[Cognitive impairment in cerebrovascular diseases]. / Kognitivnye narusheniya pri sosudistykh zabolevaniyakh golovnogo mozga.

Cognitive impairment, which is highly prevalent, especially among older people, leads to a decrease in the quality of life of patients, impairment of daily activities, and an increased risk of dementia and mortality. Currently, much attention is paid to mild cognitive impairment. The article discusses diagnostic criteria and possible clinical variants of this syndrome. Given the high rate of progression of mild cognitive impairment to dementia, it is necessary to identify risk groups and carry out therapeutic preventive measures. Correction of potentially modifiable risk factors is considered as a promising direction of therapy. Sufficient physical and mental activity, proper diet, normalization of sleep, visual acuity and hearing are necessary. Preventing stroke and controlling vascular risk factors may reduce the risk of mild cognitive impairment progressing to dementia.

[Cognitive impairment in patients with arterial hypertension]. / Kognitivnye narusheniya u patsientov s arterial'noi gipertenziei.

Arterial hypertension (AH) is a leading risk factor for cardiovascular diseases including cerebrovascular complications. Strokes and/or vascular cognitive impairment (VCI) are considered as a clinical sign of brain damage as a target organ in hypertension. To identify and assess the severity of VCI, patients with hypertension should undergo a neuropsychological assessment. Neuroimaging confirm the vascular origin of cognitive impairment. Patient management should include antihypertensive therapy along with neuroprotection. Among different neuroprotective therapy, ethylmethylhydroxypyridine succinate (mexidol) is one of medication with serious evidence of clinical efficacy.

[Features of the clinical and neuroimaging picture in patients with early-onset Alzheimer's disease]. / Osobennosti klinicheskoi i neirovizualizatsionnoi kartiny u patsientov s bolezn'yu Al'tsgeimera s rannim nachalom.

The most common cause of severe cognitive impairment in adults is Alzheimer's disease (AD). Depending on the age of onset, AD is divided into early (<65 years) and late (≥65 years) forms. Early-onset AD (EOAD) is significantly less common than later-onset AD (LOAD) and accounts for only about 5-10% of cases. However, its medical and social significance, as a disease leading to loss of ability to work and legal capacity, as well as premature death in patients aged 40-64 years, is extremely high. Patients with EOAD compared with LOAD have a greater number of atypical clinical variants - 25% and 6-12.5%, respectively, which complicates the differential diagnosis of EOAD with other neurodegenerative diseases. However, the typical classical amnestic variant predominates in both EOAD and LOAD. Also, patients with EOAD have peculiarities according to neuroimaging data: when performing MRI of the brain, patients with EOAD often have more pronounced parietal atrophy and less pronounced hippocampal atrophy compared to patients with LOAD. The article pays attention to the features of the clinical and neuroimaging data in patients with EOAD; a case of a patient with EOAD is presented.

[Features of pharmacotherapy of vascular cognitive impairment in the elderly]. / Osobennosti farmakoterapii sosudistykh kognitivnykh narushenii u lits pozhilogo vozrasta.

The problem of pharmacotherapy of elderly and senile people is currently extremely relevant due to the aging of the population and the increase in the prevalence of cardiovascular diseases. One of the most serious problems of the elderly is the development of cognitive decline due to cerebrovascular pathology. However, elderly patients often have a large number of comorbid diseases, which leads to difficulties in diagnosing and managing these patients, and often to the development of polypharmacy, which can lead to deterioration in functional status, cognitive impairment, adverse reactions and drug interactions. In addition, in elderly patients, there may be changes in pharmacokinetics and pharmacodynamics due to anatomical and physiological involutive processes. At the same time, the number of drugs whose clinical efficacy and tolerability were evaluated specifically in elderly and senile patients is relatively small. In a randomized clinical trial of sequential parenteral and oral therapy with Mexidol in patients with mild vascular cognitive impairment syndrome, a positive effect of this therapy on various domains (cognitive, emotional, autonomic, motor) of chronic cerebrovascular disease was confirmed compared with placebo, which allows us to recommend it for use in elderly and senile patients.

