Cognitive impairment (CI) is one of the most common disorders in elderly. The development of dementia is usually preceded by subjective (SCI) and mild cognitive impairment (MCI) over several years. Patients with SCI are at increased risk of developing MCI and dementia, but SCI may not progress for a long time and in many cases is functional in nature (functional CI – FCI). The article discusses the manifestations and diagnostic issues of SCI and FCI and the possibilities of diagnosing Alzheimer's disease (AD) at the SCI stage using biological markers for AD in cerebrospinal fluid (CSF). The article presents the results of a long-term follow-up (more than 4 years) of two patients with SCI who showed no significant disturbances in repeated neuropsychological examinations. In one patient with SCI, positive biological markers for AD were found in the CSF, indicating an early (second) stage of AD, while in the other patient the absence of these markers indicated a functional nature of the CI. The article discusses the treatment of patients with SCI and the possibilities of anti-amyloid therapy when the Alzheimer's nature of CI is detected.

Treatment of patients with aggressive multiple sclerosis (MS) characterized by severe progression of disability within a short period of time is a complex task as there are no uniform criteria for determining such disease progression type and, accordingly, no optimal strategies for prescribing medication. Standardised criteria are also needed to assess prevalence in the general patient population and to plan medical and social care.

Objective: to analyse clinical and demographic characteristics of patients with aggressive MS in the Republic of Bashkortostan (RB).

Material and methods. The study included 2670 patients registered in the Multiple Sclerosis Centre of the Republic of Bashkortostan. To determine the types of MS progression, criteria of the 2022 clinical guidelines for MS were used. When analysing the data on disability, the data from the control group, which consisted of MS patients without limitations in working capacity and disability, were also used.

Results. Rapidly progressive MS (RPMS) and highly active MS (HAMS) were diagnosed in 8.9% of the total number of patients. Women predominated in both groups. In the group of patients with aggressive MS, the progression rate was significantly higher than in the HAMS group. Six percent of patients included in the registry became disabled (group II or I) within 5 years of the disease, and 10% within 10 years. These groups are characterized by a high rate of disease progression.

Conclusion. In the RB, RPMS and HAMS were diagnosed in 8.9% of patients, with a predominance of women.

Characteristics of migraine in perimenopause have not been sufficiently analyzed.

Objective. To compare the course of migraine in patients of reproductive age (RA) and in perimenopause.

Material and methods. The observational cross-sectional study involved 120 women suffering from migraine: 60 in the RA group (mean age – 32.28 years), 60 in the perimenopause group (mean age – 48.13 years). Patients were interviewed and questionnaires were filled in, HIT-6, MIBS-4, HURT, Migraine ACT, MIDAS, SF-36, HADS and ISQ scales were used.

