КОГНИТИВНЫЕ РАССТРОЙСТВА, АССОЦИИРОВАННЫЕ С НАРУШЕНИЕМ ДЕТОКСИЦИРУЮЩЕЙ ФУНКЦИИ ПЕЧЕНИ, У БОЛЬНЫХ АЛКОГОЛЬНОЙ ЗАВИСИМОСТЬЮ, НОВЫЕ ПОДХОДЫ В ПЕРСОНАЛИЗИРОВАННОЙ ТЕРАПИИ

Abstract

Introduction. The disruption of the detoxifying function of the liver, the direct toxic effects of alcohol and its metabolites, as the well as increased permeability of the blood-brain barrier lead to alcohol-induced brain damage. A complication of alcoholic liver disease is progressive cognitive dysfunction. Target. Assessment of impairments in the detoxification function of the liver and cognitive disorders in personalized therapy for patients with alcohol dependence. Materials and methods. The study included 30 men 41.5 years of age (32.3-53.0) with mental and behavioral disorders associated with alcohol use, impaired liver detoxification function, and cognitive disorders. To assess cognitive impairment, the following were used: Hamilton Anxiety Scale, Montreal Cognitive Assessment Scale (MoCA), obsessive-compulsive alcohol craving scale, and short-term and long-term memory assessment. Cognitive functions were examined upon admission and on days 10 and 18 of therapy. Biochemical blood parameters (ALT, AST, alkaline phosphatase, total bilirubin, direct bilirubin, indirect bilirubin, cholesterol, malondialdehyde, reduced glutathione) were studied before and after treatment. Results. Against the background of complex therapy, there was a decrease in craving for alcohol, assessed on the obsessive-compulsive scale from 36 (34-39) to 9 (8-11) points on the 10th day of therapy and 3 (2-5) points at the end of the course of treatment (p=0.0001). Biochemical parameters of the blood have improved significantly. Cognitive abilities assessed on the MoCA scale improved from 23.5 (20.3-26.3) to 27 (25.8-28) points, p=0.0001. Prediction of a favorable outcome of therapy (MoCA score greater than 26 points after a course of treatment) is possible based on initial indicators. AST level less than 112 U/L, ALT less than 120 U/L, direct bilirubin less than 9.8 µmol/L and cholesterol less than 6, 7 mmol/l. The probability of achieving less than 7 points on the obsessive-compulsive scale after 10 days of treatment can be predicted by the level of indirect bilirubin before starting therapy of less than 14.2 µmol/l and the initial score on the Hamilton anxiety scale of less than 20.5 points. Conclusions. Restoring liver detoxification function and improving cognitive potential through the use of drugs that combine neuroprotective and hepatoprotective effects in complex therapy is an effective method of treating patients with alcohol dependence. Prediction of a favorable outcome of therapy is possible based on initial biochemical parameters and assessment on the Hamilton Anxiety Scale.