[Features of neuropsychological status and results of magnetic resonance morphometry in patients with Alzheimer's disease and glaucoma]. / Osobennosti neiropsikhologicheskogo statusa i rezul'taty magnitno-rezonansnoi morfometrii u patsientov s bolezn'yu Al'tsgeimera i glaukomoi.

OBJECTIVE: To identify the relationship of neuropsychological changes in patients with Alzheimer's disease (AD) and primary open-angle glaucoma (POAG) and to evaluate the results of magnetic resonance (MR)-morphometry in patients with these diseases. MATERIAL AND METHODS: We examined 32 patients (median age 67 [61.25; 76.75] years, 78.1% women) diagnosed with AD and POAG. The patients were divided into the AD group (n=16) and the POAG group (n=16). Complaints and anamnesis were collected for all patients, neurological status and neuropsychological status were assessed. MRI of the brain, followed by morphometry, was performed. RESULTS: Cognitive impairments (CI) were revealed in patients of both groups. The severity of CI in patients with AD was more pronounced than in patients with POAG (p<0.001). Alzheimer's type of CI was detected in both groups. MR-morphometry revealed a decrease in the volume of the left hippocampus, the volume of the right and left amygdala as well as a decrease in the thickness of the right and left entorhinal cortex in the AD group compared with the POAG group (p<0.05). A significant decrease in the thickness of the right medial orbitofrontal cortex was found in the POAG group compared with the AD group (p<0.05). CONCLUSION: In AD and POAG, there is a similarity of the neuropsychological profile, which reflects the neurodegeneration characteristic of these diseases. MRI morphometry requires an assessment of both volumes and thickness of brain structures. A neuroimaging pattern identified in patients with POAG can be regarded as an indicator of the glaucomatous process.

[Cognitive impairment and tactics of using the drug Cerebrolysin. Resolution of the International Council of Experts (May 12, 2023)]. / Kognitivnye narusheniya i taktika primeneniya preparata Tserebrolizin. Rezolyutsiya mezhdunarodnogo soveta ekspertov (12 maya 2023 g.).

The aging of the population and the associated increase in the share of cognitive impairments in the structure of a wide range of diseases are a serious challenge for modern healthcare. Difficulties in the treatment of cognitive disorders are determined by many factors, including the age of patients, comorbidity, forced polypragmasia and the adequacy of the dosage of drugs that restore cognitive activity. The experts discussed information about the therapeutic potential of the drug Cerebrolysin in the treatment of cognitive disorders of various origins, stated significant experience of its effective and safe use in many clinical studies in mild and moderate forms of dementia. At the same time, there was a lack of consistent and systematic data on the dosage regimen, frequency, and duration of use of the drug in different forms of cognitive impairment and the degree of their severity. The aim of the international council of experts was to determine the optimal dosage regimens of the drug Cerebrolysin in patients with various etiologies and severity of cognitive impairment. The result of the work was the approval of a unified scheme for the use of the drug Cerebrolysin, considering the severity of the disease and its duration.

[Diagnosis and treatment of early forms of cognitive impairment: possibilities of influencing neuronal energy metabolism. Resolution of the Council of Experts]. / Diagnostika i lechenie rannikh form kognitivnykh narushenii. Vozmozhnosti vozdeistviya na energeticheskii metabolizm neironov. Rezolyutsiya Soveta ekspertov.

Diagnosis and treatment of early forms of cognitive impairment: possibilities of influencing neuronal energy metabolism. Resolution of the Council of Experts.

[Ethnic features of multipathology in elderly and senile patients of the Republic of Sakha suffering from chronic brain ischemia]. / Etnicheskie osobennosti mul'tipatologii u patsientov pozhilogo i starcheskogo vozrasta Respubliki Sakha (Yakutiya), stradayushchikh khronicheskoi ishemiei mozga.

