PECULIARITIES OF THE GUT MICROBIOTA IN PATIENTS WITH MIGRAINE COMPARING TO HEALTHY INDIVIDUALS.

OBJECTIVE: The aim: Analyze the gut microbiome state in patients with migraine (M) and healthy individuals, to assess possible correlations between the detected changes in patients with migraine and the frequency, intensity of headaches, psycho-emotional state of the patients, and their quality of life. PATIENTS AND METHODS: Materials and methods: 100 objects were enrolled, divided into 2 groups: main - patients with M and control - healthy volunteers. Investigation of the intestinal microbiome was performed by chromato-mass spectrometry. For M patients the following scales were used: Visual Analogue Scale (VAS), Migraine Disability Assessment (MIDAS), Back Depression Inventory (BDI). RESULTS: Results: In main group increased amount of Alcaligenes spp (p = 0.0061), Clostridium coccoides (p = 0.0021), Clostridium propionicum (p = 0.0287), Eggerthella lenta (p = 0.0138), Pseudonocardia spp (p = 0.0210), Rhodococcus spp (p = 0.0164), Candida spp (p = 0.0079), Micromycetes spp (campesterol) (p = 0.0011) were found. Patients with M had a raised amount of Herpes simplex (p = 0.0305) and endotoxin level (p = 0.0459). Differences in gut microorganisms in both groups were significant. In patients with M negative correlations were observed between Alcaligenes spp ammount and BDI score (r = -0.6226, p =0.007), VAS score (r = -0.489, p = 0.046), headache frequency (r = -0.487, p = 0.046); between the levels of Clostridium coccoides and MIDAS score (r =-0.51, p = 0.035), BDI score (r = -0.54, p = 0.025) and positive correlation between Eggerthella lenta level and VAS score (r =0.4830, p=0.049). CONCLUSION: Conclusions: Correlations between changes of gut microbiome and M are promising for further research.

Pros and cons of remote medical education in Ukraine in terms of COVID-19 pandemics.

Introduction: COVID-19 is an ongoing pandemic, which forced countries across the globe to adapt all daily activities to the new reality in order to stop the disease from spreading. The educational process was not an exception, it caused a sudden shift towards the exceptional introduction of online teaching and Kyiv Medical University was one of the first universities in Ukraine to assess the quality of education under the restrictive measures. Objectives: The aim was to analyze the advantages and disadvantages of online education during the COVID-19 pandemic in the learning of neurology at the Department of Neurology, Psychiatry and Physical Rehabilitation, Kyiv Medical University. Methods: 169 students were interviewed using an online questionnaire consisting of 18 items focused on different angles of educational process. Results: According to the obtained results, the biggest pros of online teaching included: flexibility of learning schedule, learning at your own pace; ability to develop deeper problem-solving and clinical thinking skills. Social distancing, family distractions, and internet connection issues negatively affected most students' feelings during online learning. One of the most prominent cons of online learning of neurology pointed out by the majority of medical students was a lack of practical component of training and contact with patients. Conclusions: Online teaching, along with a number of advantages, has significant disadvantages, especially in medical education in case of studying clinical disciplines.

COGNITIVE FUNCTIONS IN MULTIPLE SCLEROSIS PATIENTS DEPENDING ON THE DIFFERENT RISK FACTORS PRESENCE.

OBJECTIVE: The aim: To clarify the influence of different risk factors on cognitive impairment (CI) in general and in separate domains and their association with MRI findings in patients with relapsing-remitting (RRMS) and progressive forms of multiple sclerosis (SPMS and PPMS). PATIENTS AND METHODS: Materials and methods: One hundred and thirty-seven participants with MS (102 females and 35 males) aged from 22 to 69 years were enrolled into this study. All patients completed the Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A) and undergone MRI. RESULTS: Results: According to MS phenotypes all participants were divided into two groups: patients with RRMS (n= 106) and with progressive phenotypes (n= 31). A significant positive correlation was present between MoCA and BDI scores in all participants (p= 0,0015). Presence of anxiety did not demonstrate any valid influence on cognitive performance, although severe anxiety was significantly more often found in subjects with progressive phenotypes in presence of brain atrophy (p= 0,0028). Patients with higher education had no CI more frequently compare to those without it (p= 0,0019), whereas, participants smoking cigarettes had higher prevalence of severe CI than non-smokers (p= 0,0061). CONCLUSION: Conclusions: Among cognitive domains memory, visual-spatial and executive functions, abstract thinking were impaired the most in MS patients, though abstract thinking was more often affected in progressive forms. The results demonstrated that physical disability, depression and smoking negatively impacted cognitive performance, meanwhile presence of higher education demonstrated a favorable influence on cognition in MS patients.

Cognitive impairment and depression in patients with relapsing-remitting multiple sclerosis depending on age and neuroimaging findings.

BACKGROUND: Multiple sclerosis is an insidious, disabling, both physically and mentally, demyelinating disease of the central nervous system. This work aims to evaluate relationships between cognitive impairment in separate domains, depression and their correspondence with MRI-findings, as well as the influence on each other's manifestations, in patients with relapsing-remitting multiple sclerosis. RESULTS: Visual-spatial/executive functions and memory domains suffered more frequently than others in the study subjects under 40 years; in patients over 40 years old memory, visual-spatial/executive functions and abstract thinking impairment prevailed the most. Such cognitive domains as memory, language, abstract thinking, visual-spatial and executive functions were impacted in both groups of patients even without the apparent cognitive decline according to MoCA scale. Presence of depression impacted language and attention more prominently than the rest of the domains only in participants younger 40 years. According to the MRI, frontal lobe, corpus callosum and periventricular area were affected more often compared to other brain regions in case of cognitive impairment; meanwhile, combined lesions of frontal lobe and corpus callosum, fronto-temporal region were associated with depression. CONCLUSION: Cognitive impairment and depression are one of the common, yet disabling and socially disrupting manifestations of MS. Quite frequently such complaints are neglected or considered as parts of comorbidities. At the same time cognitive impairment can be amplified by depression, especially in patients under 40 years.

