[Prevalence of cognitive impairment in older adults in the Russian Federation]. / Rasprostranennost' kognitivnykh rasstroistv u patsientov starshego vozrasta v Rossiiskoi Federatsii.

Dementia is one of the main challenges to modern society. According to estimated data, as of 2019, there were 1.949.811 people living In Russia with dementia of various etiology. At the same time, there have been no large epidemiological studies of dementia in the Russian Federation. The article provides an overview of the available data on the epidemiology of cognitive impairment (CI) In Russia given from various sources. Not only estimated, but also available clinical data were analyzed. In general, the obtained prevalence values for CI are comparable to global values. Thus, in an epidemiological study of people over 60 years of age in a separate district of Moscow, the prevalence of dementia was 10.4%, Alzheimer's disease 4.5%. A study of outpatients aged 60 years and older showed a high prevalence of both dementia and non-dementia CI at general medical appointments (incidence of dementia 7.8%, MCI 49.6%). It has been shown that the problem of non-dementia CI is already relevant in people of pre-retirement age (the prevalence of non-dementia CI in patients 55-64 years old is 36.8-44.8%). Unique data obtained in a population of institutionalized centenarians (prevalence of dementia 69%), as well as data on the relationship of CI with both somatic and demographic factors are presented.

[Personalized patient-oriented approach to the treatment of musculoskeletal pain syndrome using over-the-counter medications. Resolution of the Expert Council (May 28, 2023)]. / Personalizirovannyi patsientoorientirovannyi podkhod k lecheniyu skeletno-myshechnogo bolevogo sindroma s ispol'zovaniem bezretsepturnykh preparatov. Rezolyutsiya ekspertnogo soveta (28 maya 2023 g.).

Diseases of the musculoskeletal system in Russia affect 19.2 million people. Untimely diagnosis and inadequate therapy of pain syndrome negatively affect the daily functioning and quality of life of patients, and create significant socioeconomic problems. The most common variants of musculoskeletal pain (MSP) are osteoarthritis (OA) and low back pain (LBP). OA is seen in 57.6% of individuals over 65 years of age. It should be noted that chronic pain syndrome, rather than anatomical and degenerative changes detected by imaging studies, determines to a greater extent the quality of life of patients with OA and prognosis during the course of the disease. The global burden of disability associated with LBPD increased in all age groups between 1990 and 2019 and was highest in the 50-54 age group.

Prevalence of geriatric syndromes in frail patients and mortality risks.

The prevalence of older people in Russian population increases rapidly. Therefore, the concept of healthy aging is becoming crucial in Russia and all over the world, and thus disability prevention is one aspect of this issue. Aim: To assess a possible association between geriatric syndromes, comorbidities, and mortality rate among frail patients who receive home medical care in Moscow. Materials and methods: The study included 450 patients with home medical care provided by the State Budgetary Healthcare Institution "Diagnostic Center No. 3 of the Moscow Health Department" from June 2019 to April 2021. Physical health, functional, cognitive, social and emotional statuses were evaluated by comprehensive geriatric assessment (CGA). The mortality rate after 1 year was assessed. Results: The all-cause case mortality rate in patients during the observation period was 22.4%. There was no difference in age and comorbidities in survivors and deceased patients, but the latter group had more geriatric syndromes. The association between risks of mortality and anemia and some geriatric syndromes, such as malnutrition and hearing impairment, total dependence (Barthel index less than 60) was observed.

[The effect of physical health and functional status on cognitive functions in women aged 55-64 years old.]

Cognitive impairment is one of the most common causes of reduced quality of life in older people. The aim of the study to evaluate impact of functional status, physical health and cognitive functions in women aged 55-64 years old. The study included 250 women aged 55-64 years (mean age 59,3±2,9 years). Socio-demographic and economic factors, functional and cognitive status were analyzed, the presence and prevalence of geriatric syndromes and their association with social, demographic and economic characteristics, risk factors for the development of chronic non-communicable diseases were studied. The prevalence of cognitive impairments was independently associated with education level, low income of patients, diabetes mellitus, glomerular filtration rate, and vertebral artery diameter. In this case, the level of education was a protective factor.

[Influence of risk factors for cardiovascular diseases, history of cardiovascular diseases, and structural and functional state of the heart on 3-year survival in persons 95 years and older.]

In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4%) were women. After 36 months, data were obtained on the participants' status of life: 25 (36,2%) were alive, and 44 (63,8%) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62%, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.

[Prevention of Cardiovascular Events: Are All Recommendations Applicable to Elderly Patients With Senile Asthenia?]

