Discirculatory Encephalopathy Research Articles

Software application for predicting the efficacy of rehabilitation treatment in patients with discirculatory encephalopathy

Software application for predicting the efficacy of rehabilitation treatment in patients with discirculatory encephalopathy

Structural changes and features of heat shock protein HSP70 and HSP90 expression in the pyramidal neurons of the hippocampus of rat in the experimental discirculatory encephalopathy modeling

AbstractBackgroundThe heat shock protein (Hsp) system acts as intracellular chaperone molecules responsible for maintaining normal intracellular homeostasis by regulating the correct coagulation of newly synthesized peptides, as well as the transport and degradation of mature proteins. In addition to their role as chaperones, proteins of the Hsp family stabilize the cell membrane and inhibit the caspase‐dependent apoptosis cascadeMethodHypertensive encephalopathy was modeled on 12‐month‐old rats by the method of exposure to negative longitudinal overloads in the caudo‐cranial vector with a 9 G force for 5 minutes with 12 hours interval for 28 days. The behavioral responses, cognitive and mnestic functions, the relative number of pyramidal neurons with hyperchromic cytoplasm and shrunken perikariya, and the level of expression of heat shock proteins 70 kDa (Hsp70) and 90 kDa (Hsp90) were assessedResultAfter 28 days of exposure to 9 G negative longitudinal overloads, the rats showed functional and morphological manifestations characteristic of hypertensive encephalopathy. There was a decrease in the basic reflexes, disorders of the cognitive sphere, as well as decrease in memory and orientation‐exploratory activity. Morphological examination of the hippocampus against the background of pronounced edema revealed a significant increase in the relative number of pyramidal neurons with hyperchromatosis and perikaryon shrinkage in all zones of the pyramidal layer (p <0.01). These signs of reversible and irreversible damage were accompanied by a significant increase in Hsp70 expression, especially pronounced in the CA3 zone (p <0.01). A significant increase in Hsp90 expression was found in the CA1 zone (p <0.05)ConclusionDiscirculatory encephalopathy experimental modeling demonstrates signs of both reversible and irreversible alteration in all regions of the pyramidal layer of hippocampus. Differences in the ability of neurons of the pyramidal layer of different regions of the hippocampus to express Hsp70, Hsp90 were noted. In the CA1 and CA3 zones, compensatory reactions are more pronounced and are accompanied by a more pronounced expression of Hsp70, while in CA1, the expression of Hsp70 and Hsp90 is simultaneously enhanced

ТНЕ ANALYSIS OF THE COMORBIDITY PREVALENCE IN MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE AFTER ACUTE MYOCARDIAL INFARCTION

