[Express-method of assessment of cognitive functions in normal aging].

The authors suggest a new express-method for assessment of memory and intellect in the late age. This method allows to assess not only disturbed functions but also the intact patterns of mental processes and to conduct a quantitative assessment as well as a qualitative (syndrome) analysis of mental activity changes using a Luria's structural-functional model of the brain. The method was administered to 157 subjects of young (20-30 years), old and very old age (50-90 years). The express method may be used for the detection of age impairment and differential diagnostics of memory and intellect states in different variants of normal aging, assessment of neurocognitive deficit in patients with Alzheimer's disease and mild cognitive syndrome.

[Memory peculiarities in patients with schizophrenia and their first-degree relatives].

Eighty-four families with schizophrenia: 84 patients (probands) and 73 their first-degree unaffected relatives as well as 37 normals and their relatives have been studied using pathopsychological (pictogram) and Luria's neuropsychological tests. The most prominent abnormalities both in patients and relatives were global characteristics of auditory-speech memory predominantly related to left subcortical and left temporal regions. Abnormalities of immediate recall of short logic story (SLS) were connected with dysfunction of the same brain regions. Less prominent delayed recall abnormalities of SLS were revealed only in patients and connected with left subcortical, left subcortical-frontal and left subcortical-temporal zones. This abnormality was absent in relatives and age-matched controls. The span of mediated retention was decreased in patients and, to a less degree, in relatives. A quantitative psychological analysis has demonstrated the disintegration ("schizys") between semantic conception and image memory structure in patients and, to a less degree, in relatives. Data obtained show primary memory abnormalities in families with schizophrenia related to the impairment of decoding information process in the subcortical structures, the left-side dysfunction of brain structures being predominantly typical.

Cognitive impairments in cerebellar infarcts.

The effects of the cerebellum on cognitive functions (CF) are poorly known and inadequately studied. Neurological, neuropsychological, and neuroimaging studies were performed on 25 non-random patients (14 female, 11 male, mean age 51.8 +/- 18.0 years) with isolated cerebellar infarcts. Cognitive impairments (CI) were seen in 22 patients (88%). These included impairments of attention, planning, control, abstract thought, memory, and speech disturbances (naming difficulties, irregularity of speech, agrammatism, dysprosodia), visuospatial and quasispatial disturbances, and counting impairments, demonstrating dysfunction of the anterior and posterior associative areas of the cortex. The extent of CI varied: 16 patients (64%) showed impairments only in neuropsychological tests, while six (24%) had clinically apparent impairments. Clinically significant CI developed in lesions of particular areas (posteroinferolateral and posteromedial/median) of the cerebellar cortex associated with the dominant hemisphere of the brain. The existence of clinically significant CI was independent of infarct size: infarcts were smaller (mean 5.65 cm3) in patients with marked impairments than in others (mean 12.8 cm3). The typical signs of cerebellar infarcts (ataxia, vertigo, vomiting) were seen in all patients with clinically insignificant and in only two of six patients with clinically significant CI. The present studies demonstrated the involvement of the cerebellum in the modulation of CF. The extent of CI in cerebellar infarcts depended on infarct location. The topical localizations of cerebellar zones controlling CF and movement are different.

[Cognitive disturbances in cerebellum infarctions]. / Kognitivnye narusheniia pri infarktakh mozzhechka.

The influence of the cerebellum on cognitive functions (CF) is poorly known and understudied so far. Neurological, neuropsychological and neuroimaging non-randomized study was carried out in 25 patients (14 women, 11 men, mean age 51.8 +/- 18.0 years) with isolated cerebellum infarctions. Cognitive disturbances (CD) were detected in 22 (88%) patients. They included impairment of attention, planning, control, abstract reasoning, memory; speech (naming, fluency, agrammatism, dysprosodia), special visual, quasi-spatial and counting disorders that indicated dysfunction of the anterior and posterior associative areas of the brain cortex. The expression of CD was different: being clinically obvious in 6 patients (24%), they were found only by neuropsychological methods in 16 patients (64%). Clinically significant CD developed in the lesions of certain areas (posterior-lower- lateral and posterior-medial) of the cerebellum hemisphere related to the dominant brain hemisphere. The presence of these CD did not depend on infarctions size: in expressed CD it was smaller (mean 5.65 cm3) than in other cases (mean 12.8 cm3). Typical appearances of cerebellum infarction (ataxia, vertigo, vomiting) were observed in all the patients with clinically non-significant CD and only in 2 out of 6 with clinically significant CD. The study demonstrated a role of the cerebellum in CF modulation. The expression of CD in cerebellum infarctions depends on their localization. Topic localization of the cerebellum areas, controlling CD and movement, is different.

[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.

[Specificity of neuropsychological syndromes in disorders of higher mental functions in Alzheimer's disease and senile dementia]. / O spetsifichnosti neiropsikhologicheskikh sindromov narusheniia vysshikh psikhicheskikh funktsii pri bolezni Al'tsgeimera i senil'noi dementsii.

A comparative neuropsychological study was made of the two groups of patients: with Alzheimer's disease [AD] (n = 40) and senile dementia [SD] (n = 54). The correlation and role of different factors in the formation of syndromes of higher mental functions (HMF) impairment in AD and SD were determined. The analysis was based on the concept of the presence of operational and regulatory factors in the systemic organization of mental activity. The structure of the syndrome of HMF impairment in AD is specified by the deficiency of operational factors whereas in SD, the deficiency of regulatory factors plays the key role. The patients with AD manifest the combination of disordered operational and regulatory factors related to the work of brain blocks II and I respectively (according to Luria). In SD patients, the syndrome is marked by the predominance of the symptoms related to the deficiency of regulatory factors provided for by the structures of brain blocks III and I, with the interest of the brain areas entering block II being far less.

[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.

[Neuropsychological approach to the complex study of senile dementia]. / Neiropsikhologicheskii podkhod v kompleksnom izuchenii dementsii pozdnego vozrasta.

Thirty-eight patients with late mentally deteriorating processes were studied. Using a standardized neuropsychological method, the authors have outlined four major variants of neuropsychological syndromes characteristic of damage to definite zones of the brain. Comparison of these data with the results of clinical and computer-aided tomographic examination showed that the neuropsychological approach is an adequate method in the combined study of senile dementia.