Организация ортопедо-неврологической службы в практике врача-геронтолога

Abstract

Integrating neurological services into primary health care should be an important policy goal in both developing and developed countries. Providing neurological care through primary health care requires significant investment in training primary health care professionals to identify and treat neurological disorders. Such training should meet the specific practical needs of different groups of primary health care professionals, such as doctors, nurses, and community health workers. Preferably, continuous training is necessary to provide follow-up support to strengthen new skills. In many countries, this is not possible, and therefore suboptimal assistance is provided. Purpose: to analyze the organization of orthopedic and neurological services in the practice of a gerontologist. Methods: General clinical, neurological examination using diagnostic criteria of the DISEASE, PKP syndrome, 3-stage scale of global Deterioration (Global Determination Scale – GDS) and Clinical Dementia Rating scale (clinical Dementia Rating – CDR); neuroimaging methods – MRI/CT of the brain; quantitative EEG; experimental psychological examination: MMSE test, coding subtest, special experimental psychological study using Schulte tables, tests for memorizing 10 words and 8 numbers, Wechsler Memory Scale – Revised – WMS-R, spielberger-Hanin anxiety scale, geriatric Depression Scale; discriminant analysis was used to predict the development of dementia. Results: As a result of repeated studies, it was found that after three years in the group of patients with ART. II with PKP syndrome in 35.3%, dementia syndrome was diagnosed. Depending on the subtype of the PKP syndrome, dementia syndrome was detected in 55% of patients with the amnesic subtype, in 34.8% – with multi – domain, in 15.8% – with non-amnesic. The most vulnerable to the development of dementia were patients with the amnesic subtype of PKP syndrome. Conclusion: Using discriminant analysis of testing data of patients WITH stage II diabetes with advanced age PKP syndrome, informative and independent predictors of dementia development were established, which were included in the prognostic formula, namely, indicators of maximum reproduction of 10 words, coding subtest, complex verbal paired associations (short-term memory), visual reproduction (short-term memory), light verbal paired associations (long-term memory). There was a significant increase in pronounced correlations between various cognitive indicators in the group of patients with art. II WITH PKP syndrome in comparison with the groups of patients with ART. II without PKP syndrome, practically healthy elderly and young people, which indicates the formation of a stable pathological state in the cognitive sphere in patients with PKP syndrome. As we can see, the activity of a gerontologist is often closely related to neurology, so we consider it necessary to point out in conclusion the high efficiency of the neurology service based on a gerontologist