Objective: to determine the prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction.Research materials. An analysis of medical records of the 83 military personnel who were hospitalized to the National Military Medical Clinical Center "Main Military Clinical Hospital" in 2016-2020 with acute myocardial infarction was carried out using the method of random sampling. All patients were male, aged from 22 to 60 years (mean age 48,5±4,35 years). To study the age characteristics of the comorbidity prevalence, all patients were divided into two groups: the 1st group with individuals of 50 years old and younger (41 patients, average age 42,9±6,15 years) and the 2nd group who is 50+ years old (42 patients, average age 54,0±2,54 years).Methods. of investigation are bibliographic, statistical, systematic approach and analysis. Statistical processing was carried out using the Microsoft Excel 2007 program and the standard statistical package STATISTICA 6.0.Results. We found a high prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction. Arterial hypertension has been diagnosed in 60,2±5,4% of military personnel (58,5±7,7% of patients in the 1st group and 64,3±7,4% in the 2nd group, p>0.05). Another comorbid cardiovascular disease has been identified: carotid artery stenosis in 60,2±5,4% of patients (56,1±7,8% and 54,8±7,7% in 1st and 2nd groups, at p>0.05); dyscirculatory encephalopathy of the I-II stages in 37,3±5,3% (4,4±6,7% and 50,0±7,7% in 1st and 2nd groups, respectively, at p<0,05); peripheral artery disease in 4,8±2,3% of military personnel (in 0 and 9,5±4,5%, respectively, at p<0,05). The most common comorbid diseases of the digestive system in patients were: non-alcoholic fatty liver disease in 16,9±4,1% (22,0±6.5% in 1st group and 11,9±4,9% in 2th group, at p>0.05), chronic gastroduodenitis in 21,7±4,5% (26,8±6,9% and 16,7±5,8%, respectively, at p>0,05), peptic ulcer disease in 20,5±4,4% (7,1±5,8% and 23,8±6,6%, respectively, at p>0.05), chronic pancreatitis in 19,3±4,3% (19,5±6,2% and 19,0±6,1%, respectively, at p>0.05), chronic cholecystitis – 18,1±4,2% (14,6±5,5% and 21,4±6,3%, respectively, at p>0.05). Obesity was determined in 36,1±5,3% of patients (48,8±7,8% of patients in the 1st group and 23,8±6,6% in the 2nd group, at p<0,05); type II diabetes – in 13,3±3,7% (7,3±4,1% and 19,0±6,1%, respectively, at p>0,05), thyroid diseases – 13,3±3,7% (12,2±5,1% and 11,9±4,9%, respectively, at p>0,05). Chronic kidney disease was determined in 6,0±2,6% of patients: 4,8±3,3% and 7,2±4,0%, respectively, at p>0,05. Osteochondrosis of the spine was detected in 30,1±5,0% of military personnel (24,9±6,8% and 35,7±7,4%, respectively, at p>0,05).Conclusions. Our study demonstrated a significant prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction: the most prevalent comorbidities were arterial hypertension, carotid artery stenosis, obesity, osteochondrosis of the spine, gastrointestinal disease, type II diabetes, which must be taken into account when developing individual treatment programs to increase the effectiveness of treatment and prevent complications.No statistically significant difference has been determined regarding the frequency of detection of most comorbid diseases in the age group younger than and older than 50 years; only cerebrovascular diseases with discirculatory encephalopathy and peripheral artery disease were more often (statistical significant) in military personnel older than 50 years.

СТОМАТОЛОГИЧЕСКИЙ СТАТУС ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ИШЕМИЕЙ ГОЛОВНОГО МОЗГА

The study of the dental health plays an important role, since, on the one hand, odontogenic oral infection might be an etiological factor in the development or aggravation of the course of concomitant pathology, on the other hand, systemic diseases can affect the development and course of dental pathologies. As part of an integrated approach to the diagnosis and treatment of combined pathology of the oral cavity and internal organs, works devoted to the study of the relationship between dental diseases and cerebrovascular pathology are becoming increasingly important. In this work, we studied the dental status of patients with a history of discirculatory encephalopathy. In total, 126 people have been examined, 63 of them are patients with discirculatory encephalopathy and 63 patients are without concomitant diseases. As a result of the examination, it can be determined that patients with discirculatory encephalopathy have such changes in the oral cavity as xerostomia, a decrease in the level of oral hygiene, extensive defects in the dentition or complete secondary edentulism.

INTRODUCTION OF PATIENTS WITH CHRONIC CEREBROVASCULAR DISEASE CAUSED BY ARTERIAL HYPOTENSION, IN PATIENTS OF YOUNG AGE

Vascular diseases of the brain due to their high prevalence and severe consequences for the health of the population represent a major medical and social problem. In the structure of cerebrovascular diseases significant weight have chronic forms of vascular lesions of the brain, which in the domestic literature is traditionally treated as a discirculatory encephalopathy. In Uzbekistan the number of sufferers with chronic forms of cerebrovascular diseases is increasing, therefore the urgency of solving this problem in Uzbekistan can be defined as an extreme one, requiring the concentration of efforts of specialists in different fields.

