Neurology, Neuropsychiatry, Psychosomatics

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Vol 10, No 3 (2018)
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4-11 355

The paper characterizes the neuropathological aspects of cerebral amyloid angiopathy (CAA) and its pathogenesis. It presents in detail the current neuroimaging markers of CAA and their neuropathological correlates. The phenotypic heterogeneity of the disease and its main clinical manifestations are considered; the updated Boston diagnostic criteria are formulated. The issues of intracerebral hemorrhages, cerebral microbleeding, and cortical superficial siderosis, which are associated with CAA, are elucidated in detail. CAA is noted to be of clinical significance for the determination of therapeutic policy in hemorrhagic stroke, systemic thrombolytic therapy, and cognitive impairment.

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Peripheral nervous system involvement may be a main manifestation of systemic amyloidosis or occur in the later stages of the disease in the presence of multiple organ pathology. Focal, multiple mononeuropathy, radiculopathy, polyneuropathy, autonomic nervous system dysfunction, and myopathy develop depending on the localization of amyloid deposits in the peripheral nervous system. The most characteristic symptom in systemic amyloidosis is sensorimotor polyneuropathy accompanied in most cases by the involvement of autonomic nerve fibers in the pathological process. In cases of systemic amyloidosis, peripheral nervous system involvement is progressive, leading to disability, which makes the early diagnosis of the disease and its neurological manifestations and subsequent pathogenetic therapy relevant.


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Objective: to investigate the effect of indapamide/perindopril fixed-dose combination (FC) on 24-hour blood pressure (BP) and cognitive functions in antihypertensive treatment-naive middle-aged patients with uncomplicated grade 1–2 essential arterial hypertension (EAH) . Patients and methods. The open prospective study enrolled 25 patients (9 men and 16 women) aged 40–59 years with a diastolic BP of 90–109 mm Hg and/or a systolic BP of 140–179 mm Hg, as evidenced by routine measurements. As starting antihypertensive therapy, the patients received indapamide 1.25/perindopril 5 mg FC once daily in the morning; if necessary, after 2 weeks (if the routine blood pressure was ≥140/90 mm Hg) they took indapamide 2.5/perindopril 10 mg once daily in the morning. The follow-up period was 14–16 weeks. Before and at the end of the follow-up, the patients underwent 24-hour ambulatory BP monitoring (ABPM) and evaluation of cognitive functions using the Montreal Cognitive Assessment (MoCA), ten-words test (immediate and delayed word recall), verbal association test (literal and categorical associations), number connecting test (Trail making test (TMT), part A and numbers and letters connecting test (TMT) part B), and Stroop test. Results. At the end of the follow-up period, treatment with indapamide/perindopril fixed-dose combination showed a statistically significant reduction in BPs, as evidenced by routine measurements and ABPM (during 24-hour, and awake and sleep periods); a statistically significant cognitive improvement: an increase in the number of the so-called words in the ten-words test during both immediate (from 5.5±1.6 6.5±1.5 words; p=0.02 vs baseline) and delayed (from 6.2±1.7 to 7.4±1.4 words; p=vs baseline) recalls, a decrease in the performance time of TMTB (from 112.6±42.5 to 90.4±28.4 sec; p=0.02) and Stroop test Part 3 (from 135.5±50.1 to 112.6±19.6 sec; p=0.02), and a larger number of called words in the categorical associations test (from 6.5±2.4 to 8.1±2.9 words; p=0.02). Conclusion. The results obtained indicate that in treatment-naive middle-aged patients with EAH, indapamide/perindopril fixed-dose combination assures an effective reduction in BPs, as evidenced by routine measurements and ABPM, also improves cognitive functions, particularly attention, information processing speed, semantic memory, cognitive flexibility, and short-term and long-term memory.

