[Diagnostic approaches to assessing mild behavioral impairment in patients with mild cognitive impairment]. / Diagnosticheskie podkhody k otsenke subklinicheskikh neiropsikhicheskikh simptomov u patsientov s myagkim kognitivnym snizheniem.

OBJECTIVE: To assess the prevalence of mild behavioral impairment (MBI ) in elderly individuals with mild cognitive impairment (MCI ), refine diagnostic criteria, and characterize the identified neuropsychiatric symptoms. MATERIAL AND METHODS: Sixty-three individuals over 50 years of age (median 72 [68; 77]) with MCI underwent psychiatric and psychometric assessments using clinical and psychopathological methods and scales. Statistical analysis was conducted to evaluate intergroup differences, ROC-analysis with calculation of the area under the curve (AUC) was performed, and sensitivity, specificity, and accuracy of MBI diagnosis were determined for MBI-C. RESULTS: The prevalence of MBI using only ISTAART research criteria was 65%. An optimal diagnostic cut point for the MBI-C scale with the highest AUC (0.793), at 10 points, was identified. Upon a comprehensive assessment of MBI using criteria and optimal cut point values from the MBI-C scale, the prevalence was 33% (median 16 [14; 20]). Patients with MBI+MCI and MCI only did not significantly differ in MMSE and MoCA test results. Significant intergroup differences were observed in the severity of symptoms such as apathy (p<0.001), depression and anxiety (p<0.001), agitation and impulsivity (p<0.001), social behavioral disturbances (p=0.009), and subsyndromal psychotic symptoms (p<0.001). The most common symptoms were related to impulse control deficits, irritability, agitation, depression, anxiety, and apathy, while less common symptoms were associated with social behavioral disturbances and subsyndromal psychotic symptoms. CONCLUSION: Novel data on the diagnostic features of MBI in elderly patients with MCI in the Russian-speaking population are presented. An optimal diagnostic cut point for the MBI-C scale in a sample of patients from specialized clinics for comprehensive use with commonly accepted criteria was determined. Further research is needed to adapt and validate the MBI-C scale and provide prognostic evaluation of MBI in the context of MCI progression to dementia.

[Multi-center open comparative randomized study of efficacy and safety of Akatinol Memantine 20 mg (single-doses) vs Akatinol Memantine 10 mg (double-doses) in patients with vascular dementia]. / Mnogotsentrovoe otkrytoe sravnitel'noe randomizirovannoe issledovanie effektivnosti i bezopasnosti primeneniya preparata Akatinol Memantin, 20 mg (odnokratnyi priem) v sravnenii s preparatom Akatinol Memantin, 10 mg (dvukratnyi priem) u patsientov s sosudistoi dementsiei.

OBJECTIVE: Evaluation of the efficacy and safety of the drug Acatinol Memantine, 20 mg (once daily) in comparison with the drug Acatinol Memantine, 10 mg (twice daily) in patients with moderate to moderate severe vascular dementia. MATERIAL AND METHODS: The study included 130 patients aged 50-85 years of both sexes with instrumentally and clinically confirmed vascular dementia. The patients were randomized into 2 groups. Group I consisted of 65 patients receiving Akatinol Memantine, 20 mg once daily, group II - 65 patients receiving Akatinol Memantine, 10 mg twice daily for 24 weeks. Clinical, parametric and statistical research methods were used. The Alzheimer's disease assessment scale, the cognitive subscale (ADAS-cog), the short mental Status Assessment Scale (MMSE) and the general clinical impression scale for patients condition and illness severity (CGI-C and CGI-S) and the Hamilton Depression Rating scale (HAM-D) were used. Adverse events were collected and analyzed. RESULTS: At week 24, both groups showed statistically significant positive change in ADAS-cog total score: in group I the total score was 27.2±8.76 points (absolute difference from baseline 3.5 points; p<0.01), and in group II - 26.1±7.86 points (absolute difference from baseline 2.5 points; p<0.01) with no statistically significant differences between groups. Evaluation of secondary efficacy criteria (change in ADAS-cog total score at week 12 and MMSE at weeks 4, 12, and 24) also revealed statistically significant benefit in both groups compared to baseline with no significant differences between groups. Statistically significant improvement was noticed on CGI-S and CGI-C scales in both groups. Akatinol Memantine was safe and well tolerated in both groups. CONCLUSION: The study showed no lesser efficacy and safety of Akatinol Memantine, 20 mg (once daily) compared to Akatinol Memantine, 10 mg (twice daily) in patients with moderate and moderately severe vascular dementia.