OBJECTIVE: To study ethnic characteristics of multipathology in elderly and senile patients with chronic cerebral ischemia living in the Republic of Sakha (Yakutia). MATERIAL AND METHODS: The study included 522 inpatients, aged 60 to 89 years, who were divided into subgroups depending on the stage of chronic cerebral ischemia, ethnicity (Evens, Yakuts and Russians) and age (elderly and senile). RESULTS: In addition to vascular cerebral pathology, comorbidities were identified in patients of older age groups. At the same time, polymorbidity was less pronounced in the Evens, the indigenous inhabitants of the northern regions of Yakutia, than in the Yakuts and representatives of the non-indigenous population - Russians. CONCLUSION: The relatively rare occurrence of comorbid pathologies in Evens is presumably associated with greater adaptation to the extreme climatic conditions of the North.

[Modern possibilities of early diagnosis of Alzheimer's disease in patients with primary open-angle glaucoma]. / Sovremennye vozmozhnosti rannei diagnostiki bolezni Al'tsgeimera u patsientov s pervichnoi otkrytougol'noi glaukomoi.

The article presents data on biomarkers for the early diagnosis of Alzheimer's disease (AD). Particular attention is paid to potential neuroimaging and ophthalmological markers, such methods of early diagnosis of AD as MRI with post-processing data processing and assessment of the volume of brain structures and cortical thickness - MRI morphometry, as well as optical coherence tomography are described. The article shows the relationship between AD and primary open-angle glaucoma and considers a case of AD in a patient with primary open-angle glaucoma.

[Ethnic and age characteristics of the frequency of risk factors chronic kidney disease in elderly and senile people of the Republic of Sakha (Yakutia).]

The study included patients with chronic kidney disease aged 60-89 years, who were divided into three groups by ethnicity (Evens, Yakuts and Russians). By age, all study participants were divided into 2 age groups: elderly (60-74 years old) and senile (75-89 years old). For the first time, ethnic features of the prevalence of risk factors and progression of chronic kidney disease in elderly and senile people of the Republic of Sakha (Yakutia) were revealed on clinical material. At the same time, risk factors are more clearly and fully represented in Russians and Yakuts. The lowest frequency of atherosclerosis and coronary heart disease is observed in Even people, despite the fact that the frequency of bad habits among them is higher. The approach used in this work to the study of risk factors and the occurrence of chronic kidney disease necessitates screening for the prevention of this pathology, depending on ethnicity and age.

[Cerebrolysin in the treatment of cognitive impairment]. / Tserebrolizin v lechenii kognitivnykh narushenii.

Cognitive impairment is one of the most important problems of modern health care. Currently, according to WHO, more than 55 million people worldwide are living with dementia. Dementia is one of the leading causes of disability and addiction among older people worldwide. Even more significant is the number of patients with mild cognitive impairment who have an increased risk of progression to dementia compared to people of the same age without cognitive impairment. The number of patients with cognitive impairment has also increased due to the consequences of COVID-19. It is necessary to use drugs that not only improve cognitive functions, but also slow down their progression. One of these drugs is cerebrolysin, the effectiveness of which has been confirmed in various types of cognitive impairment. Cerebrolysin, being a preparation from the brain of a pig, belongs to the group of biological drugs. In the production of Cerebrolysin very strict measures are taken to comply with the technology, which ensures the quality and identity of the product from batch to batch. The experience of many years of clinical use of Cerebrolysin testifies not only to its high efficiency, but also to its safety. It should be taken into account that similar substances can be developed in relation to biological products - biosimilars or biosimilars, which can be considered comparable only in case of equivalent pharmacokinetic parameters, efficacy and safety.

[Current approaches in the treatment and rehabilitation of patients with neurological diseases after COVID-19. Resolution of the International Experts Forum]. / Lechenie i reabilitatsiya bol'nykh s nevrologicheskimi narusheniyami posle perenesennogo COVID-19. Rezolyutsiya Mezhdunarodnogo foruma ekspertov.

