[The primary screening of patients with autonomic disorders in outpatient clinics in Russia (START1) using the Russian version of The Four-Dimensional Symptom Questionnaire (4DSQ)].

OBJECTIVE: To develop an effective diagnostic algorithm for detection of a mental component in the state of patients diagnosed with autonomic nervous system disorder. MATERIAL AND METHODS: In the frames of START1 epidemiological study, we examined 6633 patients with autonomic nervous system disorders (ICD-10 G.90.8 and G90.9) and somatoform disorders (F45) including 18,8% patients who got a referral to a psychiatrist. A linguistically validated Russian version of The Dutch Four-Dimensional Symptoms Questionnaire (4DSQ) was tested in domain subpopulations. RESULTS: In subpopulations of anxiety and depression, more than 26% of the patients got a referral to a psychiatrist that indirectly supported the assumption on the conformity of 4DSQ to the purposes of primary screening of four-dimensional disorders in the general population of patients with autonomic nervous system disorders. CONCLUSION: The linguistically validated Russian version of 4DSQ enabled to formalize the description of clinical profile of these patients. Cluster analysis of the results allowed to single out two superdomains by the pairwise combination somatization with distress (SDis) and anxiety with depression (ADep). The detection of superdomain SDis appears to be a population specific characteristic of autonomic nervous system disorders in the Russian Federation.

[Proteolytic signaling mechanisms in skeletal muscles in patients with alcohol-induced muscle disease].

Chronic alcoholic myopathy is one of most numerous and profound manifestations of chronic alcohol intoxication. This disease is characterized by the pronounced atrophy of the locomotor muscles, which involves predominantly those fibers expressing myosin isoforms of the I "fast" type. In early experiments with alcohol-fed rats and studies of patients it was shown the impairment of the anabolic intracellular signaling pathways and decrease in protein synthesis rate. We were the first to analyze the signaling pathways involved in the pathogenesis of alcoholic myopathy with different fiber atrophy levels. At the early stages of the pathogenesis we observed also the sufficient increase of mRNA of E3 ubiquitin ligases. However the ubiquitinylation level was not altered in patients as compared to the control subjects. This phenomenon could be associated with the increased expression of the heat-shock proteins, known for their protective action.

[Chronic pain: medico-biologic and sotsio-economic aspects].

In this article the role of neurobiological, psychological and social factors in pathogenesis of chronic pain is analyzed. The chronic pain is considered not as a symptom of damage of tissue and as independent illness due to non-adequate neuroplasticity of systems involved into regulation of pain sensitivity. The major role in development and maintenance of chronic pain is devoted to the primary genetically determined and/or secondary disturbance of interaction between nociceptive and antinociceptive systems at various levels--from peripheral neuron to central structures--that provides pain perception and painful behaviour development.

[The effect of carotid endarterectomy on cognitive disturbances in patients with atherosclerotic stenosis of carotid arteries].

Clinical and neuropsychological features of non-dementia cognitive disturbances were studied in 102 patients with atherosclerotic carotid stenosis. Cognitive disturbances were assessed after the carotid endarterectomy (CEAE). Mild cognitive impairment was found in 37 (36,3%) of patients, moderate cognitive impairment was diagnosed in 36 (35,3%)patients. Moderate cognitive impairment was found more often in patients with symptomatic carotid stenosis with structural brain changes confirmed by neuroimaging data and with instable atherosclerotic plaques with the predomination of hypodensity component. It allows to suggest that both the reduction of perfusion and arterio-arterial microemboli may cause cognitive dysfunction in patients with atherosclerotic carotid stenosis. The data on the positive effect of CEAE on cognitive functions have been obtained. The positive changes were more distinct in patients with asymptomatic course of carotid stenosis. However CEAE may have a negative effect on cognitive functions in patients with moderate cognitive impairment of dysmnestic character and symptomatic carotid stenosis.

[Neurochemical markers of neurodegeneration in the early diagnosis of Alzheimer's disease, vascular and mixed dementia].

A study of 27 patients with dismnestic variant of moderate cognitive impairment (MCI) and 20 patients with neurodynamic-dysregulatory variant was carried out. The more intensive atrophic process supported by neuroimaging data and changed levels of neurodegeneration biomarkers - phosphorylated tau-protein 181 and beta-amyloid 42 - were found in patients with dismnestic MCI variant. The follow-up study showed that the large number of patients with progressive cognitive disorders associated with conversion to dementia was observed in this group. In conclusion, the determination of the neurochemical markers in the cerebrospinal fluid allows to detect the neurodegenerative process at early stages of the disease and assists in detection of cases with increased risk of Alzheimer's disease.