Results. The indicators of pain intensity, the duration of attacks and the number of days with headache per month are significantly higher in perimenopause than in RA (p<0.05). The risk of severe impact of headache on quality of life (HIT-6) and migraine burden outside of attacks (MIBS-4) are also significantly higher in perimenopause than in RA (OR=1.9 and OR=1.7, respectively; p><0.05), and most quality of life indicators (SF-36) are lower (p><0.05). The risk of arterial hypertension and musculoskeletal diseases is higher in perimenopause than in RA (OR=2.8 and OR=4.25, respectively; p><0.05). The risk of clinically pronounced anxiety and insomnia is higher in perimenopause than in RA (OR=2.4 and OR=5.15; p><0.05). Conclusion. The course of migraine in women in perimenopause is less favorable than in RA. Further studies are needed to determine the causes of the observed phenomena and to develop clinical guidelines for the treatment of perimenopausal migraine patients.><0.05) The risk of severe impact of headache on quality of life (HIT-6) and migraine burden outside of attacks (MIBS-4) are also significantly higher in perimenopause than in RA (OR=1.9 and OR=1.7, respectively; p<0.05), and most quality of life indicators (SF-36) are lower (p><0.05). The risk of arterial hypertension and musculoskeletal diseases is higher in perimenopause than in RA (OR=2.8 and OR=4.25, respectively; p><0.05). The risk of clinically pronounced anxiety and insomnia is higher in perimenopause than in RA (OR=2.4 and OR=5.15; p><0.05). Conclusion. The course of migraine in women in perimenopause is less favorable than in RA. Further studies are needed to determine the causes of the observed phenomena and to develop clinical guidelines for the treatment of perimenopausal migraine patients.><0.05) ), and most quality of life indicators (SF-36) are lower (p<0.05). The risk of arterial hypertension and musculoskeletal diseases is higher in perimenopause than in RA (OR=2.8 and OR=4.25, respectively; p><0.05). The risk of clinically pronounced anxiety and insomnia is higher in perimenopause than in RA (OR=2.4 and OR=5.15; p><0.05). Conclusion. The course of migraine in women in perimenopause is less favorable than in RA. Further studies are needed to determine the causes of the observed phenomena and to develop clinical guidelines for the treatment of perimenopausal migraine patients.><0.05). The risk of arterial hypertension and musculoskeletal diseases is higher in perimenopause than in RA (OR=2.8 and OR=4.25, respectively; p<0.05). The risk of clinically pronounced anxiety and insomnia is higher in perimenopause than in RA (OR=2.4 and OR=5.15; p<0.05)

Conclusion. The course of migraine in women in perimenopause is less favorable than in RA. Further studies are needed to determine the causes of the observed phenomena and to develop clinical guidelines for the treatment of perimenopausal migraine patients.

The optimization of antipsychotic therapy is an urgent issue not only in psychiatry, but in healthcare as a whole.

Objective: to analyze the results of the non-interventional EPIDEMICUS epidemiological study of the real-world practice of the use of quetiapine (Seroquel®) during combined treatment and therapy switching in patients with various mental disturbances.

Material and methods. Based on a special questionnaire, an analysis of the prescription of quetiapine and other antipsychotics by psychiatrists in 21 cities of Russia was carried out. The treatment data of 1264 patients aged 43.9±5.2 years were analyzed; the average duration of mental illness at the beginning of the study was 10.5 years.

Results. In most cases, physicians preferred to switch to the quetiapine monotherapy, but in 10% of cases an antipsychotic was also added. According to the doctors, patients with schizophrenia most frequently required a therapy switch (46.3%). In bipolar affective disorder (BAD), one in three patients (30.8%) required therapy switch. For other mental disorders, doctors more frequently added quetiapine to the therapy (23.2%; p<0.001) or switched the previous therapy (12.1%). The significantly more frequent reasons given by doctors for switching from oneneuroleptic to another were the need to intensify antipsychotic effect (p<0.001) , to increase sedation (p<0.001) and to improve tolerability (p<0.001) . There is no recommended "overlap period" when switching from one medication to another. Changes in the therapy with mood stabilizers and anxiolytics were performed to enhance antipsychotic and sedative effects (p<0.001) and, as a tendency to improve tolerability. The concomitant administration of two or more antipsychotics could be due to both medical error and an attempt to overcome drug resistance.

Conclusion. In the real-world clinical practice of domestic psychiatrists, at least one third of patients taking antipsychotics for various conditions (schizophrenia, bipolar disorder, etc.) require a switch or additional therapy. The reasons for therapy switching can be diagnostic errors, the choice of medication as well as insufficient efficacy or poor tolerability of the antipsychotics. Quetiapine (Seroquel®) is recognized in real-world clinical practice by psychiatrists as a highly effective and well-tolerated antipsychotic with a broad spectrum of activity that goes beyond the official indications.

Aneurysmal subarachnoid haemorrhage is one of the most severe forms of cerebral stroke, associated with a high mortality and disability rate. Development of emotional disorders (anxiety and depression), as well as functional and cognitive deficits, interfere with resocialisation of patients who have undergone surgery for a cerebral aneurysm, and impair quality of life and exacerbate cognitive impairment.

