[Somatic pathology in elderly and senile persons suffering from Alzheimer's disease and Alzheimer's type dementia.]

In order to study the prevalence of chronic somatic age-associated pathology in elderly and senile people suffering from Alzheimer's type dementia with the presentation of the hypothesis of somatopsychic pathogenetic comorbidity observation and treatment, 217 patients were observed, conditionally divided into 2 comparable groups: with a definitive diagnosis of Alzheimer's disease (n=73) and with so-called Alzheimer's type dementia (n=144). Distinct differences in the variants of comorbid to the selected types of dementia of somatic pathology were determined, which had a negative impact not only in terms of the occurrence of cognitive disorders, but also in the future, during the formation of the most severe variants of dementia. In cases of Alzheimer's disease, pathological processes in the large intestine turned out to be leading, with Alzheimer's type dementia - diseases of the circulatory system and type 2 diabetes mellitus. Nevertheless, the diagnostic algorithm of patients with dementia should include the most comprehensive somatic examination, and treatment should affect not only the mental, but also the somatic sphere, taking into account the principles of a comprehensive geriatric assessment. With such approaches and under the condition of social well-being in the family, it is possible to achieve not only stabilization, but also some improvement in terms of psychopathological disorders, in particular with Alzheimer's type dementia.

[The state of the oral cavity in early diagnosis and predicting cognitive disorders.]

A review of the literature on the problem of the use of non-invasive technologies in early diagnosis and prediction of age-associated cognitive decline associated with Alzheimer's disease is presented. The main attention is paid to the study of the buccal epithelium, oral fluid, as surrogate models of degenerative lesions of cerebral structures, as well as determining the role of oral microorganisms in the formation and development of cognitive disorders. An original hypothesis of neurodegenerative lesions of cerebral structures is presented, on the basis of which an algorithm for studying the state of the oral cavity is proposed in order to detect and predict cognitive deficits as early as possible.

[The dependence of medical and diagnostic measures carried out in geriatrics on age, gender and the doctor's health status.]

The article discusses the probable dependence of the actions of a specialist working with geriatric patients on the age, gender, and other characteristics of this specialist. This seemingly unconventional approach to research in the field of gerontology and geriatrics reveals distinct differences in a number of aspects of clinical thinking and following clinical recommendations in doctors of different ages, genders, and in different states of their own health. On the basis of a survey of 126 doctors and an analysis of 2 394 of their opinions, the results were obtained, indicating a certain conservatism of doctors over the age of 50, especially men with extensive clinical experience. The article discusses cases of so-called self-ageism of an elderly specialist who uses in his professional actions the results of diagnosis and treatment of the age-associated pathology that he himself suffers from. It is proposed in the process of continuing education or professional training of geriatricians to take into account their age, sex and health status, as well as accompany classes mandatory determination of the biological age of the specialist.

[The possibility of using the results of the study of oral fluid and buccal epithelium in the diagnosis of Alzheimer's disease.]

The article presents the results of the first experience of comparative studies of the state of the oral fluid and buccal epithelium in 12 patients suffering from Alzheimer's disease, and in 12 individuals without any signs of cognitive impairment. In the course of the study, the correlative relationships of pro-inflammatory and anti-inflammatory factors of the oral fluid, the main cytological changes of the buccal epithelium with the results obtained during neuropsychological testing using the MMSE and ADAS-COG scales were studied. This comparative study is associated with the assumption of a common ectodermal origin of the nervous tissue and buccal epithelium, which may be due to systemic pathological changes in the tissues of a single embryonic embryo leaf. The results obtained indicate the specificity of pathological changes in the oral fluid and buccal epithelium for Alzheimer's disease, which allows us to use the study of these materials to obtain additional diagnostic markers of this disease.

[Ontogenetic principles of accelerated aging and the prospects for its prevention and treatment.]

This article examines the phenomenon of «intrauterine programming¼, which largely determines the further life cycle and the likelihood of developing a number of age-associated pathological processes. The possibility of the formation of pathological (accelerated) aging at various stages of ontogenesis is discussed with the use of large literary material from the standpoint of modern science. The reasons, mechanisms and phenotypic manifestations of accelerated aging and the possibilities of the earliest one, its diagnosis starting from the perinatal period, and prediction of age-associated pathologies are discussed in close interrelation.

[Sexual activity: dependence on age, gender, various cardiovascular diseases and cerebral stroke.]

