Montreal Scale Research Articles

#1022 Vulnerability in onconephrology: women and people who live alone are at greater risk of depression and anxiety

Abstract Background and Aims Cancer is a common entity that after the new therapeutic advances is becoming chronic disease. For that reason, kidney disease prevalence is increasing in cancer patients. Consequently, Onconephrology is becoming an essential subspecialty. Psychiatric disorders are prevalent in both cancer and kidney patients. The impact of such disorders has not been studied in onconephrology patients. Our aim is to study the prevalence of psychiatric disorders in Onconephrology patients and their impact in the survival and quality of life of patients. Method This is a prospective study including all patients visited in the Onconephrology Unit in our center from November-2021 to February-2023. The following questionaries were evaluated at the first visit, 6 months and 12 months: sleep disorders (Epworth scale), depression (Geriatric Depression Scale (GDS) and Patient Questionnaire Health (PHQ)), cognition (Montreal scale) and anxiety (Generalized Anxiety Disorder (GAD). Clinical and analytical characteristics of the patients were collected. Results A total of 182 patients were included, mean age 68 (±11) years, 70 (38.5%) women, 56 (30.8%) diabetes mellitus, mean creatinine 1.7 (±0.88) mg/dL, and glomerular filtration rate (GFR) 44 (±21) ml/min. A total of 18 (9.9%) patients lived alone, 152 (83.5%) lived accompanied and 4 (2.2%) in residence. The most common neoplasm was lung (n = 38; 20.9%) and the reason for referral to Onconephrology was chronic kidney disease (n = 94; 51.6%). At the first visit, 81 patients (44.5%) had sleep disorder, 32.7% (n = 59) had depression, 72 (39.6%) had cognitive impairment and 14 (7.7%) had anxiety. In the univariate analysis we evidenced that patients who lived in residence presented more prevalence of depression (p = 0.013). Patients with cognitive impairment had a higher prevalence of DM (p = 0.003), worse kidney function and were older (p < 0.001). Patients who had sleep disorders were older (p = 0.01) and women had more prevalence of anxiety (p < 0.001). At six months of follow-up, women presented anxiety with more prevalence (p = 0.03) as well as those who presented oncological progressive disease (p < 0.001). Patients who lived alone presented more depression compared to patients lived accompanied (p = 0.002). At twelve months of follow-up, oncological progression was associated with depression (p = 0.034). In the multivariate analysis, age was identified as a risk factor for cognitive impairment (OR: 1.1; p < 0.001) and female sex for depression (OR: 3.39; p = 0.001). At 6 months of follow-up woman sex for anxiety disorder (OR:8.6;p = 0.01) and patients who lived alone were identified as risk factors for depression (OR: 10.8; p < 0.001). A total of 30 patients (16.5%) died during the follow-up. In the Kaplan-Meier analysis, more mortality was observed in patients with sleep disorders (p = 0.039), worse kidney function (p = 0.003) and oncological progressive disease (p = 0.028). These were not confirmed in multivariate analysis Conclusion Onconephrology patients had a high prevalence of depression and anxiety, especially female and patients who live alone. Therefore, it is essential to perform a comprehensive approach and to have tools to detect the vulnerable population to improve their survival and quality of life.

The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis.

Oxidative stress markers have a distinct role in the process of demyelination in multiple sclerosis. This study investigated the potential correlation of markers of oxidative stress (glutathione [GSH], catalase) with the number of demyelinating lesions and the degree of disability, cognitive deficit, and depression in patients with relapsing-remitting multiple sclerosis (RRMS). Sixty subjects meeting the criteria for RRMS (19 men and 41 women), and 66 healthy controls (24 men, 42 women) were included. In this study, GSH significantly negatively correlated with the degree of cognitive impairment. This is the first study of subjects with RRMS that performed the mentioned research of serum GSH levels on the degree of cognitive damage examined by the Montreal Scale of Cognitive Assessment (MoCA) test. The development of cognitive changes, verified by the MoCA test, was statistically significantly influenced by the positive number of magnetic resonance lesions, degree of depression, expanded disability status scale (EDSS), age, and GSH values. Based on these results, it can be concluded that it is necessary to monitor cognitive status early in RRMS patients, especially in those with a larger number of demyelinating lesions and a higher EDSS level and in older subjects. Also, the serum level of GSH is a potential biomarker of disease progression, which could be used more widely in RRMS.

