[EEG changes in patients with Alzheimer's disease]

The prevalence of cognitive impairment is steadily increasing compared to previous years. According to the World Health Organization, the number of people living with dementia will increase reaching 82 million in 2030 and 152 million in 2050. The most common cause is Alzheimer's disease (AD). The pathophysiological process in AD begins several years before the onset of clinical symptoms; so identifying it at an early stage would likely improve the clinical prognosis. The article presents EEG changes in patients with AD, and discusses the possibility of using EEG as a screening method for examining patients with cognitive impairment.

[Neurometabolic therapy of mild cognitive impairment in patients with chronic cerebral ischemia]

OBJECTIVE

To evaluate the effect of a sequential therapy regimen with Mexidol (500 mg injections intravenously for 14 days) and Mexidol FORTE 250 (250 mg tablets 3 times a day for 60 days) on higher cortical functions in patients with moderate cognitive disorders in chronic cerebral ischemia.

MATERIAL AND METHODS

A comparative, prospective study included 63 patients with chronic cerebral ischemia with moderate cognitive impairment. All patients received basic therapy aimed at reducing risk factors (antihypertensive, antithrombotic drugs as indicated). Patients of the main group (30 people: 12 men, 18 women) received Mexidol intravenously 500 mg in 100 ml of 0.9% NaCl solution once a day for 14 days, then Mexidol FORTE 250 (film-coated tablets) 250 mg 3 times a day for the next 60 days. The comparison group consisted of 33 patients (14 men, 19 women) who received only basic therapy. The groups were comparable in terms of age, sex characteristics and severity of cognitive deficit. We examined cognitive status (MoCA scale, Frontal Dysfunction Battery, 10 Word Memorization tests), severity of asthenia (MFI-20 scale), anxiety and depression (HADS scale), patient's subjective assessment of the dynamics of the condition (CGI-improvement scale) in 1st, 14th and 74th±5 days of observation. On days 1 and 74±5 of observation, patients were examined using transcranial magnetic stimulation to study the neuronal activity of the cerebral cortex.

RESULTS

In the main group, at the time of completion of taking Mexidol and Mexidol FORTE 250, a pronounced cognitive regression was noted (MoCA scale +3 points, difference with the comparison group 1 point (p<0.0001); Frontal Dysfunction Battery test +4 points, difference with comparison group 2 points (p<0.001); memory test «10 words» +2 points, difference with the comparison group 1 point (p<0.05), emotional (HADS anxiety scale -8 points, difference with the comparison group 3 points (p<0.001), depression -3.5 points, difference with the comparison group 1.5 points (p<0.01), asthenic disorders (MFI-20 scale -30 points, difference with the comparison group 15.5 points (p<0.01), improvement in the well-being of patients (CGI-improvement scale -2 points, difference with the comparison group 1 point (p<0.0001). According to the transcranial magnetic stimulation performed, a statistically significant decrease in the central motor conduction time at the level of 1 and 2 motor neurons of the pyramidal tract bilaterally from the start to the end of therapy with Mexidol and Mexidol FORTE 250 was determined (p<0.01). An inverse correlation was found between the time of central motor conduction and the results of the Frontal Dysfunction Battery test at the same time points with left-sided localization of 1 motor neuron (p<0.01). The results of a study of the use of sequential therapy with Mexidol 500 mg IV drip 1 time per day for 14 days followed by oral administration of Mexidol FORTE 250 1 tablet 3 times a day for 60 days indicate its clinical effectiveness and safety in patients with chronic cerebral ischemia with mild cognitive impairment, and also confirm its importance for preventing the progression of cognitive disorders.

[Identifying the neurostimulation target for treatment of cognitive impairment in aging and early cerebral small vessel disease]

OBJECTIVE

To develop individualized approaches to the use of neuromodulation as a non-pharmacological treatment of cognitive impairment (CI) based on the assessment of compensatory brain reserves in functional MRI (fMRI).

MATERIAL AND METHODS

Twenty-one adults over 45 years of age, representing a continuum from healthy norm to mild cognitive impairment due to aging and early cerebral small vessel disease, were studied. All participants underwent fMRI while performing two executive tasks - a modified Stroop task and selective counting. To assess the ability to compensate for CI in real life, functional activation and connectivity were analyzed using the BRIEF-MoCA score as a covariate, which is the difference in ratings between the Behavior Rating Inventory of Executive Function (BRIEF) and the Montreal Cognitive Assessment Scale (MoCA).

