Neurology, Neuropsychiatry, Psychosomatics

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Vol 4, No 2 (2012)


16-21 697
Both mild and moderate cognitive impairments (CIs) that cause no professional and social disadaptation have recently been of interest to physicians and investigators. Epidemiological surveys suggest that CIs not progressing to the manifestations of dementia are noted in the majority of elderly neurological outpatients. Both dementia and non-dementia CIs is a multietiological syndrome; the clinical features of these impairments are therewith determined by their cause. The most sensitive neuropsychological tests, such as the Montreal Cognitive Assessment (MoCA) test should be used to diagnose non-dementia CIs. Moderate CIs are associated with the high risk of dementia (10—15% yearly). As of now, the generally accepted management protocol for patients with mild and moderate CIs has not worked out. However, drugs with neuroprotective properties are of first-priority in treating CIs, by taking into account the high risk of their progression.
21-30 628
The paper considers the current foreign ideas on the structure of written speech in terms of the principle of the system structure of mental functions. It is shown that written speech is considered as a multicomponent structure within the framework of the presently dominating foreign concept Р a double route model. This structure includes both elements common to other functions and those specific only for writing. The performed analysis allows determination of the theoretical standpoint common to the Russian and foreign neuropsychological concepts of the structure of speech processes.
30-35 528
The paper gives the data obtained from the preliminary analysis of the activities of RussiaХs first Memory Impairment Laboratory. The findings allowed the authors to estimate the approximate prevalence of cognitive impairments (CIs) in patients with various pathological processes. The authors made a differential analysis of the causes of the varying severity of CIs. The causes of the latter in patients of varying age were shown to be different. There were preliminary data on the association of cognitive with other neuropsychological impairments. The ongoing studies make it possible to make a more in-depth analysis of the mechanisms of the development of these or those CIs in a Russian population, to define diagnostic approaches in detail, and to improve the quality and timeliness of medical care given to these patients.
35-41 566
Objective: to estimate the quality of basic drug therapy in patients with prior ischemic stroke and to analyze the rate and pattern of cardiovascular events according to the data of a prospective follow-up. Patients and methods. The study included 164 patients with acute ischemic stroke and sinus rhythm. After hospital discharge, the patients were surveyed by telephone survey to assess their compliance and to record cases of cardiovascular events. Results. The duration of the prospective follow-up was 21 (15; 44) months. Thirty-five (21%) patients were found to have cardiovascular events, including fatal ones in 13 (8%) patients. The latter as compared with the others, were older; they were frequently recorded to have recurrent ischemic strokes, stable forms of coronary heart disease (postinfarct cardiosclerosis, angina on exertion), a higher cardiovascular risk by the ESRS scale, they were less frequently treated with antithrombotic agents, indirect anticoagulants in particular (p < 0.05).
41-45 663
Patients and methods. Craniocerebral hypothermia (CCH) was carried out in 25 patients (18 men and 7 women aged 53—82 years) in the acute period (first 72 hours) of ischemic stroke verified by brain computed tomography or magnetic resonance imaging. An ATG-01 Russian apparatus was used for CCH, which can long maintain scalp temperature at +3±2 °С. Results. There was regression of neurological deficit apparently due to reduced brain edema, lowered intracranial pressure, as well as blood flow improvement in the great vessels of the affected hemisphere, which was indirectly suggestive of better blood supply to the penumbral area and decreased lesion volume. By and large, lower brain temperature is able to restrict the development of all basic pathogenetic mechanisms of neuronal damage in cerebral ischemia. It is stated that further investigations are required to prove the efficiency of CCH.
45-50 446
The impact of antiepileptic drugs (AEDs) on affective disorders was analyzed in women with epilepsy. One hundred and one reproductive-aged epileptic patients with depressive and emotionally labile disorders were examined. Thirty-two (31.7%) and 64 (63.4%) took one and two AEDs, respectively; 5 (4.9%) patients did not take. New-generation AEDs were shown to have a more favorable profile of psychotropic effects than traditional ones. The positive psychotropic effects of lamotrigine in treating epilepsy in women with affective disorders are described.
50-51 499
Two hundred and eighty patients (102 men and 178 women; mean age 38.8ё0.7 years) with multiple sclerosis (MS) were examined to study its clinical picture in the Tomsk Region. There was a preponderance of patients have with remitting MS whereas primarily progressive MS was rarest. The bulk of the patients had moderate neurologic deficit and moderate disease progression. The women were observed to exhibit a more favorable course of MS, which manifested itself as less severe neurological deficit and slower disease progression.
