Differentiation of rehabilitation profiles in older age groups based on ultrasound signs of the state of the brachiocephalic arteries

Objectives. Evaluation of ultrasound signs of the state of the brachiocephalic arteries in elderly patients with different rehabilitation profiles living in long-term inpatient care. Material and methods. A total of 96 patients over 65 years of age, who had been in a long-term social care institution for more than 3 months, were examined. All patients underwent ultrasound examination of the brachiocephalic arteries (UCA) in the supine position, using the gray-scale mode, color Doppler mapping, and spectral analysis. The anatomical course of the vessels, the presence of pathological tortuosity (S- and C-shaped, kinking, coiling), atherosclerotic changes, and the degree of stenosis, including in the area of the bifurcation of the common carotid artery, were assessed. Results. Based on the predominant impairments in the cognitive and/or motor spheres, taking into account the results of the assessment according to the Brief Physical Functioning Test Battery, MoCA, HADS-D, Barthel Index, Dual Cognitive-Motor Test and stabilometry, an individual rehabilitation profile is determined: motor profile (impairments only according to the motor scale with preserved cognitive function, predominantly impairments of self-care, gait, stabilometry), cognitive profile (predominantly cognitive and/or cognitive-motor deficits), mixed profile (pronounced deviations in both directions). In all rehabilitation groups, according to the results of the ultrasound examination, a wide range of variants of anomalies of the neck vessels was revealed, including S- and C-shaped tortuosity. In the group with a predominance of cognitive impairment, pronounced forms of tortuosity (kinking, coiling) were statistically more often detected, as well as atherosclerotic plaques narrowing the lumen of the vessels by 20–40 %. The most pronounced stenotic changes were observed in the bifurcation area of the common carotid artery in individuals with cognitive impairment. The vascular pattern in different rehabilitation groups demonstrates the potential for stratifying patients by the risks of cerebrovascular dysfunction. Conclusion. Ultrasound parameters of the brachiocephalic arteries can serve as significant differential features in the formation of rehabilitation profiles in patients of older age groups. Integration of vascular criteria into the clinical and functional assessment system allows to increase the accuracy of stratification and the validity of the appointment of rehabilitation measures in long-term care.