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Objective: to investigate the efficiency of treatment for acute and subacute dorsalgia, by providing information to patients and by using nonsteroidal anti-inflammatory drugs (NSAIDs) without conducting physical therapy, reflexotherapy, and manual therapy. Patients and methods. A total of 140 patients (87 women and 53 men; mean age 50.7±17.6 years) with acute and subacute back pain were followed up. Out of them 127 (91%) patients were found to have nonspecific (musculoskeletal) pain; 13 (9%) had discogenic radiculopathy. All the patients were informed of the benign nature of the disease, the high probability of its rapid resolution, the feasibility of abandoning prolonged bedrest, and the lack of need for physical therapy, reflexotherapy, massage, and manual therapy. To reduce pain, the patients received meloxicam 15 mg/day orally or intramuscularly or first 15 mg/day intramuscularly and then orally. The investigators assessed pain intensity with the numerical rating scale and functional activity restrictions with the Roland-Morris disability (RMD) questionnaire. Results. After treatment, the visual analogue scale pain intensity scores decreased from an average of 6.4 to 1.0; the RMD scores dropped from 6.8 to 1.4 (p<0.001). The duration of treatment averaged 11.0±4.4 days. Comparison of different meloxicam dosage regimens showed no significant differences; a positive result was noted in all cases. No adverse events were observed during treatment. Conclusion. The investigation has shown the high efficiency of management in patients with acute and subacute dorsalgia, by providing information to patients (an education conversation), by using meloxicam, and by applying a personalized approach (treatment for concomitant diseases and conditions). Refusing physiotherapy, massage, acupuncture, and manual therapy substantially reduces the cost of treatment in patients with acute dorsalgia.
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Migraine is a chronic brain disease with a high prevalence and a marked deterioration in quality of life. Triptans are the gold standard for migraine attack therapy, but they are not effective in all patients. The aim of an observational program was to compare a sumatriptan/dexketoprofen combination and sumatriptan monotherapy for attack relief. Patients and methods. The observation program included 38 migraine patients. A migraine attack was relieved with a combination of sumatriptan 100 mg and dexketoprofen 25 mg in 20 patients and with only sumatriptan 100 mg in 18 patients (Group 2). All the study participants filled out a questionnaire in which they indicated the time of attack onset, the time of drug intake, the intensity of pain, and the presence of concomitant symptoms (nausea, phono-and photophobia) before and 0.5, 1, 2, 4, 8, and 24 hours after drug administration. The investigators estimated the key indicators of the observation program: pain relief at 2, 4, 8, and 24 hours and a significant decrease in pain intensity at 30 minutes, 1 and 2 hours. Therapy satisfaction was determined using the Patient Perception of Migraine Questionnaire (PPMQ) that the patients filled out at 24 hours after the attack. Results. A larger number of patients receiving combined therapy with sumatriptan 100 mg and dexketoprofen 25 mg noted a significant decrease in the intensity of headache at 1 hour and the absence of pain at 2 and 4 hours compared with those in the sumatriptan monotherapy group. According to the PPMQ questionnaire, the combined therapy group showed higher treatment satisfaction. Conclusion. The combination of sumatriptan 100 mg and dexketoprofen 25 mg was shown to have some advantage over sumatriptan 100 mg monotherapy in treating migraine attack. The results of the observation program are correlated with those of previous studies. The higher efficiency of combined therapy with triptan + nonsteroidal anti-inflammatory drugs versus that of monotherapy with triptans reflects a variety of pathophysiological processes that accompany a migraine attack, as well as the presence of several targets for pathogenetic therapy.

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Objective: to study the clinical features of depression in women compared with men. Patients and methods. 120 women aged 18-65 years with recurrent depressive disorder (RDD; ICI-10 F33) (a study group) and 67 men of the same age with RDD (a control group) were clinically examined using a specially designed schedule and the Montgomery-Asberg Depression Scale. Results. The clinical picture and the course of RDD have gender differences. The earlier onset of the disease in women with a large number of depressive attacks and lower quality remissions is due to the relationship and mutual influence of menstrual and reproductive function and depression. Such typical symptoms of endogenous depression, as slow thinking, anhedony, decreased sleep duration and early morning awakenings, as well as diurnal swings of mood with its deterioration in the morning, were characteristic for most women and men. The pattern of depression in women is more commonly characterized by anxiety; ideas of self-accusation; suicidal thoughts; avoidance of contacts with others; weakness; fatigue; decreased or increased appetite; sleep onset insomnia; lack of sleep feeling. That in men is more often marked by symptoms, such as melancholy; motor retardation; decreased motivation; somatic symptoms of depression (tachycardia, constipation); comorbid panic attacks; and concomitant diseases of the cardiovascular, respiratory and genitourinary systems. Men more frequently abuse alcohol and other psychoactive substances. Conclusion. The revealed features of depression in women and men will be able to more accurately diagnose and to prescribe adequate therapy.


