Постковидный синдром: от биологии к нейропсихологии

Аннотация

Актуальность. Постковидный синдром, или длительный COVID (Long COVID), — новый синдром во врачебной практике, введенный ВОЗ после пандемии COVID-19, выявляется у многих перенесших COVID-19 пациентов.

Цель. Рассмотреть вызываемые COVID-19 когнитивные нарушения с точки зрения нейропсихологии и патофизиологии.

Выборка. В ходе поиска литературы в базах данных Pubmed, Google.scholar и Scopus были отобраны 63 источника. Ключевые слова при отборе литературы «neuropsychiatry/neuropsychology», «pathophysiology», «COVID-19», «SARS-CoV-2».

Методы. Обзор и анализ исследований COVID-19 и его связи с появлением когнитивных дефицитов у пациентов.

Результаты. Вирус SARS-CoV-2 проникает в организм человека и поражает структуры головного мозга. Сохранение симптомов усталости, одышки, проблем с концентрацией внимания и памятью, потери или изменения вкуса и обоняния, боли в мышцах и в суставах и расстройства сна могут объясняться особенностью взаимодействия вируса с ЦНС. Нейропсихологический анализ нарушений с позиции теории трех функциональных блоков мозга А.Р. Лурия позволяет выявить пораженные звенья функциональных систем высших психических функций (ВПФ) и в сочетании с анализом клинических данных дает возможность выстроить программу реабилитации, в том числе когнитивные тренинги и психологическую помощь, а также подобрать адекватную медикаментозную терапию, позволяющую редуцировать или компенсировать психические нарушения.

Выводы. SARS-CoV-2 вызывает поражение таких структур головного мозга, как ствол, лимбическая система, префронтальная кора и обонятельный тракт, что служит объяснением наблюдаемых симптомов. Нейропсихологическая диагностика позволяет выявить нарушенные звенья ВПФ у пациентов с постковидным синдромом, выстроить адекватную реабилитационную программу, а также подобрать медикаментозную терапию.

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