SLEEP DISORDERS IN RELAPSING-REMITTING MULTIPLE SCLEROSIS PATIENTS.

OBJECTIVE: The aim: Our study aimed at evaluating the relationships between sleep disorders (SD), cognitive impairment (CI), anxiety and depression in patients with relapsing-remitting multiple sclerosis (RRMS). PATIENTS AND METHODS: Materials and methods: One hundred and five patients with RRMS (80 females and 25 males) aged from 22 to 67 years (mean age: 41,8±10,7; EDSS:3,5±1,6; disease duration (DD): 10,3±8,5 years) were enrolled into the study. All participants completed questionnaires on sleep (the Pittsburgh Sleep Quality Index /PSQI), cognitive functions (The Montreal Cognitive Assessment /MoCA), anxiety (Hamilton Anxiety Rating Scale /HAM-A), depression (Beck Depression Inventory/ BDI). RESULTS: Results: According to PSQI score the patients were divided into two groups: with (n=42) and without SD (n=63). The patients with SD were older (45,36±1,66 vs 39,41±1,27, p=0.005), had higher EDSS score (3,98±0,26 vs 3,14±0,19, p=0,008), BDI (13,79±1,14 vs 8,96±0,86, p=0,0009) and HAM-A (24,52±1,42 vs 16,56±0,99, p<0,0001) scales compared with patients without SD. The frequency of anxiety (p=0,0034) and depression (p=0,038) was significantly higher in RRMS patients with compared to those without SD. No significant difference was found in gender, DD and MoCA score. In patients with SD significant negative correlation between MoCA and BDI score (r = -0,42, p<0,005) was found. In the group of patients without SD significant negative correlation between MoCA and EDSS (r = -0,27, p=0,03), MoCA and BDI (r = -0,26, p=0,043),) MoCA and HAM-A (r = -0,25, p=0,041) score was detected. CONCLUSION: Conclusions: Insomnia type SD in RRMS patients were associated with older age, higher EDSS score and presence of anxiety and depression.

VASCULAR RISK FACTORS AND COGNITIVE FUNCTIONS IN THE PATIENTS WITH CEREBROVASCULAR DISEASE.

OBJECTIVE: The aim: To assess the severity of cognitive impairment (CI) in patients with cerebrovascular disease (CVD) depending on the number of vascular risk factors (VRF). PATIENTS AND METHODS: Materials and methods: The study consisted of five hundred and eighty patients with CVD (247 females and 333 males) aged from 45 to 89 years (mean age: 64,1±8,9 years). The patients were divided into 6 groups (I, II, III, IV, V, VI) depending on the number of VRF. The examination consisted of a standard clinical evaluation, neurological examination, the application of neuropsychological tests (the MMSE; the PALT/The Paired Associates Learning Test; clock drawing test), laboratory tests, MRI of brain. RESULTS: Results: According to ANOVA, the greater the number of VRF the patients had, the lower was their total MMSE score corresponding to more pronounced cognitive decline (F=2,97, p=0,012). A significant negative correlation between patients' age and their MMSE score was detected regardless of their VRF count. The patients of the V and VI groups had substantially lower parameters of immediate, delayed memory and clock drawing test score comparing to the patients of the I group. CONCLUSION: Conclusions: The presence of 4 and more VRF was related to more pronounced CI in the patients with CVD. Decline of different aspects of memory, attention, spatial orientation, abstract thinking, planning, concentration, executive and visuospatial skills in groups of patients with 4,5 and 6 vascular risk factors was established. Age was substantially associated with cognitive decline in all the group of patients.

Age related characteristics of cognitive changes in patients with metabolic syndrome.

OBJECTIVE: Introduction: According to World Health Organization (WHO) forecasts, by 2050 the number of people suffering from dementia will constitute about 150 millions in the world. Nowadays, Alzheimer's disease plays the leading role in dementia emergence; it is the cause of age related dementia in 60% of cases. The aim: This study aimed to assess the age related cognitive changes in patients with metabolic syndrome (MetS). PATIENTS AND METHODS: Materials and methods: 503 patients aged 45 to 89 years with chronic cerebral ischemia were included into the study. All the patients were divided into two groups: group 1 - without MetS (n = 198), group 2 - with MetS (n = 305). Patients of both groups were divided into 3 age subgroups: 1st - 45-59, 2nd - 60-74, 3rd - 75-89 years old.The MetS was defined according to the criteria of the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association for the Study of Obesity. To evaluate patients' cognitive functions wide range of neuropsychological tests were used. RESULTS: Results: Patients of both groups had significant age related cognitive deficit. MetS patients of all age subgroups with mild cognitive impairment syndrome revealed a significant decline of immediate and delayed memory on the verbal stimuli (especially in patients of elderly and senior age groups), the rate of sensorimotor reactions, mental capacity, and the active attention amount in comparison to the patients without MetS. MetS patients with dementia of the middle age had significantly lower parameters of immediate and delayed memory on the verbal stimuli, the rate of sensorimotor reactions, mental capacity, and the active attention amount in comparison to the patients without MetS but with dementia. CONCLUSION: Conclusions:The presence of MetS was associated with more pronounced cognitive decline in the patients, concerning different aspects of memory, attention and executive functions.