[Comparative efficacy and safety of antidepressant mono- and multimodal therapy in elderly patients with depression (a clinical experience in a psychogeriatric hospital)]. / Sravnitel'naia éffektivnost' i bezopasnost' antidepressivnoi mono- i mul'timodal'noi terapii u pozhilykh bol'nykh depressiei (opyt klinicheskogo primeneniia v gerontopsikhiat-richeskom statsionare).

Objective. A comparative evaluation of the efficacy and safety of a multimodal antidepressant therapy with venlafaxine plus cerebrolysin and monotherapy with the same antidepressant for the treatment of depression in elderly patients in a psychiatric hospital. Material and methods. Two groups of patients (20 patients in each group), aged 60 years and older (60 to 79 years), were studied. The groups were matched for demographic and clinical (severity of depressive episode) characteristics. Patients of the first group were treated with venlafaxine in dose 75-150 mg twice a day. Patients of the second group received additionally 20 intravenous infusions of cerebrolysin (20.0 ml in 100 ml isotonic sodium chloride solution). Results. Therapeutic effect of antidepressant therapy (56 days) was characterized by a good balanced profile in relation to symptoms of depression, anxiety and apathy in both groups. However, the use of multimodal therapy allowed to get the more rapid response and more pronounced therapeutic effect compared to monotherapy with the same antidepressant, as well as to reduce adverse events. Conclusion. The results obtained allow to recommend multimodal antidepressant therapy with venlafaxine and cerebrolysin for using in hospital practice to achieve a more rapid therapeutic response, reduce the risk of adverse effects of antidepressants and shorten a period of hospitalization.

[Efficacy of actovegin in the treatment of elderly patients with vascular mild cognitive impairment].

Efficacy of actovegin was investigated in the treatment of mild cognitive impairment (MCI) of cerebrovascular genesis. Thirty patients (7 men and 23 women, mean age 71.2 years) received actovegin intramuscularly in dosage 5 ml (200 mg) daily during 4 weeks. Patient's were assessed before and after treatment using CGI and MMSE, verbal association test, scale of frontal dysfunction, clock drawing test, Boston naming test, Mattis dementia scale, test to remember 10 words, the Hamilton depression scale. An improvement was seen in all measures. A positive therapeutic effect, including increased speed of mental processes, reduction of bradiphrenia and memory disorders as well as positive impact on asthenic and depressive symptoms, was identified. Side-effects and adverse events of actovegin were not observed. It is concluded that actovegin could be recommended for elderly patients with early manifestations of cognitive decline.

[Prognosis of cognitive deficit progression in aged patients with mild cognitive impairment under prolonged therapy (a three year observation)].

The aim of the study was to predict treatment efficacy in patients with mild cognitive impairment (MCI) and to find the most reliable clinical tests for the prediction of dementia. Patients with amnestic MCI (n=53) were treated with cerebrolysin for three years and underwent regularly neurocognitive and clinical psychiatric tests. The data were analyzed using non-parametric statistics, cluster analysis, and linear discriminate analysis. The combination of statistical methods has enabled to predict the degree of cognitive impairment as well as the development of dementia. A "dementia risk group" with fast cognitive decline (i.e. the low efficacy of the treatment) was identified. The tests are ranked according to their predictive values.

[Efficacy, safety and tolerability of a single dose of akatinol memantine in comparison to two-doses in patients with moderately expressed and moderately severe dementia in Alzheimer's disease].

The compliance of patients with moderately expressed and moderately severe dementia, caused by Alzheimer's disease (AD), to the treatment with two different dose regimes of akatinol memantine was studied. The study included 40 patients with AD and mixed Alzheimer-vascular dementia (AD/VD) aged from 53 to 84 years. Patients were stratified into 2 groups: patients of group 1 received akatinol memantine in a single dose 20 mg in the morning and patients of group 2 received the drug twice in dose 10 mg in the morning and in the afternoon. The treatment duration was 24 weeks. The single dose of drug was as effective and safety as standard treatment with two doses. Therefore, treatment with a single dose of 20 mg akatinol memantine is recommended for clinical practice.

[Acetyl-L-carnitine (carnicetine) in the treatment of early stages of Alzheimer's disease and vascular dementia].