Objective: to investigate the prevalence of emotional disturbances in the remote postoperative period after surgical treatment of cerebral aneurysms (CA).

Material and methods. The prevalence and severity of emotional disturbances in the remote postoperative period after surgical treatment of CA was analysed, mean time after surgery was 3.5 years. Two hundred and one patients underwent surgery for a CA rupture, 110 for a non-ruptured aneurysm. On admission to hospital for surgical treatment, patients underwent a clinical and diagnostic examination to confirm the diagnosis and determine the extent, timing and type of intervention. In the remote postoperative period, the degree of limitation of self-care and functional capacity (using the Barthel Index and the modified Rankin Scale), cognitive functioning (using the MoCA test) and emotional domain (using the HADS scale) were assessed.

Results. In the remote postoperative period following surgical treatment of CA, subclinical and clinically significant anxiety was found in 110 (36.3%) patients and depression – in 117 (38.6%). The severity of anxiety and depressive disorders did not decrease over time. The mean score on the HADS anxiety scale during the first year after surgery was 5.9±2.8; after 5 years and more – 6.1±3.4. The mean score on the depression scale in patients tested within 1 year after surgery was 7.3±3.3; after 5 years and more – 6.7±3.5. A correlation was found between the severity of vasospasm and anxiety disorders in the remote postoperative period: anxiety symptoms predominated in patients with normal linear blood flow velocity compared to patients diagnosed with vasospasm (p=0.03). The condition of patients at hospital discharge was also associated with the severity of anxiety symptoms in the remote postoperative period: as the Glasgow Outcome Scale (GOS) score increased, so did the severity of anxiety disorders. A statistically significant correlation was found between the groups of patients with a GOS score of 3 and 5 points (p=0.016). A significant predominance of anxiety and depressive disturbances was found in female patients in the remote postoperative phase of surgical treatment (p<0.001 and p=0.002, respectively). Conclusion. Emotional disturbances in patients who underwent surgery for CA persist for a long time, with anxiety disorders predominating in patients without overt neurological disorders during hospitalization. Both anxiety disorders and depressive disorders occur most frequently in female patients. The persistence of emotional disturbances over a long period of time after the exclusion of the aneurysm from the circulation shows the need for their correction in terms of 0.001 and p=0.002, respectively).

Conclusion. Emotional disturbances in patients who underwent surgery for CA persist for a long time, with anxiety disorders predominating in patients without overt neurological disorders during hospitalization. Both anxiety disorders and depressive disorders occur most frequently in female patients. The persistence of emotional disturbances over a long period of time after the exclusion of the aneurysm from the circulation shows the need for their correction in terms of patient's social adaptation.

Objective: quantitative assessment of the activation areas of the cerebral cortex in women and men in response to olfactory stimuli using functional magnetic resonance imaging (fMRI).

Material and methods. The study included 14 non-smoking volunteers who were right-handed from birth (8 women and 6 men; mean age – 32.7±6.4 years), without anamnestic and clinical signs of diseases of the nervous system, nasopharynx and oropharynx, and without anosmia during the COVID-19 period. fMRI was performed on a Signa PET/MR 3.0 T scanner (GE Healthcare) with a 32-channel coil. Each olfactory stimulus (lavender and pine needles) was delivered alternately from a 200 ml syringe containing cotton wool soaked in essential oil through a PERFOMA-Judkins catheter. The syringe was opened for 4 seconds for delivery, after which delivery was stopped and the catheter was aspirated to remove the residual odour. Odours were presented at 40 seconds intervals and each odour was presented 4 times. Data analysis focused on the primary olfactory cortex (POC), orbitofrontal olfactory cortex (OOC), insular cortex (IC), and motor cortex (Brodmann’s areas 4 and 6).

Results. All subjects showed activation of the POC, OOC, IC and areas 4 and 6 for both odour stimuli, with a slight dominance of the right hemisphere. Lavender odour often led to a stronger activation of the olfactory and motor cortex than pine needle odour. The individual activation map of areas 4 and 6 elicited by lavender odour was characterized by greater variability than the map for pine needle odour. The intensity of activation in response to both odours was higher in women than in men.

