[BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF): NEUROBIOLOGY AND MARKER VALUE IN NEUROPSYCHIATRY].

In this review current publications about neurobiology and marker value of brain derived neurotrophic factor (BDNF) in neuropsychiatry are analyzed. It is shown that BDNF is an important member of the family of neurotrophins which widely represented in various structures of the CNS. In prenatal period BDNF is involved in all stages of neuronal networks formation, and in the postnatal period its main role is maintaining the normal brain architectonics, involvement in the processes of neurogenesis and realization of neuroprotective functions. BDNF plays an important role in learning and memory organization, food and motor behavior. BDNF brain expression decreases with age, as well as in degenerative and vascular dementias, affective, anxiety, and behavioral disorders. The reducing of BDNF serum, level reflects the decreasing of its cerebral expression and could be used as a neurobiological marker of these pathological processes but the rising of its concentration could indicate the therapy effectiveness.

[P300 potential parameters at the stages of formation of the subcortical vascular dementia in elderly].

Auditory P300 latency and amplitude values were assessed in 11 elderly persons without cognitive impairments (WCI), mean age--(70.73 +/- 4.24) years, 20 patients with subcortical vascular mild cognitive impairment (SCMCI), mean age--(75.35 +/- 5.48) years and 20 patients with subcortical vascular dementia (SCVaD), mean age (75.80 +/- 6.51) years. Obtained data suggest that P300 latency value increase at the stages of the SCVaD progression. Mean values of P300 latency were (341.09 +/- 107.70) ms in WCI group, (655.70 +/- 87.08) ms in SCMCI patients, (732.45 +/- 74.64) ms in SCVaD patients. There were significant differences between the groups. This parameter allows differentiating patients with SCMCI from elderly persons WCI, and patients with SCVaD from SCMCI. Increasing P300 latency has sufficient relationship to severity and specificity of cognitive deficit of SCVaD stages development reflecting progressive deterioration of attention, working memory, kinetic and regulator praxis.

[Serum level of S100B as a marker of progression of vascular mild cognitive impairment into subcortical vascular dementia and therapy effectiveness].

We evaluated serum level of S100B in 11 patients with subcortical vascular dementia (SVD) and 19 patients with subcortical vascular mild cognitive impairment (SVMCI). Comparable groups were age-matched (79.18 +/- 7.76 in SVD group, 77.84 +/- 3.83 in SVMCI; P = 0.53). 22 patients were assessed after 1 month therapy. It was shown that the serum S100B level significantly increased--(0.065 +/- 0.020) micro/l (P = 0.0005) in SVD patients comparing to SVMCI ones - (0.043 +/- 0.010) microg/l. S100B level was significantly correlated with the clinical parameters: MMSE performance (r(s) = -0.61), CDR (r(s) = 0.58), attention task (r(s) = -0.46), pseudobulbar syndrome severity (r(s) = 0.37) and walking alteration (r(s)= 0.37). In patients with reduction of S100B level due to therapy (positive dynamics, n = 12) we registered significant improvement of some clinical parameters: MMSE, attention level, walking. In patients with increasing of S100B level (negative dynamics, n = 10) we didn't registered improvement of any clinical parameters. We made the conclusion that the serum level of S100B could be used as marker of progression SVMCI into SVD and therapy effectiveness.

[Apraxia disorders in elderly patients with non-stroke chronic brain ischemia].

The study aimed at providing qualitative and quantitative evaluation of apractic disorders in 60 elderly patients (mean age of 75.0 +/- 0.78 years) with non-stroke chronic vascular brain disease (NS CVBD). Apractic disorders were obligatory syndromes in patients with stage 2-3 NS CVBD. Kinetic and regulator apraxia were most prominent forms according to Luria's neuropsychological analyze. Apraxia is associated with the severity of the disease. Kinetic and regulator apraxia were components of frontal lobe syndrome presented by specific mental and speech disturbances and frontal lobe gait disorders. The results may be used in differential diagnosis between NS CVBD in elderly and another type dementias, especially dementia occurred in patients with Alzheimer's disease.