[Russian experience in using a combination of fixed doses of donepezil and memantine in the treatment of Alzheimer's disease as an observational non-interventional multicenter program]. / Rossiiskii opyt primeneniya kombinatsii fiksirovannykh doz donepezila i memantina v terapii bolezni Al'tsgeimera v ramkakh nablyudatel'noi neinterventsionnoi mnogotsentrovoi programmy.

OBJECTIVE: To evaluate the efficacy, safety, and compliance to therapy with Mioreol, first used as part of routine clinical practice in patients with moderate-to-severe dementia due to AD. MATERIAL AND METHODS: The study was conducted as a non-interventional observational program. The work was performed on a group of 48 patients with moderate-to-severe AD aged from 60 to 90 years (median age 74 [69; 77]). The therapeutic dose of Mioreol was 10 mg donepezil + 20 mg memantine, the drug was taken orally, once a day at the same time, regardless of meals. The duration of the course of therapy was 24 weeks. The effects of the drug were assessed using the MMSE, ADAS-Cog, NPI, and CGI scales before the start of therapy and by the end of 12 and 24 weeks of treatment. RESULTS: The use of Mioreol in six-month therapy of AD patients with moderate-to-severe dementia improved not only cognitive but also a wide range of non-cognitive mental disorders. There was an improvement in the CGI-C scale in more than 50% of included patients, positive dynamics on the ADAS-cog scale (6.5 points reduction in total score) and reduction of non-cognitive mental disorders on the NPI scale (4 points reduction in total score). CONCLUSION: Fixed-dose combination therapy with Mioreol is an effective and well-tolerated treatment option for patients with moderate-to-severe AD. A combination of fixed-dose therapeutic doses of donepezil and memantine is potentially more appropriate than the simultaneous use of two recommended drugs for the treatment of AD, which will improve treatment adherence in patients with moderate to severe AD.

[Diagnostic potential of magnetic resonance spectroscopy in cognitive impairment in the elderly]. / Potentsial MR-spektroskopii v diagnostike kognitivnogo snizheniya u pozhilykh.

OBJECTIVE: To explore the potential use of magnetic resonance spectroscopy (MRS) in the diagnosis of pre-dementia cognitive disorders in elderly people. MATERIAL AND METHODS: A total of 65 elderly individuals (37 individuals with mild cognitive impairment (MCI) according to NIA-AA criteria, mean age 67.2 years; 28 controls, mean age 65.2 years) underwent MRS (3.0 T) with posterior cingulate cortex as the region of interest. Absolute concentrations of metabolites (tCr, NAA, Glx, mI, Cho, NAA) were calculated based on their signal intensities. Statistical analysis was performed to assess intergroup differences and correlations. RESULTS: Statistically significant differences were observed between the clinical and control groups in the absolute concentrations of metabolites: mI (MCI 4.97±0.13; controls 4.76±0.15; p=0.04) and NAA/mI (MCI 1.61±0.04; controls 1.73±0.04; p=0.04), as well as in the intensities of the choline-containing compounds signal (MCI 0.215±0.015; controls 0.205±0.005; p=0.04) in the posterior cingulate cortex region. No significant correlations between these changes and age were observed, suggesting the predominant role of neurodegeneration in the pathological process under investigation. CONCLUSION: The findings highlight the promising nature of MRS as a tool to find the neurodegeneration biomarker.

[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.