Conclusion. The odours of lavender and pine needles activate not only the olfactory areas of the cortex but also areas 4 and 6 and are characterized by certain interhemispheric and gender differences.

Neuralgic amyotrophy (NA, Parsonage-Turner syndrome) is an autoimmune multifocal painful neuropathy that has a classic pattern of brachial plexus involvement in most patients. Cases in which motor and sensory deficits occur below the elbow joint are classified as a separate form – distal NA. In contrast to the classic pattern of NA, patients with distal NA recover less well and require surgical treatment.

Objective: to describe the clinical and instrumental characteristics of patients with focal hourglass-like nerve constriction (FHNC) of the radial nerve.

Material and methods. The clinical, electrophysiological and neuroimaging data of 24 patients with painful radial nerve neuropathy (5 women and 19 men, mean age 41.9±15.5 years) were analyzed. The average time from onset of pain to diagnosis was 10.8 months (median 5 months; minimum 4 days, maximum 5 years and 8 months). Glucocorticoids (GC) were taken by 8 patients (33%). Nine patients underwent surgery. The control group consisted of 60 individuals matched for age and gender.

Results. All patients complained of neuropathic pain in the affected upper extremity with an average intensity of 9.4 (median 9.5) on the visual analogue scale (VAS). The duration of the pain syndrome was on average 13.4 days (median 12.5 days). According to electromyographic data, all patients showed changes in the muscles of the affected side in the form of chronic denervation. MRI of the nerve trunks in 12 patients, revealed no changes on the affected side in 5 patients (41.6 %). Edema of the nerve trunks was found in 5 patients (41.6%). Muscle atrophy was found in one patient (8.3%) and one patient (8.3%) had FHNC. Comparison of the ultrasound data of the cross-sectional area (CSA) of the affected and unaffected sides showed a significant enlargement of the radial nerve on the affected side (p=0.027); no statistically significant differences were found when comparing the affected and unaffected sides with the control group. FHNC in the radial nerve was found in 19 patients, with both sides affected in two cases. Four patients recovered completely, 3 of them (75 %) received GC and 2 (50 %) underwent surgery. Incomplete recovery was observed in 12 patients (50%). Eight patients (33%) did not recover, of whom only one received GC, while 4 (50%) underwent surgery. Of the patients who underwent surgery, 5 patients (55.6%) recovered completely or partially, 44% did not recover. The mean follow-up time was 10.2±2.9 months.

Conclusions. Radial nerve painful neuropathy is a variant of NA whose morphological manifestation is the phenomenon of FHNC detected by ultrasound in the peripheral nerves. The use of ultrasound facilitates the diagnosis of the disease, leading to an earlier diagnosis and consequently to a more favorable prognosis. Surgical treatment should be favored in cases of FHNC.

Thrombolytic therapy (TLT) of ischemic stroke (IS) with alteplase within the first 4.5 hours from the onset of symptoms is the most effective and proven method of treatment.

Objective: to evaluate the safety and efficacy of TLT with Revelisa (alteplase) in IS in real-world clinical practice.

Material and methods. The results of TLT with Revelisa were analyzed in 1181 patients with IS: 616 (52.2%) women and 565 (47.8%) men (mean age 68.28±12.56 years), of which 140 (11.9%) with staged reperfusion. The mean time from disease onset to TLT was 2.58±0.83 hours. The Heidelberg classification was used to assess hemorrhages during neuroimaging. Symptomatic hemorrhagic transformation (HT) was defined according to ECASS III criteria. The study group was characterized by high comorbidity: arterial hypertension (96.9%), ischemic heart disease (56.7%), chronic heart failure (55.8%) and cardiac arrhythmias (33.3%) were most common; diabetes mellitus was present in 23% of patients. IS occurred repeatedly in 15.4% of cases.

