22.03.2017 Английские резюме Неврология Психиатрия № 1 (130), 2017 г.
Английские резюме Неврология Психиатрия № 1 (130), 2017 г.
Chronic Cerebrovascular Diseas
R. Kamchatnov, A. V. Chugunov
Objective of the Review: To summarize information about the clinical manifestations of cognitive impairment and approaches to treating it.
Key Points: Cognitive impairment caused by cerebrovascular disease is characterized by reduced speed of cognitive performance and information processing, with relatively milder disturbances of some higher mental functions (aphasia, agnosia, and apraxia). Diagnosis is based on confirmation of the vascular origin of the abnormalities, the identification of cognitive impairment syndrome and the assessment of its severity. Treatment of patients with chronic cerebrovascular disease accompanied by cognitive impairment includes management of cardiovascular risk factors and therapy with drugs that improve cerebral metabolism. One such medication is cytoflavin, which is a potent neuroprotective agent.
Conclusion: This paper provides information about the effectiveness of cytoflavin in treating patients with various forms of chronic cerebrovascular disease. It also focuses on the beneficial effects of this medication on cognitive function in this patient population.
Keywords: chronic cerebrovascular encephalopathy, chronic cerebral ischemia, asymptomatic cerebral infarction, cognitive impairment, cytoflavin.
Guillain-Barre Syndrome: Review of Clinical Cases
A. Berns, K. V. Zverev, P. A. Talyzin, M. F. Talyzina, A. S. Tektova, R. R. Kurganov
Purpose of the Paper: To describe clinical cases of Guillain-Barre syndrome (GBS) treated at the Neuroresuscitation Department, M. E. Zhadkevich City Clinical Hospital, Moscow City Department of Health.
Key Points: Between February and October 2015, five patients with GBS were treated and observed at the Neuroresuscitation and Neurology Departments, M. E. Zhadkevich City Clinical Hospital, Moscow Department of Healthcare. At the time of hospitalization, these patients had different admission diagnoses, including stroke (2 cases), vertebrobasilar insufficiency, lumbar dorsopathy with associated sensory disturbances, and Quincke's edema. Four out of these five patients had a prior infection. Four of the patients were discharged in moderately severe condition with persistent signs of quadriparesis. One patient died due to complications of the disease. During treatment, four patients required mechanical ventilation; four out of the five patients received intravenous immunoglobulin G.
Conclusion: Despite the relatively low prevalence of GBS, it is important to emphasize that specialists should remain alert to this condition. Special attention should be paid to young patients who are brought to the hospital with clinical signs of ascending paresis.
Keywords: Guillain-Barre syndrome, ascending paresis, peripheral nerves, quadriparesis, immunoglobulin G.
Motor and Nonmotor Fluctuations in Men and Women with Parkinson’s Disease
A. Bykanova, N. V. Zarubina, N. V. Pizova
Study Objective: To determine the frequency of motor and nonmotor fluctuations in men and women with Parkinson’s disease (PD), describe their specific features, and establish their effects on patients' quality of life.
Study Design: This was an open-label, prospective, cohort clinical study.
Materials and Methods: Forty-three men and 57 women with PD (stages 2.5–4.0) were examined in this study. The severity of clinical manifestations was assessed using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. Fluctuations were assessed using the nine-symptom questionnaire (Wearing-off Questionnaire [WOQ-9]), a patient self-assessment diary. Quality of life was assessed using the 39-item Parkinson's Disease Quality of Life Questionnaire and the second part of the European Quality of Life Questionnaire.
Study Results: The most commonly reported motor fluctuation was the “on-off” phenomenon, which was seen in 69.8% of the men and 73.7% of the women. Autonomic fluctuations were observed in 86.0% of the men and 93.0% of the women. There was a statistically significant greater frequency of certain autonomic disorders observed in women, than in men. Mental fluctuations were observed in 79.1% of the men and 75.4% of the women. There was a statistically significant greater frequency of apathy in men, than in women. Sensory fluctuations were reported in 55.8% of the men and 50.9% of the women, with pain being observed in women with statistically significant greater frequency.
Conclusion: In patients with PD, gender influences the predominance of certain nonmotor fluctuations.
Keywords: Parkinson’s disease, motor fluctuations, nonmotor fluctuations, quality of life, men, women.
Monitoring of Clinical and Neurophysiological Parameters in Diabetic Polyneuropathy Patients Receiving Metabolic Therapy
Yu. V. Karakulova, T. A. Filimonova
Study Objective: To study the effects of cocarnit on the electroneurophysiology of peripheral nerves in patients with diabetic polyneuropathy (DPN).
