[Mental confusion in elderly patients with dementia].

Authors have studied the psychopathological structure, risk factors and predictors of mental confusion in 102 patients with dementia of different etiologies (Alzheimer's disease (AD), cerebrovascular dementia (CVD) and mixed Alzheimer disease/vascular dementia). The high frequency (>40%) of mental confusion in patients with dementia admitted to geriatric departments of a psychiatric hospital has been identified. Mental confusion was most frequently characterized by a syndrome of memory and/or confabulatory confusion. The causes of mental confusion in elderly patients with dementia, including the exacerbation of a somatic pathology and changes in conditions of patient's staying in hospital, have been specified. The frequency of mental confusion is correlated with patient's age: more than 55% of cases has been noted in the group aged over 70 years. Mental confusion develops 6 times more frequent in patients with moderately severe and severe dementia than in those with mild dementia. Timely diagnosis and adequate treatment are predictors of favorable outcome in most patients. Treatment of this syndrome should be strictly differential. Antipsychotic treatment is needed in case of persistent psychotic symptoms and severe behavioral disturbances. Drugs for pathogenetic therapy of dementia have been used in the complex treatment of mental confusion in patients with dementia, in particular AD.

[Membrane structure markers and the acetylcholinesterase activity of erythrocytes in patients with mild cognitive impairment].

Patients with the syndrome of MCI (n=22) and a control group (31 people without signs of mental and neurological diseases) were tested for the degree of hemolysis of erythrocytes (RBC), (membrane structure markers, acetylcholinesterase (AChE) activity in RBC), the level of lipid peroxidation (LPO) (content of malondialdehyde - MDA), microviscosity of surface areas of the membrane using two spin probes localized in the bulk lipids (s1) and in adjacent to the proteins regions of lipid bilayer (s2). There was no difference between the level of spontaneous hemolysis in the group with MCI and the control group which indicated the absence of changes in the mechanical resistance of the RBC membrane. Significant between- group differences were identified for s2 (the increase by >40% in MCI). A trend toward the increase in MDA level in MCI was found as well. There was a decrease by approx. 30% in the Vmax and Km for AChE reaction that indicated the changes in properties or amount of this enzyme. The value of Vmax/Km that determined the real activity of AChE was similar in both groups. No correlations between parameters of membrane structural-functional state that are characteristic of normalcy were noted in the patients with MCI. This finding demonstrated the changes in structural-functional regulation in RBC membrane in elderly people with MCI. Membrane structure status of erythrocytes in MCI holds a special position and differs both from normal ageing and developed Alzheimer's disease. The s1/s2 ratio is recommended as a membrane "marker"for identification of MCI.

[Prognosis of cognitive deficit progression in aged patients with mild cognitive impairment under prolonged therapy (a three year observation)].

The aim of the study was to predict treatment efficacy in patients with mild cognitive impairment (MCI) and to find the most reliable clinical tests for the prediction of dementia. Patients with amnestic MCI (n=53) were treated with cerebrolysin for three years and underwent regularly neurocognitive and clinical psychiatric tests. The data were analyzed using non-parametric statistics, cluster analysis, and linear discriminate analysis. The combination of statistical methods has enabled to predict the degree of cognitive impairment as well as the development of dementia. A "dementia risk group" with fast cognitive decline (i.e. the low efficacy of the treatment) was identified. The tests are ranked according to their predictive values.

[Mental disorders of cognitive and non-cognitive spectrum in the first-degree relatives of patients with Alzheimer's disease].

Mental disorders of cognitive and non-cognitive spectrum in the first-degree relatives of patients with Alzheimer's disease (AD) were studied in 134 relatives, mean age 47.6 years, including 110 children and 24 siblings of probands. Compared to the age-matched controls (22 normals without relatives with AD), the higher frequency of the following mental disorders was found in the relatives: Alzheimer's phobia, irritable weakness, mild cognitive impairment, including difficulties in learning new information and reduced sustained attention due to tiredness (2 times more frequent), difficulties in recollection of remote events (1.4 times more frequent), signs of constitutional cognitive deficit in the anamnesis (2-4 times more frequent), the combinations of two or three types of cognitive deficits (3-4 times more frequent), the combination of communicating hydrocephalus with MRI signs of cerebrovascular pathology (3,4 times more frequent). The data obtained in the study can help develop treatment/ rehabilitation measures to prevent the progression of cognitive deficit.

[Platelet cytochrome c-oxidase and glutamine synthetase-like protein in patients with mild cognitive impairment].

