[Cognitive impairment in patients of cardiac surgery with senile asthenia syndrome and preastenia]. / Narusheniya kognitivnykh funktsii u patsientov kardiokhirurgicheskogo profilya s sindromom starcheskoi astenii i preastenii.

OBJECTIVE: To identify the features of the cognitive status in patients with cardiac surgery profile with senile asthenia syndrome (SAS) and preasthenia. MATERIAL AND METHODS: A study included 272 patients admitted for coronary artery bypass grafting (CABG). Screening for preasthenia and SAS in patients before surgery was performed using the Brief Battery of Physical Functioning Tests. SAS and preasthenia were detected in 15% of patients (n=41). Seventy-five patients were selected in the comparison group without asthenia. Assessment of the state of cognitive functions was carried out using screening neuropsychological scales - the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). RESULTS: The median of the MMSE score (27 [26; 28] and 28 [27; 29], p=0.04), and the MoCA score (23 [19; 25] and 25 [23; 27], p=0.0085) was significantly lower in patients with asthenia and pre-asthenia compared to patients without asthenia. According to the MoCA, about 60% of patients in the pre-asthenia-asthenia group had severe cognitive impairment, while in the group without asthenia, more than 30% of cases had normal cognitive functions (p=0.003). Significant intergroup differences were found in MoCA subtests, reflecting visuospatial skills, abstraction, verbal fluency and working memory (p=0.01-0.04). Regression analysis showed that age and physical functioning index (severity of asthenia) most significantly contributed to the basic cognitive status assessed by MoCA. CONCLUSION: Features of the cognitive status in patients of cardiac surgery with the SAS and preasthenia are impairments of visuospatial thinking, verbal fluency, abstract thinking and working memory. The MoCA was shown to be informative in determining the basic cognitive status of cardiac surgical patients. At the same time, the greatest contribution to the basic cognitive status is made by age and the indicator of physical functioning, which characterizes the degree of asthenia.

[Neurophysiological correlates of postoperative cognitive disorders]. / Neirofiziologicheskie korrelyaty posleoperatsionnykh kognitivnykh rasstroistv.

OBJECTIVE: A special place among cognitive disorders in patients with cardiovascular diseases is given to postoperative cognitive dysfunction (POCD). The study aimed at investigating the patterns of beta-2 activity associated with postoperative cognitive dysfunction (POCD) in patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: The study included 60 patients who underwent neuropsychological testing 3-5 days before surgery and on the 7-10th day of CABG. A multichannel electroencephalogram of resting state with eyes closed in 62 standard leads was recorded. Statistical processing of the results was carried out using Statistica 10 (StatSoft Inc, USA) and the developed method of data clustering with a minimax criterion, a software implementation of the binary clipping and branching algorithm was used to find optimal solutions. RESULTS: Patients with POCD had higher pre- and postoperative high-frequency beta-2 rhythm power (20-30 Hz) compared with patients without cognitive impairment. The regression model demonstrated that POCD was associated with high values of preoperative beta-2 activity in the right frontal cortex and with low values in the left parietal areas after CABG. The clustering of beta-2 rhythm power before and after CABG revealed that the best cognitive status corresponded to a stable affiliation of patients with the selected clusters. CONCLUSION: The specific POCD correlates were established in patients after CABG. Low cognitive status was characterized by the preoperative beta-2 power increase in the right frontal areas and postoperative decrease in the left parietal cortex. The developed method for classifying patients according to the level of pre- and postoperative beta-2 rhythm power has a good discriminant ability. Stable patient affiliation with the selected clusters was associated with a higher level of cognitive status.

[Electric brain activity in patients with simultaneous coronary artery bypass grafting and carotid endarterectomy]. / Izmeneniia pokazatelei élektricheskoi aktivnosti golovnogo mozga u patsientov, perenesshikh odnomomentnoe koronarnoe shuntirovanie i karotidnuiu éndarteréktomiiu.

