Modern approaches to comprehensive rehabilitation and assessment criteria for medico-social expertise in patients with post-stroke cognitive impairment



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Abstract

Post-stroke cognitive impairment (PSCI) represents a significant medical and social problem, serving as a factor that contributes to increased disability rates among stroke survivors. Current epidemiological data indicate a high prevalence of PSCI, reaching 96% when comprehensive neuropsychological testing is applied. The socioeconomic burden of PSCI is associated with increased risks of mortality, development of affective disorders, and need for long-term specialized care, along with substantial direct and indirect economic losses (Fragment 7). The objective of this review is to analyze contemporary scientific evidence concerning effective approaches to comprehensive rehabilitation and improvement of medico-social evaluation criteria for patients with PSCI. The authors conducted a literature search in international bibliographic databases including PubMed/Ovid MEDLINE, Science Direct, Google Scholar, and eLIBRARY for publications from 2018–2025, selecting 77 relevant studies for analysis. The analysis of literature data demonstrates that modern rehabilitation of patients with PSCI is based on principles of a multidisciplinary approach integrating methods of cognitive training, controlled physical activity, non-invasive neuromodulation, and psychotherapeutic support. Combined rehabilitation strategies targeting the modulation of neuroplasticity mechanisms demonstrate the highest efficacy. It has been established that the current medico-social evaluation system has systematic limitations in objectively assessing the cognitive component of disability, failing to account for the substantial impact of executive function impairments on parameters of daily activity and work capacity. A promising direction for developing the healthcare system for patients with PSCI involves creating integrated rehabilitation-expert data transfer pathways, implementing standardized neuropsychological diagnostic protocols using validated scales (MoCA, functionally-oriented tests), and modifying medico-social evaluation criteria according to current understanding of PSCI pathogenesis and clinical manifestations. Implementation of these approaches will optimize the effectiveness of rehabilitation programs and enhance the efficacy of medico-social evaluation for patients with PSCI.

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About the authors

Airat R. Galimov

Bashkir State Medical University, Ministry of Health of Russia, Ufa, Russian Federation

Author for correspondence.
Email: airat.galim382@gmail.com
ORCID iD: 0000-0003-4403-0204
SPIN-code: 8742-4109
Scopus Author ID: 294101

cand. med. sci., associate professor; neurologist, forensic medical expert

Russian Federation, 450008, Russia, Ufa, Lenin str. 3

Shamil R. Salimov

Bashkir State Medical University, Ministry of Health of Russia, Ufa, Russian Federation

Email: shamil.salimov.011@gmail.com
ORCID iD: 0009-0007-2448-263X

6th year student

Russian Federation, 450008, Russia, Ufa, Lenin str. 3

Dilara R. Yagfarova

Bashkir State Medical University, Ministry of Health of Russia, Ufa, Russian Federation

Email: dilara.yagfarova@mail.ru
ORCID iD: 0009-0005-7463-529X

6th year student

Russian Federation, 450008, Russia, Ufa, Lenin str. 3

Fatima A. Kochkarova

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: kochkarova.f@bk.ru
ORCID iD: 0009-0002-2493-4046

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Liliya Y. Rakhimova

Bashkir State Medical University, Ministry of Health of Russia, Ufa, Russian Federation

Email: liliya_rahimova15@mail.ru
ORCID iD: 0009-0000-3765-0187

6th year student

Russian Federation, 450008, Russia, Ufa, Lenin str. 3

Anna K. Nikogosyan

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: anna.nikogosyan@list.ru
ORCID iD: 0009-0009-9445-185X

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Yulia A. Reshulskaya

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: jartr02@mail.ru
ORCID iD: 0009-0001-7496-2937

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Suzanna E. Balyan

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: suzannabalyan883@gmail.com
ORCID iD: 0009-0000-6335-914X

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Maxim A. Chernenko

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: max12464@mail.ru
ORCID iD: 0009-0000-6722-113X

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Tamara D. Ekizyan

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: tomricochaurelly13@mail.ru
ORCID iD: 0009-0001-5832-9680

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Elizaveta D. Rogozhnikova

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: lizarogozhnikova2016@gmail.com
ORCID iD: 0009-0006-5778-782X

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Alexandra Yu. Kharzhiyants

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: Xarzhiyyanc@gmail.com
ORCID iD: 0009-0008-0739-8281

6th year student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

Valeria V. Lagutina

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russian Federation

Email: lagutina2002@list.ru
ORCID iD: 0009-0004-8518-6795

student

Russian Federation, 344022, Russia, Rostov-on-Don, 29 Nakhichevansky Lane

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