Analysis of modern trends in the structure of disabilitating mental pathology of the population of the Republic of Belarus

Developments in the field of vascular cognitive impairment over the past year have been evolutionary rather than revolutionary and spread across many aspects. However, even evolutionary changes may be radical, and it is in 3 particular aspects—those of treatment, prevention, and the evaluation of white matter disease—that evolution has been at its most rapid. Since 2002, 5 large, randomized studies of the symptomatic treatment of probable and possible vascular dementia have been published. This is a radical development, and these few studies exceed everything that has been published before. These comprise 2 studies of the anticholinesterase donepezil in vascular dementia,1,2 2 studies of the NMDA receptor antagonist memantine in mild to moderate vascular dementia,3,4 and a study of the anticholinesterase galantamine in “probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease.”5 While these findings are exciting and represent new developments, there are a number of cautions. The first is the relatively modest benefits seen in all these trials. For the anticholinesterases, the benefit on the ADAS-Cog6 amounts to about 3 points and to <1 point on the Mini-Mental State Examination (MMSE).7 While statistically significant, these effects are so slight that they may not be useful routine treatments but perhaps treatments that should be tried in all but maintained only in individual responders. These drugs were originally developed for Alzheimer’s disease on the basis of the cholinergic hypothesis; much is made of the presence of a cholinergic deficit in vascular dementia, which probably occurs because of ischemic damage to the cholinergic projections, but this is proportionately considerably less than is seen in Alzheimer’s disease. Indeed, the presence of a cholinergic deficit is not required for the anticholinesterases to produce cognitive improvement8 and so the cholinergic hypothesis is neither necessary nor sufficient to explain the …

Goal. Analysis of the development of rehabilitation infrastructure in the Russian Federation, including organizations of various departmental affiliations and forms of ownership, providing rehabilitation services to children with autism spectrum disorders (ASD).&#x0D; Methods.Analytical: the level of primary child disability due to mental and behavioral disorders, including ASD, was studied in the Russian Federation for 2017-2019. according to the official statistics of the Ministry of Labor of Russia. The work of 1,788 organizations providing rehabilitation measures to children with ASD is analyzed based on Federal Resource Center for the Organization of Comprehensive Support for Children with Autism Spectrum Disorder (as of October 2019). Rehabilitation infrastructure for children with ASD is grouped by Federal Districts and presented in the diagrams. The data of the Federal Resource Center for the Organization of Comprehensive Support for Children with Autism Spectrum Disorder (as of October 2019) were used.&#x0D; Results. The data were obtained on the growth of the level of primary disability among children with mental and behavioral disorders, including autism, in the Russian Federation. Rehabilitation activities for children with ASD are provided by organizations of various departmental affiliations: education (91%), social protection (3%), healthcare (0.5%), culture and sports (0.6%), non-profit organizations (5%). The most developed rehabilitation infrastructure for children with ASD has developed in the education system. For coordination and methodological guidance, 23 regional resource centers for people with ASD were created, of which 87% are in the field of education, 13% in the social protection system.&#x0D; Conclusion.In modern Russia, there is an increase in the disability of children with mental and behavioral disorders, including autism, in this regard, the rehabilitation infrastructure for children with ASD is intensively developing. At the same time, the network of regional resource centers needs to be developed. There is a need for a unified comprehensive approach to assessing the condition, identifying needs and implementing rehabilitation measures for children with ASD, which is applicable both in departments and at the interdepartmental level. The International Classification of Functioning, Disabilities and Health (WHO, 2001) is such a universal language for interdepartmental and interdisciplinary interaction.

BACKGROUND: Mental disorders are one of the leading causes of primary disability in children, a concern for both public healthcare and clinical psychiatry. The issue is further complicated by the lack of objective diagnostic measures of mental disorders, regional differences in the interpretation of diagnostic criteria, and significant social influences. AIM: The aim of the study was to identify the main clinical and epidemiological characteristics of childhood primary disability due to mental disorders in the Republic of Tatarstan in 2021–2023. MATERIALS AND METHODS: The main statistical data provided by the Information and Analytical Center of the Ministry of Health and the Bureau of Medical and Social Expertise of the Ministry of Social Protection of the Republic of Tatarstan were used as study materials, including relative primary and overall incidence and primary disability due to mental disorders in children under the age of 18. The main correlation trends were described. Statistical significance was determined using the nonparametric t-test, and the correlation coefficient (r) was calculated using the Pearson correlation coefficient. RESULTS: A positive trend in primary mental disability in children is reported. The most common cause was organic non-psychotic mental disorders (F06 — Other mental disorders due to brain damage and dysfunction and to physical disease) at a rate of 4.02 per 100,000 of the relevant population. A significant decline in autism spectrum disorder (ASD) cases contributing to primary disability was observed between 2022 and 2023. This was associated with in-depth diagnosis as part of a comprehensive ASD care project (3.04 and 1.28 per 100,000 of the relevant population in 2022 and 2023, respectively, marking a 58% decrease). CONCLUSION: Major trends in causes of primary disability in children include an increase in the incidence of organic nonpsychotic disorders and a decrease in the incidence of autism spectrum disorders. The incidence of schizophrenia and mental retardation as causes was unchanged.

