[Analysis of frequency and structure of cerebrovascular diseases in servicemen during the military physician expertise].

Analysis of the results of medical inspection of soldiers under contract taken place in 2005-2009 is given. In 48.9% of cases was revealed diseases of blood circulatory system. In patients with cardiovascular events in 42.2% of cases different forms of cerebrovascular diseases were diagnosed. It shows high level of these diseases and its early progression among the servicemen. According to the authors, specific peculiarities of intensive military service provide the early progression of diseases. In such a case, presence of cerebrovascular diseases influences on expert decisions about professional suitability of servicemen for some military specialties including the level of suitability for military service.

[Scheme of the diagnostic of secondary cognitive impairment in outpatient].

Cognitive disorders developing as consequence of a number of diseases of brain, are an actual problem. Now diagnostics techniques of cognitive disorders have not entered yet into wide and daily medical practice. Thus timely and exact diagnostics of these conditions allows to begin therapy in the earliest term. The offered three-level diagnostic algorithm of research will help to organise early diagnostics of cognitive disorders at the minimum expenditures of labour that will be reflected in quality of rendering of medical aid and can lead to decrease in direct and indirect expenses on treatment and rehabilitation.

[Complex therapy and rehabilitation approach patients with posttraumatic cognitive defects].

The craniocerebral trauma is one of the major problems of modern medicine. The significant amount of the patients who have had a trauma of the brain become invalids, this situation promotes their social and household disadaptation. The origin of the damage of the highest cortical functions which embarrass full reintegration of patients into different spheres of activity has a particular significance. In the article the philosophies of clinical diagnostic posttraumatic cognitive disorders are set up, the possible approaches to the rehabilitation of patients are showed, the different directions of the pathogenetic pharmacological therapy with allowance of the action drugs mechanism.

[Possibilities of preventive treatment of Alzheimer's disease: results of the 3-year open prospective comparative study on efficacy and safety of the course therapy with cerebrolysin and cavinton in elderly patients with the syndrome of mild cognitive impairment].

The study was conducted in 3 Russian centers (Moscow, St. Petersburg and Nizhniy Novgorod). The total sample included 110 patients whose mental state met the definition of <> (MCI). Patient's status was assessed with widely used scales (MMSE, GDS, CDR etc) and a battery of neuropsychological tests. Genotyping for the APOE polymorphism was performed as well. Patients were stratified into 2 comparable groups in compliance with the specifics of therapy: 55 patients were treated with cerebrolysin and 55 - with cavinton. The superiority of cerebrolysin over cavinton in slowing down of the cognitive deficit progression and delaying the time or transition of patients to the diagnostic category of Alzheimer's disease was demonstrated. Cerebrolysin was particularly effective in MCI patients with the ApoE(+) genotype, i.e. in those with higher risk for Alzheimer's disease. Adverse effects during the treatment were rare in both groups.

[Clinical features of the formation and possibilities of treatment of posttraumatic cognitive disturbances].

We studied the efficacy of akatinol memantine compared to that of piracetam in the treatment of 41 patients with posttraumatic cognitive disturbances (20 patients were treated with akatinol memannine and 21 patients with piracetam) during 24 weeks. Ten patients had a severe traumatic brain injury (TBI) and 11 patients had mild TBI. Treatment efficacy was assessed during 6 months using the data of clinical examination, neuropsychological testing, CT and MRI. Akatinol exerted a distinct positive, stable and continuously effect on a broad spectrum of cognitive disturbances while the effect of piracetam was observed only for some cognitive functions and was short-term (during 1 month). Both drugs were well-tolerated by patients.

[The therapeutic potential of cerebrolysin in the preventive therapy of Alzheimer's disease].

A potential of prolonged 2-years course of cerebrolysin therapy with courses repeated every 6 months to slow down or prevent the transition of the syndrome of mild cognitive impairment, amnestic type, to clinically relevant dementia has been studied in the open comparative study of 73 patients divided into 2 groups, one of which included patients treated with cerebrolysin and another one those who did not receive this drug. The effect of the 2-years course therapy with cerebrolysin suggested by the authors has been proven. Such therapy allows to prevent the progression of cognitive deficit and development of dementia of Alzheimer's type. The results obtained give grounds to recommend this course therapy for prevention of dementia in elderly patients with mild cognitive impairment.

[Efficacy and safety of galantamine (reminyl) in the treatment of dementia in patients with Parkinson's disease (open-label controlled trial)].