The purpose of this study was to determine the place and role of sexual disorders in representatives of different sexes and ages in the development of background for cerebral stroke pathology and the formation of the clinical picture of acute stroke period and its consequences. Questions of intimate life of 111 patients (58 men and 53 women) in the periods preceding a stroke were considered in detail and possible connections with clinical features of an acute period of in-Soult were defined. In 77 of these 111 patients, we studied the dynamics of sexual disorders in connection with the features of a functional defect that formed 3-24 months after a stroke. It was revealed that the decrease in sexual activity before the stroke has a distinct significance along with age in the development of background for insulin pathology and in the formation of the consequences of stroke. In the elderly, the most severe functional consequences of stroke were formed in 8,3% in the presence of normal sexual relations in the period preceding the stroke and in 27,6% in the absence of such. Negative dynamics of sexual activity after a stroke was detected in 46,8% of cases, mainly among the elderly, and is associated in women with the presence and severity of neurological deficits, in men-with the presence of cerebral atrophic changes.

[Indicators of the hormonal spectrum in the acute period of stroke in representatives of different gender and age with different degrees of severity of functional disorders.]

The level of serum levels of a number of hormones in the acute period of stroke was determined in 29 men and 29 women aged 45 to 88 years. Comparison of the results obtained was carried out in relation to the age of the patients and the severity of the functional defect formed at the end of the acute period of stroke. The most pronounced dynamics in relation to different severity of functional disorders was found for cortisol, aldosterone and estradiol (p=0,014-0,022) in men under the age of 60 years and for testosterone (p=0,001-0,0001) in men 60-88 years. In women over the age of 60 years parallel to the increasing severity of the functional defect is only significant increase in the concentration of prolactin in the blood (p=0,02), the dynamics of the other components of the hormonal spectrum did not show any statistically significant dependence on age and functional outcome of acute stroke. It is concluded that some hormones are actively involved in the formation of post-stroke functional defects, and the level of their content in the blood serum in the acute period of stroke can be considered as prognostic criteria for acute cerebrovascular pathology. However, the present differences in the dynamics of the hormonal spectrum in representatives of different ages and genders indicate the need to personalize diagnostic and therapeutic measures in gender and age aspects.

[Cognitive aging and cognitive reserve: point of contact.]

The high risk of cognitive disorders in the elderly and senile age makes, on the one hand, to look for their causes, on the other - the possibility of prevention. In this regard, in recent years, the concept of cognitive reserve has become widespread, implying a set of quantitative parameters of the brain and its ability to maintain high functional activity in the process of aging and against the background of age-related brain pathology. The material presented in the article on the basis of the review of scientific literature highlights two main points concerning the possibility of preserving the cognitive reserve-gender and educational factors. It is pointed to the different opportunities of women and men associated with the structural and functional characteristics of the Central nervous system in representatives of different sexes and the special role of the educational process supported throughout life. The author's position on the need to separate the concepts of education and the level of General culture, and the creation of a convenient tool for determining the latter is indicated. This, in turn, would help in the development of a cognitive reserve model aimed at preventing the transformation of physiological cognitive aging into pathological aging.

[Age-associated cognitive impairment and intestinal microbiota: state of the issue and prospects for further study.]

In recent years, the relationship between the microbial flora of the gastrointestinal tract, mainly the intestinal microbiota, and the state of various brain structures responsible for cognitive functioning has been actively studied. Special attention is paid to the transformation of the intestinal microbiota during aging and against the background of age-associated pathologies such as Alzheimer's and Parkinson's diseases. The material presented in the article, based on a review of the scientific literature of recent years, highlights the main points of interaction between the intestinal microbiota and the Central nervous system in the conditions of norm, pathology and age dynamics. The article deals with the participation of intestinal microflora in the pathogenesis of cognitive disorders and the possibility of using probiotic-based drugs in the complex therapy of neurodegenerative diseases in the elderly. The author's position is indicated in terms of the need for further study of the problem, taking into account its gerontology significance and possible disorders of the gastrointestinal tract when using medications for the treatment of dementia.

[Lower urinary tract syndrome in elderly and senile people with combined pathology of the prostate and lumbar spine.]

In order to determine the place and role of degenerative changes in the lumbar spine in the pathogenesis of lower urinary tract syndrome and the success of treatment measures, 106 elderly and senile male patients suffering from benign prostatic hyperplasia and spinal pathology were observed. Long-term chronic lower back pain was experienced by 48 (45,3%) patients, 93,8% of them had night urination, 75% had difficulty urinating, and 60,4% had false urge to urinate, which motivated them to contact a urologist.The differences identified using the IPSS questionnaire, respectively 21,78±4,33 and 16,33±4,61 points, indicated a negative value of chronic pain syndrome in the formation of the overall clinical picture of urological pathology. Among the senile patients, pain and urinary tract irritation symptoms were less pronounced than among the elderly patients, and obstructive symptoms, on the contrary, were more pronounced. Chronic pain syndromes in the lumbar region were significantly more frequent (p<0,001) among 67 patients with satisfactory and unsatisfactory results of treatment for urination disorders than among 39 with the best efficiency. Thus, the pathology of the lumbar spine and associated chronic pain syndromes make a significant contribution to the pathogenesis and clinical picture of the lower urinary tract syndrome and to the effectiveness of treatment of urination disorders. The identified features should be taken into account in the process of diagnosis and treatment of combined pathology.

