[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 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.

[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.

[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.

[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.

[The relationship between cognitive impairment and changes in retinal neuroarchitectonics]. / Svyaz' kognitivnykh narushenii i izmenenii neiroarkhitektoniki setchatki.

OBJECTIVE: To study the relationship between cognitive deficits and retinal neuroarchitectonics in Alzheimer's disease, vascular dementia, and glaucoma based on optical coherence tomography. MATERIAL AND METHODS: A comprehensive examination of 90 patients with Alzheimer's disease, vascular dementia and glaucoma was conducted. The patients were divided into three groups of 30 people each. The groups were comparable by gender and age and initial socio-economic status. All patients underwent a comprehensive neurological and neuropsychological study as well as optical coherence tomography. RESULTS AND CONCLUSION: The results of optical coherence tomography in Alzheimer's disease and glaucoma reveal retinal changes in the perifocal region in the upper and lower quadrants. In patients with vascular dementia, the process is observed in the foveal (central) region of the retina, which can be considered as a potential biomarker of the neurodegenerative damage. The severity of cognitive deficit in the Alzheimer's disease group correlates with the degree of degeneration in the layers of the peripapillary layer of the nerve fibers of the retina of the temporal region, the perifocal region of the lower quadrant of the retina, ganglion cells, and the inner plexiform layers of the retina. In the vascular dementia group, the severity of cognitive deficit positively correlates with the degree of cell degeneration in the foveal region of the inner plexiform retinal layer.

[Comorbidity of Alzheimer's disease and gegontophtalmic pathology]. / Komorbidnost' bolezni Al'tsgeimera i gerontooftal'mologicheskikh zabolevanii.

AIM: To compare the frequency of age-related ophthalmic diseases in patients with Alzheimer's disease and vascular dementia. MATERIAL AND METHODS: The study included 60 patients with severe cognitive impairment divided into two equal groups matched for sex and age. The first group included patients diagnosed with Alzheimer's disease. The second group consisted of people with a diagnosis of vascular dementia. All patients underwent clinical and neuropsychological as well as standard (visometry, refraction, measurement of intraocular pressure, biomicroscopy, ophthalmoscopy, computed perimetry) and complex (optic coherent tomography) ophthalmologic examinations. RESULTS AND CONCLUSION: In patients with Alzheimer's disease, concomitant ophthalmologic pathology in the form of glaucoma was observed more often in 46,7% of cases, pseudoexfoliation syndrome in 20% of cases, age-related macular degeneration in 16,7% of cases, while in the vascular dementia group the majority (80%) of patients did not have concomitant ophthalmologic pathology. When analyzing the severity of cognitive impairment in patients with Alzheimer's disease and various concomitant ophthalmic pathology, it was shown that patients with Alzheimer's disease and glaucoma have more significant impairments compared to patients without concomitant ophthalmological pathology.

[Perspectives of the diagnosis of Alzheimer's disease using optic coherent tomography]. / Perspektivy diagnostiki bolezni Al'tsgeimera s ispol'zovaniem opticheskoi kogerentnoi tomografii.

There is a constant search for new possibilities of the diagnosis of neurodegenerative diseases that cause dementia. The problem is important because of the growing prevalence of dementia, 60-80% of which are caused by Alzheimer's disease (AD). Over the last years, changes in the retina are thought to be a marker neurodegeneration. Assessment of these changes is performed using a method of optical coherent tomography (OCT) that allows taking cross-sectional imaging of a tissue. OCT is considered a potential biomarker of the early stage of AD. Identification of the relationship of the changes in retina and the optic nerve with cognitive impairment open new possibilities for the diagnosis of AD.