УМЕРЕННЫЕ КОГНИТИВНЫЕ НАРУШЕНИЯ В ПРАКТИКЕ ВРАЧА-НЕВРОЛОГА

Abstract

Cognitive impairment and dementia are an relevant problem of modern neurology and psychiatry, which is explained by their wide prevalence, as well as the predicted increase in the number of patients in the future. However, dementia in most cases does not occur acutely, its development is preceded by a long period when cognitive impairments do not disrupt the patient’s everyday and professional life yet. Such cognitive impairments are called “pre-dementia” and are divided into subjective, subtle, and mild. With subjective cognitive impairment, patients present complaints; however, neuropsychological testing does not reveal decreased cognitive functions. Subtle cognitive impairment is accompanied by a decrease in cognitive functions when using highly sensitive scales. This article provides an overview of current data on the definition, classification, diagnosis, and treatment of mild cognitive impairment (MCI) from the point of view of the evidence-based medicine for timely diagnostics of the state and its effective correction. In patients with MCI, in addition to complaints of cognitive deficit, it is detected during screening neuropsychological testing; but unlike dementia, it does not impair the patient’s functionality. MCI is a leading risk factor for future dementia. However, according to research, cognitive deficits can not only progress, but also stabilize and even regress. In this regard, it is important to identify patients with MCI on time, establish nosological affiliation for correcting risk factors and prescribing treatment. The most common causes of MCI can be neurodegenerative disorders (primarily Alzheimer’s disease) and cerebrovascular diseases. The authors present the diagnostic value of popular scales such as the Mini-Mental State Examination, the Montreal Cognitive Assessment Scale and the 3-CT test in the diagnosis of MCI. The possibilities of using biomarkers, such as the determination of beta-amyloid and tau-protein in the cerebrospinal fluid, and the detection of signs of neuronal damage during neuroimaging of the brain, are discussed. It is stated that the most proven methods of influencing cognitive deficits in MCI are non-drug measures.