[Stress-induced pathology and accelerated aging.]

The study involving 317 former combatants aged 24 to 69 years was conducted. The aim of the study was to determine the regularities of the age dynamics of stress-induced pathology of combatants to develop the concept of their accelerated aging as a final component of the consequences of combat stress. It turned out that in relation to the period of influence of factors of combat stress and age, first manifests the pathology of the musculoskeletal system, gastrointestinal tract and arterial hypertension, then-cardiovascular disease associated with atherosclerosis. The formation of post-traumatic stress disorder occurred in 289 (91,2%) cases, and the chronic pain syndromes of different localization and different origin - in 192 (60,6%) at different times of the post-war period. But it is post-traumatic stress disorder in combination with chronic pain were decisive in the overall severity of the state of combatants, changes in indicators of free radical oxidation and an increase in biological age. It is proposed to consider accelerated aging, which is formed on the basis of the consequences of severe stress effects, as an independent disease.

[Gender-specific features of cardiovascular diseases in representatives of different age.]

The literature review systematizes the results of research devoted to age-and sex-related aspects of cardiovascular pathology and published in Russian and foreign publications is presented in the well-known scientometric databases - Scopus, Web of Science, Pub Med, RISC, etc. The article also presents the results of their own research and the author's vision of the issues. The result of the analysis was a reasonable conclusion that the representatives of different sex and age to a large extent differently formed and development pathological processes in the cardiovascular system. This, in turn, requires modern gender-oriented, personalized approaches to diagnosis, treatment and prevention.

[The diagnosis and treatment of Alzheimer's disease the representatives of elderly and senile age.]

The article deals with the important issue of diagnosis and treatment of Alzheimer's disease in the elderly and senile age. Despite the fact that this disease is considered, of course, age-associated pathology, which is the main cause of senile dementia, its diagnosis in Russia is exhibited rather rarely compared with dementia, for example, of vascular origin. This is due, in the author's opinion, not only with the difficulties of in-vivo diagnosis of Alzheimer's disease, but, first of all, with the characteristic of the elderly and senile multiplicity of pathological processes. A significant part of these pathologic processes, as well as Alzheimer's disease, can cause increasing cognitive disorders. Under this condition, dementia is already considered as a multi-factorial disease even in cases where Alzheimer's disease is the leading factor. This position, in turn, requires the expansion of the diagnostic search even in cases of full confidence in the diagnosis of Alzheimer's disease in the elderly and senile age to determine the possible role of other pathological processes in the formation and development of dementia. Ultimately, with limited opportunities for treatment of Alzheimer's disease, this will help in the selection of treatment methods aimed at reducing the role of other etiological and pathogenic moments in the development of dementia of mixed Genesis in the elderly and senile.

[Features of the clinical picture, diagnosis and treatment of pain syndromes formed on the basis of combined lesions of the spine in the elderly and senile age.]

Based on the long-term observation of 105 representatives of the elderly and senile age, the features of the clinical picture of pain syndromes formed in the elderly and senile age on the basis of combined spinal lesions in osteoporosis and spondylarthrosis are presented, and methods of diagnosis and treatment of such patients are proposed. The main variants of symptoms developing in response to long-term tonic muscle tension in degenerative age-dependent injuries of vertebral bodies, intervertebral discs and facet joints at the level of thoracic and lumbosacral spine are shown. Pathogenetic connections of frequent urination disorders in the elderly and senile age with pathological processes in the spine and muscular-tonic pain syndromes were determined. In pathological muscle hyperactivity, accompanied by pain syndromes, restrictions of movements in the spine and the formation of pathological poses, it is recommended to use in the treatment of soft techniques of manual therapy and botuline toxin therapy, and with distinct structural, anatomical defects of vertebral segments - local corticosteroid therapy.

[Possibilities of application of remote educational technologies in the training of doctors on gerontology and geriatrics.]