[Clinical and immunological effects of choline alfoscerate in the treatment of amnestic type Mild Cognitive Impairment]. / Kliniko-immunologicheskie effekty kholina al'fostserata pri lechenii sindroma myagkogo kognitivnogo snizheniya amnesticheskogo tipa.

OBJECTIVE: To evaluate the change of a number of clinical and immunological parameters of patients with amnestic type Mild Cognitive Impairment (aMCI) in the course of therapy with Choline alfoscerate (α-GPC) in order to develop a monitoring and predicting system of its effectiveness in people at risk for Alzheimer's disease. MATERIAL AND METHODS: Thirty patients with aMCI, aged 56 to 82 years (mean age 68.8±9.4 years), received course therapy with α-GPC in capsules of 400 mg 3 times a day (1200 mg per day) for 3 months. Therapeutic efficacy evaluation according to psychometric tests and scales was carried out three times (0, 45 and 90 days), immunological parameters of leukocyte elastase (LE) and α1-protease inhibitor (α1-PI) were evaluated twice on days 0 and 90 of therapy. RESULTS: A good therapeutic effect over the course treatment with α-GPC, both in terms of cognitive functioning and a number of immunological parameters in patients with aMCI was shown. Significant clinical and immunological correlations included both an improvement in cognitive functions (according to MMSE and the Boston Naming Test) and an increase in LE activity level after the completion of a course of α-GPC therapy, which suggest that an increase in LE functional activity can be considered as a potential marker of a positive therapeutic response to α-GPC treatment in aMCI patients. CONCLUSION: This study shows high significance of further research in assessing the role of immune mechanisms of α-GPC therapeutic efficacy in aMCI patients and the possibility of using immunological parameters as prognostic markers of its therapeutic effect.

[Non-cognitive psychopathological symptoms in mild cognitive impairment]. / Nekognitivnye psikhopatologicheskie simptomy pri legkikh kognitivnykh narusheniyakh.

Noncognitive psychopathological symptoms (NPS) in elderly patients are increasingly attracting the attention of researchers in the field of neurodegenerative diseases. The question is raised whether these symptoms are risk factors or initial manifestations of the neurodegeneration process. This article provides information on the prevalence of late-onset NPS together with mild cognitive impairment (MCI), combination of which reflects the risk of developing dementia. The characteristic of mild behavioral impairment syndrome, which is currently used along with the concept of MCI, is given. The authors summarized data of the studies published over the past 10 years on the effect of NPS on the progression of cognitive impairment. Topics related to the differential diagnosis of these disorders, as well as existing approaches to treatment, are considered.

[Delayed effects of cerebrolysin in the prevention of cognitive impairment progression in the first degree relatives of patients with Alzheimer's disease: the role of the ApoE genotype]. / Prolongirovannye effekty tserebrolizina v profilaktike progressirovaniya kognitivnogo defitsita u rodstvennikov 1 stepeni rodstva patsientov s bolezn'yu Al'tsgeimera: rol' ApoE genotipa.

OBJECTIVE: To assess the delayed effect of course therapy with cerebrolysin on the cognitive functioning of the first degree relatives of patients with Alzheimer's disease (AD), including, depending on the ApoE4 genotype. MATERIAL AND METHODS: A cohort of 72 blood relatives of patients with AD, including 46 with objectively confirmed clinical and neuropsychological examination signs of mild cognitive dysfunction (group 1) and 26 (group 2) with cognitive impairment that meets the diagnostic criteria of mild cognitive impairment (ICD-10 F06.7), was studied. The dynamics of the initial (0 day) indicators of cognitive functioning was compared immediately after a four-week course of treatment with cerebrolysin infusions, as well as 1 and 2 months after its completion, depending on the presence of ApoE4(+) or ApoE4(-) genotype. Clinical, psychopathological, psychometric, follow-up, molecular-genetic and statistical methods were used. RESULTS: A positive prolonged effect of course therapy with cerebrolysin on cognitive functioning of the first degree relatives of patients with AD was established in both groups. A significant negative effect of the ApoE4(+) genotype on the immediate and delayed effects of cerebrolysin treatment has been proven. CONCLUSION: The results can form the basis for the development of therapeutic measures aimed at preventing the progression of cognitive impairment and the development of dementia in the first degree relatives of patients with AD as those with the highest risk of dementia.

