[Problems in organizing neurosurgical care for patients with Parkinson's disease in the Russian Federation]. / Problemy organizatsii neirokhirurgicheskoi pomoshchi patsientam s bolezn'yu Parkinsona v Rossiiskoi Federatsii.

BACKGROUND: Currently, there are some problems in the Russian Federation complicating development of neurosurgical care for patients with Parkinson's disease (PD). MATERIAL AND METHODS: In 2022, neurologists - movement disorders specialists were surveyed to analyze situation with PD pharmacological treatment and referral of patients for surgical treatment in Russian constituent entities. Data on neurosurgical treatment of PD were obtained by collecting information on the surgical activity of medical institutions in the Russian Federation. Most hospitals involved in PD treatment took part in this study. RESULTS: The state of neurosurgical care for patients with PD is analyzed and possible ways to improve the quality of treatment are discussed. CONCLUSION: Over the past 20 years, a system of neurosurgical care for patients with PD has been formed in 14 centers in the Russian Federation (2022). Obstacles to its further development can be divided into 3 categories: problems of patient selection and routing, complexity of organization and financing surgeries, and imperfect postoperative patient management. Ways to overcome these obstacles imply expanding the network of centers for extrapyramidal diseases, development of domestic neurostimulation systems, improving the distribution of quotas taking into account the capabilities of hospitals, specialized training of neurologists for extrapyramidal centers and neurosurgeons for deep brain stimulation centers, adequate financing and systematization of postoperative management of patients with PD.

[Cognitive impairment in cerebrovascular diseases]. / Kognitivnye narusheniya pri sosudistykh zabolevaniyakh golovnogo mozga.

Cognitive impairment, which is highly prevalent, especially among older people, leads to a decrease in the quality of life of patients, impairment of daily activities, and an increased risk of dementia and mortality. Currently, much attention is paid to mild cognitive impairment. The article discusses diagnostic criteria and possible clinical variants of this syndrome. Given the high rate of progression of mild cognitive impairment to dementia, it is necessary to identify risk groups and carry out therapeutic preventive measures. Correction of potentially modifiable risk factors is considered as a promising direction of therapy. Sufficient physical and mental activity, proper diet, normalization of sleep, visual acuity and hearing are necessary. Preventing stroke and controlling vascular risk factors may reduce the risk of mild cognitive impairment progressing to dementia.

[Pathogenetic therapy of cognitive impairment: results of a multicenter placebo-controlled clinical trial of the efficacy and safety of Miladean]. / Patogeneticheskaya terapiya kognitivnykh narushenii: rezul'taty mnogotsentrovogo platsebo-kontroliruemogo klinicheskogo issledovaniya effektivnosti i bezopasnosti preparata Miladean.

OBJECTIVE: Evaluation of the efficacy and safety of the use of the drug Miladean in the treatment of patients with cognitive disorders (CDs) of vascular genesis. MATERIAL AND METHODS: In during the double-blind multicenter prospective randomized placebo-controlled phase III clinical trial, 300 patients with CDs and chronic cerebral ischemia were randomized into 3 groups: group 1 (n=100) received Miladean (daily dose: memantine 10 mg + melatonin 6 mg), group 2 (n=101) - memantine (10 mg/day), group 3 - placebo (n=99) for 8 weeks. The dynamics of the overall score (the primary criterion of effectiveness) and the proportion of patients with improvement on the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog), the dynamics of visual-spatial orientation disorders (Benton test), sleep quality (Pittsburgh Sleep Quality Index scale) and the safety of therapy were evaluated. RESULTS: Miladean demonstrated efficacy in the treatment of CDs: a statistically and clinically significant decrease in the overall score on the ADAS-Sod scale was shown (by 6.1 versus 4.7 and 3.5 points in the 2nd (p=0.009) and 3rd (p<0.05) groups) and an increase in the proportion of patients (96.9%) with clinically and statistically a significant improvement compared to the 2nd and 3rd groups (p=0.019 and p<0.001 respectively). Miladean significantly improved the performance in the Benton test (1.20±1.66 vs. 0.64±1.69 points in group 3, p=0.026) and sleep quality (84.7% of patients with CDs), compared to placebo (63.9%) and memantine (64.3%) (p=0.002 in both cases). Miladean was well tolerated, there were no cases of interaction with basic therapy drugs. CONCLUSION: The combination of many different pathogenetic effects of Miladean suggests that it has the ability to slow down the rate of progression of CDs and stabilize the condition of patients. The unique combination of active substances in Miladean has been proven to be effective and safe in the treatment of patients with CDs.