[Post-stroke depression].

In recent years, post-stroke depression (PSD) has attracted a worldwide interest. This review addresses the major research issues of PSD. PSD is the most frequent psychic complication among stroke survivors. Depression has a significant impact on post-stroke recovery and mortality. The diagnosis of PSD is based on the structured mental state examination and DSM-IV criteria as well as on the scores of the clinical symptoms scale (the Hamilton Depression Rating Scale) and self-rated inventories. PSD is multifactorial in origin and develops under the influence of biopsychosocial factors. The anatomical correlates of PSD change over time. In acute stage and 3-6 months after stroke, depression is associated with left-hemisphere lesion severity and proximity of the lesion to the frontal pole and related to the dysfunction of (cortico-) striato-pallido-thalamic-cortical projections. In post-stroke period (1-2 years) depression is significantly associated with right-hemisphere lesion severity and proximity of the lesion to the occipital pole. The most relevant psychosocial risk factors for PSD are described as follows: past history of depression and other mental disorders, dysphasia, functional impairment, living alone and post-stroke social isolation. Selective serotonin reuptake inhibitors (citalopram and fluoxetine) may be effective in the treatment of PSD.

[Serum serotonin level in patients with depression and panic attacks].

Serum serotonin level (SSL) was studied using ELISA method in 21 patients with depression associated with panic attacks (PA) and 15 non-depressed patients (8--with PA, 7--with the autonomous nervous system dysfunction). The authors found significant positive correlation between increased SSL and severity of depression, according to BDI (r = 0.82, r < 0.05). There was no correlation with other signs of the disease (anxiety, autonomous nervous system parameters). SSL in control group was about 72.6 +/- 10.06 ng/ml, in mild depressed patients--203.41 +/- 26.47 ng/ml, in severe depressed patients--438.58 +/- 36.31 ng/ml (P(1-2) < 0.001; P(2-3) < 0.001). It was proposed to use SSL for verification the depression severity.

[Depressive disorders in panic attack patients and their correction with escitalopram].

The present study aimed at investigating depression specificity and escitalopram medication efficacy in 33 patients with panic attacks (PA). Depression according to BDI was found in 96,4% patients with PA. Most important clinical peculiarities of depression in PA patients were asthenia, somatic preoccupation and anxiety in combinations with mild or severe depressed mood and mild lack of satisfaction. Development and severity of depression were significantly associated with duration and frequency of PA. Escitalopram was prescribed in a dosage of 10 mg/day for 2-months. The drug was shown to have high efficacy in the treatment of depression, high preventive activity for PA as well as good tolerability with rare and mild side effects. The conclusion was made that morbidity of depression and PA and depression specificity in patients with PA may be explained by the common pathophysiological mechanisms. Serotonin dysfunction may be the most important mechanism.

[Etiology, clinical variants, diagnosis and treatment tactic of cerebellar infarction]. / Etiologiia, klinicheskie varianty, diagnostika i lechebnaia taktika infarkte mozzhechka.

The article contains a review of revelant medical literature focusing on etiology, diagnosis and treatment of cerebellar infarction (CI). The above health problem occurs relatively seldom covering about 2% of all strokes. Common CI etiological factors include atherothrombotic lesions of the vertebrobasilar arteries, cardiac embolism. CI symptoms depend on localization and size of the infarction site. The infarct topography in accordance with the affected arterial region correlates with neurological disfunction. CI may bring about complications such as acute obstructive hydrocephalus and brain stem compression developing in the wake of the mass-effect. Computerized tomography and magnetoresonance topography permit making an early diagnosis and timely to make detect the development of complications. Cases of complicated CI need the neurosurgical treatment to be carried out.

[Neurobiology and modern approaches to the treatment of Alzheimer disease]. / Neirobiologiia i sovremennye podkhody k lecheniiu bolezni Al'tsgeimera.