AIM: To analyze the postoperative electroencephalography (EEG) power changes in patients after simultaneous coronary artery bypass grafting (CABG) and a left- or right-sided carotid endarterectomy (CEE). MATERIAL AND METHODS: Forty-four patients with indications for surgical myocardial revascularization, including 24 patients with indications for CEE, were studied. Patients after simultaneous coronary and carotid surgery were divided into groups depending on the side of CEE: the left+CEE CABG group included 14 patients, the right CEE+CABG group included 10 patients. The group of isolated CABG consisted of 20 patients. The resting-state EEG with closed eyes was recorded before and at the 7-10th day after surgery. The changes of the spectral power (µV2/Hz), theta1 (4-6 Hz), theta2 (6-8 Hz), alpha1 (8-10 Hz), alpha2 (10-13 Hz) rhythms were analyzed, the hemispheric asymmetry (HA) coefficient of the rhythms was calculated. RESULTS AND CONCLUSION: In the early postoperative period, the power of theta1 and theta2 rhythms increased compared to the preoperative level regardless of the type of cardiosurgical intervention. A local character of postoperative theta activity changes was revealed in the left+CEE CABG group, whereas the most pronounced decrease of the alpha-rhythm HA coefficient was observed in the right CEE+CABG group at the 7-10th day after surgery in comparison to the preoperative level. The results of the study suggest that the simultaneous coronary and carotid surgery does not significantly exacerbate the severity of brain damage compared to isolated CABG.

[Factors for the development of persistent postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery under extracorporeal circulation]. / Faktory razvitiia stoikoi posleoperatsionnoi kognitivnoi disfunktsii u patsientov, perenesshikh koronarnoe shuntirovanie v usloviiakh iskusstvennogo krovo-obrashcheniia.

AIM: To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC). SUBJECTS AND METHODS: 257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3-5 days before, 7-14 days and 1 year after CABS. Persistent POCD was diagnosed if there was a 20% decline in cognitive domains at 1-year postoperatively versus preoperatively in 20% of the tests of an entire neuropsychological battery. Binary logistic regression analysis was applied to identify the factors supposedly increasing the risk of persistent POCD. RESULTS: It was found that high baseline cognitive status, early POCD after CABG under EC, low adherence to the prescribed treatment regimen, as well as progressive carotid artery (CA) stenosis could predict with a high (85%) probability that persistent POCD might develop at 1 year after surgery. CONCLUSION: The findings are suggestive of the multifactorial origin of persistent POCD, a significant role in the development of which is played by not only the preoperative cognitive status, but also by postoperative factors, such as the degree of adherence to the prescribed treatment regimen, early POCD, and progressive CA stenosis.

[PREDICTORS OF MODERATE COGNITIVE DISORDERS IN PATIENTS WITH CORONARY HEART DISEASE AND TYPE 2 DIABETES MELLITUS].

AIM: To study predictors of moderate cognitive disorders (MCD) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: The study included 54 men with CPD andDM2 (mean age 56.8 ± 4.5 years). Standard medical examination was supplemented by the assessment of cognitive status, characteristics of lipid and carbohydrate metabolism. Factors allegedly influencing MCD development included the patients' age, education level, stenosis of carotid arteries, LV ejection fraction, arterial hypertension, insulin and HbAlc levels, HOMA and QUICKI indices, lipid metabolism, concentrations of total, HDL and LDL cholesterol, fructosamine, triglycerides, severity of coronary lesions (Syntax scale), trait and state anxiety. RESULTS: Fructosamine level and HOMA index were the most important characteristics responsible for MCD in patients with CPD and DM2. CONCLUSION: The data obtained demonstrate the significance of fructosamine level and HOMA index in the development of MCD in patients with CPD and DM2.

[Effect of Statins on Development of Early Cognitive Dysfunction After Coronary Artery Bypass Grafting].

We studied the effect of rosuvastatin on the development of early postoperative cognitive dysfunction (POCD) in patients after coronary artery bypass grafting (CABG). One hundred nine men aged 45-70 year was divided into two groups. Group 1 comprised 69 patients (mean age 56.8 ± 5.2 years) who were given 20 mg of rosuvastatin for 10-14 days before CABG and until discharge. Patients of group 2 (n=40, mean age 55.9 ± 5.3 years) did not take rosuvastatin. It was shown that patients of group 2 had better neuropsychological parameters after CABG in comparison with the patients of group 2. Patients of group 1 had lower concentrations of interleukin (IL)-1ß, IL-6, IL-8, tumor necrosis factor α, high sensitivity C reactive protein, and higher concentrations of IL-10. Group 2 patients had worse neuropsychological parameters which were associated with higher concentrations of proinflammatory cytokines. These results may indicate that preoperative therapy with rosuvastatin had decreased the severity of systemic inflammatory response and reduced the development of early POCD after CABG.

[Population Dynamics of Cancer: a Model of Second Order Phase Transition].

The paper deals with an approach to the description of the age and temporal dynamics of cancer, based on the model describing the dynamics of the age of cancer as a second order phase transition. This approach is widely used for studying physical systems. This model of cancer development as second order phase transitions is in a good agreement with medical statistics. The cancer incidence dynamics is described only with two free parameters, easily verified according to statistics and well interpreted. The applicability of the second order phase transition model for description of a non-physical system defines the universal nature of the processes occurring during phase transitions.

