[Nocturia in Parkinson's disease]. / Nokturiya, svyazannaya s bolezn'yu Parkinsona.

OBJECTIVE: Evaluation of nocturia and its relationship with clinical characteristics of Parkinson's disease (PD) and dopaminergic therapy. MATERIAL AND METHODS: One hundred and thirteen patients with PD of I-III Hoehn and Yahr stage (H&Y) were examined using the following scales: IPSS, including nocturia domain, UPDRS, Sch&En, PDQ-39, MMSE, FAB, BDI, STAI-S and STAI-T, PFS-16, NMSQuest, GDSS, GSRS, and orthotest. RESULTS: Nocturia was detected in 93 patients. It depended on the age of the patients (rS=0.345; p<0.001) and was more spread among women (p=0.002). We obtained positive correlations of nocturia (p<0.05) with: PDQ-39 (rS=0.296), H&Y (rS=0.223), UPDRS (rS=0.265) and its items (speech, walking disorders, standing up from chair, posture and postural stability), NMSQ (rS=0.318), FAB (rS= -0.359), BDI, STAI-S and STAI-T, PFS-16, gastrointestinal parameters and blood pressure in the supine position. No significant effect of dopaminergic therapy on the severity of nocturia was found. According to regression analysis (stepwise method), predictors of nocturia are depression, higher lying blood pressure, constipation and postural instability (R2=0.474). CONCLUSIONS: Nocturia is the most common urological symptom in patients with PD and it significantly reduces the quality of life starting from the early stages of the disease. Nocturia increases as PD progresses, it is independent of dopaminergic medications, and it is directly associated with a number of parkinsonian symptoms (postural, frontal cognitive, affective and autonomic), which are partly dopamine-resistant. This indicates the common pathogenesis of nocturia and other symptoms of PD and the significant influence of polytransmitter imbalance.

[Lower gastrointestinal dysfunction in patients with Parkinson's disease]. / Disfunktsiya nizhnikh otdelov zheludochno-kishechnogo trakta u patsientov s bolezn'yu Parkinsona.

OBJECTIVE: To assess the lower gastrointestinal tract dysfunction in patients with Parkinson's disease (PD) and to reveal its relationships with motor and non-motor symptoms. MATERIAL AND METHODS: One hundred and eighteen patients with PD of I-III Hoehn and Yahr (H&Y) stages were studied using UPDRSI-IV, Sch&En, PDQ-39, MMSE, BDI, STAI-S and STAI-T, PFS-16, NMSQ, GSRS, BSFS, AUA. Body mass index and saliva amount and lacrimation (Schirmer's test) were assessed. RESULTS: Constipation from mild to moderate intensity was present in 71.2% of the patients; predominantly mild diarrhea occurred in 27.9%; alternations of diarrhea with the difficulty in intestine emptying were observed in 25.4%. We found significant correlations of constipation with the following parameters: Sch&En scales (rS=-0.291) and PDQ-39 (rS=0.478), patient's age (rS=0.275), H&Y stage (rS=0.2604), UPDRS (rS=0.254), axial motor symptoms of parkinsonism, and a number of affective and autonomic disorders, most of which were partly dopamine-resistant. Diarrhea did not affect the quality of patient's life, or depend on age, PD stage, main digital and non-motor symptoms, but directly correlated with the severity of constipation (rS=0.263) and other gastrointestinal disorders. There were no effects of dopaminergic therapy, including levodopa, dopamine-receptor-agonists, and amantadine, on the lower gastrointestinal tract dysfunction. CONCLUSION: Dysfunction of the lower gastrointestinal tract (predominantly from mild to moderate intensity) was detected in most PD patients of I-III stages. Our data indicate a complex pathogenesis of the PD impaired bowel emptying, involving degeneration of non-dopaminergic structures, and the predominant influence of concomitant diseases and inadequate laxative therapy on the formation of diarrhea syndrome in PD.