Materials and Methods: Twenty patients with DPN (mean age 58.2 ± 5.1) were examined. Clinical examination included review of patients' complaints and medical history, neurological examination using the Total Symptom Score, the Neurological Symptom Score, and the Neuropathy Disability Score, and lower-extremity electroneuromyography. Quality of life was assessed using the Medical Outcomes Study 36-Item Short Form Survey. All participants were given cocarnit 2 mL once a day as an intramuscular injection for nine days. Patients were examined on four visits: before treatment, and at one week, one month, and three months after it.
Study Results: In patients with DPN, treatment with cocarnit rapidly reduces intensity of neuropathic pain and degree of neurological deficits, and improves quality of life. A longer-term outcome is a statistically significant improvement in axonal electrophysiology.
Conclusion: Сocarnit administered as a course of treatments can be considered pathogenetically justified for patients with DPN. For best effect it should be started at an early stage, and several courses administered per year.
Keywords: diabetic polyneuropathy, neuropathic pain, electroneuromyographic examination, cocarnit.
Carpal Tunnel Syndrome in the Elderly
S. Gilveg, V. A. Parfenov
Objective of the Review: To describe the etiology, pathogenesis, risk factors, diagnosis and treatment of median-nerve neuropathy manifested as carpal tunnel syndrome (CTS) in the elderly.
Key Points: The pathogenesis of CTS is a combination of mechanical trauma, increased intra-tunnel pressure and ischemic injury to the median nerve inside the carpal tunnel. Because the median nerve is a mixed nerve, this syndrome manifests clinically as a combination of sensory, motor, and autonomic dysfunction in the area where it innervates the hand. CTS can be treated conservatively or surgically. Conservative treatment includes splinting, using orthoses, and injections of glucocorticoids into the carpal tunnel. Surgical treatment involves decompression and reduction of pressure on the median nerve by cutting the transverse carpal ligament. In addition, this paper describes a clinical case of CTS.
Conclusion: Carpal tunnel syndrome, the most common form of tunnel compression neuropathy, is seen primarily in the elderly. Despite having typical clinical manifestations and clear diagnostic criteria, CTS often goes undiagnosed because of low awareness among health professionals about this disorder. When diagnosed in a timely manner, CTS responds well to treatment (usually surgery).
Keywords: carpal tunnel syndrome, compression neuropathies, median-nerve neuropathy.
Autonomic Mechanisms Underlying Goal-Directed Activity in Healthy People and Epileptic Patients
A. Zorin, V. A. Zhdanov, M. M. Lapkin, N. A. Kulikova
Study Objective: To carry out a comparative analysis of autonomic mechanisms underlying goal-directed activity and changes in indirect measures of gas homeostasis in apparently healthy people and epileptic patients, in order to assess the effectiveness of the goal-directed activity being modelled and the adaptive potential of these groups of subjects.
Study Design: This was an experimental, comparative, randomized study.
Materials and Methods: Fifty-four apparently healthy people and 134 epileptic patients were examined. The study methods included analysis of heart rate variability, spirometry combined with basal metabolic measurements, capnography, statistical methods, and artificial neural network modelling.
Study Results: The Schulte-Gorbov tables scores showed that the groups of apparently healthy people and epileptic patients were heterogeneous; each group had subgroups of good and poor performers. The study showed that in epileptic patients poor performance was associated with a higher mean total number of seizures and a higher mean number of complex partial-onset seizures per month. In the epilepsy group, poor performers showed higher activity of stress-mediating systems and stronger relationships between cardiorespiratory mechanisms and the indirect measures of gas homeostasis. It was also shown that in this subgroup, these mechanisms and parameters had more influence on performance than in other subgroups.
Conclusion: In epileptic patients, reduced effectiveness is explained not only by inadequate performance but also by its increased physiological cost.
Keywords: epilepsy, autonomic mechanisms underlying activity, gas homeostasis, physiological cost of activity.
Comparing Anxiety Coping Strategies in the Elderly and Very Elderly
P. Kalinichenko, Yu. I. Polishchuk
Study Objective: To determine the role of age in the choice of coping strategies by elderly and very elderly patients with anxiety disorders and mixed anxiety and depressive disorders.
Study Design: This was a comparative study.
Materials and Methods: Non-selective examination was done of 214 elderly and very elderly people (158 patients with anxiety disorders or mixed anxiety and depressive disorders and 56 people without these problems). The study tools included the Taylor Manifest Anxiety Scale, which was used to assess anxiety levels, the Geriatric Depression Scale, the Mini-Mental State Examination, and a coping strategy questionnaire developed by E. Heim.