[Clinical efficacy and safety of choline alfoscerate in the treatment of late-onset cognitive impairment]. / Klinicheskaia éffektivnost' i bezopasnost' primeneniia kholina al'fostserata v lechenii dodementnykh kognitivnykh narushenii v pozdnem vozraste.

AIM: To study the efficacy and safety of cereton (choline alfoscerate) in the treatment of elderly patients with amnestic type of mild cognitive impairment (aMCI), which often represents a pre-dementia (symptomatic) stage of Alzheimer's disease (AD). MATERIAL AND METHODS: Fifty patients (40 women and 10 men; mean age 68,8 years) received three-month therapy with cereton in a dose of 1200 mg/day in 3 divided doses. Fifteen patients received the same treatment again within 1 year. Immediate and delayed (7-9 months after treatment) effects of therapy, including those dependent on the ApoE genotype were assessed with a neuropsychological test battery. RESULTS: Psychometric measures showed a significant improvement after treatment with cereton. ApoE4 allele noncarriers performed better on tests of immediate and delayed reproduction of 10 words. Although, most indicators achieved in the end of therapy course decreased 7-9 months after treatment, the level of patients cognitive functioning remained at a higher level than before treatment. A repeated course of cereton treatment prevents cognitive deficit increasing during the follow-up period (10-12 months). CONCLUSION: The drug is well-tolerated and safe and can be recommended for preventive treatment of dementia in patients with high AD risk, in particular in elderly patients with aMCI syndrome.

[Therapeutic monitoring and prediction of the efficacy of neurotrophic treatment in patients with amnestic type of mild cognitive impairment]. / Terapevticheskii monitoring i prognoz éffektivnosti neirotroficheskoi terapii u patsientov s sindromom miagkogo kognitivnogo snizheniia amnesticheskogo tipa.

AIM: To perform therapeutic monitoring and prediction of the neurotrophic therapy efficacy in patients with amnestic type of mild cognitive impairment (aMCI) in a model of course cerebrolysin therapy. MATERIAL AND METHODS: The study involved a group of 19 elderly patients who met the diagnostic criteria of aMCI. All patients received a course of neurotrophic therapy consisting of 20 intravenous infusions of cerebrolysin (30 ml of cerebrolysin in 100 ml of isotonic sodium chloride solution). To assess the therapy efficacy, psychometric scales (CGI, MMSE, MoCA-test, МDRS, FAB, Clock Drawing Test, BNT, Word Recall test, delayed reproduction of 10 words, naming digits in a direct and reverse order) were used at 0, 4, 10 and 26 weeks of the study. Antibodies to p75 neurotrophin receptor (NTR) were measured by ELISA in blood serum of 19 patients before cerebrolysin therapy and after 10 and 26 weeks of treatment. RESULTS AND CONCLUSION: The study showed that аMCI patients had an increased level of antibodies against P75NTR that was significantly decreased after 5.5 month of cerebrolysin treatment. Therefore, it can be a potential biomarker of long-term therapeutic effect of cerebrolysin treatment in aMCI patients. The modified fragment 155-164 of P75 NTR determined in the serum of patients can be an effective indicator for monitoring and predicting the efficacy of long-term neurotrophic therapy.

[Systemic inflammatory markers in age-associated cognitive impairment and Alzheimer's disease]. / Sistemnye vospalitel'nye markery pri vozrastnom kognitivnom snizhenii i bolezni Al'tsgeimera.