Association of plasma folic acid levels with parameters of glutathione metabolism in hypertensive patients with comorbid diseases

Objective. Hypertension (HTN) is characterized by a high incidence of comorbidity. An individual approach to the management of such patientsrequires new markers for differential diagnosis. The pathophysiology of most comorbidities is closely related to endothelial dysfunction triggered by an imbalance in redox processes.The aim of this work is to assess the relationship between plasma level of folic acid (FA) and the state of the redox system of erythrocyte glutathione in patients with HTN and concomitant target organ damage in cardiovascular diseases (HTN + CVD), chronic kidney disease (HTN + CKD) and discirculatory encephalopathy (HTN + DE).Design and methods. We enrolled 93 patients with HTN admitted to the clinics of the Pavlov University, and 30 donors of the reference group. We assessed plasma concentration of folic acid, the content of reduced glutathione (GSH) and the activity of glutathione reductase (GR) in erythrocytes.Results. In HTN patients with the deficiency of FA, a lower content of GSH and activity of GR in erythrocytes were found compared to the HTN patients without deficiency and the reference group. In the groups HTN + CVD and HTN + DE, the GSH level and GR activity correlated with the plasma concentration of FA and were lower in the subgroups with FA deficiency. In subgroups with normal FA content, these parameters did not differ from the reference indicators.Conclusions. The parameters of GSH and GR in patients with HTN + CVD and HTN + DE, but not HTN + CKD, can be considered as potential markers of functional FA deficiency.

ГАМКергические препараты в терапии начальных форм дисциркуляторной энцефалопатии

В настоящее время все большее значение приобретают функциональные расстройства при цереброваскулярных заболеваниях: тревога, ларвированная депрессия, когнитивные нарушения, инсомния и др. Это и нейрокардиальная проблема, и психосоматическая патология, требующая пересмотра существующих рутинных схем фармакотерапии, более многовекторного патогенетического подхода к лечению. В статье приведены результаты открытого пилотного когортного проспективного клинического исследования среди пациентов с дисциркуляторной энцефалопатией 1–2-й стадии. У пациентов с цереброваскулярной патологией применяли препарат Гамалате В6, нормализующий психоэмоциональные и мнестические функции — краткосрочную и долговременную память, снижающий уровень личностной и ситуативной тревожности. Под влиянием курсового приема Гамалате В6 улучшается мозговое крово­обращение: увеличивается скорость кровотока и снижается периферическое сопротивление в экстракраниальных сосудах каротидного бассейна. Гамалате В6 гармонизирует активность таламокортикальных структур (увеличивает мощность альфа-ритма на фоне снижения ЭЭГ-мощности подкорковых структур, генерирующих медленные ритмы) и симпатико-парасимпатический баланс вегетативной нервной системы по оценкам вариабельности ритма сердца.

Хронічна церебральна ішемія. Нейрофізіологічні аспекти метаболічної терапії за допомогою альфа-ліпоєвої кислоти

У статті розглядаються питання лікування пацієнтів із хронічними ішемічними церебральними порушеннями. Приділяється увага застосуванню альфа-ліпоєвої кислоти. Наведено дані дослідження впливу препарату альфа-ліпоєвої кислоти ЕСПА-ЛІПОН на динаміку клінічних змін астенічного синдрому при хронічній церебральній ішемії. Підтверджено ефективність і безпечність його застосування як антиоксиданту, метаболічного нейропротектора у хворих із дисциркуляторною енцефалопатією.

