Cognitive dysfunction, pain and affective disorders in patients with Chiari malformation type 1 in the context of reciprocal relationships

Abstract

BACKGROUND. Chiari malformation type 1 (CM1) is a multicomponent pathology. The CM1 symptom complex has a variable structure within the limits of cerebrospinal fluid, cerebellar, brainstem and spinal disorders. A new component is cognitive dysfunction. Various hypotheses of its formation are discussed. Along with the independent role of CM1 in the development of cognitive dysfunction, great importance is attached to pain and affective disorders.
 AIM. To identify the features of cognitive status in patients with CM1 and to assess the relationship with pain and affective disorders.
 MATERIAL AND METHODS. The study included 110 adult patients with CM1 aged 25.616.9 years. The control group consisted of 50 people aged 26.365.0 years. The assessment of neuroimaging parameters was carried out on an MR tomograph with an induction of a magnetic field of 1.5 T. MMSE, MoCA, and the Trail Making Test were used to assess cognitive status. The pain syndrome was assessed using the SF-MPQ-2-RU questionnaire and the visual analogue scale, assessment of affective disorders HADS and DASS-21.
 RESULTS. Patients with CM1 had significantly lower cognitive indicators. Deficits are found in the domains of executive functioning, visual-spatial skills, attention, delayed recall and speech. The association of cognitive decline and pathognomonic headache for CM1 may indicate the presence of common pathogenic mechanisms. The decisive importance probably belongs to cerebellar dysregulation dysfunction of the universal process of cerebellar transformation. It is assumed that emotional disorders collectively affect the structure of cognitive status, not being the main link in pathogenesis.
 CONCLUSIONS. Patients with CM1 show significant cognitive decline. Cerebellar dysregulation may be a common mechanism underlying cognitive dysfunction and pathognomonic for CM1 headache. Emotional disorders collectively affect the structure of cognitive status, not being the main link in pathogenesis.