[Motor and autonomic disorders influence on pain syndrome of patients with Parkinson's disease of the I-III H&Y stages]. / Vliyanie motornykh i vegetativnykh narushenii na vyrazhennost' bolevogo sindroma u patsientov s I­III stadiyami bolezni Parkinsona.

OBJECTIVE: To evaluate the influence of motor and autonomic disorders on the pain of patients with PD of the I-III H&Y stages and possibility of correcting the pain with dopamine receptor agonists (ADR). MATERIAL AND METHODS: 252 patients (128 women and 124 men, 42-80 years old) with PD of I-III Hoehn and Yahr stages (H&Y) were examined using the following scales: UPDRS, daily activity Sch&En, quality of life PDQ-39, MMSE, BDI, PFS-16, NMSQuest, GSRS, AUA; 53 patients were piribedil treated during 6 months. RESULTS: Our results indicated a wide prevalence of pain syndrome in PD patients (58.6%), starting from the early stages (50% for the Ist stage). The most stable pain associations were found with the PD stage, levodopa doses, severity of motor symptoms (postural disorders and hypokinesia manifestations) and motor complications («off-periods¼ and dyskinesias), as well as non-motor PD manifestations depression and autonomic dysfunctions (constipation, swallowing disorders, and frequent urination). The regression analysis showed, that the severity of motor complications and depression were the predictors of pain occurrence. The pain syndrome in patients with PD of I-III stages underwent significant regression (by 51% and 62%, after 1.5 and 6 months of therapy, respectively) after ADR (piribedil) addition to their therapy; it's probably due to improving the motor component and decreasing depressive disorders. CONCLUSIONS: The piribedil inclusion contributes to the reduction of pain syndrome, regardless is it used in monotherapy or in conjunction with levodopa preparations.

[Imaging of brain activity using fMRI in a patient with subjective cognitive decline]. / Vizualizatsiya mozgovoi aktivnosti s pomoshch'yu fMRT u patsientki s sub"ektivnym kognitivnym snizheniem.

In clinical practice, subjective cognitive decline (SCD) is often difficult to diagnose because it is not detected by standard neuropsychological and cognitive tests.The described clinical case is presented to demonstrate the difficulties of diagnosis and treatment choice in a patient with SCD. fMRI might be considered as an instrumental method to analyze the functional relationship between the activity of brain structures and cerebral circulation in patients with SCD. Patient clinical and neuropsychological data with a detailed description of fMRI with a cognitive paradigm are presented. The article is focused on the early diagnosis of SCD and the prognostic assessment of the transition of SCD to dementia.

[Upper gastrointestinal tract dysfunction and its correction by dopamine agonists for patients with Parkinson's disease of I-III stage]. / Disfunktsiya verkhnikh otdelov zheludochno-kishechnogo trakta u patsientov na I­III stadiyakh bolezni Parkinsona i ee korrektsiya agonistami dofaminovykh retseptorov.

OBJECTIVE: To evaluate the main symptoms of the upper gastrointestinal dysfunction (salivation and swallowing disorders) and to determine their impact on the quality of life for patients with PD of stages I-III, as well as the possibility of their correction by dopamine receptor agonists. MATERIAL AND METHODS: 252 patients (128 women and 124 men, 42-80 years old) with PD of stages I-III were examined using: UPDRS items «salivation¼, «swallowing¼ and «anorexia¼, scale of daily activity (Schwab and England ADL scale), questionnaire quality of life (PDQ-39), measurement of saliva amount, BMI, MMSE scale; 53 patients were treated with piribedil during 6 months. RESULTS: The upper gastrointestinal tract dysfunction of mild to moderate severity was detected in 51.2% of patients. The prevalence of sialorrhea was 38.9, 42.9 and 46.2%, and that of dysphagia was 22.2, 24.3 and 17.3% at stages I-III, respectively. According to the results of the correlation analysis dysphagia is associated with a long history of PD, low BMI, high doses of levodopa and low Sch & En score; and sialorrhea is also associated with low BMI and with old age. For the early stages of PD we can tell, that the quality of patients' life deteriorates, and this to a large extent is due to impaired salivation and swallowing, which manifest themselves in daily activity and communication difficulties. CONCLUSIONS: The inclusion of piribedil (150-250 mg/day) in the 6-months therapy reduces the dysfunction of the upper gastrointestinal tract (by 61 and 74% of the initial level of dysphagia and sialorrhea, respectively) regardless the drug use in monotherapy or in complex therapy with levodopa.