Primary prevention of cardiovascular events is based on achievement of optimal control of risk factors - arterial hypertension, dyslipidemia, glycemia - in accordance with current recommendations of scientific societies. But most rapidly growing segment of population - elderly and old individuals - have been underrepresented in randomized clinical trials underlying recommendations on primary and secondary prevention. That is why it is problematic to directly apply recommendations to patients from this group of population. In addition, old patients are characterized by accumulation of functional deficits, development of syndrome of senile asthenia ("frailty"), and multimorbidity. Effect of these characteristics on prognosis often exceeds that of risk factors. Other important factor is high susceptibility of old patients to risk of development of unfavorable effects because of both changes of pharmacokinetics and pharmacodynamics of drugs and the need for multiple medicines (polypragmasy). While applying existing recommendations to old people one should recognize limitations of current knowledge on best ways of realization of approaches to prevention of cardiovascular prevention which effectiveness has been proved in younger individuals. Improvement of awareness and development of special skills of physicians involved in management of old patients is required for timely detection of the syndrome of senile asthenia. Special geriatric approaches should be implemented in cooperation with specialists in geriatric medicine.

[Risk of Cardiovascular Complications and Geriatric Syndromes Among Elderly Women].

AIM: to assess the prevalence of some geriatric syndromes and their association with high risk of cardiovascular complications (RCVC) among elderly women. MATERIAL AND METHODS: We examined 72 women aged 69-77 years with cardiovascular diseases. Examination included laboratory and echocardiography assessment, dual-energy X-ray absorptiometry, 6-min walk test, assessment of psycho-emotional status using Mini-mental State Examination (MMSE) questionnaire. Frailty was defined as three or more of the following: weight loss, low physical activity levels, MMSE less or equal 23 points, weakness (chair stand test>10 sec), history of multiple falls. Follow up was 7.3 (5.5-7.8) months. RESULTS: High CVR was found in 70.8% women: in 59.1% women aged 65-74 years and in 89.3% - aged more or equal 75 years, =0.006. Osteoporosis (OP) was found in 51.3% women aged 65-74 and in 90.5% - aged more or equal 75 years, =0.024; MMSE was 27 (24-28) vs 24 (20-26) points, respectively, =0.008. The geriatric syndrome of frailty was found in 13.6% women aged 65-74 and in 64.3% - aged more or equal 75 years. Frailty was associated with high CVR (odds ratio [R] 7.2, 95% confidence interval [CI] 1.5-34.2, =0.013), chronic kidney disease (CKD, R 18.9, 95%CI 5.2-20.2, <0.001), P (R 4.5, 95%CI 1.3-15.8, =0.019), history of myocardial infarction (MI, R 6.8, 95%CI 2.2-20.8, =0.001), greater age (R 6.0, 95%CI 2.1-17.5, =0.001). CONCLUSION: High CVR was prevalent among greater age women what could be explained by prevalence of chronic heart failure, atrial fibrillation, CKD. Prevalence of frailty was 13.6 and 64.3% among women aged 65-74 and more or equal 75years, respectively. It was significantly associated with high CVR, OP, PMI, CKD.

[Seven questions for elderly in the practice of primary care physicians].

Although geriatric syndromes are widespread, they often remain undiagnosed leading to the development of adverse outcomes. For the prompt detection of the most common geriatric syndromes in primary care we have created seven issues related to weight loss, vision and hearing impairments, falls, mood disorder, cognitive impairment, urinary incontinence, and the difficulties in walking. We believe that using of these questions will allow physicians to focus on addressing the important health problems associated with age and will produce the selection of patients for comprehensive geriatric assessment.

[Validation of the questionnaire for screening frailty].

For screening frailty in daily practice, we developed the questionnaire relating issues of weight loss, impaired vision and hearing, injuries related to falls, mood decline, cognitive impairment, urinary incontinence, and mobility difficulties. 356 outpatients from Moscow were included in the study (mean age 74,9±6,1 years, women - 80,4 %). Patients were interviewed using the questionnaire and underwent a comprehensive geriatric assessment. The phenotype model of frailty was determined by L. Fried criteria, the frailty index model - by K. Rockwood criteria. ROC-analysis demonstrated a satisfactory agreement between the result of the survey by the questionnaire and assessment the phenotype model of frailty and the frailty index model (AUC=0,765 and 0,731, respectively). The results statistically significantly correlated with the assessment of the phenotype model of frailty and the frailty index model (Spearman correlation = 0,4 and 0,41, p<0,001). Optimal characteristics of the questionnaire for the frailty screening were consistent to cut-off ≥3 and ≥ 4 points. We propose to use a cut-off ≥ 3 point, since it corresponds to a higher value of sensitivity (85,7 and 93,3 % compared with the phenotype model of frailty and the frailty index model respectively). The proportion of patients who scored ≥ 3 points (58,4 %) indicates a high prevalence of geriatric syndromes among outpatients in Moscow.

[Screening tools for frailty in ambulatory care].

