Evaluation of the cognitive-motor training effectiveness in combination with drug therapy among patients with moderate cognitive disorders: the own research results

Introduction. Non-drug methods of therapy for cognitive impairment is one of the topical areas of neurology. Studies have shown that cognitive training may be beneficial for maintaining mental alertness in healthy older adults, while patients with dementia and mild cognitive impairment are more likely to benefit from cognitive-motor training or rehabilitation. It is possible that the severity and type of cognitive disorders, as well as patients’ adherence to training, the correct construction of tasks, may affect the effectiveness of non-drug therapy for cognitive disorders.Аim. The aim of this study was to evaluate the effectiveness of cognitive-motor training developed at Sechenov University in patients with moderate cognitive impairment (MCI).Materials and methods. 41 patients were included in the study, including 8 women and 33 men, the average age of patients was 60.3 ± 8.5 years, the average level of education was 14.2 ± 8.7 years, of which 15 patients met the criteria AD, 26 – VCI criteria. Patients underwent quantitative neuropsychological testing, assessment of emotional disorders, and also assessed such indicators as satisfaction with the quality of life, adherence to therapy. Subsequently, the patients were divided into groups of individual and group cognitive training. Classes with patients were held according to the standard scheme, 30–50 minutes a day, for 40 days. After 3 months, 10 patients were randomly selected from the individual training group and received an additional course of group cognitive-motor training.Results. Тhe study showed that after 1.5 months, patients showed a significant decrease in the severity of cognitive disorders (p < 0.05). The greatest positive dynamics was noted in relation to the level of attention (p < 0.05), memory (including primary modal-nonspecific mnestic impairment, p < 0.05), logical operations (p < 0.05). The patients included in the study also showed a significant decrease in the severity of depression (p < 0.05). The analysis showed that significant positive dynamics was recorded both in patients of the individual CT group and in patients who received group CT (p < 0.05). The positive effect on cognitive functions was maintained during the three months of follow-up. Comparative analysis of study patients after 6 months showed that patients who received additional sessions with a trainer reported an additional improvement in well-being. These differences were statistically significant, despite the small number of patients included in the repeat CT group (p < 0.05).Conclusions. The effectiveness of cognitive-motor training in patients with MCI was noted. The results obtained allow us to recommend this type of cognitive-motor training for use in clinical practice by neurologists, therapists and psychiatrists as an additional effective method for the treatment of cognitive impairment

Nonpharmacological treatment of cognitive impairment: cognitive training guidelines

Important aspects of the treatment of cognitive impairments are their early detection, prevention and timely prescription of drug therapy. The method of non-drug prevention and, at the same time, the treatment of cognitive impairment is cognitive training. There are cognitive training, cognitive stimulation and cognitive rehabilitation. The content of  cognitive training should be determined by the type and severity of the patient’s cognitive impairment; effectiveness depends, among other things, on the duration of the sessions and on the commitment of patients to cognitive training. At the Department of Nervous Diseases and Neurosurgery of Sechenov University, guidelines have been developed that allow cognitive training for patients with mild and moderate cognitive impairments. The effectiveness of methodological recommendations has been confirmed by studies; they were introduced into the work of the neurological and neurosurgical departments of the clinic of nervous diseases of the Sechenov University. Taking into account the development of modern technologies, it seems interesting and important to create methods of cognitive training that will allow the patient to study using a smartphone, tablet or computer, and the doctor to remotely monitor the well-being and track the results of the patient’s therapy. In the fall of 2022, the Health Formula program will be launched on the basis of the My Health app, designed specifically to support patients with cognitive impairments. Health Formula is an online service for remote communication between a doctor and a patient, the purpose of which is to increase patient compliance and the effectiveness of the treatment itself. The application will contain a set of cognitive exercises to complement the prescribed drug therapy. At the initial stage, the course will be a balanced selection of video exercises, which will later be included in the global interactive program for patients with CI

Postoperative cognitive dysfunction: etiology, clinical features, diagnosis

Introduction. The present study analyzed the possibility of using neuropsychological tests to assess postoperative cognitive dysfunction. New data were obtained: in the postoperative period, hippocampal memory impairments predominate in patients, which makes it expedient to use methods for diagnosing primary modal-nonspecific memory disorders in patients who are to undergo neurosurgical intervention on the spinal cord.The aim of the study to evaluate the influence of surgery with anesthesia on the cognitive functions of middle-age patients.Materials and methods. The study included 20 middle-aged patients. All patients had to undergo spinal surgery. Patients received total intravenous anesthesia with propofol induction (4–12 mg/kg/hr). Cognitive functions before and after the operation were made with the use of the MoCA, TMT A and B, FCSRT, state-trait anxiety inventory test (STAI).Results. The development of POCD was noted in 15% of cases. The patients showed a decrease in the FCSRT prompt index (1st day = 87 ± 9.0; 2nd day = 83 ± 15; p = 0,0005), while the overall severity of cognitive impairments (total score of MoCA) did not change significantly (standard deviation according to MoCA: 24.25 ± 2.86 on day 1 and 24 ± 3.24 on the second day, p = 0.61). The RT level decreased by day 2: 44.65 ± 7.4 versus 41.1 ± 8.2 (p = 0.001). Correlation analysis did not show the relationship between the age of patients, education level, comorbidity and development of POCD; however, the duration of anesthesia was associated with a decrease in MoCA scores (Pearson’s correlation coefficient r = –0.44; p = 0.050).Conclusion. Thus, our study shows that the study of hippocampal memory impairments is important in patients with POCD. These data differ from the data of researchers presented earlier, where the most important clinical manifestations of POCD are considered to be a decrease in attention and speed of mental processes. Of course, the small sample size dictates the need for additional research