Gastrointestinal Dysfunction Impact on Life Quality in a Cohort of Russian Patients with Parkinson's Disease I-III H&Y Stage.

Background: There are still no clearly proven methods to slow down or stop the progression of Parkinson's disease (PD). Thus, improving the quality of life (QoL) of patients with PD becomes of primary importance. Autonomic dysfunction and its symptoms are known to worsen the quality of life in PD, but the degree of this influence is underinvestigated. Particularly, impacts of the separate significant gastrointestinal symptoms, such as dyspepsia, constipation, and abdominal pain, in PD should be more precisely evaluated with the help of specific scales. Objective: To assess the impacts of gastrointestinal dysfunction and its symptoms on PD patient's QoL using PDQ-39. Methods: 111 PD patients in the I-III Hoehn and Yahr (H&Y) stage were enrolled in the study. The following scales were applied: UPDRS III, PDQ-39, GSRS, GDSS, MMSE, BDI, STAI-S, and STAI-T. Results: The linear regression model showed that the PDQ-39 SI depended on summary assessments GSRS-SI (ß = 0.333, p < 0.001), BDI (ß = 0.463, p < 0.001), and UPDRS III (ß = 0.163, p < 0.05). The use of the stepwise method, adding GSRS-SI and UPDRS III scores to the BDI predictor, improved the model (R2 increased from 0.454 to 0.574). The investigation of GSRS domain's influence revealed that PDQ-39 SI had a significant correlation with almost all of them, but the regression analysis showed significant QoL impacts of only two factors: constipation and abdominal pain (ß = 0.288, p < 0.01 and ß = 0.243, p < 0.05 accordingly). Conclusions: Our results suggest a considerable negative influence of depression and gastrointestinal dysfunction (especially constipation and abdominal pain) on QoL of patients with PD. Their impact on QoL in patients with I-III H&Y stages of PD is more significant than that of motor symptoms. Therefore, the correction of depression and gastrointestinal dysfunction should be prioritized in PD therapy.

[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]. / Klinicheskie rezul'taty i perspektivy primeneniya fenozanovoi kisloty u vzroslykh patsientov s fokal'noi epilepsiei.

OBJECTIVE: To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)). RESULTS: Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients. CONCLUSION: The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[Mild cognitive impairment: modern aspects of diagnostics and therapy]. / Umerennye kognitivnye rasstroistva: sovremennye aspekty diagnostiki i terapii.

The article provides a review of current literature on the diagnosis and treatment of mild cognitive impairment (MCI). MCI is not a common outcome of brain aging; it is an intermediate state between normal cognitive status and mild dementia. The MCI concept has been actively developing over the past few decades, a lot of knowledge and clinical experience has been accumulated, and numerous clinical trials are being conducted to develop effective methods of diagnosis and therapy. Treatment of pre-dementia cognitive disorders differs in many ways from therapy for dementia and has a better prognosis, therefore, it is recommended to diagnose and begin treating cognitive disorders as early as possible. The main possibilities of drug and non-drug therapy are described, with an emphasis on the use of the dopamine receptor agonist piribedil in the treatment of MCI and sensory deficit in elderly patients. The mechanisms of action of the drug are analyzed, data from the main clinical studies of the efficacy and safety of piribedil are presented: the positive effect of the drug on cognitive functions has been shown in more than 10 international clinical trials including about 7000 patients and in a number of post-marketing works performed on the Russian population of patients. Piribedil is successfully used for various types of cognitive disorders, both neurodegenerative and vascular, of mild to moderate severity.