Neuropathological evaluation of mixed dementia

Efficacy of naftidrofuryl in patients with vascular or mixed dementia: Results of a multicenter, double-blind trial

To compare the evolution of Alzheimer disease (AD), vascular dementia (VaD), and mixed dementia by cognitive domain. The University of Western Ontario Dementia Study, which is a registry of cases of dementia seen for secondary and tertiary assessment in a university memory disorders clinica with extensive follow-up data and histopathological confirmation of clinical diagnoses. One hundred twenty-nine patients with definite or probable AD, 12 patients with definite or probable VaD, and 36 patients with definite or probable mixed dementia. Patients were grouped as having an early, moderate, or advanced stage of disease according to the extended scale for dementia (ESD). The ESD was subdivided into cognitive domains, and the domain scores were compared for each stage of disease by diagnostic category with the use of a 2-way analysis of variance with repeated measures. As expected, the scores in all domains decreased significantly with increasing severity. There was a significant difference in the decline in memory among the diagnostic groups (P = .02) that was mostly attributable to the difference between AD and mixed dementia (P = .03), with the difference between AD and VaD only approaching significance (P = .06). There was a similar finding for praxis. The interaction between diagnosis (AD and VaD) and severity was significant only for memory (P = .02), showing a less severe memory deficit at onset but a proportionately more rapid progression in VaD and arithmetic ability (AD and mixed dementia [P = .03]). Alzheimer disease, VaD, and mixed dementia evolve similarly as assessed using cognitive domains obtained by subdivision of the ESD in a patient population derived from a memory clinic and by analyzing VaD as a single entity. Only memory impairment evolves differently between AD and VaD, with this depending on the severity. Memory is more severely impaired in the early stage of AD; however, with increasing severity of dementia, memory impairment in VaD accelerates and catches up with AD at the level of moderate impairment. The differences between AD and mixed dementia are greater than those between mixed dementia and VaD, suggesting an important role for the ischemic component of mixed dementia. Simple neuropsychological tools (eg, the ESD) may be incapable of distinguishing between AD and VaD, and more focused instruments may be required. Inherent bias in case selection may prevent extrapolation of these results to VaD in general, but the neuropsychological criteria for VaD may need to vary, depending on the severity.

This article gives a broad overview of vascular cognitive impairment and dementia, including epidemiology, pathophysiology, clinical approach, and management. Emphasis is placed on understanding the common underlying types of cerebrovascular disease (including atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy) and awareness of rare inherited cerebrovascular disorders. The pathophysiology of vascular cognitive impairment and dementia is heterogeneous, and the most recent diagnostic criteria for vascular cognitive impairment and dementia break down the diagnosis of major vascular dementia into four phenotypic categories, including subcortical ischemic vascular dementia, poststroke dementia, multi-infarct dementia, and mixed dementia. Control of cardiovascular risk factors, including management of midlife blood pressure, cholesterol, and blood sugars, remains the mainstay of prevention for vascular cognitive impairment and dementia. Cerebral amyloid angiopathy requires special consideration when it comes to risk factor management given the increased risk of spontaneous intracerebral hemorrhage. Recent trials suggest some improvement in global cognitive function in patients with vascular cognitive impairment and dementia with targeted cognitive rehabilitation. Thorough clinical evaluation and neuroimaging form the basis for diagnosis. As vascular cognitive impairment and dementia is the leading nondegenerative cause of dementia, identifying risk factors and optimizing their management is paramount. Once vascular brain injury has occurred, symptomatic management should be offered and secondary prevention pursued.

The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. Copyright © 2016 John Wiley & Sons, Ltd.