Features of the impact of combat-related traumatic brain injury in the long-term period, depending on the severity and course of the injury on the cognitive sphere of patients

Background. The number of consequences of mine-explosive injuries, multiple gunshot and shrapnel wounds has increased significantly in the world of current events related to the conduct of full-scale military operations on the territory of Ukraine. In particular, cases of combat traumatic brain injury (TBI) have increased, which is becoming one of the most important problems. Purpose The purpose of the research was to study the characteristics of cognitive functions in patients with the consequences of a combat craniocerebral injury (bTBI) depending on the severity and catamnesis of the received injury. Materials and Methods. 350 patients Cognitive functions of 350 patients who suffered a combat traumatic brain injury (cTBI),was carried out using the Montreal scale of cognitive deficits (MoCA test). The assessment of neurological status was carried out by a routine method and NOS-TBI (Neurological Outcome Scale for Traumatic Brain Injury), the level of anxiety and depression was determined using the HADS scale. In addition, the state of cognitive functions was evaluated using a number of modern neuropsychological tests: the method of learning 10 words, which allowed to investigate memory processes (memorization, preservation and reproduction of information). Schulte’s tables were used to assess the pace of sensorimotor reactions, mental capacity, and the volume of active attention. Results. The results of the MoCA scale in patients with consequences of combat TBI of varying degrees of severity corresponded to mild cognitive decline: Mild cTBI 22.21 ± 0.29 points, cTBI (ST) 21.36 ± 0.33 points, Severe cTBI 21.32 ± 0.28 points. There was no statistically significant difference between MoCA values at different severity of combat TBI. A longer injury history had a negative effect on cognitive function in patients with Mild effects combat TBI and Severe combat TBI. Conclusions. As a result of the investigation, officials who contributed to the formation of cognitive deficits were identified: anxiety disorder (with mild effects combat TBI and severe combat TBI), anxiety-depressive state (with mild effects combat TBI with a follow-up period of up to 3 years and combat TBI (moderate) with follow-up). period more than 5 years), age (combat TBI (moderate) up to 7 years), neurological deficit (severe combat TBI, follow-up period in case of injury more than 5 years).

The effect of hopanthenic acid on the development of cognitive disorders in patients with a mine blast injury

Background. In the conditions of hostilities in Ukraine, the number of victims ofmine- explosive injuries among both the military and the civilian population is increasing. These injuries lead to serious damage to the organs and body systems, as well as to the development of various psychological disorders, such as cognitive disorders. The purpose of this paper is to study and correct cognitive disorders in patients with brain concussion due to a mine-explosive injury, using the calcium salt of hopantenic acid. Materials and Methods. For this, the patients underwent the Montreal scale of cognitive function assessment (MoCA), the short mental status assessment scale (MMSE), word encryption tests, and word recall tests. Results. The study was conducted three times, immediately after the injury, and 14 and 21 days later. In the course of the study, it was found that therapy with the calcium salt of hopantenic acid significantly improved neuropsychological indicators (increase in the total MMSE score) and reduced the patient’s cognitive deficit, improved concentration and short-term memory. Conclusions. Thus, the hopantenic acid effectively reduces cognitive impairment in patients with brain concussion due to a mine-explosive injury and is recommended for the treatment of this group of patients.

Neuropsychological, plasma marker, and functional connectivity changes in Alzheimer's disease patients infected with COVID-19.

Patients with COVID-19 may experience various neurological conditions, including cognitive impairment, encephalitis, and stroke. This is particularly significant in individuals who already have Alzheimer's disease (AD), as the cognitive impairments can be more pronounced in these cases. However, the extent and underlying mechanisms of cognitive impairments in COVID-19-infected AD patients have yet to be fully investigated through clinical and neurophysiological approaches. This study included a total of 77 AD patients. Cognitive functions were assessed using neuropsychiatric scales for all participants, and plasma biomarkers of amyloid protein and tau protein were measured in a subset of 25 participants. To investigate the changes in functional brain connectivity induced by COVID-19 infection, a cross-sectional neuroimaging design was conducted involving a subset of 37 AD patients, including a control group of 18 AD participants without COVID-19 infection and a COVID-19 group consisting of 19 AD participants. For the 77 AD patients between the stages of pre and post COVID-19 infection, there were significant differences in cognitive function and psychobehavioral symptoms on the Montreal Scale (MoCA), the neuropsychiatric inventory (NPI), the clinician's global impression of change (CIBIC-Plus), and the activity of daily living scale (ADL). The COVID-19 infection significantly decreased the plasma biomarker level of Aβ42 and increased the plasma p-tau181 level in AD patients. The COVID-19-infected AD patients show decreased local coherence (LCOR) in the anterior middle temporal gyrus and decreased global correlation (GCOR) in the precuneus and the medial prefrontal cortex. The findings suggest clinical, cognitive, and neural alterations following COVID-19 infection in AD patients and emphasize the need for close monitoring of symptoms in AD patients who have had COVID-19 and further exploration of the underlying mechanisms.