[Cognitive impairment and tactics of using the drug Cerebrolysin. Resolution of the International Council of Experts (May 12, 2023)]. / Kognitivnye narusheniya i taktika primeneniya preparata Tserebrolizin. Rezolyutsiya mezhdunarodnogo soveta ekspertov (12 maya 2023 g.).

The aging of the population and the associated increase in the share of cognitive impairments in the structure of a wide range of diseases are a serious challenge for modern healthcare. Difficulties in the treatment of cognitive disorders are determined by many factors, including the age of patients, comorbidity, forced polypragmasia and the adequacy of the dosage of drugs that restore cognitive activity. The experts discussed information about the therapeutic potential of the drug Cerebrolysin in the treatment of cognitive disorders of various origins, stated significant experience of its effective and safe use in many clinical studies in mild and moderate forms of dementia. At the same time, there was a lack of consistent and systematic data on the dosage regimen, frequency, and duration of use of the drug in different forms of cognitive impairment and the degree of their severity. The aim of the international council of experts was to determine the optimal dosage regimens of the drug Cerebrolysin in patients with various etiologies and severity of cognitive impairment. The result of the work was the approval of a unified scheme for the use of the drug Cerebrolysin, considering the severity of the disease and its duration.

[Bilateral peripheral vestibulopathy]. / Dvustoronnyaya perifericheskaya vestibulopatiya.

Bilateral vestibulopathy is a relatively widespread and at the same time rarely diagnosed cause of chronic postural instability. Numerous toxic factors, dysmetabolic, autoimmune and neurodegenerative processes can lead to this condition. The main clinical manifestations of bilateral vestibulopathy are balance disorders and visual disturbances (oscillopsia), which can significantly increase the risks of falls in such patients. In addition, cognitive and affective disorders, which also reduce the quality of life in patients with bilateral vestibulopathy, have been described and actively studied in recent years. The diagnosis of bilateral vestibulopathy is based on the results of a clinical neurovestibular study, including a dynamic visual acuity test and a Halmagyi test. A video head impulse test, a bithermal caloric test and a sinusoidal rotation test are used as instrumental methods confirming the dysfunction of the peripheral vestibular system. However, they are still not widespread in neurological practice. Treatment of bilateral vestibulopathy is reduced to vestibular rehabilitation. Encouraging results have been obtained in a number of studies using galvanic vestibular stimulation and the use of vestibular implants. In addition, cognitive rehabilitation methods are currently being developed, which presumably can also improve compensation for bilateral vestibular loss.

[Current approaches in the treatment and rehabilitation of patients with neurological diseases after COVID-19. Resolution of the International Experts Forum]. / Lechenie i reabilitatsiya bol'nykh s nevrologicheskimi narusheniyami posle perenesennogo COVID-19. Rezolyutsiya Mezhdunarodnogo foruma ekspertov.

Despite the significant shift in global attention away from the pandemic, the problem of a new coronavirus infection remains important in the medical community. Almost 3 years after the start of the COVID-19 pandemic the issues of rehabilitation and management of delayed manifestations and sequelae of the disease are especially important. According to numerous available data, the new coronavirus infection is characterized by multiorgan lesions. Respiratory dysfunction, clotting disorders, myocardial dysfunction and various arrhythmias, acute coronary syndrome, acute renal failure, GI disorders, hepatocellular damage, hyperglycemia and ketosis, dermatological complications, ophthalmological symptoms and neurological disorders may be found. Significant prevalence of the latter in the post-coronavirus period necessitated this International Expert Forum to develop unified approaches to the management of patients with neurological complications and sequelae of new coronavirus infection based on practical experience and considering the scientific information available on COVID-19. The expert council developed a resolution formulating the tactics for the management of patients with neurological manifestations of COVID-19.