Study Results: The very elderly, to a statistically significant degree in comparison with the elderly, more frequently employ acceptance, a maladaptive cognition-related coping strategy, to control high levels of anxiety, and diversion, a relatively adaptive action-related coping strategy, for moderate levels of anxiety. Active avoidance, an action-related maladaptive coping response to high levels of anxiety, and seeking for attention and care, an action-related adaptive coping mode for low levels of anxiety, are significantly more frequently observed in the elderly than in the very elderly.
Conclusion: The choice of coping strategies for anxiety disorders and mixed anxiety and depressive disorders differs for the elderly in comparison with the very elderly. It is influenced by the type of coping strategy itself, its category and the severity of the disorders. The lack of cognition-related coping strategies in the elderly and very elderly is compensated by intact action-related patterns of coping with anxiety.
Keywords: advanced age, anxiety disorders, coping behavior.
An Assessment Scale for Anxiety Disorders in Dementia Patients
Study Objective: To develop and test an anxiety disorder scale (ADS) for use with elderly dementia patients.
Study Design: This was a sampling, observational, comparative, longitudinal study.
Materials and Methods: The study included 236 patients with Alzheimer-type, vascular or mixed dementia and accompanying anxiety disorders. Eighty-two men and 154 women, aged 53 to 100 (mean age 79.26 ± 7.49), took part in this experiment. Cognitive status was assessed with the Mini-Mental State Examination. Screening for non-cognitive impairment was done using the Neuropsychiatric Inventory. Screening for anxiety disorders used a panel of parameters based on the Hamilton Anxiety Scale (HAM-A), Rating Anxiety in Dementia scale and the Diagnostic and Statistical Manual of Mental Disorders IV diagnostic criteria for generalized anxiety disorder.
Study Results: The data obtained helped us to develop a psychometric tool for quantitative and qualitative assessment of complex anxiety disorders, which are commonly seen in elderly subacute dementia patients.
Conclusion: Our anxiety disorder scale assesses the severity of an anxiety disorder and the intensity of physical and mental symptoms of anxiety. It also helps in identifying the type of major anxiety syndrome, which, in turn, depends on the underlying condition and the form of any prior psychosis.
Keywords: dementia, anxiety, anxiety disorder scale.
Elderly Mentally Impaired Patients: Clinical and Social Preconditions for Living Alone
F. Druz, I. N. Oleinikova, R. I. Palayeva, Ye. Yu. Antokhin, V. G. Budza
Study Objective: To determine the role of age, household conditions, clinical, and psychosocial factors as prerequisites for mentally impaired elderly patients to live alone.
Study Design: This was a snapshot, cross-sectional study.Materials and Methods: Two hundred thirty-five psychoneurological clinic patients aged 60 or older underwent clinical and psychosocial examinations.
Study Results: Patients were divided into two groups, based on whether or not they had had their own family in the past. Group 1 included patients who had been married; Group 2 was made up of patients who had never been married. Group 1 was larger and included younger patients; it was also more heterogeneous in terms of disease entities and syndromes. The study identified the following factors, predisposing a person to living alone: clinical factors, the combination of psychosocial factors with subclinical disease, specific age-related features, and poor household conditions.
Conclusion: Among the factors mentioned above, clinical entities were the most important (104 cases, 44.3%). Other significant factors included the combination of psychosocial factors and subclinical preconditions (70 cases, 29.7%), and specific age-related features (58 patients, 24.7%). Poor household conditions did not play a significant role (3 patients, 1.3%).
Keywords: clinical and social predispositions, living alone, mentally impaired patients, elderly.
Kh. S. Sayadyan, V. M. Shklovsky
Objective of the Review: To describe the unusually wide range of effects of adamantane and its derivatives, which have a high potential for the development of new drugs, including medications for patients with neurological, psychiatric, and immunological disorders.
Key Points: Adamantane is a natural compound with the chemical formula C10H16, with the spatial arrangement of the carbon atoms similar to that of a diamond crystalline lattice. Its tertiary carbon atoms at the lattice points are capable of bonding various moieties. Adamantane derivatives have been used for developing unique medications that regulate cascading reactions involving calcium ions. This review describes the effects of memantine, an adamantane derivative, which is the most commonly used drug for cognitive impairments accompanying various disorders. It also discusses different aspects of developing an array of therapeutic compounds for use in psychoneurological practice.
Conclusion: Polymeric adamantane analogues have been patented as antiviral agents. Substituted amides of adamantane-carboxylic acid can be used as sleep aids. Antimalarial drugs are produced by introducing an adamantane moiety into 2-naphthoquinone. In addition, using memantine in combination with drugs targeting other neurotransmitter pathways may be a promising option. Adamantane remains one of the most valuable basic molecules for developing new medicines.
Keywords: adamantane, rimantadine, memantine, N-methyl-D-aspartate receptors.