[Treatment of asthenic disorders in patients with psychoautonomic syndrome: results of a multicenter study on efficacy and safety of ladasten].

The study was carried out in 28 clinical centers of Russia. The data on 728 patients with psychoautonomic syndrome (91.6% of the total sample) were available for statistical analysis. All patients suffered from asthenic disorders. The duration of treatment with ladasten in daily dose from 50 to 100 mg was 28 days. Patient's state was assessed with psychometric scales at baseline, 3, 7, 14 and 28 days of therapy and one month after the end of treatment. The percentage of responders was 76.0% on the CGI-S and 90.8% on the CGI-I. The antiasthenic effect of ladasten was seen on day 3 and remained during one month after the withdrawal of therapy. We determined clinical efficacy of ladasten in regard to anxiety-depressive spectrum disorders, autonomic dystonia, sleep disorders. Ladasten therapy led to the significant increase of quality of life, which was seen not only after the end of therapy, but after the withdrawal of the drug. These results suggest the stability of the therapeutic effect achieved. Adverse effects were observed only in 3% of patients, the therapy was discontinued in 0.8%. No serious adverse effects were found. In conclusion, the efficacy of ladasten was shown in its antiasthenic, anxyolytic, autonomic nervous system stabilizing properties, the normalization of sleep-awake cycle and the increase of quality of life. Ladasten in daily dose from 50 to 100 mg is a highly effective, well-tolerated and safety drug with a wide spectrum of clinical effects. Therefore, this drug could be recommended for treatment of asthenic disorders in neurological practice.

[Peculiarities of cognitive functions in patients with chronic back pain].

The authors have studied cognitive functions and influencing factors in 64 patients with chronic low back pain. All patients have been examined using neurologic, neuroorthopedic, pathopsychological and neuropsychological methods. Patients have been divided into 2 groups according to their age: group 1 (aged 30-50 years) and group 2 (aged 51-60 years). Healthy controls were matched to patients for age, sex and education. Significant differences in neuropsychological testing, i.e. mental flexibility, delayed memory, psychomotor speed, which referred to the subtle cognitive impairment with executive function disturbances, were found in both groups of patients with chronic low back pain as compared to pain-free adults. Sensory-discriminative (pain intensity) and affective-emotional (negative emotions, in particular, anxiety) characteristics had the effect on cognitive functions in younger patients without depressive symptoms. Affective-emotional (anxiety, psychological distress) and cognitive characteristics (i.e. catastrophising) contributed to the cognitive disturbances in older patients.

[Cognitive disturbances in the progression of Parkinson's disease].

Cognitive impairment (CD) have been studied in 88 patients with progressive Parkinson's disease (PD). It has been shown that CD in PD have a progressive character mostly due the increase of intensity of dysregulation and neurodynamic disorders, disturbances of visual-spatial functions and, in some cases, insufficiency of nominative speech function. A 2-5 years follow-up revealed the high frequency of transformation of moderate cognitive dysfunction into dementia. The old age of patients at baseline, late-onset and severity of disease were identified as predictors of CD progression in PD. The highest rate of CD progression was observed in patients with more pronounced premorbid disturbances of regulative and visual-spatial functions.

[Mirapex (pramipexole) in the treatment of non-motor disturbances in Parkinson's disease].

The effect of the dopamine receptor antagonist mirapex on emotional disorders (anxiety, depression), cognitive disturbances and sleep disorders has been studied in 66 patients with Parkinson's disease. Mirapex has been administered in addition to levodopa and other antiparkinsonian drugs in dosage 3,5+/-1,1 mg daily to 36 patients with emotional and cognitive disorders and in dosage 2,9+/-0,96 mg daily to 30 patients with sleep disorders. Patient's state has been assessed using a number of psychometric scales and neuropsychological tests. The effectiveness of Mirapex in all disorders studied has been shown.

[Cognitive disturbances in patients with arterial hypertension].

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.

[Neuropathic and musculo-skeletal pain. Modern approaches to diagnosis and treatment].