Dynamic Changes in Brain Perfusion after Cognitive Rehabilitation in Patients with Type 1 and Type 2 Diabetes Mellitus

INTRODUCTION: The results of numerous studies indicate a high prevalence of cognitive impairment among patients with diabetes mellitus (DM).
 AIM: To evaluate the effectiveness of computerized training in cognitive rehabilitation in individuals with type 1 and type 2 DM, taking into account the dynamics of brain perfusion.
 MATERIALS AND METHODS: A randomized controlled study. The study group consisted of 25 patients with type 1 DM and 30 patients with type 2 DM aged 23 to 67 years. The comparison group included 20 patients with type 1 DM (mean age 28.4 years) and 20 patients with type 2 DM (mean age 56.0 years). Before and after the rehabilitation course, the patients of the study group underwent a general clinical examination, a blood test for carbohydrate metabolism, cognitive function testing using the Montreal Scale (MoCA test), contrast-free perfusion magnetic resonance imaging (MRI) of the brain. Active rehabilitation lasted 6 month; it was based on a computerized training, including exercises on verbal and nonverbal intelligence.
 RESULTS: On the initial examination, all the subjects did not have the achieved target level of glycated hemoglobin. After completion of the training program, a decrease in the parameter in both groups was noted, as well as a decrease in the mean level of fasting glycemia in people with type 1 DM. The result of neuropsychological testing in all patients at the initial stage corresponded to the diagnosis of ‘cognitive dysfunction’. The control test revealed an improvement in cognitive status according to the overall score, the abstraction scale, speech, memory and visual-constructive skills. Correlation analysis in the group with type 1 DM showed that the result of exercises on visual attention and auditory perception was influenced by memory function. In individuals with type 2 DM, increased glycated hemoglobin was associated with a decrease in cognitive functions according to the overall score of the MoCA test, as well as in tasks for speech, memory, visual-constructive skills. Dynamic analysis of changes in the MRI picture revealed hypoperfusion in the area of the right and left thalamus in patients with type 1 and type 2 DM, respectively, as well as increased perfusion of the white matter of the right parietal lobe in the group with type 1 DM, and in the putamen area on the left in the group with type 2 DM.
 CONCLUSION: In patients with type 1 and type 2 DM, as well as with cognitive deficit, who underwent a course of cognitive rehabilitation using computerized training, an improvement in cognitive status was noted, which was confirmed by the results of contrast-free perfusion MRI. to evaluate the effectiveness of computerized training in cognitive rehabilitation in people with type 1 and type 2 diabetes mellitus, taking into account the dynamics of brain perfusion.

High-definition transcranial direct current stimulation for treating cognitive and negative symptoms in chronic schizophrenia – A sham-controlled proof of concept study

Objectives: Cognitive and negative symptoms are core symptoms of schizophrenia affecting interpersonal and socio-occupational functioning. Impaired dorsolateral prefrontal cortex (DLPFC) function is implicated in negative and cognitive symptoms. Conventional transcranial direct current stimulation (tDCS) to DLPFC has attracted interest as an add-on treatment for these symptoms. High-definition tDCS (HD-tDCS), an optimized form of tDCS, has the potential for more focalized neuromodulation. Studies suggest that an increased number of sessions may increase the effectiveness of stimulation. Hence, we aimed to evaluate the efficacy of 20 sessions of HD-tDCS over the left DLPFC in the improvement of cognitive and negative symptoms in chronic schizophrenia (>2 years continuous illness). Material and Methods: Twenty patients with chronic schizophrenia with predominantly cognitive and negative symptoms were enrolled in this sham-controlled trial. Participants received 20 sessions of HD-tDCS at 2 mA for 20 min, that is, twice daily over 10 days. Montreal cognitive assessment and scale for assessment of negative symptoms were used to assess outcome variables. Assessments were carried out at baseline, 2 weeks, and 6 weeks, respectively. Results: Significant improvement was noted in both active and sham groups across all outcome variables over time. However, a statistically significant decrease in negative symptoms in the active group was noted, which was maintained at the end of 6 weeks, but there was no statistically significant improvement in cognitive symptoms between the active and sham groups at 6 weeks. The stimulation protocol was well tolerated. Conclusion: HD-tDCS has substantial potential in the treatment of negative symptoms; however, its role in cognitive symptoms needs further evaluation.

КОРРЕЛЯЦИЯ БЕЛКА S100B И СТЕПЕНИ КОГНИТИВНЫХ НАРУШЕНИЙ У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

The study aims to investigate the relation between cognitive impairments and neurospecific S100β protein in HIV patients. The quantitative content of the neurospecific S100β protein in the blood of 20 patients with HIV infection was determined using the Montreal scale (MoCa test). In all cases, HIV patients with cognitive impairment had an elevated level of S100β, while in some cases, patients with an increased level of the S100β protein did not suffer from cognitive decline. S100β may be a marker of central nervous system damage causing cognitive decline, but it is not clear whether elevated levels of S100β can be a predictor of future cognitive deficiency.