[Visual disturbances in Parkinson's disease]. / Zritel'nye narusheniya pri bolezni Parkinsona.

Parkinson's disease (PD) is a slowly progressive neurodegenerative disease, the main symptoms of which are motor impairments (bradykinesia, rigidity, tremor and postural instability). However, the longer this disease is studied, the more new (non-motor) manifestations of the disease are detected. The article discusses visual disturbances that occur in patients with PD, the underlying pathogenetic mechanisms and methods of their treatment.

[Particularities of thermoregulation in Parkinson's disease]. / Osobennosti termoregulyatsii u patsientov s bolezn'yu Parkinsona.

OBJECTIVE: To evaluate the topography of thermographic characteristics and compliance with the degree of asymmetry of motor and thermometric characteristics of patients with Parkinson's disease (PD). MATERIAL AND METHODS: The study enrolled 45 patients with PD (stage 1-3) according to the Hoehn and Yahr scale. The patients were divided into two groups: a right-sided group (n=27) and a left-sided one (n=18). The groups were matched for age, disease type and duration, and symptom severity. All the patients in the study group underwent thermography investigation. RESULTS: Lower temperature values were noted on the more affected side (p<0.05) only in patients with left-sided predominance of symptoms (p<0.05). CONCLUSION: This result may suggest that left-sided PD patients have more frequent thermoregulation dysfunction, but further research is needed to investigate the relationship between thermoregulation and motor asymmetry.

[Swimming disorders in Parkinson's disease]. / Narusheniya navykov plavaniya pri bolezni Parkinsona.

OBJECTIVE: To evaluate swimming disorders in patients with Parkinson's disease (PD). MATERIAL AND METHODS: During the pilot study, we examined 40 patients with PD, who were divided into two groups depending on the presence or absence of swimming disorders. The assessment on the Hoehn-Yahr scale in both groups ranged from 1 to 3. The severity of PD was assessed according to the unified Parkinson's disease scale of the International Society of Movement Disorders (MDS-UPDRS). The Montreal Cognitive Assessment Scale, the Hospital Scale of Anxiety and Depression, a new questionnaire of freezing when walking, a 6-minute walk test, the Eysenck Personality Questionnaire were administered. RESULTS: Of 40 patients with PD, 60% reported swimming disorders. No association was found between swimming disorders and the severity of motor symptoms of PD. At the same time, an increased level of anxiety was noted in the group of patients with swimming disorders. CONCLUSION: Further research is needed to study the mechanisms of the development of swimming disorders in PD.

[Capabilities of combined therapy of Alzheimer's disease]. / Vozmozhnosti kombinirovannoi terapii bolezni Al'tsgeimera.

Alzheimer's disease is one of the most common neurodegenerative diseases worldwide and carries a huge social burden. Unfortunately, no disease-modifying drug has been approved so far. Currently approved medications are symptomatic and include two classes: cholinesterase inhibitors, such as donepezil, and NMDA receptor antagonist memantine. Most studies have shown that a combination of both classes is better than monotherapy. The review discusses the pharmacological properties, efficacy and safety data of memantine and donepezil.

[The role of cognitive impairment in the development of balance disorders in cerebrovascular diseases]. / Rol' kognitivnykh narushenii v razvitii rasstroistv ravnovesiya pri tserebrovaskulyarnykh zabolevaniyakh.

Cerebrovascular diseases and, in particular, ischemic stroke, are an important medical and social problem, remaining not only one of the leading causes of mortality, but also often leading to severe and irreversible disability. Cerebrovascular diseases, in addition to obvious focal neurological symptoms, are manifested by cognitive disorders of varying modality and severity, among which visual-spatial disorders remain almost the least studied. Many areas of the brain are responsible for providing visual-spatial functions, some of which also take part in maintaining balance. In addition, in recent years, data have appeared on the role of damage to the vestibular system in the development of visual-spatial disorders. That is, an important condition for ensuring visual-spatial functions is probably the preservation of vestibular afferent pathways. The mechanisms of the development of visual-spatial disorders with damage to vestibular structures and their relationship with the function of maintaining balance remain almost unexplored. Disorders of visual-spatial functions in patients with cerebrovascular diseases, apparently, can make a significant contribution to the development of balance disorders and make it difficult to carry out full-fledged therapeutic and rehabilitation measures in this category of patients. Currently, the diagnosis of visual-spatial disorders is insufficiently developed. There are no universal approaches to the correction of this type of vascular (including post-stroke) cognitive disorders, as well as balance disorders that have arisen as a result of visual-spatial dysfunction. Thus, further research in this area is needed to clarify the mechanisms of formation of visual-spatial disorders, their relationship with the function of maintaining balance in cerebrovascular diseases and to develop optimal ways to correct them.

