[Gender characteristics of anxiety disorders]. / Gendernye osobennosti trevozhnykh rasstroistv.

Anxiety and depression are an extremely significant issue of the modern society. According to the epidemiological data, the development of various affective syndromes shows gender-related differences. For example, clinically significant anxiety occurs 2.5 times more often in women than in men. Anxiety disorders in women are characterized by less favorable course, a tendency to relapses and chronification, and also by poor clinical response to therapy. Taking gender differences into account, a significant role of reproductive hormones may be assumed in development of both affective disorders and the features of the course of the disease. In this review we discuss various effects of testosterone, estrogens that can influence development risks of anxiety and depression, as well as possibly influence therapeutic choices.

[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.

[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.

[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.

[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.

[Contemporary approaches to clinical diagnosis and treatment of tau-protein accumulation related multisystem degenerations]. / Sovremennye podkhody k klinicheskoi diagnostike i lecheniyu mul'tisistemnykh degeneratsii, svyazannykh s nakopleniem tau-proteina.

Tau-protein pathology is the basis of a great variety of neurodegenerative diseases. Misfolding tau-protein conformation structure is the key pathogenetic mechanism of development of such multisystem degenerations as progressive supranuclear palsy, corticobasal syndrome, and fronto-temporal degeneration, as well as relatively recently added primary age-associated tauopathies and others. This review presents current views on the pathogenesis of various forms of neurodegenerative pathology linked to tau-protein accumulation. Potential of clinical diagnosis and modern diagnostic criteria, as well as existing therapy approaches, are discussed.

[Fluctuation of cognitive functions in dementia with Lewy bodies]. / Fluktuatsii kognitivnykh funktsii pri dementsii s tel'tsami Levi.

Fluctuations of cognitive function (FCF) is one of the core diagnostic features of dementia with Lewy bodies (DLB). However, identification, pathophysiology, management of this unusual phenomena remain poor understood. The review presents modern ideas about phenomenology, causes, systematization, clinical significance and current methods of diagnosis and treatment of FCF in patients with DLB.

[Current issues in the rehabilitation of stroke patients against the background of a new coronavirus infection (COVID-19). Resolution of the Council of Experts]. / Aktual'nye voprosy reabilitatsii patsientov s insul'tom na fone novoi koronavirusnoi infektsii (COVID-19). Rezolyutsiya Soveta ekspertov.

The pandemic of the new coronavirus infection caused by SARS-CoV-2 has forced to reconsider the methods of rehabilitation of patients with emergency conditions, including neurology. The Council of Experts of Neurologists and Rehabilitation Therapists gathered to develop unified approaches to manage stroke patients based on a discussion of practical experience and, taking into account the scientific information on COVID-19 that was available by the time of the meeting. Stroke is a serious disabling condition that requires maximum rehabilitation efforts at all stages of medical care. In the context of the SARS-CoV-2 coronavirus epidemic, the process of medical rehabilitation and the routing of patients with stroke is undergoing major changes. Combining COVID-19 and stroke requires new approaches to rehabilitation and patient management. During the meeting, a resolution was developed in which the experts formulated the tactics of medical rehabilitation of patients with stroke and COVID-19 at the first and second stages. The arguments of the importance and practicability of carrying out measures of medical rehabilitation at the third stage is given and the need to continue consultations on the indicated topic is revealed.

[Speech disorders in neurodegenerative diseases as dysphasia manifestation]. / Narushenie rechi pri neirodegenerativnykh zabolevaniyakh kak proyavlenie disfazii.

OBJECTIVE: To develop the classification and methodology for assessment of speech disorders in neurodegenerative diseases, and to identify the characteristics of speech disorders for various forms. MATERIALS AND METHODS: The study included 1016 patients with neurodegenerative diseases. Screening assessment identified 42.1% patients with speech disorders exceeding isolated dysarthria. Patients were assessed using the speech disorder test battery developed by the authors. Cluster, multifactor and contingency analyses were performed. RESULTS: Nine subtypes of speech disorders were identified in neurodegenerative diseases that we denominated as dysphasia. Based on contingency analysis, the principal and the additional dysphasia variants were identified for each form of neurodegenerative pathology, which may contribute to better understanding of various phenotypes. Based on the general scheme of speech origination, the level of disorders typical for a given dysphasia subtype was identified. CONCLUSION: The proposed classification enables identification of the subtypes of speech disorders for individual forms of neurodegenerative diseases. Introducing dysphasia concept to clinical practice will improve differential diagnosis and understanding of phenotypical heterogeneity of each nosological form as well as will facilitate therapy optimization.

[Speech disorders and anxiety: interaction mechanisms and therapy potential]. / Narushenie rechi i trevoga: mekhanizmy vzaimodeistviya i vozmozhnosti terapii.