RESULTS

Both fMRI tasks were associated with activation of areas of the frontoparietal control network, as well as supplementary motor area (SMA) and the pre-SMA, the lateral premotor cortex, and the cerebellum. An increase in pre- SMA connectivity was observed during the tasks. The BRIEF-MoCA score correlated firstly with connectivity of the left dorsolateral prefrontal cortex (DLPFC) and secondly with involvement of the occipital cortex during the counting task.

CONCLUSIONS

The developed technique allows identification of the functionally relevant target within the left DLPFC in patients with CI in aging and early cerebral microangiopathy.

[Use of modern classification systems for complex diagnostics of Alzheimer's disease]

OBJECTIVE

To compare the content of β-amyloid (Aβ) peptides Aβ40, Aβ42, total and threonine phosphorylated 181 tau-protein in cerebrospinal fluid (CSF) of patients with the clinical diagnosis of Alzheimer's disease (AD).

MATERIAL AND METHODS

The study was performed on 64 patients with a diagnosis of dementia and MMSE scores of 24 or lower. All patients underwent lumbar puncture. Aβ40, Aβ42, Aβ42/40 ratio, total tau, phosphorylated tau at threonine 181 were determined in the CSF using a multiplex assay according to the manufacturer's protocol, the concentration was determined in pkg/ml.

RESULTS

The preliminary diagnosis of AD was made in 3 patients (5%). As a result of the study of protein content in the CSF, signs of AD were detected in 48 (75%) people. The findings suggest that the diagnosis of AD is made 10-14 times less frequently than it should be according to the World Health Organization data. The discrepancy between clinical diagnosis and laboratory findings is confirmed by our study.

CONCLUSION

Differences in the therapy of dementias and the development of new drugs targeting specific links in the pathogenesis of different types of dementias require accurate and complete diagnosis of dementias, especially AD, as the most common type of dementia.

[Results of a multicenter observational program to evaluate the effectiveness of complex therapy of patients with chronic cerebrovascular pathology with cognitive impairment with Cortexin and Neuromexol (CORNELia study)]

OBJECTIVE

To evaluate the effectiveness of complex therapy with Cortexin and Neuromexol in patients with chronic cerebral ischemia (CCI) and cognitive impairment (CI).

MATERIAL AND METHODS

We examined 801 patients with CCI on the background of arterial hypertension and atherosclerosis with confirmed CI: 329 (41.1%) men and 472 (58.9%) women aged 30 to 80 years (mean age 64±10 years), who were examined. Cortexin and Neuromexol. Examination - Mini-Mental State Examination (MMSE) scale, hour-long drawing test (HDT) and severity of depressive states (Brief Geriatric Depression Scale, Mini Geriatric Depression Scal, MGDS). In 30 patients receiving Cortexin and Neuromexol (main group, MG) and 30 patients in the comparison group (CG), biomarkers of ischemic brain damage (NSE, antibodies to NR2, VEGFA) were determined. The examination was carried out before the start of treatment and after 30 days.

RESULTS

During therapy with Cortexin and Neuromexol, characteristic signs of a decrease in the severity of CI were noted (p<0.05). A positive correlation was revealed between the performance indicators of the MMSE and TFC tests, both before and after treatment (r=0.5 and r=0.6, respectively; p<0.05). A positive effect of therapy on the emotional background of patients was noted, in particular, a decrease in the severity of depressive symptoms on the MGDS scale. During therapy, a 2-fold decrease in the NSE level (p<0.05) was detected in the MG, which indicates a decrease in the structural and functional parameters of biomembrane neurons in the brain. The concentration of antibodies to NR2 decreased compared to the baseline level in both groups (p<0.05), and VEGFA decreased only in the MG (p<0.05).

CONCLUSION

The results of the study allow us to recommend the complex prescription of Cortexin 10 mg/day for 10 days and Neuromexol tablets 125 mg (375-750 mg/day) for 30 days for chronic CVD. Complex therapy with Cortexin and Neuromexol is effective and safe in patients with CCI and CI.

[Cognitive impairments in various types of cardiac remodeling]

The review of the literature highlights current studies proving the relationship between cognitive impairment and various types of myocardial remodeling. The main pathophysiological mechanisms of development of concentric and eccentric myocardial hypertrophy and their influence on the formation of cognitive impairments are described. Direct causal relationships have not yet been found, but several linking factors in the development of cognitive impairment and myocardial remodeling are being investigated: arterial hypertension, increased arterial stiffness, endothelial dysfunction, microglial activation, hyperreactivity of the sympathetic nervous system, and obesity.

[Features of neuropsychological status and results of magnetic resonance morphometry in patients with Alzheimer's disease and glaucoma]

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.