Effectiveness of physical therapy of a person with a hemorrhagic stroke during the recovery period: a clinical case

Purpose: to scientifically substantiate and develop a program of physical therapy for a patient after a hemorrhagic stroke (during the recovery period) and check its effectiveness. Material & Methods: the study was conducted on the basis of the "Skalyansky Clinic" Medical Center. The organization of the study involved conducting a comparative analysis of the dynamics of indicators obtained with the help of clinical tools for assessing the patient’s functional state in the process of applying the author’s physical therapy program. A 71-year-old patient with a diagnosis of "Acute cerebrovascular hemorrhagic disorder: subarachnoid-parenchymal hemorrhage with the formation of a stroke-hematoma of the left temporal-subcortical area of the brain with breakthrough into the ventricular system with right-sided hemiplegia, sensorimotor aphasia" by a multidisciplinary team (doctor, physical therapist, speech therapist and psychologist) an individual program of physical therapy was developed. In order to evaluate the effectiveness of the experimental methodology, a formative experiment was conducted. Clinical tools for assessing the functional state of the patient during the research were domains in the form of the ICF-core-set tool (a set of ICF basic categories) (ICF Research Branch, 2022) for complex stroke: Lovett’s test, Barthel scale, Gait Velocity (GV) tests and Berg Balance scale (BBS), Montreal Scale of Cognitive Assessment (MoCA), Get Up and Go Tests, Trunk Control Test, Functional Independence Measure (FIM). The developed individual program of physical therapy for hemorrhagic stroke in the recovery period is a comprehensive course of physical therapy, occupational therapy, which is carried out in stages and includes the following components: therapeutic gymnastics classes; electrical stimulation of the shoulder, psychological (psychological counseling, psychological support, developmental classes for the recovery of cognitive impairments) and speech therapy (speech therapy gymnastics, articulation exercises, Su-Jok (massage ball and ring) component. After applying the specified author’s individual physical therapy program, qualitatively positive changes in the functional and psychophysical state of the patient, in particular: b7301.4 to b7301.2; d550.2 to d550.1; d510.3 to d510.2; d520.3 to d520.2; d540.3 to d540. 2; d598.3 to d598.2; d4100.3 to d4100.2; d450.3 to d450.2; d469.4 to d469.3; d330.3 to d330.1; d355.3 to d355.3; d998.3 to d998.2. Results: after applying the author’s program of physical therapy, we found qualitatively positive changes in the functional and psychophysical state of the patient, as evidenced by the positive dynamics of the studied indicators. The psychological and speech therapy work carried out contributed to the improvement in the process of restoring the patient’s cognitive functions (from moderate to mild impairment), stabilization of his emotional state, acquisition of stress resistance skills, harmonization of the patient’s system of relationships with himself, Conclusions: the effectiveness of using the author’s individual program of physical therapy is confirmed by the dynamics of qualitatively positive changes in the functional and psychophysical state of the patient.

The Relationship of the Risk of Falls with the Features of Cognitive Function and Emotional Status (Fear of Falls) in Older People

Objective. To assess the frequency of falls, the relationship between fear of falling and the risk of falls in people aged 60 years and older. Material and methods. The open cross-sectional study included 51 outpatients (49 women, 2 men) aged 61 to 90 [70 (67; 75)] years. A conventional physical examination, clinical and biochemical blood tests, screening for fragility (the “Age is not a hindrance” questionnaire), the risk of falls (history, the “Get up and go” test), fear of falls (“Short scale for assessing the fear of falls”, “Scale of effectiveness falls”), assessment of cognitive function (CF) — Montreal scale of cognitive assessment — MoCa-test). Results. A high risk of senile asthenia was found in 38 %, preasthenia — in 31 %, a history of falls — in 75 %, fear of falls — in 78 %, impaired CF — in 49 % (MOCA 24.3±2.9 points) of patients. An association was found between fear of falls and history of falls (odds ratio [OR] 9.92, p=0.003, 95 % confidence interval [CI] 2.20-44.63), 2 or more comorbidities (OR 10.86, p=0.013, 95 % CI 1,66- 71,09); between the “Get up and go” test for more than 10 seconds and MOCA less than 25 points (OR 8.57, p=0.001, CI 2.4-30.3); scores less than 25 on the Fall Effectiveness Scale and MOCA (OR 5.6, p=0.018, CI 1.34-23.36). The optimal value of the “Get up and walk” test for predicting falls was 10.5 seconds or more (area under the curve 0.753±0.083, p=0.019), the MOCA test was 24.5 points or less (area under the curve 0.792±0.065, p <0.001); the fall effectiveness scale for predicting fear of falls — 72.5 points or more (area under the curve 0.743±0.092, p=0.014); test “Get up and go” — 9.5 seconds or more (area under the curve 0.708±0.098, p=0.036). Conclusion. Fear of falls was associated with a history of falls, соmorbidity, low functional activity, and a decrease in CF, which confirms the multifactorial origin of the fear of falls in older age and requires consideration in the development of comprehensive treatment and prevention programs.