ВЛИЯНИЕ МЕДИКО-СОЦИАЛЬНЫХ ФАКТОРОВ НА ТЯЖЕСТЬ КОМОРБИДНОСТИ И ВЫЖИВАЕМОСТЬ АМБУЛАТОРНЫХ ПАЦИЕНТОВ

The aim of this study was to study the effect of gender, age and social status on the severity of comorbidity and survival of outpatients. A retrospective analysis of 133 outpatient records of patients of one of the outpatient clinics in Minsk was carried out by the method of continuous random sampling, incl. 50 men (38%) and 83 women (62%). Comorbidity was studied using the following methods: CIRS system; Kaplan – Feinstein index, Charlson index. The study revealed comorbidity in 78.6% of outpatients with chronic diseases, and on average it corresponded to a mild degree (according to three methods). Among comorbid diseases, the most common combination of ischemic heart disease and arterial hypertension with osteoarthritis, discirculatory encephalopathy, and pathology of the gastrointestinal tract. Comorbidity was more common in female patients, elderly and senile patients, workers, pensioners and disabled people. A poor prognosis was established in 42.8% of comorbid patients (according to the Charlson index), with a ten-year survival rate of less than 21% in 35.1% of patients. Among those with a survival rate of less than 21%, elderly patients and people with disabilities predominate, while young people and employees have a survival rate of more than 99%.

Препарат Цитофлавін® у лікуванні дисциркуляторної енцефалопатії у хворих на цукровий діабет 2-го типу: досвід використання

У статті наведені результати застосування препарату Цитофлавін® для лікування дисциркуляторної енцефалопатії в 42 хворих на цукровий діабет 2-го типу.

Interval normobaric hypoxic therapy as a method of correction in neurological patients

This article is devoted to the analysis of modern literature on the use of interval normobaric hypoxic therapy among neurological patients. Its relevance is determined by the need to find measures to prevent the negative effects of oxygen deficiency, as hypoxia is a key factor in the development of many pathological conditions in the human body and in the central nervous system in particular. Hypoxic effects of excessive strength or duration, leads to decompensation of adaptation mechanisms, triggers a chain of irreversible metabolic disorders that lead to cell death, destruction of intercellular and neural network interactions in the brain and, consequently,to the development of neurological deficit and disability ofthe patient.However,when the body adapts to hypoxia,which can be achieved by using interval normobaric hypoxic therapy, it is possible to achieve a positive effect in the correction of patients with various diseases of the central nervous system. We have considered both general mechanisms of the body’s defense formation during adaptation to hypoxia, and individualmechanisms related directly to the central nervous system. The role of biologicalmarkers and markers of oxidative stress determining the body’s individual response to oxygen deficiency has been evaluated. An analysis of studies evaluating the effect of interval normobaric hypoxic therapy on the course of such diseases as Alzheimer’s disease, Parkinson’s disease, discirculatory encephalopathy and the consequences of craniocerebral injuries was performed. It was found that properly performed interval normobaric hypoxic therapy contributes to the correction and compensation of impaired functions, improves the quality of life of patients and increases the adaptive reserve of the body to stressful influences.

ABOUT DEMENTIA

Dementia is a general term used to describe a loss of memory that keeps getting worse - or is 'progressive'. There can be many different causes, they will all involve loss of memory, but they have other symptoms which are different according to the cause. Dementia often starts off with just memory problems, but can also involve: difficulty planning and carrying out day-to-day tasks, difficulty communicating and changes in mood, judgement or personality. Aim of this article is to identify spread of dementia in 200 patients who have not been diagnosed before . Research was done in ONCO center of Adjara during 2014-2015 , involved 200 patients , female-130 , male-70, . For diagnosis of dementia we studied anamnesis, physical data, psychic and cognitive development of patient, family members were questioned often because of the difficulties patients had to explain symptoms they experienced. All patients had CT scan and evaluated bey Vavilov Method. Arterial Hypertension ,Discirculatory encephalopathy -171, Cancer-5 , Parkinson disease-10 , endocrine disorders-14 , family history of dementia -3 were noted in patients . From 200 patient examined 170 were diagnosed with dementia , Light dementia(10%). experienced memory deterioration Average quality dementia (55%) , During severe dementia (35%). Some risk factors for dementia, such as genetics and age . Cannot be changed. but researchers continue to explore the impact of other risk factors on brain health and prevention of dementia.