Neuropsychological assessment and cerebral vascular disease: The new standards

Patients with mild cognitive impairment (MCI) have an increased risk of dementia. The identification of predictors of conversion to dementia is therefore important. The aim of our study was to test the hypothesis that subcortical hyperintensities (SH) are associated with an increased rate of conversion to dementia in MCI patients. This was an observational study on consecutive MCI patients attending a memory clinic. We assessed SH on a baseline MRI scan, using a semiquantitative rating scale. A multivariable Cox regression model was used to test the association of SH with conversion to dementia. We included 170 MCI patients. The median duration of follow-up was 3.8 years. During this period, 67 patients (39.4%, 95% CI: 32.1 to 46.8%) developed dementia: Alzheimer disease (AD) in 29 patients, dementia with Lewy bodies in 19, mixed dementia in 8, vascular dementia in 7, fronto-temporal dementia in 2, and primary progressive aphasia in 2. SH were not associated with the risk to develop dementia as a whole, including AD. However, the risk to develop vascular or mixed dementia increased significantly with increasing amounts of SH at baseline (HR=1.14 [95% CI: 1.06 to 1.24]), especially periventricular hyperintensities (HR=2.71 [95% CI: 1.60 to 4.58]), independently of medial temporal lobe atrophy, age, gender, vascular risk factors, education, and cognitive functions at baseline. The risk of vascular or mixed dementia, but not of other types of dementia, was significantly increased in MCI patients with a large amount of subcortical hyperintensities at baseline.

Background Vascular mild cognitive impairment (VaMCI) is the prodromal syndrome of vascular dementia (VaD) and key target for drug treatment. There is controversy over the diagnostic criteria and screening tools of VaMCI, which affects its clinical diagnosis. This paper aims to explore the clinical features, diagnostic criteria and screening technique of VaMCI. Methods Taking "vascular mild cognitive impairment OR vascular cognitive impairment no dementia" as retrieval terms, search in PubMed database from January 1997 to March 2015 and screen relevant literatures concerning VaMCI. According to Guidance for the Preparation of Neurological Management Guidelines revised by European Federation of Neurological Societies (EFNS) in 2004, evidence grading was performed on literatures. Results A total of 32 literatures in English were selected according to inclusion and exclusion criteria, including 3 guidelines and consensus and 29 clinical studies. Seven literatures (2 on Level Ⅰ, 5 on Level Ⅱ) studied on neuropsychological features in VaMCI patients and found reduced processing speed and executive function impairment were main features. Two literatures reported the diagnostic criteria of VaMCI, including VaMCI criteria published by American Heart Association (AHA)/American Stroke Association (ASA) in 2011 and "Diagnostic Criteria for Vascular Cognitive Disorders" published by International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2014. Fifteen literatures (4 on LevelⅠ, 11 on Level Ⅱ) described the diagnostic criteria of VaMCI used in clinical research, from which 6 operational diagnostic items were extracted. Fourteen literatures (4 on Level Ⅰ, 10 on Level Ⅱ) described neuropsychological assessment tools for VaMCI screening, and found the 5-minute protocol recommended by National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) was being good consistency with other neuropsychological assessment tools. Conclusions The neuropsychological features of VaMCI have guiding significance for diagnosis. VASCOG diagnostic criteria for VaMCI is practical in clinical practice, and 5-minute protocol is suitable for clinical rapid screening of VaMCI. DOI: 10.3969/j.issn.1672-6731.2015.07.007

