Obesity and Circadian Cycle of Sleep and Wakefulness: Common Points and Prospects of Therapy

Hyperprolactinemia in the postmenopause: versions and contraversions

The prevalence of hyperprolactinemia in postmenopausal women is unknown and has been estimated as infrequent by many studies. Prolactinomas found after menopause are usually macroadenomas and remain unrecognized for a long time due to atypical clinical signs or their absence. The growth potential of prolactinomas persists after menopause, most of them are invasive and accompanied by high prolactin levels. Treatment with dopamine agonists is usually long-term, the goals of which are to reduce tumor size, normalize prolactin levels and the negative effects of hyperprolactinemia. Treatment with cabergoline makes it possible to achieve remission of the disease in the first years after discontinuation, however, the proportion of relapses in postmenopausal women increases 5 years after discontinuation of the drug. Remission of prolactinomas is not evident in postmenopausal women. The modern management of patients with prolactinoma and/or hyperprolactinemia does not have clear positions in the postmenopausal period. Controversial issues remain: an ambiguous relationship between prolactin levels and breast cancer, there are no convincing conclusions on the improvement of bone mineral density and/or a decrease in the risk of fractures with normalization of prolactin levels, there are no data on metabolic parameters after the end of treatment with dopamine agonists, conflicting information about the relationship of prolactin levels and the severity of the manifold manifestations of the climacteric syndrome. The use of estrogen-progestin drugs in women with hyperprolactinemia/prolactinomas is also not well understood. Thus, the problem of hyperprolactinemia in the perimenopausal and postmenopausal period is underestimated and requires additional research, as well as the development of diagnostic and therapeutic strategies for potential benefits in terms of weight loss, improving insulin sensitivity, reducing the risk of fractures, maintaining sexuality and psycho-emotional well-being.

Cognitive impairments in patients with overweight and obesity

Background. In modern society, the growth of the overweight and obese population increase every year. This confirms the status assigned to the problem under consideration as a non-infectious epidemic of the 21st century. At the same time, the amount of scientific information about the influence of excess weight on various aspects of human life is actively increasing. This undoubtedly requires a systematic generalization of the available data.

Aims. The presented literature review is devoted to the analysis of modern scientific research on the specificity of cognitive impairment in overweight and obese people.

Materials and methods. Information search was carried out using Internet resources (PubMed, Web of Science, eLibrary.ru, frontiersin.org, sciencedirect. com, ncbi.nlm.nih.gov), literature sources were analyzed for the period from 2001 to 2020 for the following keywords: obesity, overweight, cognitive functions, cognitions, cognitive impairments.

Results. As a result of the literature review, the main directions of research on the relationship between cognitive impairment and overweight, as well as the relationship between cognitive dysfunction and obesity, were identified. The specificity of diametrically opposed opinions within the framework of each consecrated trend is presented. According to the results of the analysis of the identified areas, in the scientific community the most common point of view is the presence of a connection between obesity and cognitive impairment. In this connection, the authors identified the main cognitive impairments associated with excess weight and their mediating mechanisms. And also the age specificity of the problem under study is indicated.

Conclusions. Despite the fact that the problem of the relationship between obesity, overweight and cognitive functions is comprehensively studied, there is a shortage of data on the state of thinking, attention, praxis, gnosis, and speech in overweight people.