[The use of the Mini-Cog, MMSE, and GPCOG tests in domestic clinical practice for the evaluation of cognitive disorders in elderly and senile patients: the results of a survey of experts' opinions]

OBJECTIVE

To explore the experts' opinion on the feasibility of using Mini-Kog, MMSE and GPCOG tests for screening assessment of cognitive impairment in elderly and senile patients at the primary stage of medical care, as well as to compare different characteristics of these tests according to experts' opinion.

MATERIAL AND METHODS

The survey of specialists was carried out on the basis of 6 Medical Centers. Prior to the survey, specialists tested cognitive functions in elderly and senile patients during routine visits undergoing routine admission using Mini-Kog, MMSE and GPCOG tests, as well as interviewed their relatives using the corresponding section of the GPCOG. During the survey, specialists filled out a special physician checklist containing items for indicating socio-demographic information and questions regarding the use of tests for assessing cognitive functions in elderly and senile patients in daily clinical practice.

RESULTS

The survey involved 40 specialists from different cities of Russia (mean age±SD - 38.6±14.3 years, 82.5% - women). Elderly and senile patients accounted for the predominant proportion (76-100%) of all followed-up patients. All physicians considered it important to conduct a cognitive assessment in elderly patients and they have to use various cognitive tests in their practice. According to most experts, among the Mini-Kog, MMSE and GPCOG tests, all three tools are informative, convenient and suitable for screening cognitive impairment in geriatric patients. The MMSE test is more informative and convenient. Mini-Kog, compared to the other two tools, is the simplest and most time-efficient tool that is also better perceived by patients. An advantage of the GPCOG is the possibility of participation of informants in the assessment of cognitive functions in older patients.

CONCLUSION

The findings could be used in further research focused on improving the approaches for early detection of cognitive impairment in geriatric patients by primary care physicians.

Cognitive status in older patients with limited mobility as a predictor of negative outcome

Background. Cognitive impairment (CI) is one of the important disability factors in the elderly. The role of CI in prognosis of the frailest patients with limited mobility is uncertain.The aim. To determine the influence of the initial cognitive status in the group of patronage patients aged 60 years and older on the risk of mortality within one year.Materials and methods. Study group consisted of 450 patients from patronage group with one-year period of observation (from July 2019 till July 2020). Initial physical, functional, neuropsychiatriac and social statuses were evaluated by comprehensive geriatric assessment. Cognitive impairment was screened by Mini-Mental State Examination (MMSE), with dividing patients into dementia group (MMSE ≤ 24) and no-dementia group (MMSE > 24). The mortality rate after one year was assessed.Results. Of the 450 patients included in the study, dementia was present in 44.2 %. Patients with dementia were more prone to greater severity of chronic pain, sleep disturbances, depression, malnutrition and anemia. After one year of observation 34 out of 196 patients (17.3 %) in the group of patients with dementia and 18 out of 248 patients (7.3 %; p = 0.002) in the no-dementia group died. According to multivariate analysis, independent risk factors for death in patients with dementia were anemia, hearing impairment and a history of bone fractures.Conclusion. Thus, the assessment of the cognitive status of frail patients with limited mobility is important for the purpose of identifying the most vulnerable individuals with a high risk of adverse outcomes.

[Linguistic and cultural adaptation of the Russian version of general practitioner assessment of cognition questionnaire - GPCOG in elderly and senile patients at the primary care level]

MATERIAL AND METHODS

Russian version of the General Practitioner's Assessment of Cognition (GPCOG) questionnaire-test was adapted in accordance with modern international recommendations, including the procedure of its consecutive translations, testing of the Russian version of the questionnaire as part of interviewing geriatric patients and their relatives, as well as expert evaluation of the Russian version by specialists and decentering.

RESULTS

The testing procedure involved 8 geriatric patients (age 61-77 years, men/women - 3/5), as well as their relatives/other close persons; 8 specialists participated in the questionnaire (age 24-52 years, all women). Based on the data of interviewing patients and their relatives, an acceptable indicator of the external validity of the Russian version of the tool was established, according to the results of the questionnaire of specialists, its substantive validity was confirmed. The results of testing the GPCOG questionnaire-test in the focus group of patients and the questionnaire of specialists made it possible to make changes for two tasks at the decentering stage, which made it possible to improve the equivalence of the instrument to its original version, taking into account the ethno-linguistic characteristics of the domestic population.

CONCLUSIONS

In the process of linguistic and cultural adaptation, the final version of the GPCOG questionnaire-test In Russian was formed, equivalent to the original and corresponding to the ethnolinguistic features of the population. The use of GPCOG in domestic geriatric practice and scientific research is possible after testing the instrument in a population of elderly and senile patients with the participation of primary care specialists and evaluating the psychometric properties of the instrument - reliability, sensitivity and specificity within the validation procedure.