AIM: To determine a complex of immune markers reflecting various links of multicomponent inflammatory reactions in amnestic type of mild cognitive impairment (aMCI) in comparison with Alzheimer's disease (AD). MATERIAL AND METHODS: Sixty-seven patients with aMCI, aged 72 [63; 77] years, and 91 patients with Alzheimer's disease at the age of 74 [68; 79] years were examined. The aMCI was diagnosed according to the criteria of R.S. Petersen et al. (1999) and B. Dubois et al. (2014). The diagnosis of AD was established in accordance with the ICD-10 and NINCDS-ADRDA criteria. The degree of dementia severity was determined by clinical signs using the CDR (Clinical Dementia Rating) and the Mini Mental State Examination (MMSE) total score. The control group included 38 age- and sex-matched individuals. Immune and biochemical parameters were determined in blood plasma. The activity of LE and α1-PI was determined by spectrophotometric method. Concentrations of IL-6 and CRP were measured by enzyme immunoassay. RESULTS: AD was characterized by the significant decrease in LE activity (p<0.0001) and increase in the activity/levels of α1-PI, CRP and IL-6 (p<0.001; p<0.05; p<0.01, respectively) compared to controls. CDR and MMSE scores were correlated with the LE activity (r=-0.38, r=0.31, p<0.05), i.e. cognitive decline was associated with decreased activity of LE. aMCI was characterized by the significant increase in the activity/level of α1-PI and IL-6 (p<0.0001; p<0.01). In 30% of patients with aMCI, a spectrum of inflammatory markers, typical for patients with AD, was determined. CONCLUSION: Based on the results of comparative analysis of aMCI and AD, one can suggest that one third of patients with aMCI represents a group of ultra-high risk of AD. These patients need a dynamic follow-up with a regular assessment of the state of cognitive functions and possibly preventive therapy.

[Detection of effective treatment of amnestic mild cognitive impairement with cereton by testing of lipids markers]. / Issledovanie éffektivnosti tseretona pri miagkom kognitivnom snizhenii amnesticheskogo tipa na osnove testirovaniia markerov lipidnoi prirody.

AIM: Determination of effectivity and safety of Cereton (Choline alfoscerate, production by Sotex) 1200 mg/day in the treatment of cognitive functioning disorders in patients with amnestic mild cognitive impairment (aMCI) and determining its influence in the process (after a 3 month course of taking the drug) and 3 months after the end of treatment of aMCI on the change in the content of phosphatidylcholine, sphingomyelin, ceramide-metabolite sphingolipids and the activity of genes controlling the synthesis of enzymes, which control ithe metabolism of sphingomyelin and ceramide (sphingomyelinase and ceramidase). MATERIAL AND METHODS: The study involved a group of elderly patients (20 people), consisting of 14 women and 6 men, aged 51 to 82 years (mean age 70.3±9.1 years). The patients' condition met the criteria for diagnosing aMCI syndrome. Analysis of phosphatidylcholine, sphingomyelin and ceramide in the blood plasma of patients was carried out by thin layer chromatography, expression of sphingomyelinase and ceramidase genes by RtPCR. RESULTS AND CONCLUSION: A sharp increase in the content of phosphatidylcholine and ceramide, the product of sphingomyelin hydrolysis, was detected. Expression of genes (acidic sphingomyelinase and ceramidase), controlling the metabolism of ceramide, is significantly reduced in the majority of patients in the treatment with ceretone. An increase in the level of phosphatidylcholine and a decrease in the expression level of the ceramide metabolism genes during treatment with ceretone and other drugs that affect the metabolism of phosphatidylchodine and sphingolipids can be used as markers of the effectiveness of therapy.

[Clinical experience of the use of memantal in patients with moderate and severe Alzheimer's disease].

OBJECTIVE: To assess the efficacy and safety of memantal, a generic formulation of memantine, in patients with moderate and severe dementia due to Alzheimer's disease (AD). MATERIAL AND METHODS: Thirty patients with moderate and severe AD, aged from 55 to 84 years, were examined. Memantal was used in the dose of 20 mg per day after the titration period. Duration of treatment was 3 months. RESULTS: To the end of the study, there was a moderate positive effect as assessed by the CGI. During the treatment, cognitive functions and different forms of daily activity have improved. Significant positive changes in behavioral symptoms of dementia were noted. No adverse effects were observed during the treatment. CONCLUSION: The results of the analysis revealed the clinical efficacy and safety of memantal in treatment of AD.

