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Neurology, Neuropsychiatry, Psychosomatics

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Vol 9, No 4 (2017)
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https://doi.org/10.14412/2074-2711-2017-4

LECTURES

4-9 566
Abstract

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaces the term «dementia» with «major neurocognitive disorder» (MNCD), which can reduce the  stigmatization of patients and focus the attention of specialists on  the preserved abilities of patients rather than deficit symptoms. In  the next 35 years, the number of patients with MNCD in the world is  predicted to almost triple. The article considers the concept,  epidemiology, and etiological pattern of this syndrome. It  characterizes in detail Alzheimer's disease (AD) that is a cause of  MNCD in 50–70% of cases. The current diagnostic criteria and  clinical presentations of the disease are given. The presence of early and significant episodic memory disorders as both alone or  concurrent with other cognitive and behavioral changes reflects the  main clinical phenotype of AD. Magnetic resonance morphometry,  amyloid positron emission tomography, and estimation of  cerebrospinal fluid β-amyloid and tau protein levels find increasing  applications in research and routine practice. Drug and non-drug  treatments for MNCD are considered. The use of akatinol memantine to treat this disorder and the issues related to the comprehensive management of patients with severe cognitive impairment are analyzed.

ORIGINAL INVESTIGATIONS

10-16 216
Abstract

Objective: to study the clinical phenomenology of vascular cognitive impairment (VCI) in individuals with different rates of passive transmembrane ion transport.

Patients and methods. Cognitive functions were evaluated in 372 patients with different clinical variants of moderate VCI after 1, 5, and 10 years of follow-up. Quantile analysis was used to group  patients into quartiles according to the ranges in the rate of passive  transmembrane ion transport reflecting the genetically determined  properties of cell membranes and identified by the study of Na+–Li+ countertransport (NLC) in the erythrocyte membrane.

Results. There was initially a monofunctional non-amnestic type in 11.0% of the patients, a monofunctional amnestic type in 16.1%, a multifunctional non-amnestic type in 34.9%, and a multifunctional amnestic type in 37.9%. At the same type, in the patients with high-speed NLC, the number of amnestic VCI types statistically dominated: 77.1% of the patients belonging to IV quartile. After 1 year and 5 years of follow-up, there was an increase in the number of patients with severe cognitive impairment, reaching the degree of dementia (33.2% of all the examinees following 1 year). The patients with high-speed NLC showed a significant predominance of not only the total number of dementias (86.7% of the patients in IV quartile; p<0.001), but also a more unfavorable mixed (disregulatory + Alzheimer's disease) type of dementia (74.7% of the patients in IV quartile; p<0.001). The dysregulatory type of dementia was more common in patients with low- and moderate-speed NLC. 70% of all dementias formed from the multifunctional amnestic type of mild cognitive impairment (MCI). Different types of MCI were observed to be transformed to the prognostically unfavorable multifunctional amnestic type of MCI. The study conducted 10 years later noted the same trends.

Conclusion. The NLC speed has been shown to be associated with the VCI profile, which makes this indicator promising for predicting the course of VCI in the early stage of the disease and for choosing a treatment policy.

17-25 220
Abstract

Many mechanisms for the brain organization of speech processes remain poorly understood now.

Objective: to assess the structural and functional organization of speech prosody, by applying functional magnetic resonance imaging (fMRI). This technique allows non-invasive studies of the organization of the speech system.

Patients and methods. Using their proposed three paradigms, the authors evaluated speech prosody in healthy volunteers. The first paradigm was aimed to determine the intonation characteristics of a sentence; the second paradigm is to study the given accentuated and non-accentuated rhythms, and the third to recognize melodies.

Results and discussion. In the first paradigm, there was bilateral activation of Wernicke's speech area (Brodmann's Area 22) that significantly prevailed in volume and intensity in the right hemisphere of the brain. Also, the right hemisphere predominantly showed activation of the supplementary motor region included in cytoarchitectonical Brodmann's Area 6. There was a significant activation Brodmann's Area 9 when a rhythm was determined in the right hemisphere and in Brodmann's Area 46 when melodies were recognized. The cerebellum, limbic system, subcortical structures, etc. were noted to be activated, which permits speech function to be regarded as a whole brain process.