Analysis of The Safety and Efficacy of Different Types of Anesthesiological Support During Aesthetic Interventions For The Breast Glands In Ukraine

In the prevailing era, mammoplasty is prevalent among women. Undeniable benefits of the method are the preservation of most anatomical structures and skin, and also better psychological status of patients after intervention. Hence, the present study intends to examine the features of aesthetic and reduction surgical interventions on the mammary glands in Ukraine. Materials and methods. The study was conducted by analyzing the inpatient ambulatory cards of 320 patients. Anesthesia was provided by propofol (n=130), sevoflurane (n=140) and combined use of sevoflurane and nalbuphine (n=50). The results of the study. It was found that usage of combined inhalation analgesia of sevoflurane with opioids was characterized by 41.9% less recovery time. It was found that 8 hours after surgery, the individual assessment of pain was lower in the group of combined analgesia with opioids relative to intravenous anesthesia with propofol (87.5%, p<0.05) and inhalation anesthesia with sevoflurane (71, 3%, p<0.05). After 24 hours all patients reported about pain below 1.0 point, however, in groups where sevoflurane and nalbuphine were used, the level of pain self-esteem was 2.61 and 3 times lower than after intravenous propofol. It was found that within 1 hour after surgery, the average cognitive score on the Montreal scale decreased in the group of intravenous propofol by 5.0% (p<0.05) and by 1.7% under inhalation anesthesia with sevoflurane. Under combined anesthesia the cognitive score remained at 12.0 points. The frequency of postoperative nausea was the highest level in the group of inhalation anesthesia - 16.7%. The addition of nalbuphine to sevoflurane significantly reduced the risk of postoperative nausea (? 2=7.250; p=0.007). Conclusions. Combined anesthesia with opioids is a highly effective anesthetic choice for aesthetic and reconstructive interventions on the mammary glands.

Features of treatment of chronic brain ischemia in young patients with arterial hypertension

Actuality: Increasing the frequency of hypertension among the young population is a socially significant problem. The insidiousness of hypertension in young people is that it has the character of a disease with few symptoms. Since hypertension plays one of the main roles in the pathogenesis of chronic disorders of cerebral blood circulation, including both arterial and venous systems, the search for pathogenetically determined medicinal approaches to the elimination of cerebrovascular disorders, especially at a young age, continues. The purpose of the study: to study the effectiveness, tolerability and safety of the combination of Flego and Cognitium in young patients with chronic cerebral ischemia (CMI) on the background of hypertension. Methods: clinical-neurological, psychodiagnostic (asthenic state scale (ASS), anxiety scores according to the Spielberger-Hanin scale and Beck depression scale, Montreal scale of cognitive function assessment (MoCA)), ultrasound examination, general scale of clinical impression, statistical. Results: 52 patients (28 men and 24 women) at a young age with AMI on the background of hypertension were examined. The median age of the examined patients was (37.7 ± 4.6) years; among them, 23 patients suffered from hypertension of the 1st century. and 29 patients with hypertension of the second stage. Patients were randomly divided into two groups - the first - 23 (44.2%) patients (received only hypotensive drugs), the second - 29 (55.8%) patients (in addition to the standard hypotensive therapy received a combination of Phlego and Cognitium). Dynamic monitoring of patients after 2 months of treatment did not show significant changes in the distribution structure of objective clinical and neurological symptoms. However, positive dynamics of indicators of cognitive functions and the psychoemotional state of the subjects were observed, as well as a statistically significant decrease in the blood flow rate in the direct sinus at the end of the 2-month course using the combination of Phlego and Cognitium (decreased from 36.27±2.84 cm/s to 25.65±1.47 cm/s.). Conclusions: The introduction of the combination of Phlego and Cognitium into the treatment of young patients with arterial hypertension and chronic brain ischemia had a positive effect on the subjective state, on indicators of asthenia, emotional and cognitive state of the patients. A significant positive effect was noted in the dynamics of venous blood flow indicators (speed of blood flow in the direct sinus). Such treatment was well tolerated by patients, had few side effects and was combined with other drugs

Clinical characteristics of cognitive impairment and its related risk factors in post-stroke epilepsy