[Efficacy and safety of noophen in the treatment of chronic fatigue syndrome in patients with cerebrovascular insufficiency]. / Éffektivnost' i bezopasnost' preparata noofen v terapii sindroma khronicheskoi ustalosti u bol'nykh s tserebrovaskuliarnoi nedostatochnost'iu.

AIM: To assess the efficacy and safety of noophen in the treatment of chronic fatigue syndrome in patients with cerebrovascular insufficiency. MATERIAL AND METHODS: Fifty-three patients with cerebrovascular disease, who complain about persistent fatigue, were randomized into two groups. Patients of the main group (n=33) received standard therapy and noophen, patients of the control group (n=20) received only standard therapy. Treatment efficacy was assessed using MFI-20, HADS-A, LSEQ. In addition, cognitive functioning was evaluated using Schulte test. RESULTS AND CONCLUSION: Treatment with noophen resulted in the marked decrease in the total intensity of fatigue measured with MFI-20. The decrease in fatigue intensity by 30-50% was observed in 3/4 of patients of the main group. Noophen reduced all components of fatigue syndrome, including a mental component, and improved motivation. The reduction of the mental fatigue component was combined with the improvement of cognitive functioning assessed with Schulte test. Therefore, the effect of noophen on motivation and mental fatigue component can promote cognitive training in patients with cerebrovascular insufficiency.

[Cerebral markers of endothelial dysfunction in chronic brain ischemia]. / Markery éndotelial'noi disfunktsii pri khronicheskoi ishemii mozga.

A review of the main markers of endothelial dysfunction in chronic cerebral ischemia is presented. The quantitative changes in the level of endothelial dysfunction markers in chronic cerebral ischemia help to evaluate the efficacy of preventive and therapeutic pharmacological activities. The results of clinical trials have demonstrated that the course use of divazа in patients with chronic cerebral ischemia leads to improvement of both clinical indicators and laboratory markers for normalization of cerebral ischemia and endothelial dysfunction.

[The strategies for psychological self-control of seizures in patients with focal epilepsy]. / Strategii samokontrolya epilepticheskikh pristupov u patsientov, stradayushchikh fokal'noi epilepsiei.

AIM: To investigate self-control strategies for epileptic seizures and their relationship to the individual coping-style in patients with focal epilepsy. MATERIAL AND METHODS: Twenty one adult patients with focal epilepsy were examined. Strategies for seizure control and coping-style were estimated with the CBES-SC and the Brief COPE scale, respectively. The control group consisted of 20 healthy individuals. RESULTS: 86% of patients tried to control their seizures. Most of the patients (33%) preferred to use behavioral self-management strategies, which reduced the consequences of seizure. Patients with the high self-control activity more often had adaptive problem-focused coping-style in comparison to the patients with the low self-control (p<0.01). CONCLUSION: The psychological coping-style modifying support can motivate patient to the wider use of strategies for seizure control and improve a psychosocial adjustment of the patient.

[An open comparative observational study of the efficacy and safety of adaptol in anxiety-asthenic disorders in patients with chronic cerebral ischemia]. / Otkrytoe sravnitel'noe nablyudatel'noe issledovanie effektivnosti i bezopasnosti preparata adaptol v terapii trevozhno-astenicheskikh rasstroistv u bol'nykh s khronicheskoi ishemiei golovnogo mozga.

AIM: To assess the efficacy and safety of adaptol in anxiety-asthenic disorders in patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Forty-nine patients with CCI and comorbid anxiety-asthenic disorder were randomized to standard treatment group (20 patients) and main group which consisted of 29 patients treated with adaptol (500 mg 2 times daily for 6 weeks) in addition to standard treatment. The efficacy of treatment was assessed with HADS-A, HADS-D, FAS and SF-36. Physical fatigue was evaluated using cycle ergometry test. RESULTS: After 6 weeks, anxiety symptoms were stopped in the most of the patients of the main group (72.4%). The threshold during cycle ergometry was higher in the patients of the main group compared to the comparison group (132.2 vs 114.0 VT, respectively) and the patients experienced less fatigue after the test. Quality-of-life was improved by >10% in patients treated with adaptol and did not changed in the patients of the comparison group. CONCLUSION: The addition of adaptol to standard treatment of patients with CCI allows to stop symptoms of anxiety, increase the tolerance to load and improve quality-of-life.