Conclusion. The investigation has confirmed that different regions of both hemispheres of the brain are involved in the systemic organization of speech, which enables the authors to speak about the codominance of the hemispheres in respect of this function. The presented paradigms fully meet the objectives of the study and can be used to map the prosodic characteristics of speech.

26-30 391
Abstract

Objective: to evaluate the efficacy and safety of botulinum toxin type A (BTA) injections into the neck muscles to reduce dystonic postures, head tremor, and pain syndrome in patients with cervical dystonia (CD) within the first 8 cycles of treatment.

Patients and methods. The investigation included 76 patients (26 (34%) men and 50 (66%) women) with CD and dystonic head tremor, who were given BTA injections into the neck muscles for the first time. All the 76 patients received at least one cycle of BTA therapy. At the same type, 18 of these patients received 4 cycles of injections and 36 patients had 8 cycles. Injections were given when the symptoms of CD recurred or increased and the patient needed to be retreated. The interval between the injection cycles was arbitrary, but not less than 12 weeks. The doses of BTA agents per treatment cycle were as follows: Dysport was 400 to 1000 U, xeomin was 50 to 300 U, and Botox 200 to 300 U. The symptoms of CD were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Tsui scale before the first injection of BTA and injection cycles 4 and 8; the presence or absence of head tremor was recorded.

Results. The TWSTRS severity of CD symptoms decreased from 38 [36; 41] to 30 [27; 33] scores by injection cycle 4 (p < 0.001) and to 26 [23; 27] scores by cycle 8 (p<0.01). The Tsui severity of CD reduced from 9.3 [9; 10] to 7.2 [7; 8] scores by injection cycle 4 (p<0.001) and to 6.7 [6; 7] scores by cycle 8. The Tsui tremor scores decreased from 1.9 [1.6; 2.1] to 1.4 [1.1; 1.6] scores by injection cycle 4 and to 1.1 [0.9;1.4] scores by cycle 8 (p<0.01). Tremor completely disappeared in 6 (11%) of patients by injection cycle 4 and in 6 (18%) patients by cycle 8. According to Section 3 of the TWSTRS, pain intensity was reduced from 9.9 [8.9; 11.0] to 5.0 [3.3; 6.6] scores by injection cycle 4 (p<0.001) and to 2.1 [0.7; 3.6] scores by cycle 8 (p < 0.01); pain regressed completely in 12 (41%) and 9 (64%) patients by cycles 4 and 8, respectively.

 

Conclusion. BTA injections into the neck muscles are an effective treatment for CD symptoms, such as dystonic tremor, posture, and pain. Successive injection cycles have a cumulative effect that is more marked by injection cycle 8. It is appropriate to prescribe longer treatment cycles to patients with CD and head tremor. Dystonic head tremor, unlike dystonic postures, may regress fully after BTA injections

31-37 307
Abstract

Objective: to study the prevalence of depression and anxiety and the pattern of sleep disorders in 45-69-year-old population with different levels of depression and anxiety in Russia (Siberia).

Patients and methods. A total of 4171 Novosibirsk dwellers were surveyed. Men and women were 42.4 and 57.6%, respectively. Depression and anxiety were assessed using the modified scales,  such as Welsh's Depression (WD) and Bending's Anxiety (BA) Scales, the Minnesota Multiphasic Personality Inventory, and the Jenkins Sleep Questionnaire (JSQ).

