Acute disorders of cerebral circulation are one of the leading problems of modern clinical medicine, due to their significant spread in the human population and the extremely negative impact exerted on the patient’s body. Currently available data allow us to talk about the multi-vector nature of the pathogenesis of ischemic brain damage. Within the framework of the cascade of developing pathochemical and pathophysiological processes, an essential role in the formation of ischemic stroke belongs to the inflammatory reaction occurring through the immune system’s response to cerebral tissue ischemia. One of the places of its implementation is the vessel wall located in the ischemic zone, where monocytes and neutrophils are attracted with the help of cell adhesion proteins. Complement activation plays a significant role, carried out mainly due to the C3 component or during the initialization of the mannose pathway. Activation of microglia and astrocytes plays a huge role directly in the focus of ischemia. It should be noted that in the process of activation, both microglia and astrocytes are able to acquire a pro-inflammatory or anti-inflammatory phenotype. The prevalence of the pro-inflammatory variant contributes to prolonged damage to brain tissue, while the predominance of the anti-inflammatory phenotype has a protective effect. An important role is played by a violation of the function of the blood-brain barrier, which provides an additional influx of leukocytes to the site of ischemia. In addition, individual subpopulations of T-lymphocytes penetrating through the damaged barrier also play a significant role in the organization and dynamics of the immuno-inflammatory response. The action of Th1 and Th2 cells, gamma-delta T lymphocytes, natural killer cells, as well as regulatory T lymphocytes has been most studied. The role of B-lymphocytes in the formation of a stroke focus is considered.

Dementia is one variant severe disorder’s higher cortical function and is currently considered as one most important cause a decrease in the quality household, social adaptation patients, and a violation their ability function in the world around them. It can be formed in a wide range disease, main which are neurodegenerative processes, in particular Alzheimer’s disease. In the diagnosis cognitive disorders, in addition to clinical and neuropsychological, as well as laboratory examination, modern methods computer neuroimaging plays an essential role. Same time, significant importance is attached research based on magnetic resonance, which has achieved great progress in recent years. Changes recorded by structural magnetic resonance imaging (MR tomography) often “lag behind” recorded clinical symptoms and are determined advanced disease. New MR methods have been proposed to verify early manifestations of neurodegenerative changes observed in the brain. These include, in particular, MR morphometry. It allows you to determine absolute values severity of atrophic changes, to establish their exact topical localization. Its use not only improves the possibilities of diagnosis pre-stage stages, but also improves quality of differential diagnosis various pathogenetic variants observed cognitive disorders. In addition, use special postprocessing data processing programs reduce the likelihood errors in interpretation received data. Currently, three options have been proposed for evaluating the results of MR morphometry, based on the analysis volume individual brain structures, thickness gray matter, as well as the spatial shape certain formations. Integrated use these options contributes highest quality MR morphometric examination of the brain during formation neurodegenerative process.

Background. Acute disorders of cerebral circulation are one of the most urgent problems of modern clinical neurology. Its significance is due to both the high frequency of occurrence and a large number of unsatisfactory outcomes, as well as the significant impact on the quality of life. Cognitive disorders are one of the main syndromes that manifest in post-stroke period and are associated with the rehabilitation potential, as well as opportunities for social and household adaptation. Our objective was to study the profile of cognitive impairment in a continuous sample of patients with cardioembolic stroke in the acute period of stroke, as well as to determine the correlations between their occurrence and the factors determining the course of the disease. Design and methods. The study involved 46 patients of both sexes in the acute stage of ischemic stroke (average age was 69 ± 11 years). The selection of patients was carried out in accordance with the diagnostic criteria of the International Association of Vascular Behavioral and Cognitive Disorders VASCOG. The results of the Hachinski scale were also considered. All patients underwent interview for history, complaints, as well as the assessment of the neurological status. Risk factors for stroke were evaluated. We also assessed the results of computer and magnetic resonance imaging, standard “stroke” scales and performed a neuropsychological examination aimed at a comprehensive study of cognitive functions. All studies were conducted at the end of 10-14 days from the development of focal neurological symptoms. Results. Cognitive disorders in patients with cardioembolic ischemic stroke turned out to be quite heterogeneous. Their severity in the majority of our patients was considered as mild cognitive impairment. Changes at dementia level were much less common and were characteristic of patients with extensive lesions or in the case of disorders in the field of cognitively significant “strategic” foci. Neurodynamic disorders predominated in the profile of disorders of higher cortical functions. Memory impairment was expressed slightly and was of a secondary nature. With the aggravation of cognitive disorders, mnestic disorders progressed. In addition, regulatory disorders began to be detected. The most significant correlations were found between the results of neurocognitive tests on the one hand and the assessment on the Bartel scales, the assessment of changes in white matter, as well as the volume of the necrosis focus, the presence of heart failure and dyscirculatory encephalopathy in the anamnesis. Conclusions. Cognitive impairment is a significant component of the clinical picture of cardioembolic stroke. Their severity is largely determined by the volume and topical localization of the ischemic focus, as well as the presence and severity of previous chronic cerebrovascular pathology. This determines the need to develop methods to assess the state of cognitive functions before the development of stroke.