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Objective: to investigate the influence of the aesthetic component of dental health on the anxiety level and quality of life of socially active elderly patients. Patients and methods. A total of 32 patients aged 60 to 67 years who had a poor aesthetic appearance of the hard tissues of the front teeth were followed up. All the patients underwent determination of anxiety levels by the Spielberger–Hanin procedure and assessment of quality of life using an abbreviated 26-item version of the World Health Organization Quality of Life (WHOQOL-BREF-26) questionnaire; the updated Oral Health Impact Profile (OHIP-14) was also used. Aesthetic rehabilitation of vital front teeth was carried out using photo composite materials made in Russian and foreign countries. Results. Before treatment, the state anxiety scores were 54±1.4 scores; the trait anxiety ones were 41±1.2 scores; at 1 week after treatment, these were 42±0.5 and 39±0.6, respectively (p ≤ 0.05 for both indicators), and at 6 months, these were 44±0.5 and 43±0.7, respectively. Conclusion. The aesthetic component of dental health in socially active elderly patients is directly proportional to quality of life and inversely proportional to the level of trait or state anxiety. Russian and foreign photo composite restorative materials showed equal sustained performance.
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Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

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Post-stroke cognitive impairment (PSCI) is often characterized by a complex prognosis of neurorehabilitation, insufficient restoration of the functional status of patients, and a high risk of recurrent strokes and disability, which determines considerable health care costs. Objective: to carry out a comparative pharmacoeconomic analysis of the use of actovegin (Takeda Pharmaceuticals, Switzerland) in Russian patients with PSCI. Patients and methods. The investigation was conducted using a modeling method to determine the cost-effectiveness of competing treatment strategies: standard patient management; standard patient management and use of actovegin. Data from the ARTEMIDA clinical trial were used. Results and discussion. The use of actovegin was economically justified, which was expressed in more preferable cost-effectiveness indicators. Also, the use of actovegin in patients significantly reduced the risk of post-stroke dementia and, accordingly, the cost of treatment in future periods. Conclusion. The findings data indicate the clinical and economic feasibility of using actovegin in patients with PSCI.

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Stroke is one of the leading causes of death and disability in the population, has a complex multifactorial nature and develops through the interaction of environmental factors and genetic predisposition, the pattern and mechanisms of which have been insufficiently studied. Ischemic stroke (IS) is most commonly encountered. Objective: to investigate the differential expression of microRNAs (miRNAs) in the plasma of patients in the acute and subacute stages of stroke. Patients and methods. The investigation enrolled 10 patients (5 men and 5 women; mean age, 64.5 years) with IS and 10 gender- and agematched volunteers (a control group). A real-time polymerase chain reaction (PCR) was used to analyze the expression of 45 miRNAs isolated from the plasma samples of the patients on days 1 and 8 after onset of IS and isolated once from those of the controls. Results. A list of 45 miRNAs, that might be potential biomarkers and/or prognostic factors of stroke, was compiled. The investigation showed a decrease in let-7i-3p and miR-23a-3p miRNA expression in patients on the first day after onset of IS compared to the control group. The expression of miR-23a-3p increased in the patients at 8 days after IS. The patients with IS and the controls both showed gender differences in the expression of let-7i-5p and miR-92b-3p. Conclusion. The in-silico analysis revealed specific miRNA clusters associated with the peculiarities of clinical manifestations of IS. This may suggest that the patients with the favorable and unfavorable course of stroke may have its different molecular basis. In addition, it is necessary to take into account gender differences in the expression of individual miRNAs in assessing their significance in the pathogenesis and prognosis of IS.

