients have better cognitive status, while patients with right hemispheric lesions have better verbal outcomes. Including attention skills in cognitive programs may increase the effectiveness of rehabilitation in patients with first-ever stroke.
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