Functional state of the brain bioelectric activity in treatment of diaphyseal lesions of the radius using the transosseous osteosynthesis of the wire and rod arrangement

Radial fracture is the most common trauma to the musculoskeletal system and accounts for 50 % of traumatic injuries to the bones of the upper limb. Disability in patients with fractures of the forearm bones ranges from 6 to 8 months, so the choice of the most effective method of treatment is very relevant. Currently, an important point is the tendency of optimizing the transosseous method by eliminating the disadvantages and looking for new advantages of external fixation. Bone fracture and associated surgical intervention are always accompanied by varying degrees of changes in the links of the central nervous system, hemodynamics and metabolism. In order to study the bioelectrical activity of the brain in 47 patients with a fracture of the radial diaphysis treated in the Traumatology Department of the Irkutsk Scientific Centre of Surgery and Traumatology, in the pre- and postoperative period we compared EEG indicators of two variants of the layout of the external fixation apparatus (EF): wire and rod. Analysis of the rhythms of bioelectrical activity of the brain in both groups in the preoperative period revealed a normal zonal distribution with the dominance of the alpha rhythm on the EEG, which generally reflects a rather high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the group of patients with a wire-mounted EF device in the postoperative period, EEG indices significantly differed from the values of the norm and ndicators in the group with a rod-shaped arrangement. A decrease in the amplitude of alpha and beta rhythms was noted, as well as a shift in the frequency of bioelectric activity towards slow waves, which is a sign characteristic of discirculatory encephalopathy. An EEG study using the method of transosseous osteosynthesis with EF devise of a rod assembly showed its greater efficiency compared to the use of an EF device of a wire assembly during treatment and rehabilitation. Thus, the study of the bioelectric activity of the brain is a reliable method for assessing its functional state after an injury, as well as the effectiveness of the treatment.

РАСПРОСТРАНЕННОСТЬ И ФАКТОРЫ РИСКА РАЗВИТИЯ ИШЕМИЧЕСКОГО ИНСУЛЬТА У РАБОТНИКОВ ПРАВООХРАНИТЕЛЬНЫХ ОРГАНОВ

Background. Stroke is the second leading cause of death worldwide and the third leading cause of long-term disability in adults. In law enforcement officers, stress may contribute to the development of cardiovascular disease, exacerbating a number of stroke risk factors. Aim. Study of prevalence and identification of leading risk factors for ischemic stroke in law enforcement workers. Material and methods. A retrospective analysis of case records of patients diagnosed with atrial fibrillation, acute insufficiency of cerebral circulation and transient ischemic attack who received treatment in the Republican Hospital of the Ministry of Internal Affairs of Azerbaijan from 2016 to 2020 (n=1864) was performed. Of these, 225 case records of patients with a concomitant diagnosis of ischemic stroke [(12,07±2,2)%] were selected. We studied such pathological conditions as transient ischemic attack, hypertensive cerebral crisis and chronic forms of cerebrovascular disease as risk factors for stroke. Results and discussion. We found that there were 81 [(36,0±3,2)%] cases of cerebrovascular disease among the 225 examinees, including 64 [(28,44±2,9)%] established and 17 [(7,56±3,6)%] probable cases of cerebrovascular disease. Acute forms of cerebrovascular disease often occurred together with chronic forms. (6,98±3,2)% of patients aged 40–54 years (n=129) and (17,70±3,9)% of patients aged 55–65 years (n=96) had discirculatory encephalopathy. There was a total of 6 cases of transient ischemic attack [(2,67±1,4)%] in the patients examined, of which 2 cases [(0,89±1,2)%] were «definite» and 4 cases [(1,78±0,9)%] were «possible». The overall prevalence of transient ischemic attack in patients was (2,67±1,4)%. In 75,0% of the cases detected, transient ischemic attacks were registered predominantly once. Out of the total number of all detected cases of transient ischemic attack, 4 (66,67%) cases were registered for the first time upon history taking. Arterial hypertension was registered in 198 of 225 [(88,0±2,1)%] patients examined. Hypertensive crisis during ischemic stroke was detected in 14 of 225 patients (6,22% of all patients examined) and in (17,68±2,7)% of patients with arterial hypertension (34 patients). Additionally, there were 15 [(6,67±3,83)%] cases of hypertensive cerebral crisis: 5 (2,22%) established cases of hypertensive cerebral crisis and 10 [(4,44±2,80)%] «possible» cases. Conclusion. A comprehensive study of the clinical features, course, and complications of ischemic stroke will allow us to develop new approaches to solve the urgent research problem, which is the management strategy to be applied to patients in the acute period of ischemic stroke.