Despite the significant shift in global attention away from the pandemic, the problem of a new coronavirus infection remains important in the medical community. Almost 3 years after the start of the COVID-19 pandemic the issues of rehabilitation and management of delayed manifestations and sequelae of the disease are especially important. According to numerous available data, the new coronavirus infection is characterized by multiorgan lesions. Respiratory dysfunction, clotting disorders, myocardial dysfunction and various arrhythmias, acute coronary syndrome, acute renal failure, GI disorders, hepatocellular damage, hyperglycemia and ketosis, dermatological complications, ophthalmological symptoms and neurological disorders may be found. Significant prevalence of the latter in the post-coronavirus period necessitated this International Expert Forum to develop unified approaches to the management of patients with neurological complications and sequelae of new coronavirus infection based on practical experience and considering the scientific information available on COVID-19. The expert council developed a resolution formulating the tactics for the management of patients with neurological manifestations of COVID-19.

[Vascular cognitive impairment]. / Sosudistye kognitivnye narusheniya.

Vascular cognitive impairment is considered the second most common cause of dementia after Alzheimer's disease. One of the most significant factors leading to vascular dementia is stroke, which increases the risk of developing dementia by about 2 times. Delayed-onset post-stroke dementia is mainly due to severe small vessel disease, recurrent stroke, or concomitant Alzheimer's disease. Among the many mechanisms involved in the development of vascular cognitive impairment, cerebral small vessel disease is perhaps the most common, contributing to cognitive impairment independent of stroke. An important feature of small vessel disease is its steady progression. The cognitive decline in cerebrovascular disease, including small vessel disease, is also usually gradual and gradual, progresses slowly, and the underlying defect extends to processing speed, complex attention, and fronto-executive functions. Vascular cognitive impairments are quite heterogeneous in nature, while having a negative impact on all major cognitive domains. Patient management should include the earliest possible diagnosis of cognitive impairment and the appointment of timely therapy. One of the drugs that has been successfully used to treat vascular cognitive impairment is nicergoline (Sermion). The clinical efficacy of the drug is achieved due to the improvement of cerebral blood flow, a positive effect on cholinergic neurotransmission and neuroprotective action.

[Focused ultrasound as a non-invasive method with therapeutic potential in patients with Alzheimer's disease]. / Terapevticheskii potentsial fokusirovannogo ul'trazvuka u patsientov s bolezn'yu Al'tsgeimera.

Alzheimer's disease (AD) is a common, progressive neurodegenerative disease characterized by abnormal deposition of ß-amyloid (Aß) and hyperphosphorylated tau protein. Despite the fact that biomarkers and methods of treating AD are currently being actively studied, there is still no therapy that can significantly reduce the progression of this disease. Therefore, the search for therapeutic disease-modifying strategies is becoming increasingly popular. One such strategy is the use of focused ultrasound (FUS) under MRI guidance using a contrast agent (microbubbles). Under the influence of low-intensity FUS, the blood-brain barrier (BBB) is temporarily opened, which is the main obstacle to the effective delivery of therapeutic compounds to the brain, imposing dimensional and biochemical restrictions on the passage of molecules. One of the processes associated with AD is BBB dysfunction, and therefore the study of the effects of FUS in patients with AD is of interest. The literature data show the effectiveness of FUS in animal models of AD. The researchers attribute the effectiveness of the method to the fact that exposure to FUS induces the opening of BBB and reduces the number of amyloid plaques. It has also been demonstrated that FUS can facilitate the delivery of therapeutic drugs to the brain. This allows considering FUS as a new non-invasive method of treatment. Further research is needed to assess the effectiveness of this method in patients with AD.

[Potential biomarkers of early diagnosis of Alzheimer's disease]. / Potentsial'nye biomarkery rannei diagnostiki bolezni Al'tsgeimera i pervichnoi otkrytougol'noi glaukomy.