Post-stroke epilepsy (PSE) patients are prone to cognitive impairment (CI) due to multiple factors. This study aimed to assess clinical characteristics of CI and its related risk factors in newly diagnosed Chinese Han adult epilepsy patients with ischaemic stroke. Data were collected on PSE patients hospitalized in the neurology ward of the Affiliated Hospital of Yangzhou University, from January 2016 to May 2019. Newly diagnosed PSE patients were followed for six months; their cognitive functions were then assessed according to the Chinese Beijing version of the Montreal Scale (MoCA) and patients were divided into a PSE+CI group (MoCA scale score <26) (n=81) or PSE-CI group (MoCA scale score ≥26) (n=36). Data collection tools also included the Chinese versions of the Zheng Self-assessment Anxiety Scale, the Zheng Self-assessment Depression Scale, the Barthel index and the National Hospital Seizure Severity Scale. We compared the basic clinical characteristics between the two groups of patients and investigated the factors of CI in PSE patients. In total, CI was present in 81 (69%) and absent in 36 (31%) PSE patients. MoCA total score in the PSE+CI group was 20.85±4.13 and 27.53±1.34 in the PSECI group. The Bonferroni corrected significance level was 0.0013. Scores for multiple cognitive domains (visuospatial/executive skills, naming, attention, language and delayed recall) were lower in the PSE+CI group than the PSE-CI group. Moreover, the PSE+CI group had a higher incidence of depression and anxiety. Univariate analysis showed that diabetes (p= 0.000) and the number of antiepileptic drugs (AEDs) (p= 0.001) were associated with CI in PSE. Binary logistic regression analysis showed that diabetes (odds ratio [OR]: 5.242, 95% confidence interval [CI]: 1.680-16.363, p= 0.004), high homocysteine levels (OR: 1.103, 95% CI: 1.008-1.207, p= 0.033) and the number of AEDs (OR: 3.354, 95% CI: 1.225-9.180, p= 0.019) were associated with CI in PSE. Diabetes, high homocysteine levels and a higher number of AEDs may be risk factors for CI in PSE.

Affective disorders and сognitive impairment in the early stages of Parkinson’s disease

Background: Parkinson's disease (PD) is an age-related neurodegenerative disease in developed countries. The prevalence of PD ranges from 41 per 100,000 in the fourth decade of life to more than 1,900 per 100,000 in people over 80 years of age. Neurodegeneration associated with Parkinson's disease probably occurs several decades before the onset of motor symptoms. Affective and cognitive impairments are one of the most frequent non-motor manifestations of PD, which can lead to a number of adverse outcomes. Aim: to evaluate affective and cognitive impairments in patients at the early stages of PD. Methods: 61 patients with PD participated in the study. All the participants were divided into two groups depending on the presence or absence of a diagnosis of depression verified by psychiatrists: Group 1 was the main group (n=48), group 2 was the control group (n=13). The control group included patients without depression. The average age of the participants was 62.29.6 years. The analysis of the PD stages was carried out in both groups. In the main group, stage II PD was diagnosed in 75%, in the control group in 31% of patients. The average duration of the disease was 2.51.6 years. A clinical examination was carried out using the Beck depression questionnaire, apathy scale, Spielberger anxiety questionnaire and anxiety assessment scale in PD (to assess emotional disorders), cognitive function assessment scale in PD (SHOBP-Cog, Scopa-Cog), digital symbol replacement test (symbols-numbers test), Montreal assessment Scale cognitive functions (MoCA test), a test for connecting numbers and letters, and a Stroop test (for evaluating cognitive functions). Results: It was revealed that in the early stages of PD, the prevalence of depression, clinically significant apathy, personal and reactive anxiety was high. Significantly higher rates of depression severity, depression level, apathy level and personal anxiety were noted among the patients with stage II PD compared to the patients with stage I PD. There was a marked tendency to a decrease in cognitive functions at stage I of PD, aggravated at stage II of the disease, which was confirmed by the results of the tests: a low level of cognitive functions on the Montreal scale was detected in 52%; 70% of patients, regardless of the PD stage, showed a low rate of completion of the 1st and 2nd parts of the Stroop test for their age; the results of the digital character replacement test were below normal in 75% of cases. Conclusion: The most common affective disorders in the early stages of PD are depression and anxiety. Apathy and depression have a negative impact on the cognitive functions of patients, which worsen with the progression of the disease.

Impact of General Anesthesia and Antioxidants on Cognitive, Static and Locomotor Functions During Laparoscopic Cholecystectomy