Патогенетичні аспекти превентивної корекції когнітивних порушень при метаболічному синдромі

Мета. Вивчити можливості збільшення ефективності патогенетичної терапії пацієнтів з хронічними цереброваскулярними захворюваннями (ЦВЗ) (дисциркуляторна енцефалопатія, ДЕ) на фоні метаболічного синдрому (МС) з використанням препарату Вітаксон®. Особливістю роботи було виявлення стратегічних ділянок мозку при когнітивних та емоційних розладах у пацієнтів з МС та за його відсутності. Матеріали та методи. Спостерігали 49 пацієнтів з ДЕ ІІ ст. віком від 37 до 73 років на фоні МС. Основна група — 30 пацієнтів — у складі лікування отримувала препарат Вітаксон®. Контрольна група становила 19 пацієнтів з ДЕ ІІ ст. на фоні МС, порівнянних за віком і стадією захворювання, які не приймали препарат Вітаксон®. Пацієнтів спостерігали протягом 12 тижнів. Крім неврологічних, загальноклінічних обстежень, визначення ознак МС, застосовували нейропсихологічне тестування за шкалою Mini Mental State Examination (MMSE) та шкалою оцінки когнітивних функцій Montreal Cognitive Assessment (МоСА), шкалою тривоги Спілбергера; шкалою депресії Бека; дослідження уваги: пошук чисел за таблицями Шульте з оцінкою часу виконання завдання. Головний мозок і його лікворну систему у 41 пацієнта (27 пацієнтів з МС — перша група та 14 пацієнтів без МС — друга група) оцінювали за допомогою методу волюметрії (вимірювання об’ємів окремих ділянок мозку) на МРТ-сканері Toshiba Vantage Titan 1,5. Результати. Когнітивні порушення в обох групах проявлялись у зниженні пам’яті, порушенні уваги, уповільненні психічних процесів. На 12-му тижні медіана за шкалою ММSE вірогідно збільшилась на 3,3 % (р < 0,05 порівняно з першим тестуванням) у групі пацієнтів, які приймали препарат Вітаксон®. За шкалою МоСА, що чутливіша при визначенні легких когнітивних порушень, у групі, де пацієнти приймали препарат Вітаксон®, когнітивні функції покращились на 5 %, а в групі контролю — на 1,66 %. За шкалою Спілбергера показники реактивної тривожності покращились більше в тій групі, де пацієнти приймали досліджуваний препарат; на початку лікування — 42,4 ± 3,4 бала та 24,6 ± 2,8 бала на 12-му тижні (р < 0,05). Було визначено, що показники когнітивної функції за шкалою МоСА обернено залежні від показників глікованого гемоглобіну. Результати волюметричних досліджень показали вірогідне (р < 0,05) зменшення об’єму речовини мозку, об’єму кори та білої речовини великих півкуль мозку, скроневої частки у пацієнтів з ЦВЗ на фоні МС порівняно з пацієнтами аналогічного віку без ознак МС. Крім того, у пацієнтів з МС визначалось вірогідне зменшення площі мозолистого тіла (р < 0,05) порівняно з пацієнтами без МС. Висновки. При лікуванні пацієнтів з ЦВЗ на фоні МС слід ураховувати тривожно-астенічні стани та когнітивні порушення, що часто виникають при цій патології. Додавання до загальноприйнятої терапії препарату Вітаксон® сприяє відновленню психоемоційних розладів. У пацієнтів з хронічними ЦВЗ на фоні МС ступінь атрофії кори та білої речовини великих півкуль мозку, лобної та скроневої часток, а також мозолистого тіла визначався вірогідно більшим (р < 0,05) порівняно з хворими без МС.

