ПОСТИНСУЛЬТНЫЕ КОГНИТИВНЫЕ НАРУШЕНИЯ: КЛИНИКО-ПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ, ПРОГНОЗИРОВАНИЕ ФУНКЦИОНАЛЬНОГО ВОССТАНОВЛЕНИЯ И ПЕРСОНАЛИЗИРОВАННЫЕ СТРАТЕГИИ НЕЙРОРЕАБИЛИТАЦИИ

Abstract

Background. Post-stroke cognitive impairment represents one of the most clinically significant consequences of cerebrovascular disease, affecting functional independence, quality of life, and long-term outcomes. Its development involves complex interactions among focal cerebral injury, cortical-subcortical network disruption, cerebral small vessel disease, impaired neurovascular regulation, and premorbid cognitive vulnerability. Despite advances in acute stroke treatment, cognitive recovery remains a challenging interdisciplinary problem requiring standardized assessment and individualized rehabilitation.

Materials and Methods. A narrative analytical review of international clinical guidelines, prospective cohort studies, randomized controlled trials, systematic reviews, and meta-analyses was conducted. Cognitive consequences of ischemic and hemorrhagic stroke, cerebrovascular risk factors, neuropsychological assessment, magnetic resonance imaging, cognitive rehabilitation, physical exercise, and noninvasive neuromodulation were examined.

Results. Major clinical and neuropsychological phenotypes, prognostic factors, and neuroimaging characteristics were systematically analyzed. Conventional cognitive training, compensatory strategies, computerized rehabilitation, repetitive transcranial magnetic stimulation, and transcranial electrical stimulation were compared. Six analytical tables and an original conceptual framework, STROKE-COG-RECOVERY, were developed to integrate vascular, cognitive, functional, and rehabilitation-related parameters.

Conclusion. Comprehensive management of post-stroke cognitive impairment requires early recognition, assessment of premorbid cognitive status, identification of cerebrovascular risk factors, and individualized rehabilitation planning. Digital cognitive training and noninvasive neuromodulation represent promising adjunctive approaches, although evidence concerning sustained improvements in everyday functional independence remains limited.