Efficacy, safety and tolerability of acetyl-L-carnitine (ALC) were studied during the double-blind placebo-controlled 12-week trial in patients with mild (initial) dementia caused by the Alzheimer's disease (AD) and vascular dementia (VD). ALC was administered in doses from 2250 to 3000 mg per day. Patient's state was assessed with some scales (MMSE, CGI etc) and a battery of neuropsychological tests. The treatment effect of ALC was 2,8 times higher than in placebo-treated patients. The clinical improvement by CGI scores was significantly better in AD patients compared to VD and did not depend on the severity of baseline cognitive deficit. The drug was well-tolerated. Carnicetine can be recommended in the abovementioned doses for treatment of early stages of AD and VD.

[Ceraxon (citicoline) in the treatment of the mild cognitive impairment syndrome].

The objective was to study efficacy and safety of ceraxon (citicoline) used perorally in dose 1000 mg daily in the treatment of cognitive disturbances in patients with amnesic type of mild cognitive impairment (MCI). Twenty patients, aged from 50 to 90 years, received ceraxon in dose 1000 mg twice a day during 90 days. The state of patients was assessed with a battery of scales and tests with the following statistical data analysis. The significant results on the clinical effect of the drug on cognitive disturbances and good tolerability of ceraxon have been obtained. The authors recommend ceraxon for long-term preventive treatment in high risk populations for Alzheimer's disease.

[Possibilities of preventive treatment of Alzheimer's disease: results of the 3-year open prospective comparative study on efficacy and safety of the course therapy with cerebrolysin and cavinton in elderly patients with the syndrome of mild cognitive impairment].

The study was conducted in 3 Russian centers (Moscow, St. Petersburg and Nizhniy Novgorod). The total sample included 110 patients whose mental state met the definition of <> (MCI). Patient's status was assessed with widely used scales (MMSE, GDS, CDR etc) and a battery of neuropsychological tests. Genotyping for the APOE polymorphism was performed as well. Patients were stratified into 2 comparable groups in compliance with the specifics of therapy: 55 patients were treated with cerebrolysin and 55 - with cavinton. The superiority of cerebrolysin over cavinton in slowing down of the cognitive deficit progression and delaying the time or transition of patients to the diagnostic category of Alzheimer's disease was demonstrated. Cerebrolysin was particularly effective in MCI patients with the ApoE(+) genotype, i.e. in those with higher risk for Alzheimer's disease. Adverse effects during the treatment were rare in both groups.

[Galantamine (reminyl) in the treatment of severe Alzheimer's disease].

Twenty-five patients with Alzheimer's disease (AD) in moderate-severe and severe stages received galantamine in dosage 8 mg daily during the 1st month with the following increasing to 16 mg daily. Six patients received 24 mg per day from the 3rd month. The total duration of therapy was 26 weeks. 15 patients received in addition the antipsychotic therapy. Reminyl had a positive effect on cognitive functions and psychotic symptoms of dementia, in particular delusions, aggression and irritability, apathy, aberrant motor behavior, eating and sleep disorders. The therapeutic reduction of these disorders resulted in the distinct reduction of physical and mental burden on the caregivers. The therapeutic effects of reminyl and its good tolerability allow to recommend this drug for treatment of severe stages of AD.

[The therapeutic potential of cerebrolysin in the preventive therapy of Alzheimer's disease].

A potential of prolonged 2-years course of cerebrolysin therapy with courses repeated every 6 months to slow down or prevent the transition of the syndrome of mild cognitive impairment, amnestic type, to clinically relevant dementia has been studied in the open comparative study of 73 patients divided into 2 groups, one of which included patients treated with cerebrolysin and another one those who did not receive this drug. The effect of the 2-years course therapy with cerebrolysin suggested by the authors has been proven. Such therapy allows to prevent the progression of cognitive deficit and development of dementia of Alzheimer's type. The results obtained give grounds to recommend this course therapy for prevention of dementia in elderly patients with mild cognitive impairment.

[The treatment of Alzheimer's disease in patients with comorbid somatic pathology].

To study efficacy and safety of cholinergic therapy in patients with Alzheimer's disease or combined Alzheimer's and vascular dementia and marked somatic pathology, 30 patients, aged from 54-85 years, with mild or moderate dementia have been studied. Patients were treated with rivastigmine (exelon) in dosage 3-12 mg daily during 3 months. The safety of the drug for patients with comorbid somatic pathology has been shown: during the treatment no severe aversive effects or strengthening of diseases of visceral organs were observed. The improvement of global clinical state as well as reduction of cognitive and behavioral disorders indicate the high effectiveness of exelon. The recommendations allowing to improve the tolerability of treatment with exelon of patients with comorbid pathology of visceral organs are worked out.

[ApoE genotype and efficacy of neurotrophic and cholinergic therapy in Alzheimer's disease].