Alzheimer's disease (AD) is the most common type of dementia among older people. AD is characterized as neurodegenerative disease showing impairment of cognitive function, death of neuronal cells, numerous numbers of senile plaques and tangle of neurofilaments. The paper contains the literary review concerning the most important neurobiological mechanisms of the AD development. The modern strategy of treatment such as acetylcholine esterase inhibitors, neuroprotectors, neurotrophic factors, inhibitors of beta- and gamma-secretase, beta-amyloid aggregation inhibitors, beta-amyloid degradation stimulators, beta-amyloid vaccination, inhibitors of tau protein phosphorylation, estrogens, nonsteroid anti-inflammatory drugs is discussed.

[Pathological aspects of post-stroke muscle tone disorder: clinical-neuro-visual study]. / Patogeneticheskie aspekty postinsul'tnykh narushenii myshechnogo tonusa: kliniko-neirovisualizatsionnye issledovaniia.

We studied how different patterns of muscle tone disorders depend upon lesion site using CT. 111 patients not earlier 3 months after hemispheric stroke were studied. We showed the degree of spasticity to be determined by depth of hemispheric damage in relation to posterior limb of capsula intema. It also correlates with the degree of corticoreticular pathway damage. Even or irregular damage to this pathway which accompany pyramidal tract stipulates different patterns of spasticity, distribution and its interaction with structure of hemiparesis. Degree and structure of post-stroke muscle tone disorders after 3 months from the onset of stroke is depend on hemispheric damage but do not depend on the duration of recreative or residual period of the disease. It can be applied in medical expertise that pattern and prominence of post-stroke muscle tone disorders 3 months after stroke onset depend on lesion location, but not on the length of recovery period or period of residual changes.

[The weakening of the inhibition of the H-reflex in patients with different sites of a hemispheric stroke]. / Oslablenie tormozheniia H-refleksa u bol'nykh s razlichnoi lokalizatsiei polusharnogo insul'ta.

Inhibition was studied of H-reflex of musculus soleus in patients (n = 31) with posterocapsulolenticular, anterocapsular, lenticular, thalamic, and corticosubcortical locations of hemispheric insult. Relationship was demonstrated of the pathological focus localization to abnormalities in the H-reflex inhibition, the most pronounced of them being recordable in patients presenting with complete damage to the posterior limb of the internal capsule.

[The main locations of post-stroke cysts in the cerebral hemispheres and the clinical characteristics of the motor deficit (based on computed tomographic data)]. / Osnovnye lokalizatsii postinsul'tnykh kist v polushariiakh bol'shogo mozga i klinicheskie osobennosti dvigatel'nogo defitsita (po dannym komp'iuternoi tomografii).

Overall eighty-eight patients with hemispheric stroke were examined 3 months following the outset of the disease. Clinical findings and computerized tomography scans showed the cerebral hemispheric cysts to be in posterocapsulolenticular, anterocapsulocaudal, lenticular, thalamic, lobar, frontal, combined, multiple positions. Locations of hemispheric cysts were found out to be associated with polymorphous structure of motor deficit.

[A new classification of the motor disorders in patients who have had a cerebral stroke]. / Novaia klassifikatsiia dvigatel'nykh narushenii u bol'nykh, perenesshikh mozgovoi insul't.

A new classification of motor disorders in patients after brain hemisphere's stroke as well as with its sequelae was proposed on the basis of clinical electromyographic studies. The classification validity was confirmed by mathematic statistic methods. The classification was composed of motor syndromes and is based on the following criteria: the severity of paresis, the correlation between gravity of paresis of the upper and lower limbs, muscular spasticity, alteration of integral estimation of active movements (the motor algorithm). The most informative signs of classification are the following: the paresis gravity, the degree of muscular spasticity, the alteration of motor algorithm, the parameters of stimulative electromyography. The described classification permits to carry out differentiated actions of neurorehabilitation directed to intensification of effectivity of treatment after hemisphere's stroke.