52-55 433
In chronic pain, the state of suprasegmental brain structures (the cortex, limbic system, truncodiencephalic structures, which form the motivational-affective and cognitive components of pain behavior), actively affects pain afferentation as well. The purpose of the study was to comparatively analyze the parameters and topographic distribution of P300 cognitive evoked potential in patients with lower back pain. Sixty patients aged 22 to 60 years were examined. The authors made their clinical and neurological examinations, collected medical history data, and assessed back pain intensity by a visual analog scale. The findings were compared with the parameters of cognitive evoked potentials (the separating of P300 to count; keystroke in the recognition of significant stimuli; elaboration of a verbal and nonverbal visual stimulation protocol, by using emotionally significant stimuli). The processes of recognition and differentiation, those of directed attention, and the rate of information processing slowed down in patients with different stages of pain syndrome. The P300 separating procedure using the emotionally significant stimuli allows one to assess the specific features of chronization of pain syndromes and the presence of pain memory in the central nervous system of such patients. The estimation of P300 parameters over time or during treatment are of particular value for the optimization and evaluation of its efficiency.
56-60 668
The objective of the investigation was to study the clinical efficacy, tolerability, and side effects of adepress in patients with mild and moderate anxiety-depressive disorders and psychoautonomic syndrome. The investigation included 30 outpatients, of whom 29 completed it. Monotherapy with adepress (paroxetine) was used in a dose of 10—20 mg/day for 8 weeks. Adverse reactions were observed in one-third of the patients within the first 2 weeks of therapy. Their intensity was not more than 3 visual analog scale scores. They required neither dose adjustment nor drug discontinuation and ceased spontaneously. After 8 weeks, the positive effect of the therapy was noted in all the patients. Adepress was found to show a high clinical efficacy and antidepressant, anxiolytic, and autonomic stabilizing activities. Adepress also normalized the sleep-wake cycle and diminished tension headache.
60-62 460
Objective: to elaborate and substantiate an algorithm of a complex of muscle-strengthening exercises for patients with lumbago. Patients and methods. Seventy-nine patients aged 20—45 years were examined and divided into 2 groups: 1) those who received rehabilitation treatment (an individual complex of muscle-strengthening exercises) and 2) those who had standard treatment (exercise therapy, physiotherapy, and pharmacotherapy). Results and discussion. A significant reduction in pain syndrome was demonstrated in Group 1 just after their first therapy session whereas in Group 2, it regressed after session 5. After 12 sessions of the individual complex of muscle-strengthening exercises, the pain syndrome was also ascertained to be diminished statistically significantly (p <0.05). Conclusion. The developed procedure of rehabilitation treatment using the individual complex of muscle-strengthening exercises in patients with pain in the lumbar spine could enhance therapeutic efficiency and considerably improve the quality of life.
63-68 515
Objective: to study the efficacy of paxil in the treatment of depression of varying severity in elderly male. Patients and methods. Thirty-five males aged 50—78 years with depressive symptoms of varying severity in the framework of a depressive episode [n = 14 (40%)], recurrent depressive disorder [n = 12 (34.3%)], and bipolar affective disorder [n = 9 (25.7%)] were examined. The efficacy of paxil 20—40 mg/day was clinically evaluated using psychometric scales (CGI, HDRS, and UKU) on days 7, 14, 28, and 42. Results. Paxil was found to be highly effective in treating depressions in elderly males. The mean HDRS scores decreased from 24.7±0.3 to 4.9±1.1. By day 42, the reduction in depressive symptoms was 80.2%. 74.3% of the patients achieved recovery and a borderline state according to the CGI-S scale. There was cessation of asthenic symptoms and adynamia at week 1 of therapy, hypothymia at week 2, and anxiety caused by the consecutive manifestations of stimulating, antidepressant, and anxiolytic effects.
68-73 979
The authors present their experience in treating 280 patients (115 man and 165 women; mean age 47.1±13.3 years) with acute or chronic nonspecific back pain or radiculopathy. All the patients were given movalis (as intramuscular injections and/or orally in a dose of 15 mg). The majority of patients received myorelaxants; lyrica, milgamma, or other vitamin B preparations were used in radiculopathy. The duration of the treatment in patients with acute, subacute, or chronic pain was 12.1±5.2, 17.1±5.7, and 18.0±7.9 days, respectively. Most (96.4%) patients were observed to have complete regression of pain or its substantial reduction (to 1—2 visual analog scale scores). Movalis therapy showed good tolerability and a low rate (1.8%) of side effects that were transient and required no additional treatment. The positive effect of management in patients with back pain (particular subacute and chronic pain) was largely associated with the use of the elements of rational psychotherapy and therapeutic exercises.