Синдромы нарушений постуральной устойчивости и походки у пациентов с дисциркуляторной энцефалопатией: клинические формы и особенности патогенеза

The problem of discirculatory encephalopathy (DEP) is still relevant in modern medicine due to the high prevalence of this pathology. The symptoms of gait disturbance and postural instability, which are an additional factor of disability and a decrease in the quality of life in patients with DEP, are discussed in this article. Modern concepts of the pathogenesis and clinical picture of static-dynamic disorders are highlighted.

Relationship between spectral indicators of heart rate variability and fasting glucose level in healthy persons and elderly patients with discirculatory atherosclerotic encephalopathy

Objective — to establish the peculiarities and relationship of spectral indicators of heart rate variability (HRV), fasting glucose level and lipid profile indicators in practically healthy persons and in elderly patients with dyscirculatory atherosclerotic encephalopathy (DEP). Materials and methods. The study involved 77 subjects of various age, who were divided into two groups: group 1 consisted of apparently healthy persons (19 subjects of middle age and 27 elderly subjects) and group 2 that included patients with DAP manifestations (15 subjects of middle age and 16 elderly persons). In the groups of elderly persons, the subgroups were extracted based on the fasting glucose levels: lower than 6.1 mmol/l and 6.1 mmol/l. The measurements of systolic and diastolic blood pressure were performed in a sitting position after at least 10 min of rest. Plasma glucose levels were determined by a standard glucoseoxidase method, lipid profile was determined by using the automatic analyzer. To assess the risk of cardiovascular disease development, calculations were performed for the indices of the cardiovascular risk: Castelli index and Boizel index. All patients with DEP manifestations underwent 24‑hour Holter ECG monitoring, and healthy people underwent 5 min ECG. Results. The incidence of fasting hyperglycemia in patients with 1 — 2 stage DEP manifestations was in 3.4 times higher (p < 0.05) vs healthy subjects of the same age. The significant correlation has been reveled between age and HDL‑C (r = 0.47, р < 0.05), atherogenic index (r = –0.40, р < 0.05), heart rate (r = –0.45, р < 0.05), Castelli index (r = –0.40, р < 0.05), Boizel index (r = –0.31, р < 0.05), heart rate (r = –0.45, р < 0.05). Moreover, correlation has been established between Boizel index and heart rate (r = +0.44, р < 0.05), heart rate and LF/HF (r = +0.57, р < 0.05), between TG and heart rate (r = +0.43, р < 0.05), LF/HF (r = +0.53, р < 0.05) and between levels of very low density lipoprotein cholesterol and heart rate (r = +0.44 р < 0.05), LF/HF (r = +0.53, р < 0. 05). It has been established that hyperglycemia and dyslipidemia significantly affected spectral heart rate variability indices in patients with encephalopathy manifestations. Conclusions. With ageing, the frequency of fasting hyperglycemia in patients with 1 — 2 stage DEP manifestations was significantly higher in 3.4 times in comparison with practically healthy individuals of the same age. In the group of practically healthy persons over 60 years old, the tendency has been revealed towards a decrease in the spectral parameters of HRV LF and HF, which indicates HRV decrease. With the development of 1 — 2 stages DEP, even in the middle age, a significant decrease in the value of HF (parasympathetic influence) and a significant increase in the value of LF (sympathetic activity) were revealed. In elderly people with signs of 1 — 2 stage DEP with normoglycemia and fasting hyperglycemia against the background of dyslipidemia, the sympathetic link of the autonomic nervous system is activated, accompanied by an increase in the index of vascular complications. In patients with 1 — 2 stages DEP and fasting hyperglycemia, this tendency was even more pronounced. This fact can serve as confirmation that in the development of pre‑diabetic disorders (fasting hyperglycemia) one of the pathogenic mechanisms is the violation of the central regulatory mechanisms, which in turn leads to the violation of the autonomic balance with the prevalence of sympathicotonia, and a decrease in the parasympathetic effect on the heart, which leads to development of autonomous cardiac neuropathy.

