[The prevalence of osteoarthritis and its association with geriatric syndromes in people over 65: data from the Russian epidemiological study EVKALIPT].

BACKGROUND: Osteoarthritis (OA) in elderly and senile patients is not only common, but also one of the main diseases affecting the duration of active life, its quality, the appearance of addictions and loss of autonomy. Data on the relationship between OA and geriatric syndromes (GS) in our country are extremely scarce. AIM: To estimate the prevalence of OA and to analyze its associations with HS in persons aged 65 years. MATERIALS AND METHODS: The study included 4308 people (30% of men) aged 65 to 107 years, living in 11 regions of Russia. The patients were divided into 2 groups: with OA (n=2464) and without OA (n=1821). All patients underwent a comprehensive geriatric assessment. RESULTS: The prevalence of OA was 57.6%. With age, the frequency of OA increased significantly. According to the results of a comprehensive geriatric assessment, patients with OA had lower walking speed, the sum of points on the Bartel, Lawton scales and a short battery of physical functioning tests and higher the sum of points on the geriatric scale of depression and the age is not a hindrance scale. Patients with OA rated the quality of life and health status lower and higher the intensity of pain syndrome. Patients with OA were more likely to use any assistive device, with the exception of a wheelchair. In patients with OA, the most common HS were chronic pain syndrome (92%), senile asthenia syndrome (64%), basic (66%) and instrumental (56%) dependence in everyday life, cognitive impairment (62%), probable depression (51%) and urinary incontinence (50%). Univariate regression analysis showed that OA is associated with a 1.23.0-fold increase in the risk of a number of GS and a 28% decrease in the risk of malnutrition. CONCLUSION: OA is widespread in the elderly population. The presence of OA is associated with a number of GS associated with loss of autonomy.

[Chronic pain in patients older than 60 years: a view of the geriatrics]. / Khronicheskaia bol' u patsientov starshe 60 let: vzgliad geriatra.

AIM: To analyze the geriatric status of patients with chronic pain. MATERIAL AND METHODS: One hundred and sixteen patients of a geriatric unit, aged 75.66±7.98 years (110 women, 94.8%), were studied. All patients underwent general clinical examination and complex geriatric assessment, on the results of which geriatric syndromes were identified. Characteristics of pain syndrome (cause, intensity, localization) are described. RESULTS: Chronic pain syndrome is identified in 85 (73.3%) patients. Most often pain is localized in large joints (n=44 (51.76%)) and back (n=50 (58.8%)). The intensity of pain was higher in patients with moderate dependence in daily activities compared to those with mild dependence (p<0.05). Pain intensity is associated with the degree of impairment of physical functioning (p<0.05). Patients with chronic pain have more geriatric symptoms (6.8±2.8). More syndromes (9.11±2.37) are identified in patients with marked impairment of physical functioning. The reduction of muscle strength is observed in 45.9% patients with- and 9.7% patients without chronic pain syndrome. The velocity of pace is 0.59 m/s and 0.71 m/s, respectively. CONCLUSION: The high prevalence of chronic pain in patients of a geriatric unit is shown. The intensity of pain iss higher in patients with moderate dependence in daily activities compared to those with mild dependence. Pain intensity increases with the reduction of patient's physical functioning. Patients with chronic pain more often have dynapenia and significantly lower velocity of pace that indicates the poor outcome in elderly patients.

Characteristics of the formation of chronic fatigue syndrome and approaches to its treatment in young patients with focal brain damage.

Chronic fatigue is among the manifestations of focal brain lesions. It is most often encountered in multiple sclerosis (MS) and patients with the sequelae of traumatic, inflammatory, and vascular brain damage (encephalopathies). The aim of the present work was to study the mechanisms of formation of this syndrome in 50 patients with focal brain lesions of different origins (in the inactive stage) and to assess the possibility of correcting it using the combined agent Fezam (2 capsules t.i.d. for one month), which contains piracetam and cinarrizine. In patients with encephalopathies, chronic fatigue syndrome was directly associated with the severity of depression. Patients with MS showed changes in the value-sense sphere. Neuropsychological testing showed that the psychological and personality components played a greater role in the origins of chronic fatigue in patients with encephalopathies than in those with MS. Fezam significantly decreased the severity of chronic fatigue, particularly in patients with MS; in the second group (non-MS patients) this was accompanied by a decrease in the severity of depression. Mild side effects (in six patients--12%) consisted generally of sleep disturbances. These results indicate that Fezam should be used in the treatment of chronic fatigue in patients with focal brain lesions; in encephalopathies it should be combined with psychoactive agents.

[The peculiarities of formation and approaches to the treatment of chronic fatigue syndrome in young patients with focal brain damage].

Chronic fatigue (CF) is a syndrome manifesting in cases with focal brain damage. It is frequent in multiple sclerosis (MS) and encephalopathies (post-traumatic, cerebrovascular, etc). Treatment of this syndrome remains problematic. The study aimed to analyze the genesis of CF in patients with different non-active neurological diseases with brain damage and possibility of its treatment with the complex drug fezam (piracetam plus cinnarizin) in dosage 2 capsules 3 times per day. Before the treatment, all the patients had CF, which was directly associated with severity of depression in patients with encephalopathies. In MS patients, changes in the valuable-and-sense sphere that plays a significant role in human behavior and activity underlying self-regulation in critical situations were found. Neuropsychological data revealed that in patients with encephalopathies psychological and behavioral aspects were more significant in regard with CF genesis than in patients with MS. Fesam caused significant decrease of the CF severity, which was more prominent in the MS group, while in another group it was associated with a decrease of depression severity. Mild side-effects were observed in 6 patients (12%) and appeared mainly as sleep disorders. This trial allows recommending Fezam for complex treatment of CF syndrome in MS and in combination with psychocorrective medicines in cases of encephalopathies.

[Specifics of personality and mental status in children and adolescence with chronic tension-type headache]. / Osobennosti lichnosti i psikhicheskogo sostoianiia detei i podrostkov, stradaiushchikh khronicheskimi boliami napriazheniia.

Neurological and psychiatric examination of 334 children, aged 7-15 years, 87 (23%) of them suffering from chronic tension-type headache (CTTH) is presented. All the patients had mental (mostly depressive and anxiety) disorders and 95.3% of them--psychosomatic ones. Clinical heterogeneity of CTTH was revealed: in the cases of daily continuous headache there were depressive disorders, in daily intermittent headache--depressive and anxiety-phobic disorders and in frequent headache pattern neurasthenia was predominantly detected. Personality features of CTTH patients were as follows: high anxiety, aggressiveness, asthenia, low "Ego" power, high frustration, sensitivity, hypochondriac, depressive and hysterical tendencies, affective rigidity. Patients realized mostly non-adaptive coping styles both for high and low pain intensiveness. Combination of psychopharmacology, psychotherapy and biofeedback for the CTTH treatment is recommended.