Chronic pain syndromes comprise a heterogeneous group of very common clinical conditions having important medical and social implications. The author briefly reviews evolution of the concepts of mechanisms and characteristics of neuropathic, nociceptic, and psychogenic pain and current approaches to the diagnosis and treatment of neuropathic pain syndromes and musculo-skeletal pains. The recommended therapeutic modalities for patients with chronic pains are based on the results of original studies conducted in the Department of Neural Diseases, I. M Sechenov Moscow Medical Academy, during the last years and recent data obtained in foreign clinics.

[Neuromidin in the treatment of vascular cognitive disorders].

Neuromidin (ipidacrin) was administered to 41 patients, aged 51-79 years, with mild cognitive impairment (MSI) (19) and vascular dementia (22). The drug was prescribed in increasing dosages from 10 to 40 mg during 6 months (a dosage of 40 mg was administered from the 4th week of the treatment). Cognitive functioning was assessed using some clinical scales (CGI, MMSE, GDS etc) and common neuropsychological tests at the base-line and on the 3rd and 6th month of the treatment. A statistically significant therapeutic effect of neuromidin was revealed in both types of cognitive disorders, with the maximal improvement on the first 3 months and further maintenance of the effect. The most distinct dynamics was observed for memory, attention, abstract reasoning, constructive abilities and general mental activity. The drug was well tolerated.

[Cognitive dysfunction in elderly patients: diagnosis and treatment].

Current clinical picture, diagnosis and treatment of cognitive disturbances in elderly patients are reviewed with a main focus on moderate cognitive impairment (MCI). The results of correction of such disturbances by pronoran according to the "Prometei" program are considered. One hundred and thirty-two physicians from 33 cities who treated 3210 patients took part in the study. Pronoran was administered to 574 patients aged over 60 years. Their health was assessed using the MMSE scale and clock-drawing test. Pronoran was used in the dosage of 50 mg daily during 12 weeks in monotherapy and in combination with vascular and metabolic drugs in combined therapy. The physicians reported improvement of cognitive functions in 82% of cases, patients--in 78%. No differences were found in efficacy of mono- and combined therapy.

[The problem of cerebral stroke: its contemporary state].

The authors consider the prevalence and the clinical outcomes of cerebral stroke in Russia and the most promising methods directed towards lowering stroke incidence and raising the quality of pre-hospital and hospital aid. The authors also pay their attention to rehabilitation techniques improving the life quality of patients after cerebral stroke, and characterize the areas of scientific research into the lowering of the medicosocial consequences of cerebral stroke.

[Tanakan (EGb 761) in the therapy of mild cognitive impairment].

Mild Cognitive Impairment (MCI) means cognitive deterioration not yet causing disability or dementia. Aged patients with MCI constitute a group of high risk for Alzheimer disease and other types of dementia. Currently, there is no generally adopted approach to MCI management but medications with neuroprotective properties are presumed to be the most perspective. Presented are the results of a multicentral open-label clinical trial of vascular and neuroprotective drug tanakan (EGb 761). The study has shown the decrease of cognitive impairment, which was both clinically and statistically significant, in patients at early stages of vascular and neurodegenerative pathological process. Probable efficacy of long-term tanakan treatment in prevention of dementia is discussed.

[Moderate cognitive impairment syndrome in cerebral vascular insufficiency].

Frequency of clinical and psychological peculiarities of moderate (mild) cognitive impairment (MCI) in cerebral vascular insufficiency (CVI) was studied in 42 patients, mean age 67.7 +/- 7.7 years. Along with neurological examination, a battery of psychiatric and neuropsychological scales and tests was used. MCI was diagnosed in 28 (66.7%) patients. In 20 patients (47.6%), cognitive hypoactivity was most prominent related to impaired neurodynamics and regulation of voluntary activity which may reflect subcortical and frontal lobes functions. In 8 patients (20.1%), there was a prominent memory impairment characteristic of hippocampus lesion. The authors suggest the presence of concomitant neurodegeneration in patients with amnesic MCI.

[Cognitive dysfunction in patients with Parkinson's disease].

Neurocognitive functions have been studied in 100 patients with Parkinson's disease (PD). PD was associated with cognitive impairment due to frontal lobes dysfunction, with hippocampus and right hemisphere involvement in advanced stages of the disease. Severity of cognitive impairment increased simultaneously with severity of movement disorder. Patient's age correlated with cognitive abilities. Mild dementia developed in the oldest patients with advanced PD. Besides typical cognitive disturbances, there were more pronounced memory impairment and speech disorders in some patients that might be related to concomitant pathology.