[Clinical phenomenology and pathophysiology of daytime and nighttime imperative movements]. / Klinicheskaya fenomenologiya i patofiziologicheskie mekhanizmy dnevnykh i nochnykh imperativnykh dvizhenii.

Imperative movements have an intermediate position between voluntary and involuntary movements and are also referred to as semi-voluntary, or induced. Their common characteristic is the urge, forcing the patient to perform an action that can have a different duration and degree of complexity - from a short twitch (with tics) to prolonged episodes of general motor restlessness (for example, akathisia or stereotypes). The ability to slow down this movement for a short or longer period of time by volitional effort is associated with the urge to make a movement, which predetermines the patient's perception of the degree of its imperativeness and arbitrariness. All motor syndromes based on an imperative need to make movements (akathisia, tics, restless legs syndrome, some levodopa-induced dyskinesias, tardive dyskinesia, compulsive disorders, stereotypes), despite their differences, can be conditionally combined by the term «akathisia spectrum disorders¼. In some cases, violent imperative movements are paradoxically combined with hypokinetic disorders, primarily with parkinsonism, which makes the discomfort experienced by patients particularly severe.

Neurological Complications of COVID-19 in the Elderly.

SARS-CoV-2 virus is a ß-coronavirus and produces a severe viral pneumonia which can be complicated by acute respiratory distress syndrome and multiorgan failure. As knowledge of the new coronavirus infection (COVID-19) increases, it has become known that SARS-CoV-2 has pronounced neurotropism, producing a wide spectrum of neurological complications. This article addresses the characteristics of the neurological complications of COVID-19 in elderly people.

[Glymphatic system]. / Glimfaticheskaya sistema.

Glymphatic system - is a recently discovered system for waste clearance and solute balance regulation in the brain. In this article we review the modern views on anatomy and physiology of glymphatic system, the factors known to regulate glymphatic flow, as well as the role of glyphatic dysfunction in the development of central nervous system pathology.

[Roadmap for ecosystem-based approach for patients with Alzheimer disease in Russia: current needs, barriers, and possible solutions (resolution of the scientific and practical experts meeting)]. / Dorozhnaya karta po okazaniyu pomoshchi patsientu s bolezn'yu Al'tsgeimera v Rossii v formate ekosistemy: tekushchie potrebnosti, bar'ery i vozmozhnye resheniya (rezolyutsiya nauchno-prakticheskoi vstrechi ekspertov).

The care of a patient with Alzheimer's disease (AD) is considered from the perspective of an ecosystem, that is, a systemic approach describing effective partnership, collaboration and research aimed at creating value, involving all participants in the AD patient journey. The effectiveness of this ecosystem is only possible with the involvement of all stakeholders in its development, including patients, healthcare professionals at all levels, government agencies, private companies, and patient organizations. The unmet health care and information needs of patients with AD are a consequence of barriers in the AD ecosystem. Key barriers for the patient include low awareness and stigmatization of the disease in society, lack of quality epidemiological data, difficulties in timely diagnosis, lack of prevention programs, unpreparedness of most physicians to conduct AD patient rehabilitation, and other factors. Based on the analysis of the ecosystem of AD and the patient pathway, 10 main directions (strategies) necessary for the formation of the ecosystem were identified: conducting research in the diagnosis and epidemiology of AD, creating and implementing a cognitive health program, forming a legal framework, raising public awareness, optimizing patient routing for timely diagnosis, organizing a network of memory clinics/laboratories, creating a register of patients with dementia, developing digital solutions and supporting social projects.