Alzheimer's disease (AD) is a progressive neurodegenerative disease of the brain, in which there are cognitive and behavioral disorders, but also visual impairment can occur. Deposits of beta-amyloid (Aß) were also found in the retina of AD patients. At the same time, primary open-angle glaucoma (POAG) occupies the first place among geronto-ophthalmic pathologies in patients with AD. POAG, like AD, is a neurodegenerative disease. AD and POAG have common symptoms, and therefore several common principles for their early diagnosis can be developed. Therefore, a promising direction is the search for biomarkers for the early detection of AD and POAG. Currently, the diagnosis of early AD biomarkers in cerebrospinal fluid and biomarkers in the brain (imaging of amyloid plaques and tau positron emission tomography) are well studied, while data in literature on using these biomarkers in patients with POAG is scarce. However, the above diagnostic methods are not considered in routine clinical practice due to their invasiveness and high cost. There is a growing need for conventional, affordable biomarkers for AD and POAG, as it is necessary to start treatment of prodromal conditions from symptoms to onset of symptoms. In this connection, biomarkers such as Aß and tau protein in blood serum and plasma are actively evaluated in patients with AD. In patients with POAG, there is no published data on studies of these biomarkers, which requires scientific research. Many authors discover the role of sirtuins (SIRT) in aging and age-related diseases, such as AD, glaucoma, age-related macular degeneration, and others. Possibly, SIRT could become potential biomarkers of neurodegenerative diseases.

[Postoperative cognitive dysfunction]. / Posleoperatsionnaya kognitivnaya disfunktsiya.

In recent years, there has been an aging trend throughout the world. Globally, it is estimated that 50% of all older people have had at least one surgical operation. It is well known that compared with younger patients, people over 60 years of age have a higher risk of adverse postoperative outcomes. One of the possible complications of surgical intervention is the development of postoperative cognitive dysfunction (POCD), which is observed in about a quarter of patients. Among gerontological patients and those who underwent cardiac surgery, cognitive impairment is more common, reaching 80%. POCD has a negative impact on the course of recovery processes and life prognosis. There are a large number of risk factors for the development of POCD, associated both with the surgical intervention itself and with the patient's condition. One of the ways to prevent the occurrence of POCD is the use of neurometabolic drugs. Cytoflavin, containing inosine, nicotinamide, riboflavin and succinic acid, has demonstrated its effectiveness in relation to the risk of POCD in cardiac surgery patients. The results of a multicenter, double-blind, placebo-controlled, randomized study confirmed that Cytoflavin is an effective means of preventing and correcting postoperative cognitive disorders in high-risk patients.

[Roadmap for ecosystem-based approach for patients with Alzheimer disease in Russia: current needs, barriers, and possible solutions (resolution of the scientific and practical experts meeting)]. / Dorozhnaya karta po okazaniyu pomoshchi patsientu s bolezn'yu Al'tsgeimera v Rossii v formate ekosistemy: tekushchie potrebnosti, bar'ery i vozmozhnye resheniya (rezolyutsiya nauchno-prakticheskoi vstrechi ekspertov).

The care of a patient with Alzheimer's disease (AD) is considered from the perspective of an ecosystem, that is, a systemic approach describing effective partnership, collaboration and research aimed at creating value, involving all participants in the AD patient journey. The effectiveness of this ecosystem is only possible with the involvement of all stakeholders in its development, including patients, healthcare professionals at all levels, government agencies, private companies, and patient organizations. The unmet health care and information needs of patients with AD are a consequence of barriers in the AD ecosystem. Key barriers for the patient include low awareness and stigmatization of the disease in society, lack of quality epidemiological data, difficulties in timely diagnosis, lack of prevention programs, unpreparedness of most physicians to conduct AD patient rehabilitation, and other factors. Based on the analysis of the ecosystem of AD and the patient pathway, 10 main directions (strategies) necessary for the formation of the ecosystem were identified: conducting research in the diagnosis and epidemiology of AD, creating and implementing a cognitive health program, forming a legal framework, raising public awareness, optimizing patient routing for timely diagnosis, organizing a network of memory clinics/laboratories, creating a register of patients with dementia, developing digital solutions and supporting social projects.

