[Treatment of cognitive, behavioral and mental disorders in patients with vascular dementia: results of a multicenter, randomized, double-blind, placebo-controlled clinical trial]. / Lechenie kognitivnykh, povedencheskikh i psikhicheskikh narushenii u patsientov s sosudistoi dementsiei: rezul'taty mnogotsentrovogo randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo klinicheskogo issledovaniya.

OBJECTIVE: Evaluation of the efficacy and safety of Prospect in the treatment of cognitive, behavioral and mental disorders in patients with vascular dementia (VSD). MATERIAL AND METHODS: In a double-blind, placebo-controlled, parallel-group randomised clinical trial, 406 patients aged 60-85 years old with a diagnosis of mild/moderate vascular dementia (10-24 on the Mini-Mental State Examination (MMSE)) and without signs of depression (Cornell Scale for Depression in Dementia (CSDD) scores ≤10) were included. At Visit 1, complaints and medical history were collected, vital signs were recorded, cognitive impairment was assessed using MMSE and MoCA, NPI-C and CSDD were completed, and an MRI brain scan was performed. Patients were randomised into two groups: patients in group 1 received Prospekta in a dosage of 2 tablets two times a day for 24 weeks, and patients in group 2 received Placebo according to the study drug regimen. RESULTS: Patients in both groups had no differences in demographic and baseline clinical characteristics. Administration of Prospekta for 24 weeks reduced cognitive impairment in patients with vascular dementia compared to the placebo group. The mean MoCA score increased from 17.0±3.6 [17.1±3.6] to 20.5±4.7 [20.4±4.7] in patients treated with Prospekta, whereas it increased from 17.3±3.7 [17.3±3.8] to 19.2±4.9 [19.2±5.0] in the Placebo group. Treatment with the medication also reduced the severity of neuropsychiatric symptoms as measured by the NPI-C scale. The mean score on this scale decreased from 57.0±26.7 [56.7±25.4] to 39.8±23.6 [39.8±23.5] in the Prospekta group and from 55.5±25.5 [55.3±24.4] to 42.8±27.6 [42.3±25.3] in the Placebo group. The difference in mean MoCA and NPI-C scores between the Prospekta and Placebo groups was statistically significant. CONCLUSION: Prospekta is an effective and safe drug for treating cognitive, behavioural and mental disturbances in patients with vascular dementia.

[Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts (June 8, 2023)]. / Bioregulyatsionnyi preparat N'yureksan v lechenii trevozhnosti i dissomnii. Rezolyutsiya Soveta ekspertov (8 iyunya 2023 g.).

Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts.

[Migraine burden and clinical inertia: what can we do?] / Migren' i klinicheskaia inertsiia: chto my mozhem sdelat'?

AIM: To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines. MATERIAL AND METHODS: The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years. RESULTS: Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications. CONCLUSION: To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.

['Point of no return' in diabetic neuropathies: a dangerous delusion]. / 'Tochka nevozvrata' pri diabeticheskikh neiropatiiakh: opasnoe zabluzhdenie.

Polyneuropathy in patients with diabetes mellitus is manifested by a lesion of peripheral sensory, motor and autonomic nervous system. Different severity of damage of sensory, motor and autonomic fibers in typical and atypical forms of diabetic polyneuropathy, requires a differentiated approach to therapy, but not the rejection of its implementation. In an interdisciplinary consensus, consultations are held with physicians from different regions of the Russian Federation, and modern methods of diagnosing and assessing the severity of diabetic polyneuropathies, which determine the algorithm for treating patients, are discussed.

[Sleep disorders in neurological department and Kleine-Levin syndrome]. / Rasstroistva sna v nevrologicheskom statsionare i sindrom Kliaine-Levina.

The authors present a case-report of a 22-year-old man with Kleine-Levin syndrome (KLS) and consider the historical description of the syndrome, its symptoms, diagnostic criteria, its place in modern classifications of sleep disorders and KLS pathogenesis. Own data on the frequency of different sleep disorders in inpatients of a neurological unit are presented.

[Efficiency of post-stroke rehabilitation measures at hospital: quantitative analysis of motor function recovery]. / Éffektivnost' reabilitatsionnykh meropriiatii posle insul'ta v statsionare: kolichestvennyi analiz vosstanovleniia dvigatel'nykh funktsii.