[Pharmacotherapy of anxiety disorders in patients with chronic cerebral ischemia]. / Farmakoterapiya trevozhnykh rasstroistv u patsientov s khronicheskoi ishemiei golovnogo mozga.

AIM: To compare the effects of the daytime anxiolytic adaptol and the tranquilizer/nootropic drug noophen on target symptoms related to anxiety spectrum disorders in patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Sixty-two patients with CCI and comorbid anxiety spectrum disorders were randomized to adaptol group (n=29) and noophen group (n=33). Results of treatment were assessed with CGI, MFI-20, HADS-A and HADS-D, MMSE. RESULTS AND CONCLUSION: Both drugs showed the comparable efficacy and speed of achievement of anxiolytic effect. Anxiety symptoms were stopped in 79.0% of the patients. Adaptol was superior to noophen in regard to nonspecific somatic symptoms (р=0.037). Asthenia and sleep disorders have decreased significantly in the noophen group. Use of target symptoms in the individual choice of anxiolytic therapy in patients with anxiety spectrum disorders associated with CCI can increase treatment efficacy.

[A prospective, open, non-randomized study on the safety and efficacy of natalizumab (tisabri) in the Russian population of patients with relapsing-remitting multiple sclerosis]. / Prospektivnoe otkrytoe nerandomizirovannoe klinicheskoe issledovanie bezopasnosti i éffektivnosti terapii natalizumabom (tizabri) v rossiiskoi populiatsii patsientov s retsidiviruiushche-remittiruiushchim rasseiannym sklerozom.

AIM: To evaluate safety and efficacy of natalizumab (tisabri) in the RUSTYS study of patients with relapsing-remitting multiple sclerosis (RRMS) during one year. MATERIAL AND METHODS: This prospective, open, non-randomized clinical study included 100 RRMS patients treated with natalizumab in dose 300 mg intravenously every 4 weeks during 48 weeks. The safety was assessed by the percentage of patients with infusion reactions as well as by the distribution of undesirable effects (UE). Before treatment and after 48 weeks, antibodies to JC virus (JCV) were determined. The efficacy was evaluated by the frequency of relapses, progression of disability, MRI results and quality of life indices. RESULTS: After treatment, 87% of the patients had no relapses, disease progression assessed by EDSS was not observed in 96% . To 48th week, 71% of patients had no MRI changes in T2 lesions and 79.6% - in T1 hypointense lesions. Quality of life has been improved. At least one UE, including the development of tuberculosis in one patient, was noted. Infections (upper respiratory tract infection, nasopharyngitis, flu) were recorded in 25% of the patients. Three out of 28 (10.7%) of the patients with negative results of JCV analysis at baseline had the seroconversion with the change of the negative status to the 48th week. No cases of progressive multifocal leukoencephalopathy related to natalizumab were found. CONCLUSION: The results are in line with those of earlier studies in patients with RRMS with high disease activity.

[The impact of erythrocyte adrenoreceptors functional activity and clinical factors on the prognosis and outcome of atherothrombotic stroke]. / Prognozirovanie techeniia i iskhoda aterotromboticheskogo insul'ta na osnovanii otsenki aktivnosti adrenoretseptorov éritrotsitov i klinicheskoi kartiny.