[Association of cognitive impairments with carbohydrate and lipid metabolic parameters in type 2 diabetes mellitus patients undergoing coronary bypass surgery].

UNLABELLED: AIM. To comparatively analyze neuropsychological parameters in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (DM) and to evaluate their relationship to carbohydrate and lipid metabolic parameters. SUBJECTS AND METHODS: Fifty-two male patients with type 2 DM (mean age 58.0 ± 5.7 years) and 46 male patients without this condition (mean age 57.1 ± 6.2 years) were examined. Besides standard clinical examination, neurophysiological testing and determinations of glycated hemoglobin (HbA(1c),) and insulin concentrations, QUICKI index, and blood lipid profile were made. RESULTS: The patients with DM differed from those without DM in the lower speeds of sensorimotor reactions during neurodynamic testing and in worse attention values. In the patients with type 2 DM, the worse neuropsychological status was associated with the higher plasma concentrations of glucose, insulin, HbA(1c), total cholesterol, low-density lipoproteins, and triglycerides and with the lower levels of high-density lipoproteins. These relationships were not observed in the patients without DM. CONCLUSION: The patients with CAD concurrent with DM had a worse neurophysiological status than those without DM. Only the DM group demonstrated a relationship between cognitive impairments and carbohydrate metabolic markers. Carbohydrate and lipid metabolic disturbances may be assumed to make a negative contribution to the development of cognitive impairments in patients with CAD concurrent with type 2 DM.

[A role of carotid stenoses in the structure of early postoperative cognitive dysfunction in patients underwent coronary artery bypass grafting].

OBJECTIVE: To analyze the structure and severity of early postoperative cognitive dysfunction as well the accompanying spectral electroencephalographic (EEG) changes in patients underwent coronary artery bypass grafting (CABG) depending on the presence or absence of small and moderate internal carotid stenosis. MATERIAL AND METHODS: Fifty seven patients, aged from 45 to 70 years, were stratified into two groups: without stenosis (n=35, mean age 54.3±6.4 years) and with internal carotid stenosis (n=22, mean age of 57.5±5.8 years). For all patients planned on-pump CABG was performed. RESULTS: The frequency and severity of cognitive deficits in the postoperative period were higher in patients with internal carotid stenosis compared to patients without stenosis. Also, the patients with stenosis had more pronounced EEG signs of cortical dysfunction and brain damage after CABG compared to patients without stenosis. CONCLUSION: The presence of carotid >50% stenosis increases the severity of cognitive deficits and brain damage in patients underwent on-pump CABG.

[Mild cognitive impairment in patients with coronary artery disease: clinical-demographyc and EEG-correlates].

OBJECTIVE: The clinical and demographic factors associated with mild cognitive impairment (MCI) and the topographical features of electroencephalogram (EEG) spectral power in patients with coronary artery disease (CAD) depending on the presence or absence of MCI were studied. MATERIAL AND METHODS: Seventy-five male patients with CAD were assigned to the groups with (n=31) and without MCI (n=44). The control group included 15 healthy people (the mean age 60.0 ± 4.39 years). The MMSE, the Frontal Assessment battery, the Trail-Making Test, Khanin-Speilberger and Beck depression scales were used. RESULTS: A lower level of education, more severe coronary lesions and lower cardiac contractility, as well as higher spectral power (Θ-rhythm) of parietooccipital theta activity have been found in CAD patients with MCI compared to patients without MCI. The latter parameter in MCI patients also differed from controls. CONCLUSION: Education is an important factor to preserve cognitive abilities in patients with CAD. In addition, the severity of coronary artery lesions and low cardiac contractility affect the degree of cerebral ischemia and neuronal dysfunction detected by spectral EEG power. The efficacy of quantitative EEG analysis methods for early detection and prevention of cognitive disorders in CAD patients was confirmed.

[The reward impact on the performance of verbal creative tasks: behavioral and EEG effects].

The aim of this study was to compare the effects of stimulating originality verbal instruction (IN1) and monetary reward (IN2) on originality of solutions of a verbal creative task and EEG-correlates of activity, determined on the basis of biopotentials power mapping in the frequency range 4-30 Hz. Right-handed students (10 men and 10 women) took part in experiment. An increase of solutions originality under the influence of monetary reward was revealed. At the promise of monetary reward in comparison with IN1, there was a global increase of the task-related theta2 power. Common to the teta1, 2 and alpha2 bands was increase in hemispheric asymmetry of these rhythms power with higher values in the right hemisphere of the brain. These changes have been observed already in the background EEG after IN2 and testify that generalized changes in hemispheric asymmetry provide the preparatory state after the promise of monetary reward. Regional brain activity changes were associated with beta2 rhythm. Under IN2 in comparison with IN1 the task-related power decreased in all posterior electrode sites except for frontotemporal. Reward-related EEG changes were more typical for men. In men only, promised monetary reward increased theta2 asymmetry and task-induced alpha power. Our results suggest that promise of monetary reward for creative thinking can increase verbal creativity. Gender differences in the reward-related EEG power changes show that men and women differ in neurophysiologic mechanisms that underlie increase of creativity.