Correlation association between an ApoE4 genotype in patients with mild-moderate Alzheimer's disease and efficacy of neurotrophic (cerebrolysin) and cholinergic (exelon) therapy was studied in the groups of patients formed using case-control method. A 4-month treatment has shown that both types of therapy had a significant clinical effect, however clinical effect proved to be more higher and stable in patients treated with cerebrolysin. A number of responders in the cerebrolysin group was 1.7-fold higher comparing to that in the exelon group. Patients with the ApoE4(+) genotype did not differ in response to either drug but in those with genotype ApoE4(-) the number of responders was 3-fold higher in the group treated with cerebrolysin compared to the group given exelon. A follow-up estimation of cognitive impairment in ApoE4(-) patients revealed that long-term clinical effect of cerebrolysin treatment was 6.5 times higher than that of exelon.

[Neuropsychological evaluation of long-term therapy of Alzheimer's disease using different cerebrolysin dosages].

An open comparative randomized clinico-neuropsychological study of 4 cerebrolysin treatment courses was conducted during 19 months. The differences in long-term effects of different medication dosages (10 and 30 ml) were revealed. The higher cerebrolysin dose was more effictive for cognitive functioning of patients. In patients receiving a dosage of 10 ml, the disease progress was significantly more pronounced. The results obtained indicate that a course of cerebrolysin treatment in higher dosages significantly inhibited neurodegenerative process.

[Social and environmental factors and mental health in the elderly]. / Sotsial'no-sredovye faktory i sostoianie psikhicheskogo zdorov'ia pozhilogo naseleniia.

The paper gives data on trends in the prevalence of mental disease and disorders incidence in old age groups for 10 years (1984-1994) and analyzes whether macro- and microsocial factors can affect mental health in the elderly. Clinical and epidemiological surveys of 1109 examinees aged 60 years and older residing in a limited Moscow area have yielded morbidity rates for mental disease and disorders (including those by sex and age) in the population. Diagnoses was rated according to the International Classification of Disease (ICD-10). Varying mental disorders and nosological entities (without taking into account abnormalities) were found in 36.6% of examinees, including 6.1% with psychotic states, i.e. proper psychoses and clinical mental deficiency. Comparison of the results of two studies. One study was carried out in the 1980s and the present one performed 10 years later, that is, within the period of socioeconomic changes in the country, is indicative of a considerable growth of the morbidity rates in nonpsychotic forms of psychopathology of cerebrovascular genesis and psychogenic affective disorders among the Moscow elderly population. A correlation between the incidence of psychic pathology at an elderly age and different socioenvironmental factors has been studied. There are significant differences in accumulation of stress-induced life events in elderly patients with different psychopathology types. The obtained results confirm the author's assumption that the growth of psychic disorder morbidity rates, specifically, in non-psychotic forms of mental diseases of cerebrovascular genesis and psychogenic affective disorders in the past decade may be caused by increased stress-induced load on elderly people both in connection with unfavorable socioeconomic conditions of the reform epoch and a frustration of their outlook stereotypes. In the authors' opinion, their hypothesis on the correlation between the increase in the incidence of some psychogeriatric diseases and the frequency of stress-induced factors, needs further testing, in particular, by way of prospective population clinical and epidemiological studies.

[Longitudinal approaches to the problem of clinical heterogeneity of Alzheimer-type dementia]. / Longitudinal'nye podkhody k probleme klinicheskoi geterogennosti dementsii al'tsgeimerovskogo tipa.

A total of 160 patients with Alzheimer-type dementias (ATD), including 84 with Alzheimer's diseases (AD) and 76 with senile dementia (SD), were examined. The initial signs of the disease were analyzed by making a retrospective assessment of informative history data. The prospective follow-up involved clinical, neuropsychological and electrophysiological (EEC mapping, evoked potentials) studies by applying the standardized assessment of results. There was shown to be a set of clinical and paraclinical parameters for the status of ATD patients, indicating a distinct-quantitative and qualitative difference between patients with AD and those with SD and supporting the heterogeneity of ATD.

[EEG-mapping in Alzheimer-type dementias]. / EEG-kartirovanie pri dementsiiakh al'tsgeimerovskogo tipa.