Objective. To assess the prognostic value of erythrocyte membrane adrenoreceptor activity in the peripheral blood in the acute phase of ischemic stroke (II). Material and methods. We studied 89 patients with hemispheric atherothrombotic stroke, 49 women and 40 men, aged from 40 to 87 years (mean age 66.69±13.64 years). Results and conclusion. The prospective six-month trial established that the most significant predictors of poor stoke outcome were: age more than 71, severity of stroke in acute phase (IV-V Rankin scale degree), erythrocyte membrane beta-adrenoreception level (EMBR) more than 50 RVU in the acute phase and high EMBR (>40 RVU) in 7-10 days after stroke. Erythrocyte membrane beta-adrenoreception level (EMBR) more than 50 RVU was associated with mortality during the first 6 months after stroke (р=0.0017). Prediction model of stroke based on EMBR level was suggested.

[Treatment of emotional and cognitive disorders in patients with chronic cerebral ischemia].

OBJECTIVE: To study clinical efficacy of the drug divasa in patients with chronic cerebral ischemia. MATERIAL AND METHODS: One hundred and forty-two patients, mean age 58,6±8,8 years, were treated during 11,9±0,2 weeks. Neurological examination and evaluation of a patient's status with psychometric scales were performed. RESULTS: The drug reduced anxiety, depressive and asthenic disorders beginning from the 4th week of treatment. The positive effect of treatment on cognitive functions appeared later. CONCLUSION: Divasa proved to be an effective drug in the complex treatment of patients with chronic disturbances of cerebral blood circulation.

[Methodical approaches to the substantiation of hygienic requirements for the application of deicing materials].

In the paper there is presented a review of existing guidelines and rules of operation of deicing materials (DIM), as well as opportunities for their processing with the aim to ensure the security for the environment and public health. There are described the ecological- hygienic and toxicological properties of chemicals. There are reported results of a pot experiment for the assessment of the impact of DIM on the lawn.

[Evaluation of the autonomic regulation of the cardiac oxygen supply of measured physical activity in patients with remitting multiple sclerosis].

Results of the study on the autonomic nervous system dysregulation in multiple sclerosis (MS), in particular, the autonomic heart regulation, are presented. The variability of cardiac rhythm at rest and after measured physical activity is evaluated. The autonomic cardiovascular balance at baseline was analyzed in 32 patients during 5 min at rest (resting awakening state) and 7 min after the cycle ergometry test (CET) during 5 min. At resting state, there was the decrease in the autonomic regulation of the cardiac rhythm assessed by the indicators of the total variability due to the parasympathetic insufficiency. All patients had low tolerability to the physical loading. After CET, patients intolerant to physical loading had significantly lower values of the indicators compared to those who completed the test. The low values of spectral indicators in patients intolerant to physical loading during the restoration may suggest the exhaustion of adaptive resources of the cardiovascular system during the CET and reduced possibilities for the restoration of autonomic reserves after the attempt to perform physical tasks.

[Regulation of safe levels of polychlorinated biphenyls in soil: Russian and international experience].

The article presents data on the levels of soil pollution by polychlorinated biphenyls (PCBs) in different regions of Russia and foreign countries. For the time present proposed regulatory value for the regulation of PCBs in soils of different land uses have been established to be set mainly on the results of the calculations of risk. However used initial values and features of the methodology for calculating determine significant variability of proposed levels of PCBs in soils. Analysis of the discussed problem of regulation of PCBs in soils in different countries permitted to make the conclusion that for the sound management of PCBs in the environment, it is necessary, first of all, the solution of questions of selection of a single standardized PCBs sample and the most appropriate method for risk assessment for the characterization of the state of contaminated soils.

[Characteristics of gender differences in patients with panic disorder].

The individual gender type was assessed using the Bem sex role inventory. Seventy patients with panic disorders (PD) and 50 healthy people (controls) were studied. There was a few patients with masculine features (4.3%) compared to the control group (22%). The correlations between a small number of masculine characteristics (less than 10 traits), the development of agoraphobia in PD, the progressive course of PD with the poor response to treatment and marked social maladaptation were found. It has been concluded that the insufficient masculinization is a personality feature of PD patients predisposing to avoidant behavior.