The study aimed to develop pre-clinical diagnosis of Alzheimer's disease (AD) and - in future - preventive therapy in patients with mild cognitive impairment (MCI). The MCI group (n=44) and AD group (n=42, including 18 patients with soft dementia and 24 patients with mild dementia) were studied. The groups were matched for age (median 70 and 69 years for MCI and AD groups, respectively). The control group comprised 24 mentally healthy relatives of the patients. Correlations between the activity/amounts of platelet enzymes: cytochrome c-oxidase (COX), glutamine synthetase-like protein (GSLP) and the extent of cognitive impairment were studied. The COX activity in MCI and AD groups was significantly lower than in the control group (Kruskal-Wallis test p=0.0001, χ²=11.6, p=0.003). These tests showed significant differences in GSLP amount between three groups (p=0.04 and χ²=9.38, p=0.01, respectively). Significant reverse correlation (Spearman R= -0.43, p=0.007) was found between GSLP amount and MMSE scores for MCI+AD group, i.e., the lower MMSE scores, the higher platelet GSLP level. Platelet COX and GSLP may be considered as early markers of cognitive impairment.

[Efficacy, safety and tolerability of a single dose of akatinol memantine in comparison to two-doses in patients with moderately expressed and moderately severe dementia in Alzheimer's disease].

The compliance of patients with moderately expressed and moderately severe dementia, caused by Alzheimer's disease (AD), to the treatment with two different dose regimes of akatinol memantine was studied. The study included 40 patients with AD and mixed Alzheimer-vascular dementia (AD/VD) aged from 53 to 84 years. Patients were stratified into 2 groups: patients of group 1 received akatinol memantine in a single dose 20 mg in the morning and patients of group 2 received the drug twice in dose 10 mg in the morning and in the afternoon. The treatment duration was 24 weeks. The single dose of drug was as effective and safety as standard treatment with two doses. Therefore, treatment with a single dose of 20 mg akatinol memantine is recommended for clinical practice.

[Ceraxon (citicoline) in the treatment of the mild cognitive impairment syndrome].

The objective was to study efficacy and safety of ceraxon (citicoline) used perorally in dose 1000 mg daily in the treatment of cognitive disturbances in patients with amnesic type of mild cognitive impairment (MCI). Twenty patients, aged from 50 to 90 years, received ceraxon in dose 1000 mg twice a day during 90 days. The state of patients was assessed with a battery of scales and tests with the following statistical data analysis. The significant results on the clinical effect of the drug on cognitive disturbances and good tolerability of ceraxon have been obtained. The authors recommend ceraxon for long-term preventive treatment in high risk populations for Alzheimer's disease.

[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.

[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.

[The treatment of Alzheimer's disease in patients with comorbid somatic pathology].

To study efficacy and safety of cholinergic therapy in patients with Alzheimer's disease or combined Alzheimer's and vascular dementia and marked somatic pathology, 30 patients, aged from 54-85 years, with mild or moderate dementia have been studied. Patients were treated with rivastigmine (exelon) in dosage 3-12 mg daily during 3 months. The safety of the drug for patients with comorbid somatic pathology has been shown: during the treatment no severe aversive effects or strengthening of diseases of visceral organs were observed. The improvement of global clinical state as well as reduction of cognitive and behavioral disorders indicate the high effectiveness of exelon. The recommendations allowing to improve the tolerability of treatment with exelon of patients with comorbid pathology of visceral organs are worked out.

[Prognosis of the syndrome of mild cognitive impairment: the data of the biennial follow-up study].

Structure and prognostic significance of the syndrome of mild cognitive impairment (MCI) were studied in a prospective biennial study of a randomized cohort of elderly people meeting current MCI criteria. The study comprised 40 patients aged from 50 to 80 years. Clinical follow up study included psychopathological, psychometric, neuropsychological, neuroimaging and molecular genetic (ApoE genotyping) examinations were made. Psychopathological structure and psychometric characteristics of the MCI syndrome are described, and clinical and genetic factors of prognostic value are singled out.

[Experience in clinical use of tanakan in the treatment of the syndrome of mild cognitive impairment].

Clinical efficacy and safety of tanakan has been studied in 30 patients with the syndrome of mild cognitive impairment. The results suggest a clear therapeutic effect of the 6 month course therapy. The efficacy of tanakan was confirmed by significant improvement of cognitive functioning of patients measured with MMSE, MDRS, FAST and other scales. The feature of tanakan effect is its positive influence on memory and other cognitive functions that allows the use of the drug in the treatment of elderly people with the syndrome of mild cognitive impairment. The safety of tanakan used in high therapeutic dosages (240 mg daily) and its good tolerability during chronic administration are revealed.

[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.