Avaliação de potenciais alterações neuropsiquiátricas nos períodos agudo e subagudo precoce em pacientes vítimas de acidente vascular encefálico isquêmico

Abstract

Introduction: Stroke is a clinical syndrome, of vascular origin, with a sudden onset of dysfunction of brain activity that persists for more than 24 hours. Stroke survivors are regularly affected by cognitive decline and neuropsychiatric disorders such as depression and / or anxiety that affect about one-third of these individuals. Neuropsychiatric sequelae are often neglected, having a negative impact on the rehabilitation process. Objectives: To evaluate possible neuropsychiatric changes in patients with ischemic stroke (IS) in the acute (up to 7 days) and early subacute (30 to 60 days) periods. Methods: Neuropsychological tests were applied to patients admitted to the stroke unit of the Odilon Behrens Municipal Hospital from December 2017 to March 2019. The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (UFMG) under protocol number CAAE 02811212.5.3001.5129. In this study, patients with a diagnosis of IS over 18 years of age, of both sexes, with stroke time (time elapsed between initial symptoms of IS and care in this hospital) up to 7 days and who had the ability to understand and respond to neuropsychological test questions that have been applied to the patient's bed. Patients were excluded with neurological diseases (such as aneurysm and others), neurodegenerative diseases (such as Alzheimer's disease and others), psychiatric disorders prior to stroke (such as Depression, Anxiety and others), other types of stroke (haemorrhagic stroke), neurosurgery, inflammatory and infectious diseases (such as sarcoidosis, human immunodeficiency virus infection - HIV and others) and in the ‘Other group’ (cancer and other conditions). The NIHSS (National Institute of Health Stroke Scale) was applied at the patient's admission, MMSE (Mini-mental State Examination), FAB (Frontal Assessment Battery), and HADS (Hospital Anxiety and Depression Scale) in the hospital for up to 7 days. The second battery of neuropsychological tests 30 to 60 days after the first symptoms, which included, in addition to the 3 tests already mentioned, The Brief Cognitive Battery (BCB), Verbal Fluency Test (VFT), Digit Span subtest WAIS-III (DS) and Facial Emotion Recognition Test (FERT). A control group of 21 healthy individuals also performed the complete neuropsychological battery. Results: A total of 46 eligible patients underwent neuropsychological tests at the hospital in the acute period and 18 of them returned to the second battery of neuropsychological tests 30 to 60 days after the first symptoms. The IS caused a general decline in cognitive efficiency and psychiatric changes in the acute phase in all applied tests. In the early subacute phase, patients presented symptoms of anxiety and depression, as well as a decline in immediate memory, recall and recognition. And the group of patients who returned, when their scores were compared in the acute and early subacute phases, had improvements in the MMSE, FAB and HADS_A (anxiety subscale) tests, but remained with depressive symptoms for 30 to 60 days, showing no change in relation to the acute period. NIHSS (acute stroke severity), in the acute post-stroke period, worsened MMSE, FAB, HADS_A, but did not correlate with HADS_D (depression subscale). In the early subacute period, the NIHSS did not correlate with any of the tests applied at that stage. Conclusion: Individuals with ischemic stroke presented cognitive impairment and significant psychiatric disorders. The study supports the premise that post-stroke neuropsychiatric disorders should not be neglected, paving the way for future research with a focus on diagnosis, multidisciplinary treatment and effective rehabilitation in order to achieve better recovery and favorable outcomes for these patients.