Anxiety and speech disorders frequently co-exist, provoking and intensifying each other's manifestations, which is important to consider when choosing optimal therapeutic strategy. Linguistic anxiety is a separate anxiety disorder in which the speech itself, the fear of making a mistake may act as principal fear and start up the negative affect. Linguistic anxiety may develop due to disturbance of functional interactions between various systems in any healthy individual, but the risk of it developing increases significantly by the presence of initial speech defect such as post-stroke aphasia. Comorbidity of speech disorders and affective specter disorders is also noted in patients with neurodegenerative diseases. Strategies aimed at stopping anxiety may be effective for decreasing speech disorders severity.

[Speech disorders in Parkinson's disease]. / Rechevye narusheniia pri bolezni Parkinsona.

Speech disorders are widely spread in patients with Parkinson's disease, and these symptoms are only getting worse as the disease progresses. Nevertheless, only a few percent of the population have an access to an adequate and qualified care. This review describes the pathophysiology of parkinsonian speech disorders, methods of diagnostics and monitoring and treatment modalities, which include pharmacotherapy, speech therapy and surgical approaches. The authors believe that treatment of parkinsonism-related speech disorder is an integral part of a multidisciplinary patient care.

[Rapidly progressive dementia]. / Bystroprogressirushchie dementsii.

Accurate establishment of the etiology of rapidly progressive dementia is a difficult but very important task, since a number of diseases and conditions that can cause cognitive decline are potentially curable and can be completely reversible with proper diagnosis and timely treatment. While a delay in treatment can lead to severe residual deficiency or death. The article provides current data on the etiology, pathogenesis, clinical presentations, diagnosis and treatment of major diseases and pathological conditions that may cause rapidly progressive dementia.

[Depression and cognitive decline in elderly: causes and consequences]. / Depressiia i kognitivnoe snizhenie u pozhilykh: prichiny i sledstviia.

The authors discuss the relationship between depression and cognitive impairment in the aspect of mechanisms of their development, variants of comorbidity and recommendations on differentiated therapy in elderly. The diagnostic differentiation between depression and dementia at different stages of dementia as well as in younger and older ages, a role of depression as a risk factor for dementia, a role of other factors, in particular age, as well as treatment approaches on the example of antidepressants and cerebrolysin are considered.

[The efficacy and safety of naproxen in the treatment of nonspecific lumbalgia: the results of an open multi-center study (NEST)]. / Éffektivnost' i bezopasnost' naproksena v lechenii nespetsificheskoi liumbalgii: rezul'taty otkrytogo mnogotsentrovogo issledovaniia (NEST).

AIM: To assess the efficacy and safety of naproxen in patients with nonspecific low back pain. MATERIAL AND METHODS: Ninety patients with nonspecific low back pain were enrolled in the study. Patients took 550 mg of naproxen twice a day. All patients were assessed with VAS, the Oswestry questionnaire, Schober's test and clinical global impression scale. The treatment lasted from 7 to 14 days depending on the pain relief (VAS ≤10 mm). RESULTS: The pain syndrome relief was observed in 77 patients (88.5%) during the first week of the treatment and in 81 (93.1%) by the end of the study. The average value of VAS was reduced by 6.2 times (by 52.9 mm) in comparison to the baseline. According to the Oswestry questionnaire the influence of pain syndrome on the life quality was reduced by 4,78 times in comparison to the baseline. Schober's test revealed an increase in the amplitude of movements during therapy by 27% in comparison to the baseline. Only 5 (5.7%) drug-related adverse reactions were observed during the whole study, 80% of those were mild. CONCLUSION: Naproxen in the dose of 550 mg twice a day demonstrates the high efficacy and safety in patients with non-specific pain in lumbosacral spine.

[The feasibility of using Quick Dementia Rating System in clinical practice: results of a multi-center prospective validation study]. / Vozmozhnost' ispol'zovaniia shkaly bystroi otsenki dementsii v klinicheskoi praktike: rezul'taty mnogotsentrovogo prospektivnogo issledovaniia.

AIM: To determine the sensitivity and specificity of the Quick Dementia Rating System (QDRS), a 10-item questionnaire for the assessment of cognitive, behavioral, and functional impairments, in the Russian population. MATERIAL AND METHODS: The authors examined 2357 patients,1479 female (63%) and 878 male (37%), with subjective cognitive impairment (SCI), mild cognitive impairment (MCI) or dementia. Their average age was 73,1±9,7. All patients were assessed using QDRS and MMSE on baseline visits and reassessed after 1, 3, and 6 months. RESULTS: The sensitivity and specificity of QDRS were 79,2% and 81,2%, respectively, at cut-interval of more than 7 points. There was a strong inverse correlation between QDRS and MMSE indicators (r=-0,740). QDRS was the most sensitive for the detection of severe dementia (sensitivity of 78,2% and specificity of 85,2%), while for mild and moderate dementia the sensitivity was high (79,4% and 81,6%) and specificity was low (56,6% and 61,9%, respectively). The sensitivity and specificity of separate subtests were variable. CONCLUSION: The QDRS sensitivity and specificity allow recommending it for clinical practice. The questionnaire is the most sensitive to detect more severe cognitive impairment.