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Objective: to investigate the short- and long-term results of surgical median nerve decompression via classical and minimally invasive approaches in patients with carpal tunnel syndrome (CTS), as well as factors that influence surgical outcomes. Patients and methods. The investigation enrolled 70 patients (13 men and 57 women) aged 36 to 84 years (mean age, 62±10.8 years) who had undergone median nerve decompression. Surgery was performed in the classical way in 35 patients (Group 1) and via a minimally invasive access in the remaining 35 patients (Group 2). The efficiency of treatment was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analog scale for pain before and 1, 3, 6, and 12 months after surgery, as well as from patient satisfaction with surgical outcomes. Results. No complications of surgical treatment were detected. There was a marked reduction in pain and other neuropathic disorders just 1 month after surgery and a substantial hand functional improvement following 6 months. After 12 months, in Group 1, the mean BCTQ Symptom Severity Scale and Functional Deficit Scale scores decreased from 2.76 to 1.15 (p≤0.01) and from 2.72 to 1.24 (p≤0.01), respectively; in Group 2, these dropped from 2.86 to 1.14 (p≤0.01) and from 2.95 to 1.24 (p≤0.01), respectively. Complete recovery from sensory problems occurred in 24 (69%) patients in Group 1 and in 25 (71%) patients in Group 2; their partial recovery was observed in 11 (31%) and 10 (29%) patients in these groups, respectively. One 1 month following decompression, the patients in Group 1 had more severe pain syndrome than those in Group 2; these differences became statistically insignificant after 6 months. The patients were found to be highly satisfied with surgical treatment. Permanent numbness, subjective weakness, thenar muscle atrophy, stage III CTS, and diabetes mellitus (DM) were predictors for less pronounced improvement in BCTQ scores after surgical treatment (p<0.05). The paper describes a clinical case that achieved full postoperative occupational and home rehabilitation. Conclusion. The patients with CTS were observed to have a marked reduction in pain and other neuropathic disorders just one month after surgical decompression and a substantial hand functional improvement following 6 months. The benefit from a minimally invasive access is less severe pain syndrome at 1 month after surgery. The predictors of less successful results of surgery are age (the older the patient is, the greater likelihood of having a worse result), permanent numbness, subjective hand weakness, thenar muscle atrophy, DM, and stage III CTS.

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Objective: to evaluate the effect of intravenous mexidol on the efficiency of intravenous thrombolytic therapy (TLT) during the therapeutic window. Patients and methods. The retrospective study enrolled 123 patients with ischemic stroke (IS) who had undergone intravenous TLT in the vascular centers of the Republic of Tatarstan. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the time course of changes in their neurological status. According to the baseline severity of a neurological deficit, all the patients were divided into three subgroups: 1) mild IS (<8 NIHSS scores at admission); 2) moderate IS (>8 scores); and 3) severe IS (<16 scores). All the patients underwent X-ray computed tomography at admission, at 24 hours after TLT, and in case of worsening of their health status. Results. The prehospital use of mexidol followed by TLT in patients with IS had a positive effect on the regression of neurological deficit regardless of the severity of the disease. There were significant differences in the degree of regression of neurological deficit according to NIHSS at 24 hours and 10 days after hospital admission in patients with severe IS, who received intravenous mexidol at the prehospital stage and who did not take this drug before TLT. The pre-TLT use of mexidol contributed to higher regression of neurological deficit. There was a lower frequency of hemorrhagic transformations in the patients who used mexidol at the prehospital stage versus those who did not. Conclusion. The findings demonstrate the positive effect of mexidol on the efficiency and safety of TLT in patients with IS.
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Interleukin 6 (IL-6) plays an important role in the pathogenesis of ischemic stroke (IS), exerting a modulating effect on a number of processes that determine the outcome of this disease. Objective: to investigate the peripheral blood levels of IL-6 in patients in the acute period of different IS pathogenetic subtypes and its effect on recovery rates. Patients and methods. The study enrolled 155 patients (74 men and 81 women; mean age, 63.8 years). A control group consisted of 28 people without IS. Pathogenetic subtype II was established in accordance with the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria on the basis of their clinical picture and the data of computed tomography or magnetic resonance imaging and ultrasonography of the main arteries of the head. The severity of a patient's condition and a focal neurological defect and the time course of clinical changes after stroke were determined using the National Institutes of Health Stroke Scale (NIHSS). An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. Results. In the acute period of IS, there were significantly elevated levels of IL-6. The latter reached its highest values on day 7 in patients with the atherothrombotic pathogenetic subtype of IS. On day 7 of the study, the peak concentration of IL6 was typical for patients with all subtypes of IS, except for lacunar stroke. After its increase on day 1 of the study, the IL6 level in patients with lacunar stroke did not change significantly in all other periods. In acute IS, the concentration of IL-6 was significantly influenced by the following cardiovascular risk factors: hypercholesterolemia of days 1, 7 (p<0.01) and 21 (p<0.05), hypertension in day 1 (p<0.05), diabetes mellitus on days 1 and 7 (p<0.05), and coronary heart disease in all the study periods (p<0.01). The IL-6 concentration significantly correlated with the severity of neurological defect, but did not significantly affect the rate of recovery in the patient with acute IS. Conclusion. IL-6 was established to be of prognostic value for the outcome of acute IS on day 7. The rate of recovery can be used to identify targets for therapeutic intervention.