73-78 683
It is suggested that mitochondrial diseases might be identified in 22—33% of cryptogenic stroke cases in young subjects. The incidence of mitochondrial disorders in patients with stroke is unknown; it is 0.8 to 7.2% according to the data of some authors. The paper gives data on the prevalence, pathogenesis, and clinical manifestations of mitochondrial diseases, such as mitochondrial encephalopathy, lactic acidosis, and stroke-like syndrome (MELAS) and insulin-like episodes; myoclonic epilepsy and ragged-red fibers (MERRF) syndrome, and Kearns-Sayre syndrome (sporadic multisystem mitochondrial pathology).
78-83 587
Dopaminergic stimulation with levodopa, a biological precursor of dopamine precursor, and dopamine receptor agonists (DRA) remains the leading pharmacotherapeutic strategy for Parkinson’s disease (PD). The long-term use of levodopa is associated with the development of characteristic fluctuations in its symptoms and drug-induced dyskinesias so DRA are the drugs of choice and may be used alone and as part of combination therapy in a number of cases of parkinsonism in young patients in particular. Pramipexole (mirapex) is one of the most effective representatives of non-ergoline DRA, which has an extensive evidence base. The paper analyzes the heterodirectional properties of pramipexole in detail and its effect on motor (including tremor) and nonmotor (depression) manifestations of PD and discusses the possible neuroprotective action of the drug. It also separately considers the potential of the new unique 24-hour controlled release formulation: the administration of the drug considerably reduces the dose titration period and enhances patient compliance.
88-91 904
To thoroughly collect medical history data and to elucidate the causes, degree, specific features, and trend of pain syndrome are of great importance in the diagnosis of acute back pain. When back pain is treated, it is necessary to keep in mind not only the intensity and onset of the pain and its other characteristics, but also a propensity to the chronicity of the process, individual patient characteristics, age, and comorbidity. Analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and myorelaxants are effective in treating acute back pain. Data on the use of NSAIDs (nayz and ketorol) to relieve back pain are presented. The issues of chronic back pain and the administration of antidepressants, psychotherapy, and therapeutic exercises are discussed.
91-96 529
The paper gives an update on therapy for osteoarthrosis (OA). Symptomatic sustained-release drugs, particularly structural analogues of the cartilage (glucosamine and chondroitin sulfate), that have the weightiest body of evidence is noted to occupy a special place in the treatment of OA. Therapy involving these agents contributes not only to the suppression of pain and the recovery of affected joint function, but also to the slow progression, normalization, or stabilization of structural changes in the hyaline cartilage, to the prevention of changes in the intact joint, and to improved quality of life in the patients.
96-100 580
There is evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) may be used in combination with B group vitamins. A number of independent trials demonstrates that B group vitamins potentiate the analgesic effect of NSAIDs and contribute to a rapider regression of pain syndrome than their monotherapy. To reduce the risk of adverse reactions of NSAID therapy, to enhance its adherence, and to reduce its cost, it is reasonable to administer combination drugs that contain these components and allow the dose of active substances to be decreased due to their synergism. The new combination drug neurodiclovit contains slow-release enteric-coated granules and individual immediate-release granules of vitamins B 1, B 6, and B 12. Incorporation of neurodiclovit into treatment regimens for back pain syndromes will promote optimization of their therapy.
100-105 795
The paper reviews the literature dedicated to an association between sleep and memory problems and acetylcholine (AC) levels. Moderate impairments of circadian rhythms can develop with aging; however, these changes become quite significant in dementia, which impairs the sleep-wake cycle. Low AC levels during slow-wave sleep are critical for declarative (verbal) memory consolidation. An abnormal nocturnal reduction in cholinergic activity can worsen memory problems and provoke sleep deterioration. The results of the studies suggest that the type of an AC esterase inhibitor and the time of its administration are important for the development of these problems. Galantamine ensures high daytime concentrations of AC and its low nighttime levels, which enables the tone of cholinergic system to be maximally approaches physiological circadian rhythms. This may be essential to the improvement of sleep and memory in patients with dementia.

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