Aim of the study: to reduce cognitive impairment during laparoscopic cholecystectomy by perioperative administration of drugs with antihypoxic and antioxidant effects under the control of stabilography. Materials and methods. We studied the effect of general anesthesia and antioxidants on cognitive, static and locomotor functions during laparoscopic cholecystectomy. We studied 90 patients with acute calculous cholecystitis randomized into three experimental groups (n=30, each group). The control group was composed of 24 healthy individuals. Group 1 patients received no antioxidants, group 2 patients received the combination antioxidant drug (sodium fumarate+sodium chloride+potassium chloride+magnesium chloride) in the post-operative period, and group 3 patients received methylethylpyridinol. The patient groups were comparable in sex, age and type of inflammatory and destructive process in the gallbladder. Surgical intervention was performed under endotracheal anesthesia. Premedication with atropine and promedol was given, and anesthesia induction was carried out with propofol, fentanyl and suxamethonium. Sevoflurane, fentanyl andcisatracurium were employed to maintain anesthesia, analgesia and myorelaxation, respectively. The patients were examined before surgery, 24 and 48 hours after surgery. In the groups of patients who received antioxidant therapy, blood sampling for hematological and biochemical examinations was performed 30 min after the administration of antioxidants. Stabilographic studies and MoCA test (Montreal Scale) were performed before antioxidant administration prior to surgery and after surgery, on days 2 and 3. Results. Neuropsychological testing revealed postoperative cognitive dysfunction on standard therapy which included impaired attention and concentration, executive function, memory, speech, visual constructional skills, abstract thinking, counting, and orientation (21 points on the MoCA scale versus 28–30 points for normal). We found that the pathogenetic factors of cognitive dysfunction included insufficient antioxidant protection, decreased TNF-α and elevated interleukin-18 levels along with an increased level of C-reactive protein in plasma, which manifested as activation of free-radical oxidation processes and reduced antioxidant system and performance of nonspecific resistance. Perioperative use of the combination antioxidant drug and methylethylpyridinol antioxidants reduced the frequency and severity of postoperative cognitive impairment in patients after laparoscopic cholecystectomy. Conclusion. The most important pathogenetic factors of cognitive dysfunction after laparoscopic cholecystectomy include activation of free-radical oxidation, reduction of antioxidant defense system performance and lack of nonspecific resistance factors. Adding the combination antioxidant drug or methylethylpyridinol to the standard therapy reduces the intensity of radical oxygen species generation, maintains the antioxidant potential, activates production and secretion of nonspecific resistance factors, preventing the development and reducing the severity of cognitive disorders in the perioperative period. Neuropsychological testing and stabilographic examination allow identifying the risk of cognitive disorders in patients after laparoscopic cholecystectomy and provide a rationale for the use of antioxidant therapy for their prevention.

Association between Cognitive Decline and Altered Cerebral Perfusion in Adults with Moyamoya Disease after Revascularization

Introduction: Certain studies have observed that patients with moyamoya disease (MMD) have cognitive decline after revascularization. Thus, this study analyzed the relationship between cognitive decline and altered cerebral perfusion after revascularization. Methods: Here, 313 adult patients with MMD underwent single unilateral revascularization. First, cognitive function was scored using a Mini-Mental Scale (MMSE) and Montreal cognitive function scale (MoCA) before and 3 months after the operation (superficial temporal artery-middle cerebral artery anastomosis with encephalo-myo-synangiosis). Then, computed tomography perfusion was performed before and 1 week after the operation to assess the cerebral perfusion. Results: Our data showed that cognitive function decreased in 55 cases (17.6%) after revascularization. Furthermore, the incidence of cerebral hyperperfusion (CHP) was significantly higher in the cognitive decline group (49/55) than in the cognitive nondecline group (89.1% vs. 5.4%, p < 0.001). Results also showed that although all 55 patients had postoperative cognitive decline, 47 experienced relative cerebral blood flow (CBF) decrease at a relatively distant area of the anastomosis compared with that before the operation, which was significantly higher than in patients without cognitive decline (85.5% vs. 1.94%, p < 0.001). In addition, 41 patients had a simultaneous occurrence of local CHP and paradoxical CBF decrease at a relatively distant anastomosis area, which indicated the incident of watershed shift (WS). As observed, WS occurred in 74.5% of patients with cognitive decline, significantly higher than in patients without cognitive decline (74.5% vs. 0%, p < 0.0001). Through multiple logistic regression analysis, WS was also observed to be a strong independent risk factor for predicting postoperative cognitive decline 3 months after revascularization (odds ratio 17.780, 95% confidence interval 1.668–18.564; p = 0.017). Conclusion: Therefore, cognitive decline in patients with MMD after revascularization is related to WS, leading to an uneven distribution of CBF.

Polyfactorial approach in the correction of cognitive impairment in patients with post-Covid syndrome

The article discusses a multi-level polyfactorial approach in the correction of cognitive impairment in patients with post-Covid syndrome based on the combined use of cognitive-motivational correction of the psychological state and physiotherapeutic methods of treatment: multi-level magnetolaser therapy, advanced blood irradiation, transcranial neuroacoustic and light-pulse stimulation.&#x0D; According to the results of the analysis of the results of testing patients based on the Montreal scale for assessing cognitive functions before the start, after 6 and 12 procedures, as well as 4 weeks after the completion of rehabilitation in the first group, the average indicators of the level of cognitive functions changed from 18.2 to 21.4 points, in the second group from 17 to 26 points.&#x0D; Psychological testing using the psychometric tables of A. Beck and Spielberger-Hanin showed a decrease in the average level of depression after the procedures in the first group by 5.4±1.4 (from 27.5 to 22.1) points, the anxiety level by 4.9±0.3 (from 35.1 to 30.2), in the second group by 9.9±1.2 (from 27.3 to 17.4) and 8.2±0.4 (from 35.2 to 27.0), respectively. Additionally, it should be noted that the clients of the second group were more interested in conducting a second course.&#x0D; A multi-level approach in the medical rehabilitation of patients with post-Covid syndrome based on the use of psychological correction, magnetolaser effect on the projection of the liver, supravenous irradiation of blood and combined transcranial neuroacoustic and light-pulse stimulation in combination with endonasal breathing of a singlet-oxygen mixture in a magnetic field turned out to be the most effective for restoring cognitive functions.