[The addition of memantine to galantamine increases treatment efficacy in patients with moderate dementia with Lewy bodies]. / Dobavlenie memantina k galantaminu povyshaet éffektivnost' lecheniia u patsientov s umerennoi stepen'iu tiazhesti dementsii s tel'tsami Levi.

Dementia with Lewy bodies (DLB) is the most frequent cause of dementia in the elderly. Both open and few placebo-controlled studies have demonstrated the efficacy of monotherapy with cholinesterase inhibitors (CI) and memantine in the treatment of these patients. However the efficacy and safety of combined therapy with CI and memantine are poorly studied. AIM: To assess the efficacy of modern antidementia drugs (memantine and galantamine). MATERIAL AND METHODS: Thirty-eight patients with DLB were studied. Monotherapy with galantamine in the dose of 16 mg/day was used during the first 6 months in according with current therapeutic recommendations. Then 19 patients who responded to treatment received in addition memantine in the dose of 20 mg/day. Patients' state was assessed using a battery of scales and tests. RESULTS AND CONCLUSION: The combination of memantine and galantamine significantly improved attention, memory, speech functions and behavior. Therefore, the early treatment with the combination of CI and memantine may be effective in treatment of DLB.

[Rate of progression of Parkinson's disease with early and delayed prescription of levodopa preparations.] / Temp progressirovaniia bolezni Parkinsona pri rannem i otsrochennom naznachenii preparatov levodopy.

AIM: To optimize therapy with levodopa preparations in relation to the rate of disease progression. MATERIAL AND METHODS: Eighty-six patients with Parkinson's disease (PD) were studied. Rate of progression was assessed by time of developing the 3rd stage of the disease. Patient state was assessed using MDS-UPDRS, MMSE, verbal activity test, clock drawing test, Beck depression scale, apathy scale and scale of autonomic disorders. RESULTS AND CONCLUSION: In 37 patients, early prescription of levodopa preparations (on average 1,7 years after disease onset) facilitates a decrease in the rate of progression assessed by time of developing the 3rd stage of the disease (7,3±4,4 vs 5,8±2,8 years). Despite early levodopa prescription, dyskinesias developed in the same timeframe as in case of delayed prescription (7,5 vs 7,9 years since onset). Clinical features asymmetry as the disease progresses, behavior disorders in rapid eye movement sleep phase during premotor stage, and orthostatic hypotension can be predictors of the high risk of complications of levodopa therapy. More severe axial disturbances are an adverse predictor of more severe course of the disease, the low levodopa efficacy, and the low risk of dyskinesia. Therefore, delayed prescription of levodopa facilitates the rate of progression, wherein the development of medicinal dyskinesias depends, to a greater extent, on the duration of disease rather than on time of treatment onset.

[Possibilities of retention of work capacity in patients with Parkinson's disease]. / Vozmozhnosti sokhraneniia trudosposobnosti u patsientov s bolezn'iu Parkinsona.

AIM: To study the efficacy of replacement of the single daily dose of two-component levodopa by three-component levodopa in work capable patients with Parkinson's disease with motor fluctuations during the most active working hours. MATERIAL AND METHODS: The study included 157 patients from 19 Russian centers specialized in extrapyramidal pathology. The period of highest working activity was analyzed in all patients. In these patients, the previous treatment with two-component levodopa was replaced by three-component levodopa in the equivalent dose. Other antiparkinsonian treatment remained unchanged during the study period. The duration of the study was 1 month. RESULTS AND CONCLUSION: The single replacement of two-component levodopa by stalevo allows increasing the optimal working activity by 19% and improving patient's state.

[Social cognitive function in neurodegenerative diseases]. / Sotsial'nye kognitivnye funktsii pri neirodegenerativnykh zabolevaniiakh.

The ability to perceive, analyze people's mental states, intentions, thoughts and feelings is an important cognitive function for normal social behavior and interaction. Over the past decade, more attention has been paid to studying how behavioral disorders in patients with neurodegenerative diseases may be explained by theory of mind deficit and whether it can be useful for differential diagnosis. The authors consider the issues of neuroanatomy, neurophysiology of a special kind of cognitive functions provided normal social interaction and interpersonal relationship, problems of its determining in neurodegenerative diseases.