[General mechanisms of the pathogenesis of neurodenerative and cerebrovascular diseases and the possibilities of their correction]. / Obshchie mekhanizmy patogeneza neirodenerativnykh i tserebrovaskulyarnykh zabolevanii i vozmozhnosti ikh korrektsii.

The recent research has revealed several common pathogenetic mechanisms underlying both vascular and neurodegenerative processes. This refers to chronic cerebral hypoperfusion, pathology of neurovascular units and the blood-brain barrier. The process of brain recovery in various lesions is realized due to the mechanisms of neuroplasticity. Using the example of Cerebrolysin, which has a multimodal effect, which includes an effect on the blood-brain barrier, a neurotrophic effect, an improvement in the drainage function of the brain, an anti-inflammatory effect, a direct effect on neurovascular units, the advantage of simultaneous action on various links of pathogenesis can be shown.

[Neuropsychological disorders in patients with glaucoma]. / Neiropsikhologicheskie narusheniya u patsientov s glaukomoi.

OBJECTIVE: To compare the structure of cognitive deficit in patients with glaucoma, Alzheimer's disease (AD) and vascular dementia (VD). MATERIAL AND METHODS: Ninety patients were comprehensively examined and divided into 3 groups of 30 people each: AD group, VD group and open-angle glaucoma group. All patients underwent neurological and neuropsychological examination. RESULTS: The data on the similarity of the structure of cognitive deficit in patients with AD and glaucoma were obtained. More than half of patients with open-angle glaucoma were newly diagnosed with moderate cognitive impairment. CONCLUSION: The results indicate the need for a comprehensive neurological and neuropsychological examination of patients with glaucoma for the early diagnosis of cognitive disorders, timely therapy and an improvement in the prognosis of the disease.

[The assessment of the efficacy of Ethoxidol treatment in patients with chronic cerebral ischemia]. / Otsenka effektivnosti primeneniya preparata Etoksidol u patsientov s khronicheskoi ishemiei mozga.

OBJECTIVE: To evaluate the clinical effects of ethylmethylhydroxypyridine malate (Ethoxidol) in patients with chronic cerebral ischemia in an outpatient practice. MATERIAL AND METHODS: 60 patients were examined, 58 patients with a diagnosis of cerebrovascular disease (chronic cerebral ischemia) completed the participation in the program. The average age of the patients is 61.2±8.2 years. Neurological complaints typical of patients with chronic cerebral ischemia were recorded. To assess the dynamics of neurological disorders during therapy were used: The Montreal Cognitive Assessment (MoCA), Multidimensional fatigue inventory (MFI-20), Berg Balance Scale (BBS), Tinnitus Handicap Inventory (THI), Clinical Global Impression of Improvement Scale (CGI). The doctors and the patients satisfaction with therapy was assessed using the Visual Analogue Scale (VAS); quality of life - by the VAS of the European Quality of Life Group (EQ-VAS). The course of therapy lasted 60 days. All patients received daily Ethoxidol chewable tablets 400 mg/day (2 tablets (200 mg) in the morning and 2 tablets (200 mg) in the evening). RESULTS: The results of the observational program showed high efficacy and good tolerability of Ethoxidol in patients with chronic cerebral ischemia. A statistically significant decrease in the severity of the clinical manifestations of chronic cerebral ischemia was noted as early as the 30th day of therapy, followed by maintaining a positive trend until the end of the course of treatment with the drug (60th day). On the therapy, the severity of asthenia, cognitive impairment, dizziness, balance disorders, and tinnitus decreased. There was a decrease in the severity of the condition and the presence of clinical improvement on the CGI scale; there was an increase in the quality of life of patients on the EQ-VAS scale. The majority of the patients and the doctors rated the therapy as effective and safe and were satisfied with it. No serious adverse events were reported. CONCLUSION: The data obtained allow us to consider Ethoxidol as an effective drug in the treatment of patients with chronic cerebral ischemia in an outpatient practice.