Когнитивные флуктуации на фоне терапии у пациентов с болезнью Паркинсона

Abstract

The aim of the research is the assessment of cognitive status dynamics during levodopa pharmacotherapy. Material and methods. A new approach was created to assess cognitive status in patients with PD. It allows diagnosing cognitive fluctuations at an early stage at the highest quality level as well as to correct the disorders rationally and timely. The patients were randomized into two groups. In group 1 (n = 25), the assessment of cognitive status was carried out at the “peak” dose of levodopa and in 6 months at the state of levodopa dose “outcome”. In group 2 (n = 25), respectively, on the contrary, the initial assessment of cognitive status was carried out at the “outcome” of levodopa dose and in 6 months later at the “peak”. The study groups were comparable in terms of such parameters as: age, gender, average duration and stage of disease. On average, all the participants by the study time were at 2.5 stage of the disease according to Hoehn and Yahr scale; and the average length of the disease was 5 years. Results. Th e following statistically signifi cant results were obtained: in the fi rst group (peak–outcome) the average values on MMSE scale at the “peak” were 27 points; at the “outcome” they were – 25; MOCA values were 25 and 22 points, respectively; on FAB scale the values were – 16 and 14.5 points, SCOPA-Cog values were 33 and 28 points. In the second group (outcome – peak), the average values on MMSE scale at the “outcome” were 27, at the “peak” – 28, on MOCA scale – 23 and 25.5, respectively, on FAB scale – 16 and 17.5, SCOPA–Cog – 30 and 33. Conclusion. The present study confi rms that cognitive status of patient associated with antiparkinsonian therapy changes depending on the peak of levodopa and its outcome. At the peak of levodopa action, patients show signifi cantly better results on scaling, and at the end of the day, they demonstrate more significant cognitive impairments. A new two-stage method for assessing CF allows diagnosing cognitive impairments at a better level. Such method is necessary for timely initiation of therapy and rational correction of antiparkinsonian treatment.