[Neuropsychological status of patients with low and moderate carotid artery stenoses after the coronary artery bypass surgery].

The purpose of the study was a comparative evaluation of a neurological and neuropsychological status of patients with and without carotid artery stenoses less than 50% after coronary artery bypass grafting. The study involved 65 patients divided into two groups: the first group included 35 patients (mean age 56.2±5.7 years) without carotid artery stenoses, the second group included 30 patients (56.8±5.5 years) with the presence of carotid artery stenoses. Initially, all patients had comparable clinical parameters. Before surgery, the high frequency of asthenic, vestibulopathic and vestibular-atactic syndromes was observed in patients with the presence of low and moderate stenoses of carotid arteries compared to patients without stenoses. After coronary artery bypass grafting, the neurological status of patients became worse in both groups. Patients with the presence of low and moderate stenoses of carotid arteries performed worse on neuropsychological tests one month after surgery.

[EEG changes in patients undergoing on-pump coronary artery bypass grafting].

We studied the changes of electroencephalograms (EEG) related to on-pump coronary artery bypass grafting (CABG) in 28 right-handed male patients with coronary heart disease (CHD), 10 from which had accompanying moderated (30-50%) carotid artery (CA) stenoses. All EEG studies were performed 3-5 days before and 7-11 days after CABG. EEG data of healthy age-matched males (n=14) were examined. Before surgery, the CHD patients differed from the control group by less expressed theta2 and beta1 rhythm power asymmetry. The differences demonstrated worse conditions for cognitive processes in CHD patients. After CABG, the higher power of teta1 and 2 rhythms, predominantly in the frontal lobe of the left hemisphere which was mostly expressed in patients with CA stenosis, was observed in all CHD patients. This effect can be considered as the appearance of ischemic neuronal injury caused by on-pump CABG. The localization of changes in the frontal cortex of the left hemisphere can be related to a high vulnerability of these regions. The deficit of cerebral blood flow in these regions will define a clinical picture of cognitive decline after CABG.

[Electrophysiological mechanisms and possibility of increasing figural creativity under conditions of monetary reward].

Analysis of EEG correlates of figural creativity (Torrens "Incomplete figures" subtest) and its efficacy after the instruction "to create an original solution" (condition I) and after the same instruction with the promise of a monetary reward for high performance (condition II) was carried out. Fifteen right-handed men and 16 women were examined. In condition II, the image originality was not increased, but performance fluency was reduced as compared to condition I. Promise of the monetary reward in condition II was followed by a decrease in the theta1-rhythm power before the task performance, which persisted during the image creation. Baseline values of the power of rhythms alpha1 and 2 were higher in condition II as compared to condition 1. Promise of the monetary reward in condition II was associated with a reduction of the experimental beta1- and beta2-rhythm power in posterior regions of the cerebral cortex. These effects may be associated with pre-setting to the forthcoming activity and task performance under increased extrinsic motivation. The enhancement of external motivation in condition II also induced changes in hemispheric power asymmetry of the teta1-, alpha1, and beta2-rhythm at the expense of the left-hemisphere activity, which may be the basis of different effects of high motivation levels on subjects, who preferred right or left hemispheric strategies during figural divergent thinking.

Pecularities of prolonged use of moxonidine in patients with hypertension associated with metabolic syndrome.

A 6-month clinical study with active therapeutic intervention was carried out to evaluate the efficacy of moxonidine for the correction of arterial hypertension in 30 patients with metabolic syndrome. Along with the metabolic neutrality for the lipid and purine metabolism, the drug demonstrated a distinct antihypertensive effect, which against the background of pronounced sympatholytic action after 3 months of therapy tends to disappear, which can be prevented by dosage correction. It was shown that the efficacy of moxonidine in reducing insulin resistance in patients with metabolic syndrome directly depends on the severity of hypersympathicotonia manifesting in heart rate over 80 bpm at rest.

Gender-related differences in changes in the coherence of cortical biopotentials during image-based creative thought: relationship with action efficacy.