Aim – to study the features of moderate cognitive disorders in patients with acute ischemic stroke of the cardioembolic subtype during comprehensive neuropsychological testing in comparison with data on structural changes in brain tissue identified using visual semi-quantitative scales during magnetic resonance imaging of the brain. Material and methods. The prospective observational study involved 60 patients (22 women and 38 men) diagnosed with cardioembolic stroke. The study participants were divided into two groups: patients with non-amnesic (neurodynamic) multifunctional type of moderate cognitive disorders (40 patients: 70% men, 30% women, mean age 64.3 years) and patients with amnestic multifunctional type (20 patients: 50% men, 50% women, mean age 76.1 years). All patients underwent a comprehensive neuropsychological examination and magnetic resonance imaging of the brain using standard magnetic resonance scales. Results. Patients with non-amnestic multifunctional type of moderate cognitive disorders accounted for 67% of the examined patients (40 people), and 33% (20 people) were patients with amnestic multifunctional type. During the examination, neuropsychological features were identified in each group. 22% of patients (13 people) had infarctions in the “strategic” zones, and 45% of patients (27 people) had multiple focal ischemic strokes. In 90% of patients (54 people), there was a pronounced lesion of the white matter in the form of a hyper-intense signal from the periventricular and subcortical areas and a moderate widening of the cerebral sulci against the background of slight atrophy of the gyri. Conclusion. The comprehensive diagnostic approach, including neuropsychological testing and assessment of structural changes in the brain using visual semi-quantitative magnetic resonance scales, allows for the detection of cognitive impairments at the pre-dementia stage and the initiation of therapy aimed at preventing the progression of these impairments.

By now, methods structural magnetic resonance imaging (MRI) have firmly taken their rightful place in the diagnosis diseases accompanied by impaired cognitive functions. They make it possible to determine topical localization foci brain damage, degree impairment, and also contribute clarifying etiology disease. However, it should be noted that possibilities standard MRI are absolutely not exhaustive and are not always able diagnose changes specific particular disease. In addition, there is no complete correspondence between observed degree damage structure individual parts brain and features clinical manifestations disorders higher cortical functions. This makes it difficult use conventional MRI for prognostic purposes calculating course diseases. Currently, new methods neuroimaging based on magnetic resonance are being actively developed. These include, in particular, functional MRI (fMRI). Feature of fMRI is the ability to identify specific parts brain involved in the implementation certain cognitive functions. Knowing the topographic and anatomical localization these departments in healthy individuals, it is possible to characterize the changes observed in the development disorders higher cortical functions. This makes it possible to understand structural and functional foundations certain clinical equivalents observed in certain nosological forms. In addition, this approach makes it possible to predict development course disease, and also has a serious potential for assessing rehabilitation opportunities. Obtaining such data helps to improve the construction diagnostic models, optimizes therapeutic and diagnostic algorithm. The purpose of this publication is to analyze and systematize data available in the literature use fMRI in elderly patients with impaired cognitive functions in cerebrovascular pathology and Alzheimer's disease.