[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.

[Falls in patients with chronic systolic heart failure 65 and more years old.]

Today we can see a rapidly growing number of patients with systolic heart failure (HF) 65 and over years old. Geriatric conditions may play an important role in such patients. Falls are one of geriatric syndromes, which can influence in prognosis and quality of life in patients with chronic systolic heart failure. Aim of our research was to appreciate prevalence of falls in patients with systolic HF 65 and over years old, identify fall predictors in this group of patients. Patients with chronic HF 65 and over years old with depressed ejection fraction (EF less than 50%) were included in the main group (n=240). Control group (n=200) was composed by patient with cardiac diseases but with no evidences of congestive HF, without EF decline and with no significant valve dysfunctions. Patients were asked about falls and fall equivalents. Risk of falls was also validated by 1 leg balance test. Falls and fall equivalents were more frequent in the main group of patients (p=0,022). High predictive value of 1-leg balance test for such patients was validated. Time of 1-leg balance test was significantly lower in the main group of patients. Significant relations were observed between falls, fall equivalents and echocardiographic parameters. Depression of EF increase risk of fall in 1,56 times (p=0,022) but with no correlation between EF and falling risk. Falls are significantly related with left ventricular hypertrophy and diastolic dysfunction in patients with chronic systolic heart failure 65 years old and older.

[Comparative Randomized Study of the Effects of Long-Term Therapy With Rosuvastatin and Combination of Atorvastatin and Ezetimibe on Carbohydrate Metabolism and Adipokines Levels in Patients With Coronary Artery Disease and Diabetes Mellitus].

OBJECTIVE: This open randomized study compares the effects of 24-week-long treatment with rosuvastatin and with atorvastatin coadministered with ezetimibe on the parameters of carbohydrate metabolism and the plasma levels of adipokynes in patients with coronary artery disease and type 2 diabetes mellitus or impaired glucose tolerance (IGT). METHOD: A total of 31 patients with coronary artery disease and type 2 diabetes mellitus or IGT were recruited in the study. Patients were randomized into two groups: group 1 included patients who received rosuvastatin therapy in an average dose of 12.5 mg/day (n = 16); group 2 included patients who received combination treatment with atorvastatin in an average dose of 13.3 mg/day and ezetimibe (10 mg) (n = 15). Plasma levels of lipids, apoB, apoA1, glucose, insulin, leptin, and adiponectin were evaluated; HOMA-IR index (an empty stomach insulin, mu/l x fasting glucose, mmol/l)/22.5) was calculated. RESULTS: During the therapy, the LDL-C and apoB levels decreased by 51.7% and 42.3% in group 1 and by 51.8% and 44.9% in group 2, respectively. Reduction in the triglyceride levels was significantly more pronounced in group 2 than in group 1: 43.2% vs 17.4% (p < 0.02), whereas we did not observed significant changes of HDL-C and apoA1 in either group. The increases in basal glycemia, basal insulinemia, HbA1c levels (from 6.47% [6.10-7.02%] to 6.98% 16.23-8.18%]), and HOMA-IR (from 2.14 [1.68-3.51] to 4.30 [2.31-5.77]) were found only in group 2 (p < 0.05 for all). These changes were observed in 75% of patients of group 2 independently of the presence of diabetic state or IGT, but the changes were more pronounced in patients with disturbed carbohydrate metabolism. Changes of leptin levels during the therapy were diverse: 73% patients of group 1 demonstrated decrease in the leptin levels, whereas 67% of patients in group 2 experienced 57%-increase in the leptin concentrations. Degree of increased basal glycemia was associated with increase in the leptin levels (r = 0.37, p = 0.04) in the entire group of patients (n = 31). Furthermore, changes in leptin levels were negatively associated with decreased adiponectin levels (r = -0.57, p = 0.034). CONCLUSIONS: In case of equivalent degree of the decrease in LDL-C levels, 24-week combination therapy with atorvastatin and ezetimibe, unlike rosuvastatin treatment, induced increases in basal glycemia, insulinemia, HbA1c, and HOMA-IR index irrespective of the presence of carbohydrate metabolism disturbances before treatment. Our data suggest that adiponectin and leptin are involved in the mechanisms of adverse metabolic effects of the combination of atorvastatin and ezetimibe.

[Comparative Randomized Study of the Effects of Long-Term Therapy With Rosuvastatin and With Combination of Atorvastatin and Ezetimibe on Carbohydrate Metabolism and Adipokynes Levels in Patients With Coronary Artery Disease and Diabetes Mellitus].

OBJECTIVE: This open randomized study compares the effects of 24-week-long treatment with rosuvastatin and with atorvastatin coadministered with ezetimibe on the parameters of carbohydrate metabolism and the plasma levels of adipokynes in patients with coronary artery disease and type 2 diabetes mellitus or impaired glucose tolerance (IGT). METHOD: A total of 31 patients with coronary artery disease and type 2 diabetes mellitus or IGT were recruited in the study. Patients were randomized into two groups: group 1 included patients who received rosuvastatin therapy in an average dose of 12.5 mg/day (n=16); group 2 included patients who received combination treatment with atorvastatin in an average dose of 13.3 mg/day and ezetimibe (10 mg) (n=15). Plasma levels of lipids, apoB, apoA1, glucose, insulin, leptin, and adiponectin were evaluated; HOMA-IR index (an empty stomach insulin, mu/l x fasting glucose, mmol/l) / 22.5) was calculated. RESULTS: During the therapy, the LDL-C and apoB levels decreased by 51.7% and 42.3% in group1 and by 51.8% and 44.9% in group 2, respectively. Reduction in the triglyceride levels was significantly more pronounced in group 2 than in group 1: 43.2% vs 17.4% (p<0.02), whereas we did not observed significant changes of HDL-C and apoA1 in either group. The increases in basal glycemia, basal insulinemia, HbA1c levels (from 6.47% [6.10-7.02%] to 6.98% [6.23-8.18%]), and HOMA-IR (from 2.14 [1.68-3.51] to 4.30 [2.31-5.77]) were found only in group 2 (p<0.05 for all). These changes were observed in 75% of patients of group 2 independently of the presence of diabetic state or IGT, but the changes were more pronounced in patients with disturbed carbohydrate metabolism. Changes of leptin levels during the therapy were diverse: 73% patients of group 1 demonstrated decrease in the leptin levels, whereas 67% of patients in group 2 experienced 57%-increase in the leptin concentrations. Degree of increased basal glycemia was associated with increase in the leptin levels (r=0.37, p=0.04) in the entire group of patients (n=31). Furthermore, changes in leptin levels were negatively associated with decreased adiponectin levels (r=-0.57, p=0.034). CONCLUSIONS: In case of equivalent degree of the decrease in LDL-C levels, 24-week combination therapy with atorvastatin and ezetimibe, unlike rosuvastatin treatment, induced increases in basal glycemia, insulinemia, HbA1c, and HOMA-IR index irrespective of the presence of carbohydrate metabolism disturbances before treatment. Our data suggest that adiponectin and leptin are involved in the mechanisms of adverse metabolic effects of the combination of atorvastatin and ezetimibe.