BACKGROUND: Mobility recovery is one of the main purposes of physical rehabilitation after acute stroke and in a number of other neurological diseases. AIM: To quantify the efficiency of rehabilitation measures in patients after stroke and to compare the effectiveness of motor function restoration in patients in the acute phase of stroke and in the early recovery period. METHODS: Examinations were made in 116 patients aged 27 to 88 years who had experienced a stroke (75% of ischemic stroke cases) and been admitted to the Department of Medical Rehabilitation. A control group consisted of 111 sex- and age-matched patients who had suffered a stroke (86% of ischemic stroke cases) and been admitted to the Department of Neurology for patients with acute cerebrovascular accident. The methods of working with patients included a clinical interview and an evaluation of complaints and history data, as well as a classic neurological examination using quantitative scales to assess symptoms, degree of disability and mobility. RESULTS: The cycle of rehabilitation measures provided the following quantitative recovery indicators: the strength scale showed recovery indicators (from 0 to 5 scores) by an average of 1 score in both groups; Ashworth's scale scores for spasticity improved by an average of 1 in the Department of Rehabilitation; the average Rankin scale demonstrated 1 score better in both groups; and the Rivermead mobility index improved by an average of 3 scores in the Department of Rehabilitation and by an average of 8 scores in the Department of Neurology for patients with acute cerebrovascular accident. CONCLUSION: The investigation demonstrated the quantitatively best indicators in patients with acute stroke, in those with more severe motor deficits, and in younger individuals.

[An impact of affective and cognitive impairment on the quality of life in patients with lymphoproliferative diseases]. / Vliianie affektivnykh i kognitivnykh narushenii na kachestvo zhizni u patsientov s limfoproliferativnymi zabolevaniiami.

AIM: To assess the neurological and cognitive status, identify the frequency of anxiety and depression in patients with lymphoproliferative diseases, and analyze their impact on the quality of life of patients. MATERIAL AND METHODS: Fifty-eight patients, including 35 (60.34%) men and 23 (39.66%) women aged from 42 to 86 years, with a diagnosis of chronic lymphocytic leukemia (CLL) or multiple myeloma (MM) were examined. Clinical and anamnestic methods, the Montreal scale of cognitive function assessment, the Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Cancer Therapy-General (FACT-G) were administered. RESULTS: Cognitive impairment was observed in 44 (75.86%) patients. Thirty-two (56.14%) patients had no symptoms of depression, clinically diagnosed depression was observed only in 8 (14.04%). In 37 (64.91%) patients, there were no symptoms of anxiety, clinically diagnosed anxiety was revealed in 6 (10.53%). The average score on the FACT-G scale for quality of life was 62.72±23.29 with a maximum score of 108. CONCLUSION: Cognitive impairment was observed in a large number of patients. Symptoms of depression were found in less than half of the patients, and manifestations of anxiety were found in one third. The presence of affective disorders, such as anxiety and depression, reduced quality of life evaluated in all its modules.

[Ways of optimizing the management of patients with migraine in Russia (resolution of the council of experts)]. / Puti optimizatsii vedeniia patsientov s migren'iu v Rossii (rezoliutsiia soveta ékspertov).

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.

[Depression and depression-related disorders after a subarachnoid hemorrhage]. / Depressiia i paradepressivnye rasstroistva posle subarakhnoidal'nogo krovoizliianiia.

Psychiatric disorders often develop after subarachnoid hemorrhage (SAH); the most frequent of them are depression and depression-related disorders (anxiety, apathy, pathological fatigue, posttraumatic stress disorder, etc.). Both biological and psychological mechanisms may underlie the development of these disorders. Depression and depression-related disorders decrease patients' quality of life and prevent the full recovery after SAH. Identification and correction of these disorders should take a prominent place in the rehabilitation of post-SAH patients. More research is needed in this area.

[Pathological fatigue and fatigability after stroke]. / Patologicheskaya ustalost' i utomlyaemost' posle insul'ta.

AIM: To compare the phenomena of pathological fatigue and fatigability in patients after stroke. MATERIAL AND METHODS: Forty-two patients were examined 6-24 months after stroke onset. Fatigue and fatigability were assessed by Russian versions of the Fatigue Assessment Scale and the Dutch Exertional Fatigue Scale, respectively. RESULTS AND CONCLUSION: The severity of both fatigue and fatigability was related to the levels of anxiety and depression. The degree of fatigability, but not fatigue, depended on the severity of cognitive and physical deficits. Thus, fatigue and fatigability after stroke represent different phenomena.