Results. Depression, anxiety, and sleep disorders are significantly common in the Russian/Siberian population aged 45–69 years. The frequency of high depression and anxiety levels were 20.4% (51.3% of the respondents had medium and high depression) and that of anxiety was 15.6% (61.8% of the respondents were found to have medium and high anxiety). The women were noted to have higher levels of depression (21.4%) and anxiety (17.8%) than the men (19 and 12.5%, respectively). No clear relationship was found between high depression levels and age. Apparently, the value of age after 45 years is reduced and the level of depression remains approximately the same in 45–69-year-olds. The study of the relationship between the level of anxiety and age established that it was absent in the older men aged 45–69 years and the women showed a U-distribution characterized by the maximum proportion of individuals with high and low anxiety levels in the 65–69-year age group. Impaired sleep quality and sleep duration were more common in women (24 and 62%) than in men (18 and 59%). There was a relationship between the high level of depression and the duration and quality of sleep: more than 40% of the respondents with high levels of depression had impaired sleep quality and 65% had impaired sleep duration.

 

Conclusion. The high incidence of cardiovascular diseases in Siberia (Russia) is associated with the widespread of psychosocial risk factors, such as high anxiety and depression levels and sleep disorders. The survey has demonstrated that the population shows a high demand for preventing these conditions.

38-45 271
Abstract

Most in-hospital strokes occur after cardiac or vascular surgeries, during invasive therapeutic and diagnostic procedures on the heart and blood vessels. The incidence of stroke after coronary artery bypass grafting is about 2%; that after valve surgery and percutaneous cardiac intervention is 1 to 10% and 0.03 to 0.4%, respectively.

Objective: to analyze the risk factors, pathogenetic, clinical, and laboratory characteristics of stroke after cardiac surgery and invasive interventions.

Patients and methods. The investigation enrolled in-hospital stroke patients who had undergone invasive cardiac or open-heart surgery in Sverdlovsk Regional Hospital One in 2011 to 2015. A comparison group consisted of 196 patients with community-acquired stroke.

Results. Stroke after cardiac surgical or endovascular interventions developed in 88 patients (44.9% of all the in-hospital stroke cases registered in the above period). The incidence of stroke after open-heart surgery was 0.97% (63 cases), depending on the type of surgery. Stroke following open-heart surgery was recorded after combined correction (1.4%), two-valve replacement surgery (1.98%), aortic and mammary coronary artery bypass grafting under extracorporeal circulation (1%), and beating heart bypass surgery (0.25%). The severity of stroke and the degree of disability did not differ in patients after invasive cardiac and open-heart surgeries.

Conclusion. Patients who have undergone cardiac surgery and are at high risk for in-hospital stroke should be followed up and should receive preventive treatment for stroke in the early postoperative period.

46-54 204
Abstract

Objective: by using the pharmacoinformation profiling, to comprehensively assess all possible effects of the molecules of mexidol, choline alfoscerate, piracetam, glycine, and semax in accordance with the anatomical therapeutic and chemical (ATC) classification system.

Material and methods. Chemoreactomic, pharmacoinformation, and geriatric information analyses of the properties of the molecules are based on chemoreactomic methodology. The chemoreactomic analysis uses the information from the PubChem, HMDB, and String databases; the pharmacoinformation analysis applies the information from the international ATC classification and a combined sample of data from the Therapeutic Target Database (TTD), SuperTarget, Manually Annotated Targets and Drugs Online Resource (MATADOR), and Potential Drug Target Database (PDTD); geriatric information analysis employs the data on the geroprotective effect of individual substances from the PubChem database and the data available in the literature data on geroprotection from the PubMed database, which have been collected through the artificial intelligence system.

Results and discussion. Mexidol is characterized by the maximum set of positive effects (the drug is used to treat CNS and cardiovascular diseases and metabolic disorders and has anti-inflammatory and anti-infective properties, etc.). Mexidol and glycine are predicted to cause the lowest frequency of adverse reactions, such as itching, constipation, paresthesia, vomiting, etc. Geriatric information assessments of changes in the life span of model organisms have shown that mexidol contributes to the higher life expectancy of C. elegans (by 22.7±10%), Drosophila (by 14.4±15%), and mice (by 14.6±3%); the control drugs do by no more than 6.1%.

Conclusion. The results of the study indicate that mexidol has a high potential to be used as a geroprotector.