The article raises a very important problem devoted to the possibility of using distance learning technologies in the system of postgraduate training of doctors in gerontology and geriatrics. In the comparative aspect, the advantages and disadvantages of distance education are given, the possibilities of their application in different variants of training a geriatrician doctor with different duration of training cycles are evaluated. The problem is considered from the point of view of the doctor, his employer, representatives of the educational organization taking into account the existing normative, legislative acts. The results of the studies performed at the medical University. Recommendations aimed at improving the programs of postgraduate training of geriatric doctors and other specialists solving medical and medical social problems of the elderly and senile age with the use of remote technologies are presented.

[The main diseases and syndromes identified in patients of elderly and senile age, hospitalized in the hospitals of a different profile.]

There was held stationary survey of 661 patients in different age: 234 - from 60 to 102 years, 427 - from 18 to 59 years. Identify options for pathology, clearly increasing its prevalence in parallel with the increase of age. It is, first and foremost, diseases of musculoskeletal apparatus, gastrointestinal tract and cardiovascular system. At the same time, acute violations of cerebral circulation in the form of strokes, on the contrary, prevailed among persons under the age of 60 years, and an increase in the frequency of ischemic heart disease, angina without myocardial infarction among patients of elderly and senile age in relation to persons under the age of 60 years was insignificant. Senile asthenia as an independent disease and age-related disorders of cognitive functions were identified for clinical features and etiological moments of its development in relation to the classic asthenic syndrome and cognitive disorders developing in young and middle-aged. This dictates the necessity of bringing to the diagnosis and treatment of patients under the age of 60 specially trained of geriatricians with the comprehensive geriatric assessment of the patient's condition. It is necessary to increase the state geriatric hospitals by doctors - neurologists and psychiatrists with the priorities of the holding in these hospitals diagnostic and therapeutic measures, and not providing primarily palliative care.

[Age-associated pathology and the location of geriatrics as a medical specialty (reflections of Clinician).]

In this article from the perspective of an experienced Clinician discusses controversial issues of pathological processes associated with the elderly and senile age, and some aspects of the problem of the formation of the geriatric services that require further discussion. The contents of this document may be submitted for all General discussion on the pages of the magazine.

[Status and prospects of gerontology and geriatricsin the regions of Russia (on the example of Sverdlovsk region).]

The article describes the situation with the development of gerontology in the regions of the Russian Federation on the example of Sverdlovsk region. The positive and negative aspects of the possibilities of scientific research in the field of gerontology, training of geriatric doctors in the Ural medical University and the state of geriatric service of the region are presented. A number of changes are proposed in the existing provisions on the formation and development of gerontology science and practice, while preserving decades of regional traditions.

[Epidemiological, clinical and pathogenic features of stroke in elderly and senile age].

A comparative investigation of the epidemiological, clinical and pathogenetic indices of cerebral stroke in 1 153 representatives of different age was conducted. The predominance in the incidence of strokes among women of elderly and senile age largely is due to higher life expectancy of women compared to men. A significant number of intracerebral blood effusions in elderly and senile can arise secondarily, after the ischemic focus formation by the type of «red softening¼. This, to a certain extent, can be explained by the high frequency of somatic complications of stroke, disorders of consciousness and high mortality among persons older than 60 years compared to younger. Less positive clinical outcomes of stroke in elderly and senile age even if you increase the length of their stay in hospital may indicate shortcomings in the existing standards of diagnostics and treatment with completely different from that of the young, combination a background of stroke pathology.

[Age aspects of the muscular-tonic and urological syndromes in men with disorders of the pelvic functions: the features of clinic, diagnostics, treatment].

A comparative examination of 100 patients at different ages, suffering from disorders of micturition, erectile function and pelvic pain, identified age-related peculiarities of these pathological manifestations. Irritative disorders of urination was detected significantly more frequently among persons of young and middle age than the elderly, and obstructive-related disorders were more frequent in the elderly. In elderly and senile age more prevalent was reducing of the contractility of the detrusor, and at a younger age - increased tone of striated sphincter of the urethra and bladder hyperactivity. It was shown that the participation of long-existing spasm of some muscle formation of the lumbar, pelvic and femoral region in the genesis of urinary symptoms, erectile dysfunction and pelvic pain. When using manual therapy, physiotherapy and botuline-therapy high effectiveness against disorders of micturition, erectile function and pelvic pain was achieved regardless of the age of the patients. It is recommended for the diagnosis of urological pathology to involve specialists in the field of neurology and manual therapy. In cases of diagnosis of musculo-tonic disorders not etiologically associated with pathological processes in the organs of the urogenital system, in the complex of therapeutic measures it is recommended to include methods such as manual-therapy, physiotherapy, botuline-therapy.