Clinical efficacy and safety of Ethoxidol in cerebrovascular diseases

Evaluation of efficacy and clinical safety of ethylmethylhydroxypyridine malate (Ethoxidol) in cerebrovascular disease in out-patient, and in-patient setting. In the observational study was included of the 70 patients (aged 62.84±6.54 y.o) diagnosed with unspecified cerebrovascular disease, hypertensive encephalopathy, atherosclerosis of cerebral vessels. To access neurological deficit Montreal Scale (MoCA test) was used, MFI-20 test for asthenia. Berg balancing (BBS-test), tinnitus severity score (THI), and general clinical condition score also were recorded. Quality assurance was evaluated by VAS, and EQ-VAS Scores (European life quality gr). Interventions were identical, except treated received Ethoxidol 200 mg IV once/day, or 200 mg IM once/day and 200 mg per os (400 mg/day) during 7 days, follow up by oral administration of Ethoxidol 600 mg/day (200 mg TID) for the period of 53 days. The results of the observational study has shown of high clinical efficacy and tolerability of the Ethoxidol therapy. Statistical significance between baseline and treatment period was recorded on the 7th and 60th day of observation (p<0.001). Stabilization of the archived condition persisted on the 60th day. Ethoxidol administration reduced asthenia cognitive dysfunction, dizziness, balance disorders, and tinnitus. CGI Score revealed reduction of the severity of patient's condition and total of clinical improvement; EQ-VAS Score showed growth of quality of life. The majority of patients were satisfied with performed therapy, attending physicians highlight Ethoxidol safety. Serious adverse events weren't recorded. Ethoxidol was considered as efficient and safe medication for in-patient and out-patient treatment of patient with cerebrovascular diseases (chronic cerebral ischemia).

Analysis of the correlation between neuroimaging markers of the brain damage and the severity of postural instability in patients with chronic cerebrovascular insufficiency (NEMAN open observational study)

To analyze the relationship between the severity of postural instability in patients with CCI (chronic cerebral ischemia) and brain changes according to MRI, as well as to evaluate the efficacy and safety of vinpocetine. The study included 60 patients with CCI: 40 people with postural instability made up the main group and 20 people without balance disorders - the control group. The severity of manifestations of cerebrovascular pathology was assessed according to the protocol STRIVE. Severity of postural instability was assessed with the VAS, anxiety syndrome - Hamilton Anxiety Rating Scale, asthenia - Asthenic Condition Scale, daytime sleepiness - Epworth Sleepiness Scale, cognitive impairment - Montreal scale assessment of cognitive functions, the overall impression of treatment - Global Rating of Change Scale. The main group was associated with older age, more significant decrease in cognitive functions, urination disorders, anxiety syndrome and asthenia, changes according to MRI of the brain. CCI burden scale was significantly associated with VAS: β=0.479, P=0.035, 95% CI 0.023-0.928. The presence of lacunae was the most significant marker for the development of severe imbalance: β=0.482, p=0.041, 95% CI 0.022-0.925. A significant relationship was found between the total number of lacunae and VAS (r=0.509, p=0.021), as well as between the number of lacunae in the basal ganglia (r=0.793, p=0.019), especially the lenticular nuclei (r=0.498, p=0.036), and VAS. After 3 months of vinpocetine treatment, a significant improvement in statodynamic function was noted in the main group, moreover - absence of anxiety, normalization of daytime sleep, «weak» asthenia, increasement in the value of the MoCA scale. Most of the patients regarded the improvement from the therapy as «moderate» and «pronounced». The presence of lacunes in the basal ganglia is a most prominent neuroimaging marker of brain damage in patients with CCI and postural instability. The use of vinpocetine can significantly reduce the severity of imbalance, anxiety and asthenia, and normalize the circadian rhythm of sleep.

PRACTICAL ASPECTS AND RESULTS OF COGNITIVE THERAPY IN THE EARLY RECOVERY PERIOD OF ISCHEMIC STROKE.

The aim: To determine the impact of cognitive training on the degree of cognitive functions recovery and quality of life in the early recovery period of ischemic stroke. Materials and methods: 108 patients with cerebral infarction were examined outpatiently, follow-up from 1 to 3 months from the onset of the disease. Basic assessment methods: screening index of cognitive disorders according to the Montreal Cognitive Assessment Scale (MoCA), SF-36 questionnaire. Results and Conclusions: Comprehensive rehabilitation measures for the early recovery period of ischemic stroke achieve improvement of the cognitive sphere: a significant increase in the average score on the Montreal scale of cognitive functions assessment (MoCA scale) in both observation groups.