Drug and non-drug treatments of vertigo

Patients with complaints of “dizziness” often make an odyssey of visits to physicians belonging to various specialties. The prevalence of vertigo in the population is 17–30%. In most cases, disorders of various areas of the vestibular analyzer form the pathogenetic basis of vertigo and unsteadiness, while the most common cause of these complaints is the pathology of the peripheral area of the vestibular system: benign paroxysmal positional vertigo, vestibular neuronitis, Meniere’s disease. The cerebral vessel disease caused by hypertensive cerebral microangiopathy and cerebral atherosclerosis can also manifest by vertigo and unsteadiness. They can be represented by acute cerebrovascular disorders in the vertebrobasilar arterial system, transient ischemic attacks, as well as manifestations of chronic cerebrovascular disease (chronic cerebral ischemia, discirculatory encephalopathy). Episodes of recurrent spontaneous vestibular vertigo can be caused by vestibular migraine, which is rarely diagnosed in our country. The variety of reasons for complaints of vertigo and unsteadiness defines many therapeutic approaches to the treatment of these diseases. In recent times, modern drug and non-drug approaches to the treatment have been developed for patients with various diseases manifested by vertigo and unsteadiness. The most effective treatment is a comprehensive therapeutic approach that combines non-drug therapy, including vestibular gymnastics, training on the stabilographic platform with biofeedback according to the support reaction, and drugs that help reduce the severity, duration, and frequency of vertigo attacks, as well as accelerate vestibular compensation. Many studies have shown the efficacy of drugs enhancing microcirculation used for the prophylactic treatment of various causes of vertigo and unsteadiness.

Cerebrovascular disease with neurocognitive impairment

In the International Classification of Diseases 11th revision in the section «Diseases of the nervous system», it is proposed to distinguish «Cerebrovascular disorder with neurocognitive impairment», which corresponds to both discirculatory encephalopathy (DEP) or chronic cerebral ischemia (CCI) accepted in our country, and also vascular cognitive impairments. The terminology, prevalence, risk factors and pathological basis of the disease are discussed, in particular multiple infarctions, strategic infarctions, cerebral small vessel disease, specific microangiopathies, intracerebral hemorrhage and global hypoperfusion. Post-stroke cognitive impairments are discussed in detail. The article presents relevant data on the pathogenesis of the disease, highlights the issues of clinical and neuroimaging diagnostics. Based on the data presented in the article, we can conclude that the diagnosis of DEP, CCI should be based on the presence of cerebrovascular disease with neurocognitive impairment, which implies the verification of vascular cognitive impairments and reliable neuroimaging signs of cerebrovascular pathology while excluding other causes. Early diagnosis and effective treatment of cerebrovascular disease with neurocognitive impairment (DEP, CCI) is becoming increasingly important, since treatment can slow the progression of the disease and lead to a decrease in the incidence of stroke and dementia.

Цереброваскулярные заболевания как фактор риска развития ишемического инсульта

The conducted studies found that among the 225 examined there are 81 (36.0 ± 3.2%) cases of cerebrovascular diseases, including 64 (28.44 ± 2.9%) established and 17 (7.56 ± 3.6%) probable cases of cerebrovascular diseases. Acute forms of cerebrovascular diseases were often found together with chronic forms. Discirculatory encephalopathy was observed in 6.98 ± 3.2% of patients aged 40-54 and 17.70 ± 3.9% of patients aged 55-65. The examined patients had 32 cases of initial manifestations of insufficient blood supply to the brain, which is 14.22 ± 4.2% of cases. A pronounced degree of severity of the neurotic state was revealed in 11.72 ± 2.2% of the examined, in 25.0 ± 2.9% — a moderate degree, in 63.28 ± 3.2% — a mild degree of severity.