[Current approaches to optimize treatment of dementia and Alzheimer's disease]. / Sovremennye podkhody k optimizatsii terapii bolezni Al'tsgeimera.

Currently, substitution therapy is the main focus in the treatment of Alzheimer's disease (AD). It is aimed at overcoming neurotransmitter deficits in a variety of neuronal systems affected in AD. To overcome the cholinergic insufficiency, acetylcholinesterase inhibitors (rivastigmine, donepezil and galantamine) are primarily used. The efficacy and safety of these drugs in AD have been convincingly shown in numerous clinical trials in different countries. Memantine is the main drug in glutamatergic strategies in the treatment of AD, which has a neuroprotective effect and relieves symptoms at the level of the remaining glutamatergic synapses. Some other formulations (cerebrolysin, nicergoline etc) can be also applied as vasoactive and neuroprotective agents.

[The reduced level of antibodies to acetylcholine receptor alpha 7 fragment in the blood serum of patients with Alzheimer's disease].

OBJECTIVE: Determination of antibodies to neuronal membrane proteins in the blood serum of patients is of interest for diagnosis and optimization of treatment of Alzheimer's disease (AD). Authors studied the level of antibodies to acetylcholine receptor alpha 7 protein fragment (AChR), prion protein (РrР) and glycation end-products (RAGE) as well as to intracellular proteins nucleophosmin (Nuc) and survivin (Sur) in the serum of AD patients. MATERIAL AND METHODS: Serum samples of 26 patients with probable AD and 13 healthy people were studied. Exposed sections of each protein were used for the choice of peptides for antibody visualization. ELIZA was a main method in this study. RESULTS AND CONCLUSION: Antibodies to several proteins were identified but significant differences were found only for AChR-(173-193). The results demonstrated the involvement of AChR and AChR-antibodies in the development of AD. Determination of antibodies to AChR-(173-193) may be a marker of AD and a method for specifying the diagnosis of AD.

[Clinical experience with agomelatine for the treatment of depression in elderly patients in outpatient practice].

UNLABELLED: Objective. To determine the therapeutic efficacy and safety of agomelatine (valdoxan) in elderly patients with mild and moderate depression during outpatient treatment. Material and methods. The 60-79-year-old age group consisted of 20 patients with mild and moderate depressive episode who received agomelatine. Mild and moderate depressive episode was determined according to depressive disorder criteria of ICD-10. The therapeutic dose for agomelatine treatment was 25 or 50 mg/day once daily (in the evening) during 6 weeks. Results. Depressive symptoms reduced during the first 2 weeks of therapy with agomelatine. Agomelatine was effective in reducing both anxiety and depressive symptoms as well as significantly improved the health-related quality of the patient's life. Agomelatine did not negatively impact on cognitive function and had not pronounced and serious adverse events. CONCLUSION: Agomelatine can be recommended for use in clinical practice for the treatment of elderly outpatients with mild and moderate depression disorders.

[Test scores as indicators of treatment efficacy in dementia caused by Alzheimer's disease in clinical practice].

OBJECTIVE: To analyze the possibility of using MMSE and CGIS as well as the Clock drawing test for the objectification of treatment efficacy in Alzheimer's disease (AD). MATERIAL AND METHODS: Authors examined 765 patients with mild and moderate dementia treated with donepezil during 3 months. The efficacy was assessed using the MMSE and CGIS. RESULTS AND CONCLUSION: The methods demonstrated the reproducibility compared to those used in earlier clinical trials and efficacy of donepezile in the treatment of mild and moderate AD, the Clock drawing test can be recommended as an additional technique for assessment of treatment efficacy in relation to opticospatial function.

[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.