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Syringomyelia is a chronic disease with progressive cavitation and clinical presentations of spinal cord injury. The paper describes clinical cases of a rare benign variant of syringomyelia with spontaneous cavity collapse. The peculiarity of the described clinical cases is childhood-onset of the disease, lack of progression and/or development of myelopathic symptoms, and signs of syringomyelia cavity collapse according to magnetic resonance imaging findings. The authors designate this childhood-onset variant of the disease as abortive. The tendency towards collapse in the cavity in these patients may be due to a single pathogenetic mechanism, which is of interest for a further investigation.

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This paper describes a case of Balo's concentric sclerosis, a rare demyelinating disease of the central nervous system (CNS), which is currently classified as multiple sclerosis. In recent years, there has been a more favorable clinical course of Balo's sclerosis. The significant polymorphism of clinical manifestations of the disease, its neuroimaging pattern, and laboratory tests cause difficulties diagnosing this pathology. Its differentiation with CNS tumors presents a particular challenge. So it also happens in the described clinical case, when computed tomography revealed the signs of space-occupying lesion, the histological pattern of concentric focus biopsy specimen indicated the presence of protoplasmic astrocytoma. However, immunohistochemical analyses of the biopsy specimen, immunological examination of cerebrospinal fluid, as well as the typical magnetic resonance imaging changes of Balo's sclerosis could suggest the demyelinating nature of the pathological process. The article shows that immunohistochemical techniques for examining a brain biopsy specimen and immunological assays of blood and cerebrospinal fluid are of great diagnostic value.

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The concurrence of amyotrophic lateral sclerosis (ALS) with parkinsonism syndrome and dementia is described as Guam ALS, in which up to 70% of patients have a positive family history. The concurrence of parkinsonism with other neurological disorders, such as autonomic failure, dementia, cerebellar ataxia, visual disturbances, and pyramidal syndrome, is characteristic of some neurodegenerative diseases, for example, multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy, and corticobasal degeneration. These diseases are common in the practice of a neurologist, have a detailed description and clear diagnostic criteria. The isolated concurrence of parkinsonism and ALS without other neurological disorders is extremely rare. This disorder is known as Brait–Fahn–Schwartz disease and is named after the scientists who first described this overlap syndrome. No cases of familial neurodegenerative disease concurrent with parkinsonism and ALS have been found in the literature. This paper presents the authors' own case of two siblings, one of whom is observed to have parkinsonism with ALS syndrome; and the other had Parkinson's disease.


