The leading factors of post-stroke disability are motor disorders and cognitive dysfunctions. The aim of the study was to identify and provide a rationale for the variable early cognitive dysfunction in right and left hemispheric damage in patients with acute stroke. The study included 80 patients diagnosed with ischemic stroke. All patients were assessed for cognitive status, depression, fatigue and anxiety. For objectification, the method of evoked potentials (P300) and neuroimaging were used. Our findings revealed distinguishing features of cognitive dysfunction and identified a combination of the most informative markers characteristic of right and left hemispheric damage in patients with acute ischemic stroke. In patients with damage to the left hemisphere, a predominance of dysregulation syndrome (decrease in executive function and attention) was revealed, accompanied by various disorders such as severe anxiety and fatigue. The causes of this cognitive dysfunction may be directly related to stroke (damage to subcortical structures), as well as to a preexisting reduction in higher mental functions associated with age and vascular conditions. Cognitive impairments in patients with lesions of the right hemisphere were characterized by polymorphism and observed in the mental praxis, speech (with predominant semantic component) and abstract thinking domains. They are closely linked to each other and are more related to the lateralization of the lesion and preexisting neurodegeneration than to the localization of the ischemic lesion. The study of P300-evoked potentials is a good tool for confirming cognitive dysfunction. The latent period of the P300 wave is more sensitive to neurodegeneration, while the amplitude factor characterizes vascular pathology to a greater extent. The results of the study provide a rationale for a comprehensive assessment of lateralization, stroke localization, underlying diseases, neurophysiological parameters and identified cognitive impairments when developing a plan of rehabilitation and neuropsychological measures aimed at cognitive and emotional recovery of patients both in the acute phase of ischemic stroke and when selecting further personalized rehabilitation programs.

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The aim of this study is to identify and substantiate early cognitive dysfunction in patients with brain damage in the acute period of ischemic stroke.Materials and research methods. The study included 140 elderly patients. The main group included 70 patients of Vascular Surgery Center with a diagnosis of ischemic stroke in the carotid pool, the control group consisted of 70 outpatients. Cognitive function and psycho-emotional background were assessed using the Montreal Cognitive Function Scale, tests for kinetic, constructive and ideation praxis, the Stroop test, the Boston Naming Test, the apathy rating scale, the Hospital Anxiety and Depression Scale, and the MFI-20 asthenia scale. Assessment of neuroimaging parameters was carried out usingcomputed tomography. Assessment of long-latency acoustic endogenous evoked potential P300 using the «oddball active» paradigm technique was used for neurophysiological examination.Research results. Ischemic stroke was more often detected in the parietal, frontal lobes and basal ganglia. Moderate cognitive impairment was detected in 57.5% of patients with stroke and 27.5% of the control group. Dementia was diagnosed in 30% of patients in the main group and 5% of the control group. In patients with IS indicators characterizing the executive function, praxis, speech, attention, memory, depression, and apathy were statistically significantly lower comparing with the control group. The analysis of neurophysiological data revealed a statistically significant prolongation of the latency of the P300 wave in all leads and a decrease in the amplitude of the P300 peak in leads Cz and C3 in patients of the main group. Conclusion. Within the framework of this study, significant factors in the development of early post-stroke cognitive impairment were established. Dysfunction in attention, executive function, episodic memory, and speech is the result of a combination of causes directly related to cerebrovascular disease and pre-stroke factors. The evoked potential method reflects the degree of cognitive decline and can be used as a method for assessing the effectiveness of cognitive rehabilitation in stroke patients.

Ведение пациентов с хронической тазовой болью (ХТБ)-актуальная междисциплинарная проблема современной клинической медицины. К ХТБ относят хроническую или персистирующую боль, локализованную в структурах таза у мужчин или женщин, длительностью более 6 мес, ассоциированную с негативными когнитивными, поведенческими, эмоциональными последствиями, а также с симптомами повреждения нижних мочевыводящих путей, кишечника, тазового дна, нарушениями репродуктивной функции или сексуальной дисфункцией. В соответствии с биопсихосоциальной моделью ХТБ представляет собой результат динамического взаимодействия биологических, психологических и социокультурных факторов. При диагностике ХТБ наиболее приемлемо фенотипирование пациентов по классификации UPOINTS. В стратегии лечения необходимо придерживаться мультидисциплинарного персонифицированного подхода управления болью с активным участием пациента. Важное место в лечении ХТБ занимает когнитивно-поведенческая терапия (КПТ). Имеются клинические и нейрофизиологические доказательства эффективности КПТ у пациентов с ХТБ, разработан протокол совместного применения КПТ и физической терапии. КПТ рекомендуется включать в комплексную программу лечения и реабилитации пациентов с ХТБ. Ключевые слова: хроническая боль; хроническая тазовая боль; синдром хронической тазовой боли; когнитивно-поведенческая терапия.