Forty-one Parkinson's disease patients with dementia (21 galantamine group, 20--control group) with onset of dementia at least two years after the manifestation of parkinsonian symptoms participated in this open-label controlled trial of galantamine in maximum dose 16 mg/day. Cognitive, psychiatric and motor symptoms were assessed before and after 4, 12 and 24 weeks of treatment using clinical assessment as well as rating scales, including the Mini-Mental State Examination (MMSE), ADAS-cog, clock drawing test, Frontal Assessment Battery (FAB), and the Neuropsychiatric Inventory (NPI-12) with assessment of caregiver distress. Patients treated with galantamine had better scores on MMSE (p<0,05), ADAS-cog (p<0,05), clock drawing test (p<0,05) and FAB (p<0,01) to the end of the trial comparing to the control group. NPI scores on individual items changed from baseline at week 12 and 24, showing benefits of galantamine treatment as compared to the controls, with significant difference for hallucinations (p=0,0002), anxiety (p=0,04), sleep disorders (p=0,04) and apathy (p=0,006). Galantamine therapy was associated with a significant reduction in caregiver distress (p=0,007), improvement of daily life activity (p=0,003). Gait, freezing and falls were improved in the galantamine group but a mild worsening of tremor was noted in two patients. Adverse events (drooling, postural hypotension, nausea, dysuria) were observed in 7 (30%) of galantamine treated patients.

[Tanakan (EGb 761) in the therapy of mild cognitive impairment].

Mild Cognitive Impairment (MCI) means cognitive deterioration not yet causing disability or dementia. Aged patients with MCI constitute a group of high risk for Alzheimer disease and other types of dementia. Currently, there is no generally adopted approach to MCI management but medications with neuroprotective properties are presumed to be the most perspective. Presented are the results of a multicentral open-label clinical trial of vascular and neuroprotective drug tanakan (EGb 761). The study has shown the decrease of cognitive impairment, which was both clinically and statistically significant, in patients at early stages of vascular and neurodegenerative pathological process. Probable efficacy of long-term tanakan treatment in prevention of dementia is discussed.

[Use of movalis in treatment of dorsopathy]. / Primenenie movalisa v lechenii dorsopatii.

In regard to therapeutic effect of different medications used in dorsopathy treatment, non-steroid anti-inflammatory drugs rank first. Compounds selectively blocking COX-2 received special attention due to their minimal impact on COX-1 that provides good anti-inflammatory and analgesic effect with simultaneous dramatic reduction of ulcerogenic activity. One of the first drugs with such an action is Movalis (meloxicam). Thirty patients were divided into 2 groups, the first including 22 patients with vertebral diseases and musculotonic syndromes; patients of the second group (8) had a pain syndrome caused by disk herniation. During the first 3 days Movalis was administered in the form of injections (15 mg/day) and in the same doses in tablets for the following 20 days. After the treatment course, complete arrest of pain syndrome was observed in 33.3% patients, significant improvement--in 53.3% and insignificant effect--in 13.3%. Patients with reflex pain and musculotonic syndromes had a good analgesic effect after 3-day course of intramuscular injections, with the effect being mostly expressed in 8-10 days. Patients with diskogenic compressive radicular syndrome demonstrated a stable analgesic effect after a week of Movalis intake in tablet form. Movalis is well tolerated; side effects have occurred in 10 patients but they were minimal and did not lead to the change of medication dose or additional therapy.

[The diagnosis of epilepsy by using blood analysis for the content of autoantibodies to glutamate neuroreceptors]. / Diagnostika épilepsii s pomoshch'iu analiza krovi na soderzhanie autoantitel k neiroretseptoram glutamata.

The glutamate receptor autoantibody level was studied in blood of 170 epileptic patients as well as of 114 control donors (64 patients with nonepileptic cerebral pathology and 50 healthy individuals). The elevation of autoantibodies level (higher than 140%) was observed in 63.5% of patients with paroxysmal epileptic disturbances. This elevation was observed more frequently in the initial period of the disease as well as in generalized (convulsive or nonconvulsive) fits irrespective of disease etiology. Combined application of the test with EEG method permitted to confirm the epileptic nature of the disease in 83.5% of cases. The results of repeated analysis of glutamate receptor autoantibody level in blood proved to be a significant criterion of the effectiveness of anticonvulsive therapy. It also allowed to predict the development of posttraumatic epilepsy in individuals with craniocerebral trauma in the past.