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Placebos are drugs, devices, or other treatments that are physically and pharmacologically inert. The placebo effects are therapeutic responses to the context of the treatment process. They are mediated by factors, such as training of a patient, his/her expectations associated with treatment, as well as social conditions, the features of cognitive functioning, etc. and can affect the clinical and physiological responses caused by the health status. The analgesic effects of placebo in different types of pain syndromes reach 25–80%. The formation of placebo analgesia involves the brain structures that belong to the pain matrix and are implicated in the basic processes of perception, in the mechanisms of pain modulation, and in a number of other cognitive and affective processes, as well as in the emotional reactions not caused by pain. A deeper understanding of the mechanisms of action of placebo analgesia can optimize the strategy of current pain therapy.

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The paper reviews an update on the status of neurological care and thrombolysis in patients with ischemic stroke (IS) who take oral anticoagulants. The possibilities of providing effective and relatively safe emergency care to patients with IS, including those receiving new oral anticoagulants, are shown to be substantially expanded now. Since it is necessary for recanalization therapy to block the effect of an anticoagulant, the latter that has a specific antagonist should be prescribed as a basic therapy to prevent stroke.

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Post-hypoxic encephalopathy is a brain damage manifested by neurological, neuropsychiatric, and mental disorders, which is caused by a reduction in cerebral blood flow and by a resultant effect of an episode of hypoxia of various etiology and duration. This complication is most characteristic of patients who have undergone cardiac surgery in view of the high prevalence and severity of clinical manifestations, worse quality of life, the longer length of hospital stay, and the higher cost of treatment and rehabilitation. To determine the individual management tactics for such patients, combining both successful surgical treatment, by reducing perioperative stress, and prevention of cerebral complications, it is necessary to analyze the patterns of their development. The role of pathophysiological risk factors, including preoperative, perioperative and postoperative ones, for posthypoxic encephalopathy, is considered. Its preoperative risk factors include age, gender, concomitant diseases, education level, and cognitive functions before surgery, cardiac morphofunctional changes, and depressive disorders. There are surgery-related (type and duration of anesthesia, operating-suite temperatures, and hyperglycemia) and postoperative (pain syndrome after surgical intervention, sleep disorders, and the environment) risk factors. Emphasis is placed on the technical characteristics of on-pump operations, among which there are cerebral hypoperfusion, microembolism, non-pulsatile flow, and duration of extracorporeal circulation. Classifications of cerebral complications are presented. Different types of brain dysfunction are analyzed to assess their incidence rates, clinical features, and dynamics in the postoperative period.
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Today, there is no reliable pharmacological correction of dementia, despite its high prevalence worldwide. The clinical presentation of Alzheimer's disease at one or another stage is accompanied by neuropsychiatric disorders (NPDs) in addition to cognitive defect. The intensity and range of NPDs are different. The possibilities of drug therapy for NPDs are demonstrated. The role of akatinol memantine in correcting a number of psychological and behavioral disorders is highlighted. Biological, psychological, social, and environmental factors are identified among those that contribute to or provoke the development of NPDs. Knowledge of the triggers of mental disorders makes it possible to prevent and thereby reduce or eliminate NPDs. Special emphasis is laid on the patient-caregiver relationship. In recent years, non-pharmacological interventions have been increasingly used as priority-line therapy for NPDs. There are data on main methods for non-pharmacological correction and on the efficiency of their application.

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Botulinum toxin injection therapy is the mainstay for managing patients with motor manifestations of dystonia. It is important to identify possible cognitive and mental disorders, sleep and perceptual disorders (non-motor disorders) in these patients. Correction of these disorders will be able to optimize treatment and to improve quality of life of patients. 

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Cognitive impairment (CI) is common in patients with migraine; its causes and pathogenesis continue to be discussed. Some authors consider that migraine proper does not lead to decreased cognitive functions, neuroimaging changes in the brain white matter are asymptomatic in migraine; and CI in patients with this condition is caused by comorbidities (depression, anxiety disorder) and/or concurrent cerebrovascular and neurodegenerative diseases. Other authors report the pathogenetic role of migraine in the development of CI and the importance of the frequency of headache attacks and neuroimaging changes in the brain matter in migraine. The paper reviews clinical trials dealing with the prevalence, causes, and pathogenesis of CI in patients with migraine. It sets forth the current principles of prevention and treatment of CI in patients with this condition.

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