Goal. A study of the rehabilitation infrastructure of the social and pedagogical spectrum of the Northwestern Federal District for children with autism spectrum disorder (ASD).&#x0D; Materials and methods. The indicators of the level of disability of children with ASD were calculated and analyzed on the basis of data from the state statistical reporting in the Northwestern Federal District for 2018. Based on the information provided by the portal of the Federal Resource Center for the Organization of Comprehensive Support for Children with Autism Spectrum Disorders (FRC) a review of social and psychological and pedagogical services was carried out, indicators of the provision of children with organizations providing assistance to people with ASD, the structure of organizations by departments were studied (education, social protection of the population, non-profit organizations, excluding health care and culture and sports).&#x0D; Results. In 2018, 5770 children were registered in the Northwestern Federal District, for the first time and repeatedly recognized as disabled due to mental disorders and behavioral disorders, of which 684 are disabled children with autism spectrum disorders, which amounted to 3.3% of the total disability of the child population on appeal to the bureau of medical and social expertise in the Northwestern Federal District. Rehabilitation measures/services for children with these disorders are provided in 205 organizations: mainly educational institutions - 94%, as well as social protection - 4%, non-profit organizations - 2%. Five regional resource centers have been organized: four of which are in the field of education - in the Leningrad, Murmansk, Pskov regions and the Komi Republic, one - in the field of social protection - in the Novgorod region. In the field of education, organizations implement adapted educational programs in accordance with Federal state educational standards and provide a range of medical and social rehabilitation services for children with ASD, depending on the type of organization (pre-school educational organizations, general education organizations, educational centers and others). In the field of social protection, organizations (rehabilitation centers and others) mainly provide assistance according to the standard for the provision of social services, including social, socio-medical, socio-psychological, socio-pedagogical, socio-labour, socio-legal services. Non-profit organizations located in St. Petersburg and Arkhangelsk provide social-psychological, social-pedagogical and social-labor services to children with ASD.&#x0D; Conclusion. The results of the study showed that a social and pedagogical rehabilitation infrastructure was created for children with ASD in the Northwestern Federal District in 2018 (healthcare institutions were not studied). Children with ASD and their families can receive services in organizations of various departmental affiliation, which are represented in all constituent entities of the Russian Federation that are part of the Northwestern Federal District, but are concentrated mainly in urban areas, which limits children in obtaining services directly near their places of residence. A system has been created to inform specialists and parents about the rehabilitation infrastructure for children with ASD, which is presented by the FRC portal, at the same time, the need for the organization to submit data to the portal is optional. Services for children with ASD are aimed at solving issues of psychological, pedagogical, social and vocational rehabilitation, including career guidance work with adolescents and, as a result, at the social adaptation of a child with ASD and his integration into society.

Vascular disease, depression, and dementia.

Taking into account the relevance of the diseases of old age and the consequences of cardiovascular diseases, which are increasing every year, we conducted a study of neuropsychiatric symptoms (NPS) of vascular dementia (VD) and the correlation of these symptoms both within one etiological group of dementia (VD) and in comparison with others groups (neurodegenerative disorders, NDD and mixed dementia, MD). With the statistical processing of data, a reliable relationship was established and the difference in the course of NPS in patients with VD was determined in relation to psychotic, affective and behavioral clusters of NPS. In the study of psychotic disorders, the highest frequency of delusions of poisoning is found in patients with VD. The study of affective disorders gave an understanding of higher frequency in combination of different manifestations of affective NPS within this cluster (in particular, apathy and anxiety in one patient) and with other clusters (for example, irritability and movement disorders or depression or anxiety and delusional syndrome) in patients with VD than among other etiological groups. Behavioral disorders in patients with VD were characterized by the following differences: wandering in the middle of the night is more common in patients with VD; the use of non-edible products is not as common in VD as in NDD. The study of neuropsychiatric symptoms in patients with vascular dementia makes it possible to better understand the peculiarities of the course of the pathology, evaluate the possibilities of implementing effective management of these symptoms, and predict their complications to ensure proper adaptation of the medical system, the patient and his caregivers to the challenges that arise when the diagnosis of vascular dementia is established.

There were 56.9 million people worldwide living with dementia in 2021, according to the Global Burden of Disease study, and this number is projected to exceed 137 million by 2050. Vascular dementia (VaD) is the second leading cause of dementia. While high-quality global epidemiological data on VaD remain limited, population-based studies with autopsy confirmation allow an approximate estimation. These show that pure VaD represents approximately 15% of all dementia cases, with mixed vascular and degenerative dementia accounting for an additional 16%. According to these estimates, approximately 8.5 million people worldwide suffer from pure VaD, and 9.1 million from mixed dementia. Under the assumption that existing proportional rates remain constant, the global burden of total VaD (i.e. pure VaD and mixed dementia) will reach 42.7 million cases by 2050. However, the impact of cerebrovascular disease is likely to be even greater. Increasing evidence demonstrates that vascular pathology commonly coexists with Alzheimer’s and other neurodegenerative pathologies, increasing the risk that these neurodegenerative pathologies cause clinical dementia. Despite the importance of VaD, it remains underrecognized and underresearched compared to other forms of dementia. This fact sheet highlights the urgent need for improved recognition, standardized diagnostic approaches, and enhanced preventive strategies for this highly prevalent yet underrecognized cause of dementia. The factsheet has been reviewed and approved by the World Stroke Organization (WSO) executive.