The aim of the present work was to study the characteristics of cortical interactions during performance of an image-based creative task in men and women with high and low levels of creativity. Subjects were divided into groups on the basis of the median originality score. EEG recordings were made in baseline conditions and during performance of the task (the Torrance Tests of Creating Thinking, "Incomplete Figures"). EEG coherence was calculated in six frequency ranges, from theta1 to beta2. Total coherence was analyzed for each of 16 leads calculated separately for intrahemisphere and interhemisphere coherence links. Differences in changes in coherence evoked by performing the task between subjects with high and low levels of originality were seen at the theta2, alpha1, and alpha2 frequencies. These differences resulted from decreases in coherence at low levels of originality, accompanied by increases in coherence in the theta1 and alpha 2 ranges and, at high levels of originality, a less significant decrease in the alpha2 range. The alpha2 range also showed an interaction between the gender, creativity, laterality, and electrode position factors on analysis of task performance-linked intrahemisphere coherence of cortical biopotentials. The patterns of the spatial distributions of coherence across the hemispheres were found to be similar in men and women with opposite levels of creativity, while task-linked changes in coherence in the anterior areas of the left and posterior areas of the right hemisphere were larger in high-creativity men as compared with those with low creativity. The results are evaluated in relation to the possibility that men and women use different cognitive strategies to achieve identical results from creative activity.

[Relationships between theta- and beta-oscillations and the level of creative achievement].

The interrelations between the level of creative ability and features of baseline power and event-related desynchronization/synchronization (ED/ES) of the theta and beta rhythms during a figural creative task (Torrance Test "Incomplete figures") in conditions of different motivation were studied. Increased motivation was induced by instruction "to create most unique images" in comparison with instruction "to create images". The subjects, right-handed students (14 males and 14 females), were divided into groups with high and low originality scores. Baseline theta2 and beta1,2 power and ED/ES of the rhythms were related to creativity level and sex of participants. These relationships were found only under instruction "to create images". Males with higher originality scores differed from males with lower originality scores by more pronounced ED in temporal-parietal-occipital regions of the brain. Such differences were absent in women. In the betal band, during task performance the high-creative men demonstrated ED in contrast to ES that was demonstrated by the high-creative women. Analysis of the beta1,2 reference power showed that only in the high-creative women beta1 power was higher in the caudal then in the frontal hemispheric regions. The high creative participants of different genders had different laterality patterns of activity in electrode loci Fp1/2 (betal) and Fp1/2, F7/8 (beta2). The obtained results allow to suggest that high creativity in men and women is related to gender specific patterns of frontal-occipital and lateral organization of activity of theta and beta brain oscillators.

[The characteristics of cortical interactions in high and low verbal creative subjects].

The characteristics of cortical interactions depending on level of creative achievements were investigated in 40 right-handed subjects (22 men and 18 women). The subjects were divided into the two groups with high and low ability by the originality score median split. EEG was recorded in rest and during task performance (the verbal creative task "Cognitive synthesis"). EEG coherence was computed in the six frequency range from 4 to 30 Hz. Total values of coherence for each of 16 sites, calculated separately for intrahemispheric and interhemispheric connections were analyzed. It was revealed that subjects with higher originality scores (OS) in comparison to low original ones were characterized by decreased the theta 1.2 rhythms interhemispheric coherence, that was expressed in the frontal cortex, and increased beta1-rhythm interhemispheric coherence in the occipital and temporoparietal regions of the brain. The obtained results are discussed from the point of view of the contribution of the right and left hemispheres of the brain to processes "top-down" and "bottom-up" regulation during creative thinking.

Changes in the coherence of cortical biopotentials during performance of a verbal creative task in men and women.

Changes in EEG coherence patterns evoked by performance of a verbal creative task were studied in 14 men and 13 women (university students). EEG coherence was calculated in six frequency ranges from 4 to 30 Hz. The experiment consisted of two series: in the first, the task was performed with the instruction to "create a sentence;" in the second, the instruction was to "create an original sentence." Independently of the instruction given, the reactivity of total coherence of biopotentials (experimental data minus the corresponding baseline measure) in all subjects was negative in the theta-1 and alpha-2 frequency ranges, while reactivity in the beta-2 range was positive. Gender-related differences linked with the type of experimental instruction were seen in changes in intrahemisphere coherence of biopotentials, and these were indifferent in relation to EEG frequencies. Performance of the verbal creative task with the instruction to "create an original sentence" was accompanied in women by substitution of right-hemisphere dominance (greater levels of coherence in the right hemisphere compared with the left) by left-hemisphere dominance as compared to performance with the instruction to "create a sentence," while the reverse changes were seen in men.