Results. An improvement of 4 points or more on the NIHSS scale one day after TLT was observed in 41% of patients. The dynamics of the decrease in neurological symptoms one day later and at the time of discharge were statistically significant (p<0.001). The hospital mortality rate for the entire group was 8%, for the TLT group without endovascular intervention 5.6%. Twenty-nine patients (2.46%) had symptomatic HT, 14 of whom underwent endovascular intervention. The proportion of patients with a favorable clinical outcome (0–2 points on the modified Rankin scale) at discharge and at day 90 was 50.1% and 65.5%, respectively. Conclusion. The results of the PRIMA study confirm the high level of efficacy and safety of Revelisa in patients with IS, including during staged reperfusion. The data obtained are consistent with the published registry studies on alteplase in IS.><0.001). The hospital mortality rate for the entire group was 8%, for the TLT group without endovascular intervention 5.6%. Twenty-nine patients (2.46%) had symptomatic HT, 14 of whom underwent endovascular intervention. The proportion of patients with a favorable clinical outcome (0–2 points on the modified Rankin scale) at discharge and at day 90 was 50.1% and 65.5%, respectively.

Conclusion. The results of the PRIMA study confirm the high level of efficacy and safety of Revelisa in patients with IS, including during staged reperfusion. The data obtained are consistent with the published registry studies on alteplase in IS.

The article presents our own clinical observation of a rare combination of two neurological conditions – lower spastic paraplegia (Strumpell disease) and the formation of a cavity in the central canal of the spinal cord (hydromyelia). The development of slowly progressive muscle weakness and spasticity in the patient's legs was associated with the presence of a cavity in the spinal cord detected on neuroimaging, leading to a misdiagnosis of syringomyelia. Subsequent review of the MRI and clinical data allowed us to interpret the formation of a cavity in the spinal cord as hydromyelia – a "benign" dilation of the central canal of the spinal cord, in contrast to syringomyelia, with no signs of neurological manifestations and no progression according to the MRI data. The revision of the diagnosis and the clinical and genetic analysis enabled the diagnosis of hereditary lower spastic paraplegia (Strumpell disease). Possible common pathogenetic mechanisms of hydromyelia and spastic paraplegia as well as modern data on the course, clinical and MRI features of hydromyelia and its differential diagnosis from syringomyelia are discussed.

In recent years, the incidence of multiple sclerosis (MS) has increased in the pediatric population. As there are no separate clinical guidelines for the treatment of pediatric MS and therapeutic options have expanded, it is important to discuss and establish new protocols for the treatment of MS in children and adolescents. This article presents a series of clinical cases of the use of ofatumumab in patients under 18 years of age with a relapsing-remitting MS (RRMS).

In the first observation, a 16-year-old female patient with RRMS was switched to ofatumumab therapy due to persistent clinical and radiological activity of the disease during dimethyl fumarate therapy. After the first injection, hyperthermia of up to 38.6 °C and cephalgia were observed, which resolved on the background of symptomatic therapy. No adverse events occurred with subsequent injections, and the patient had clinical and radiological remission during the six-month use of the drug.

In the second observation, a 17-year-old female patient with a four-year history of the disease showed resistance to first-line therapy (interferon β1a and glatiramer acetate), so therapy was switched to ofatumumab. After the first injection, persistent hyperthermia of up to 39.3 °C was observed for two days, therefore, premedication with antipyretic and antihistamine medication was performed for the next two injections. No further adverse events were recorded, the therapy was well tolerated, and premedication was not required. The clinical remission of the disease lasted for six months and the results of the control MRI showed no signs of disease activity.

In the third observation, ofatumumab therapy was initiated in a 17-year-old patient with rapidly progressive MS. No adverse events were recorded during the 9-month treatment, no signs of the disease activity were detected on the control MRI, and a decrease in the size of some foci was observed. Thus, high short-term efficacy, good tolerability and safety of ofatumumab in the treatment of MS in patients under 18 years of age were demonstrated, which are consistent with the results of the use of the drug in the adult population; no unexpected adverse events were observed. The subcutaneous route of administration contributed to improved patients’ adherence to therapy.