[General mechanisms of the pathogenesis of neurodenerative and cerebrovascular diseases and the possibilities of their correction]. / Obshchie mekhanizmy patogeneza neirodenerativnykh i tserebrovaskulyarnykh zabolevanii i vozmozhnosti ikh korrektsii.

The recent research has revealed several common pathogenetic mechanisms underlying both vascular and neurodegenerative processes. This refers to chronic cerebral hypoperfusion, pathology of neurovascular units and the blood-brain barrier. The process of brain recovery in various lesions is realized due to the mechanisms of neuroplasticity. Using the example of Cerebrolysin, which has a multimodal effect, which includes an effect on the blood-brain barrier, a neurotrophic effect, an improvement in the drainage function of the brain, an anti-inflammatory effect, a direct effect on neurovascular units, the advantage of simultaneous action on various links of pathogenesis can be shown.

[Stress, asthenia and cognitive disorders]. / Stress, asteniya i kognitivnye rasstroistva.

Asthenia is a clinical syndrome that nearly any somatic and neurological pathologies can manifest with. Being is essence a defense mechanism that signals the depletion of energy resources, asthenia can become a pathological, extremely disabling condition, and even transform into a nosology of its own - the chronic fatigue syndrome, an immune-mediated disease. Besides, asthenia is often combined with affective and cognitive disorders, which facilitates difficulties in the establishing of the primary diagnosis. In this article we examine the complicated weave of asthenia, chronic fatigue syndrome, cognitive, and affective disorders.

Stress, Asthenia, and Cognitive Disorders.

Asthenia is a clinical syndrome that can be manifest in almost all somatic, infectious, and neurological diseases. Initially a protective mechanism indicating depletion of energy resources, asthenia can become a pathological and extremely disabling condition, and can even progress to an independent immune-mediated disease - chronic fatigue syndrome. Asthenia is often combined with affective and cognitive disorders, producing diagnostic difficulties. The article addresses the complex interweaving of asthenia, chronic fatigue syndrome, and cognitive and affective disorders.

[Neurological complications of COVID-19 in elderly people]. / Nevrologicheskie proyavleniya COVID-19 u pozhilykh.

Virus SARS-CoV2 (beta-coronavirus) can induce severe pneumonia with acute respiratory distress syndrome, respiratory failure and multiorgan dysfunction. As more we learned about Covid-19, we understand that SARS-CoV-2 have neuroinvasive properties and can cause different neurological complications. In this article we discusses about the features of neurological sequences of Covid-19 in elderly people.

[Diagnosis and treatment of low back pain in old patients]. / Diagnostika i lechenie boli v spine u pozhilykh.

The back pain is one of the most common and socially significant neurological syndromes, leading to limited mobility and household independence of elderly patients. Specific «serious¼ causes of back pain account for 1-2% of all cases of back pain, approximately 10% of cases of pain correspond to radiculopathy, while the rest of the most common variants is related to nonspecific axial back pain. In the most cases of back pain, a clear connection between degenerative-dystrophic changes in the spine and the clinical manifestations and intensity of back pain is absent. On the other hand, dystrophic changes in the spine, which under certain conditions can be a source of chronic pain, cannot be completely ignored. Therefore, «osteochondrosis¼ is currently considered as a heterogeneous cascade process with the different course variations. In practice, it is not always possible to draw a line between nociceptive, neuropathic, nociplastic and psychogenic pain, more often in this case we can talk about a mixed nature of pain. Unreasonable neuroimaging with the identification of «accidental¼ findings can complicate the interpretation of the causes of pain, however, it is absolutely indicated to exclude serious specific diseases, spinal stenosis, when determining the indications for surgery. The presence of comorbid affective disorders, certain personality characteristics of patients contributes to the persistent nature of low back pain, therefore it is important to take these factors into account when diagnosing the causes and treatment of pain. Along with conventional anti-inflammatory drugs and other analgesics with a proven effect in the complex treatment of patients with degenerative-dystrophic changes in the spine with radicular and non-root pain syndromes, Symptomatic Slow-Acting Drugs in Osteoarthritis can be recommended.