The article gives a brief description of the frailty syndrome and comprehensive geriatric assessment. We describe two classical models - a model of the phenotype and the index of the frailty. The basic questionnaires for frailty syndrome screening in outpatient practice, as well as research on the validation of these questionnaires are presented. The results of comparative studies of questionnaires for frailty screening are shown.

[Antihypertensive Therapy and its Efficacy in Outpatient Elderly and Very Elderly Subjects].

PURPOSE OF THE STUDY: The study of the characteristics and effectiveness of antihypertensive therapy (AHT) in patients aged 65 years and older. MATERIAL AND METHODS: The study included 356 patients, mean age 74,9+/-6,1 years, 80.4% women. The prevalence of arterial hypertension (AH) and the current intake of antihypertensive drugs were evaluated by self-reported patient. RESULTS: The prevalence of hypertension was 88.5%. The predominant variant was isolated systolic hypertension. 51.1% of patients have systolic blood pressure as measured at the reception turned >140 mm Hg in 34.7% of patients >150 mm Hg AHT received 91.6% of patients with hypertension in 65.6% of cases it was combined. Of the various combinations of bicomponent most patients took angiotensin converting enzyme inhibitor in combination with a -adrenoblocker or a diuretic. CONCLUSIONS: The study showed the high prevalence of hypertension and the lack of efficacy in patients AHT elderly seeking outpatient care.

[Cognitive impairment in postmenopausal women with arterial hypertension].

The aim of the study was to assess relationship between organ damage and changes of cognitive function in postmenopausal women with arterial hypertension during 3 years of follow-up. A total of 55 women (aged 69 ± 9,5 years) with stable course of hypertension were included. During period of observation and treatment cognitive function deteriorated in 40 and improved in 60% of women. Cox regression analysis showed that worsening of cognitive function was associated with low level of education (OR 3.85, p = 0.021), lack of work (OR 5.71, p = 0.035), left ventricular (LV) end-diastolic diameter (OR 6.89, p = 0.019), LV end-systolic diameter (OR 3.21, p = 0.047), left atrium (OR 15.20, p = 0.020), microalbuminuria (OR 11.14, p = 0.041) and duration of chair-rising test (OR 7.0, p = 0.025). Our findings indicate that progressive organ damage, low level of education and lack of work are associated with deterioration of cognitive function and functional mobility in women with hypertension. Our results reinforce the need for early detection of cognitive impairment as a marker of subclinical brain damage to prevent dementia.

[Cognitive Impairment in Postmenopausal Women With Arterial Hypertension].

The aim of the study was to assess relationship between organ damage and changes of cognitive function in postmenopausal women with arterial hypertension during 3 years of follow-up. A total of 55 women (aged 69+/-9,5 years) with stable course of hypertension were included. During period of observation and treatment cognitive function deteriorated in 40 and improved in 60% of women. Cox regression analysis showed that worsening of cognitive function was associated with low level of education (R 3.85, =0.021), lack of work (R 5.71, =0.035), left ventricular (LV) end-diastolic diameter (R 6.89, =0.019), LV end-systolic diameter (R 3.21, =0.047), left atrium (R 15.20, =0.020), microalbuminuria (R 11.14, =0.041) and duration of chair-rising test (R 7.0, =0.025). Our findings indicate that progressive organ damage, low level of education and lack of work are associated with deterioration of cognitive function and functional mobility in women with hypertension. Our results reinforce the need for early detection of cognitive impairment as a marker of subclinical brain damage to prevent dementia.

[Use of olicard retard in patients with stable angina of low effort in an outpatient setting]. / Poliklinicheskii opyt ispol'zovaniia Olikarda retard u bol'nykh stabil'noi stenokardiei malykh napriazhenii.

Efficiency of olicard 40 retard monotherapy and its combination with beta-blockers and calcium antagonists was studied in 33 IHD patients with effort angina of functional class III. It was established that olicard retard is an effective antianginal drug pharmakinetics of which allows assignment of individual therapy of IHD outpatients.

[The circadian profile of the arterial pressure and the structural-functional changes in the cardiovascular system in the initial stage of hypertension]. / Sutochnyi profil' arterial'nogo davleniia i strukturno-funktsional'nye izmeneniia serdechno-sosudistoi sistemy pri nachal'noi stadii gipertonicheskoi bolezni.

24-h blood pressure (BP) monitoring conducted in 52 patients with mild to moderate essential hypertension have shown that the average 24-h systolic and diastolic BP correlates with left ventricular (LV) mass index, while at casual clinical measurements only systolic BP correlates with LV mass index. In non-dippers (patients with a nocturnal BP decrease less than 10%) LV hypertrophy is observed 2 times more often than in dippers (patients with a nocturnal BP decrease more than 10%). In the group of dippers 24-h variability of systolic BP and daily systolic BP correlate with LV mass index. Increased variability of night BP correlates with increased venous tone in the calf, increased structural component of vascular resistance and a reduction of blood flow reserve in lower extremities.