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system of polygenic nature, characterized by focal inflammation, demyelination and neurodegeneration. The clinical course of MS is characterized by great heterogeneity. The consistency of the clinical forms of MS in families indicates the involvement of genomic variation in the development of the clinical phenotype. Identifying the genetic basis of MS progression may not only explain the nature of the observed clinical heterogeneity but also contribute to the development of new tools for appropriate prognosis and personalized treatment of the disease. To describe the clinical course of MS, disease severity scores are used; they characterize the degree (speed) of MS progression. The most important methods for assessing the severity of MS are based on the Multiple Sclerosis Severity Score (MSSS) and Age-Related Multiple Sclerosis Severity Score (ARMSS) scales. This review summarizes the data on the contribution of polymorphic genetic variants to MS severity as assessed by the MSSS and ARMSS scales. These data were obtained using the "candidate gene" method and genome-wide association studies.

The article examines the relationship between social fragility and cognitive impairment (CI) in elderly in the context of population ageing and the increasing proportion of age-related diseases. Social fragility is defined as a progressive loss of social resources, including support and social engagement, which is associated with an increased risk of depression, cognitive decline and dementia.

A comprehensive review of studies published between 2017, and November 2024 was conducted to examine social fragility and its association with CI. The paper provides an overview of current approaches to assessing social fragility, including the use of indices and scales. The main risk factors, including depression, physical activity and CI, and the mechanisms underlying this relationship are analyzed in detail.

Particular attention is paid to the consequences of social fragility for cognitive health and possible prevention strategies. The article discusses the role of social isolation, loneliness, reduced physical activity and diminished social interactions as key aspects that increase the risk of cognitive decline. It also points out that maintaining an active social network and participating in social life can slow the progression of CI and improve the quality of life of elderly.

Our work emphasizes the need for an interdisciplinary approach to the diagnosis and treatment of social fragility, which includes the development of social relationships, the promotion of physical activity and the participation in group activities. These measures can help to strengthen cognitive reserves, reduce the negative effects of social fragility and ensure an active, long life for the elderly population.

The review contains information on the pharmacodynamics, pharmacokinetics and clinical pharmacology of the non-steroidal anti-inflammatory drug (NSAID) tenoxicam (trade name – Texared®). Some features of the chemical structure of tenoxicam and the specificity of pharmacological action based on them are discussed, as well as clinical effects that distinguish tenoxicam from its homologues. The efficacy is compared with that of other NSAIDs. Issues of clinical pharmacokinetics (low dissociation constant – pK; exposure levels; long T0.5; Cmax, etc.) are discussed. The clinical part of the review presents comparative studies on tenoxicam and its homologues as well as on combinations of tenoxicam with drugs from other groups.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the main class of analgesics used in Russian medical practice to control acute and chronic pain in various conditions. NSAIDs have proven to be effective, easy to use and affordable. On the other hand, NSAIDs are potentially unsafe: the use of these drugs is clearly associated with an increased risk of class-specific complications in the gastrointestinal tract, cardiovascular system and kidneys.

None of the NSAIDs available on the modern pharmaceutical market can be considered ideal in terms of efficacy/safety ratio. This determines the feasibility of developing new drugs from this group.

A new NSAID has now found its way into the therapeutic arsenal of Russian doctors – a member of the 2-arylpropionic acid derivative family, pelubiprofen. This drug, which is structurally similar to ibuprofen, is a moderately selective inhibitor of cyclooxygenase 2 with a very favorable profile of pharmacological properties. Pelubiprofen has been extensively tested in a series of double-blind, randomized and controlled trials comparing it with aceclofenac and celecoxib. These studies have shown the efficacy and low incidence of adverse events in the treatment of non-specific back pain, osteoarthritis and rheumatoid arthritis with the new drug.