[The early post-stroke mobilization].

Early mobilization is an important prerequisite for the successful recovery after stroke. However, it is unclear at present how early mobilization should be started after stroke. Three randomized controlled trials were devoted to the comparison of the effectiveness and safety of very early (within the first day after stroke) and early (within two days after stroke) mobilization. The meta-analysis of the results of these studies did not reveal any advantages of very early mobilization over early mobilization. One randomized control study was designed to compare the consequences of mobilization within 3 and 7 days after stroke. It has demonstrated that earlier mobilization is associated with fewer complications and does not exert negative effect on cerebral haemodynamics. A number of observational studies confirmed the positive effect of early mobilization on the outcome of stroke. It is concluded that it may be justified to start mobilization on the second day after stroke provided there are no contraindications to such modality. The practicability of very early mobilization remains to be elucidated.

[Impairment of attention in post-stroke fatigue and depression]. / Narusheniya vnimaniya pri postinsul'tnoi ustalosti i depressii.

OBJECTIVE: To study the relationship between impairment of attention and development of pathological fatigue and depression after non-disabling stroke. MATERIAL AND METHODS: Thirty patients were examined. Attention was assessed by the Attention Network Test (ANT). Pathological fatigue and depression were assessed by the Fatigue assessment scale and depression subscale of the Hospital Anxiety and Depression Scale, respectively. RESULTS AND CONCLUSION: The association between the severity of depression and fatigue after stroke and reduction of mean reaction time in ANT was found. A decrease in the reaction time may be one of the factors reducing working ability in patients with post-stroke fatigue and depression even in the absence of severe neurological deficit. This has to be taken into account when planning rehabilitation.

[Confusion assessment method for intensive care unit (CAM-ICU)].

Delirium is a serious complication of disorders of nervous system and requires early detection for successful treatment. Confusion assessment method for intensive care unit (CAM-ICU) is a fast and reliable tool for detection of delirium. We performed screening for delirium among patients of neurological ward using CAM-ICU. Our experience showed that CAM-ICU could be used for the identification of delirium in neurological patients excluding those who suffer from severe aphasia.

[Delirium in the clinical practice of a therapist].

Delirium is a neuropsychiatric condition that may complicate any visceral disease. Its rate is especially high among patients with inflammatory diseases or metabolic disturbances and in the elderly. Brain injury concurrent with an abnormal stress response underlies the development of delirium. The clinical picture of delirium is characterized by clouding of consciousness accompanied by global cognitive and behavioral changes. According to the nature of changes in motor behavior, delirium is divided into hyperactive, hypoactive, and mixed subtypes. Special scales, such as Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), are used to identify delirium. Management of delirium includes specific therapy for the underlying disease and adequate care. Low-dose neuroleptics, haloperidol in particular, are recommended to correct behavioral changes.

[Posttraumatic stress disorder in patients after stroke]. / Simptomy posttravmaticheskogo stressovogo rasstroistva u patsientov s tserebral'nym insul'tom.

Objective. To assess the frequency of main symptoms of posttraumatic stress disorder (PTSD) in post stroke patients. Material and methods. Forty-eight patients took part in the study. We used the Impact of Events Scale (IES) and other scales to assess the severity of posttraumatic stress. Results and conclusion. Thirty three percent of patients experienced posttraumatic stress, 12.5% suffered from PTSD. We found an association between the severity of posttraumatic stress after stroke and the level of anxiety, sleep disturbances and decrease of quality of life. Symptoms of posttraumatic stress are often observed after stroke, this needs to be taken into account during planning of rehabilitation programs.

[Delirium in the acute phase of stroke: frequency and predisposing factors].

Delirium is a common complication of stroke worsening its prognosis. In this work we have analyzed the frequency of delirium and factors, predisposing to its development in the population of Russian patients in hyperacute phase of stroke. Twenty two of 96 (around 23%) recruited patients revealed symptoms of delirium according to DSM-IV criteria. Patients of older age, those with severe stroke, with prominent chronic cerebral changes on brain CAT scan, with fever, those with urine catheter and with positive snout reflex were more likely to develop delirium. Severity of posterior leucoareosis was the only independent predictor of delirium according to multivariate analysis.