55-59 332
Abstract

Comorbidities in chronic daily headache (CDH) include emotional disorders (depression, anxiety), insomnia, and musculoskeletal pain at other sites. In CDH, the most common type is a subjective  (according to patients themselves) and/or objective (based on the  results of cognitive tests) reduction in cognitive functions, which can  be caused by emotional disorders, insomnia and/or brain diseases,  and a negative effect of chronic pain on cognitive functions.

Objective: to analyze cognitive complaints and their changes in patients with CDH.

Patients and methods. Subjective complaints and cognitive functions were evaluated in 90 patients (76 women and 14 men) aged 23 to 78 years (mean age, 46.7±12.0 years) with primary  forms of CDH according to the Montreal Cognitive Assessment (MCA) for 12 months. The majority (68.9%) of patients with CHD  complained of diminished memory; however, its mild disorders (25– 26 MCA scores) were found in only a small proportion (23.3%). All  patients with subjective diminished memory were ascertained to  have neurotic disorders (depression, anxiety disorder) and/or insomnia or a concurrence of mental disorder and insomnia.

Results and discussion. All the patients received treatment options, including optimal pharmacotherapy for headache and concomitant diseases, an educational conversation, cognitive- behavioral therapy, and therapeutic exercises. In cognitive  impairment (CI), cognitive training was used and Ginkgo biloba  extract (EGb 761®) prescribed; in sleep disorders, sleep hygiene  rules were explained. Therapy declined the mean number of  headache days a month from 29.1±2.03 (at baseline) to 9.3±9.35  (at 12-month follow-up) (p=0.002); while the subjective complaints regressed in the majority of patients; mild MCA changes persisted only in 6.7% of the patients. Management tactics for CHD patients  having mild CI and cardiovascular risk factors and the use of EGb  761® to improve cognitive functions were considered.

Conclusion. It has been ascertained that in many cases, CI is associated with emotional disorders and insomnia, as well as with pathophysiological mechanisms of chronic pain itself; CI in some  patients has a vascular origin. The use of combined treatment  programs can promptly and effectively reduce the frequency of  headache and improve cognitive functions. EGb 761® (Tanakan®) has a beneficial effect on subjective CI and mild CI.

CLINICAL OBSERVATIONS

60-64 281
Abstract

The paper describes a clinical case of hypertension and somatic depression in a female patient. It considers the differential diagnosis of somatic symptomatology within affective disorders, depicts the manifestations of a somatic disease, and analyzes the aspects of personal predisposition to a mental disorder. The authors note the  advantages of an interdisciplinary approach to therapy with  antihypertensive drugs and antidepressants and psychotherapy. Of  particular interest is the problem in the diagnosis and therapy of  moderate cognitive impairment in a patient with cardiac and psychiatric comorbidities.

65-69 1151
Abstract

The paper describes a patient with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS). The features of  the course and therapy of epilepsy in MELAS are discussed. The disease  is known for its late diagnosis when years elapse from the onset of the  clinical manifestations to diagnosis. The paper presents clinical criteria  for the diagnosis of MELAS and the specific features of brain neuroimaging changes that allow identification of the disease at an early stage.

REVIEWS

70-76 344
Abstract

Hypertension is one of the main modifiable risk factors for cognitive impairment (CI) and dementia in middle-aged and elderly patients. CI occurs in patients with hypertension even with its short duration and is manifested by controlling dysfunctiona and cognitive speed decline. The paper presents the results of a neuropsychological examination in 50 patients of middle age (47.54±5.2 years) with short-term (2.6±5.5 years) and uncomplicated hypertension. Stable blood pressure normalization during antihypertensive therapy improves cognitive function and prevents the progression of CI and the development of dementia. The use of nicergoline in patients with hypertension and CI is  discussed.

77-81 263
Abstract

The paper discusses gender differences in the clinic presentations, course and outcomes of schizophrenia from the standpoint of a biopsychosocial approach. It reviews foreign publications on this matter. Neuromorphological and hormonal factors in gender differences are given paramount consideration in foreign countries. The author presents the results of his own empirical studies in this area. It is concluded that psychosocial factors and traditional gender stereotypes play a no less important role in gender differences in schizophrenia rather than hormonal and neuromorphological factors.