EEG topographic correlates of the severity and type of Alzheimer-type dementias have been studied in 21 patients with senile dementia (SD) and 18 with Alzheimer's disease (AD) who were subdivided into smaller groups by MMSE grades for the severity of dementia, as well as in 15 mentally normal elderly persons. EEC maps in SD and AD patients differed from those in normal subjects in increased theta-delta EEG spectral power and suppressed alpha-band power that was more pronounced in the left hemisphere in AD than in SD patients. AD and SD patients had also different EEG topographical changes with intensified cognitive dysfunctions. The results suggest that there is a great cholinergic deficiency and cortical rather than subcortical impairments in patients with AD than in those with SD.

[Clinical heterogeneity of dementia of the Alzheimer type]. / O klinicheskoi geterogennosti dementsii al'tsgeimerovskogo tipa.

Using clinico-psychopathological, clinico-neuropsychological and computer-aided tomography approaches, material differences were ascertained between groups of patients with Alzheimer's disease (AD) and senile dementia (SD) in terms of the clinical parameters, including the age at which the disease sets in; the disease standing; the build-up features of the patients; the frequency of diverse exogenous and environmental actions at the premorbid stage and at the disease debut; the psychopathological structure of dementia and the initial disease manifestations. The clinical differences indicated were in agreement with different structures of the neuropsychological syndrome marked by the impairment of higher mental functions in AD and SD and with different structures and topography of alterations in the medulla, discovered by means of computer-aided studies. The differences in the clinical and morphofunctional characteristics of AD and SD allow a conclusion that AD and SD are clinically independent disease entities within the framework of the common group of the Alzheimer's type dementias.

[Comparative clinico-genetic studies of senile dementia and Alzheimer's disease]. / Sravnitel'noe kliniko-geneticheskoe izuchenie senil'noi dementsii i bolezni Al'tsgeimera.

The families of 128 probands with senile dementia (SD) and Alzheimer's disease (AD) were entered into the study. The correlation between the familial and sporadic cases of the disease was established. A geneticomathematic analysis was employed to estimate the clinicogenealogical findings. Two genetic models (monogenous and multifactorial) were tested. The contribution of the genetic factors to SD and AD liability was assessed. As a result of a comparative clinicogenetic study of SD and AD it was found that there is no doubt about the contribution made by the genetic factors to the origin of the Alzheimer type dementia (ATD). The rate of the afflicted relatives considerably exceeded the population rates of the investigated patterns of dementia. The limit estimations of the genetic similarity between the manifestations of AD and SD, both in the monogenous and multifactorial models, were obtained, which rejects the presence of the common major gene responsible for liability to these patterns of the ATD. It was assumed that AD and SD are characterized by the presence of the common genes modifiers. In addition, the difference was established between the types of inheritance in persons afflicted with these diseases: an oligogenic type of inheritance in SD, a quasidominant type with incomplete penetrance of homo- and heterozygotes in AD.

[Clinical picture of initial manifestations and the characteristics of the subsequent course of senile dementia]. / Klinika initsia'lnykh proiavlenii i osobennosti posleduiushchego techeniia seni'lnoi dementsii.

Retrospective analysis of initial events in senile dementia was performed in patients examined while staying in hospital at the stage of clinically manifested dementia. The data indicated that psychopathological structure of initial stage of the disease is of prognostical value for later formshaping and the rate of progression of the disease.

[Prognosis of mild dementia based on catamnestic study of the population]. / Prognoz miagkoi dementsii po dannym katamnesticheskogo populiats- ionnogo issledovaniia.

A clinico-catamnestic investigation of a group of patients with initial psychoorganic changes qualified at first examination as the "soft" dementia and "accelerated mental aging", attributed the states of "soft" dementia a high value in prediction of manifested senile dementia. Predictive value of a complex of signs classified as "accelerated mental aging" was ambiguous.

[Epidemiology of dementias in the middle-aged and elderly]. / Epidemiologiia dementsii pozhilogo i starcheskogo vozrasta.

The authors analyze clinico-epidemiologic and statistical data on the incidence and nosological distribution of organic dementias in urban population of advanced age (60 years and over), including their correlation with the sex and age of the examined groups of population. The authors have determined parameters of the "registered" morbidity (0.7 per 1,000 individuals aged 60 years and over) and the incidence (3.9 per 1,000 individuals aged 60 years and over) of debilitating processes of old age, i. e., actual prevalence of dementia in people of advanced age. Organic dementia (moderate and severe) was detected in 4.0% of elderly people (4.1%--males, 4%--females). Furthermore, mild dementia was identified in 1.5% of elderly individuals. The follow-up findings (6-9 years after the first examination) of the same urban population demonstrated prognostic significance of mild dementia states with regard to the development of clinically manifest dementia.