82-87 222
Abstract

The review deals with the problem of neuropsychological disorders in Parkinson's disease (PD), one of the most common neurodegenerative diseases in the world. A global search for foreign and Russian investigations in this topic in 2001 to 2016 has been carried out in the scientific databases Medline and Russian science citation index. Particular emphasis is laid on emotional, cognitive, and psychotic disorders that largely worsen quality of life and cause professional and social dysadaptation. The manifestations of and diagnostic criteria for impulsivecompulsive disorders in PD and the contribution of genetic and sociodemographic factors to their genesis are also depicted. Clinical neuropsychological assessment scales are assessed. Sleep disorders that are pathogenetically similar to neuropsychological disorders are characterized.

88-94 553
Abstract

Nocturnal sleep disorders are one of the most important non-motor manifestations of Parkinson’s disease (PD). The clinical significance of sleep disorders in PD is determined by their frequency (up to 88%) and negative impact on quality of life in patients. The paper presents the clinical spectrum of sleep disorders in PD, current approaches to their diagnosis. It discusses the multifactorial nature of the pathophysiology of these disorders. Current views on the relationship of sleep disorders to the neurodegeneration of brain structures involved in the regulation of sleep and wakefulness, to circadian disorders and therapy are depicted. On the basis of the heterogeneity of sleep disorders in PD, a differentiated approach to their treatment is substantiated having regard to the nature of dyssomnic disorders and leading pathophysiological factors. Emphasis is focused on the basic principles of differentiated therapy for sleep disorders in PD in relation to the degree of nocturnal motor symptoms of the disease. There are clinical findings indicating an improvement in the characteristics of nocturnal sleep and a reduction in nocturnal sleep disorders during therapy with long- acting ropinirole, a D2-receptor agonist. Approaches to the pharmacotherapy of non-motor disorders of PD, which worsen nocturnal sleep, are depicted. Non-drug therapies for sleep disorders and their efficiency in patients with PD are discussed.

95-100 518
Abstract

Nervous system lesions associated with chronic alcohol intoxication are common in clinical practice. They lead to aggravated alcoholic disease, its more frequent recurrences, and intensified pathological craving for alcohol. Neurological pathology in turn occurs with frequent exacerbations. The interaction of diseases, age, and medical  pathomorphism modifies the clinical presentation and course of the  major pathology, as well as comorbidity, the nature and severity of  complications, worsens quality of life in a patient, and makes the  diagnostic and treatment process difficult. The paper discusses the  classification, clinical variants, biochemical and molecular biological  aspects of various complications of alcoholic disease. It considers its  most common form, in particular alcoholic polyneuropathy, as well as its rarer variants, such as hemorrhagic encephalopathy with a subacute course (Gayet–Wernicke encephalopathy).

EXPERIMENTAL STUDIES

101-105 402
Abstract

Vitamin B complex is widely used therapeutically and prophylactically in neurology; they are often prescribed for long-term treatment (for weeks and months). In this connection, it is important to comprehensively estimate the feasibility and safety of its use, especially at high (therapeutic) doses. The paper discusses the potential anticancer effects of vitamin B complex.

Objective: to evaluate the effect of thiamine disulfide, pyridoxine hydrochloride, and cyanocobalamin (neurobion 110 mg/kg/day) on the growth and metastatic spread of malignant tumors in mice.

Material and methods. Experiments were carried out in 25 F1 hybrid male mice (aged 2.5–3 months; body weight, 23–26 g). Transplantable Lewis lung epidermoid carcinoma (LLC) was used as a tumor model

Results and discussion. The experimental animals tolerated the drug well; there were no symptoms of intoxication. The drug's effects lasting up to 21 days of LLC development were accompanied by a growing trend towards tumor growth inhibition by 10–20% (p=0.059).

Conclusion. After subchronic intragastric administration of B12 at a daily dose of 110 mg/kg to tumor-bearing animals, there is a steady tendency to LLC growth inhibition. No antimetastatic activity was found.



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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)