Cognitive impairments in common and rare somatic diseases

The paper gives an update on the pathogenesis, clinical presentation, and pathomorphology of cognitive impairments (CIs) in different autoimmune, endocrine, and infectious diseases, such as systemic lupus erythematosus, Sjögren's syndrome, BehНet's disease, primary angiitis of the central nervous system, polyarteritis nodosa, cryoglobulinemic vasculitis, hypothyroidism, herpetic lesion, and neurosyphilis. These patients are observed to have ischemic-hypoxic brain damage, the causes of which are free radical-induced cell injury, oxidative stress, excitation toxicity, cell necrosis and/or apoptosis, inflammation and immune disease, molecular sequestration, and cell death. There is enhanced imbalance in the pro-oxidant and antioxidant systems as cerebrovascular insufficiency progresses; as this takes place, the nerve cells are most susceptible to the induction of free radical reactions. In these cases, antioxidants that block the effects of free radicals and may potentially improve brain perfusion, by assisting the coupling of neurons and vessels, are first-choice drugs. To improve the cognitive status and to prevent the progression of CIs, it is important to build a cognitive reserve in a patient; this is largely favored by the preservation of a proactive approach to life and social bonds, as well as intellectual work

Outpatient management after severe stroke with dementia

To render outpatient care to poststroke patients, particularly to those who have severe motor and/or speech disorders is an urgent problem in neurology. These patients have frequently cognitive and psychoemotional disorders that make rehabilitation much difficult. If there are no promises for functional restoration, these patients need care, prevention of restroke and complications associated with immobilization. Current methods for preventing restroke include modification of lifestyle, normalization of blood pressure, use of antithrombotic agents and statins (after prior ischemic stroke), treatment of cognitive and depressive disorders, pain syndromes, urination disorders, correct care, diet, passive and active exercises, positional treatment, and local domiciliary procedures. The use of up-to-date treatment options is now shown to substantially reduce the risk of restroke and to improve recovery of lost functions and quality of life in the patient

HEADACHE, SEIZURES, COGNITIVE DISORDERS, AND CEREBROVASCULAR DISEASES AS THE MOST COMMON NEUROPSYCHIC SYNDROMES IN SYSTEMIC LUPUS ERYTHEMATOSUS

The nervous system is often involved in the pathological process in systemic lupus erythematosus (SLE). Neuropsychic SLE includes a combination of syndromes. Headache, seizures, cognitive disorders, cerebrovascular diseases are the most common ones. Pathogenetic mechanisms for the development of neuropsychic syndromes are different. Individual diagnostic and therapeutic strategies for the disease and the patient should be used. This article presents the literature and our own data on the most common neuropsychic syndromes associated with SLE

Cognitive impairments in some cardiovascular and somatic diseases

The paper gives an update on the pathogenesis, clinical presentation, and pathomorphology of cognitive impairments (CIs) in different autoimmune, endocrine, and infectious diseases: systemic lupus erythematosus, Sjögren’s syndrome, Behchet’s disease, primary angiitis of the central nervous system, polyarteritis nodosa, cryoglobulinemic vasculitis, hypothyroidism, herpetic lesion, and neurosyphilis. It is noted that treatment for CIs should be individual in terms of virulence factors. In vascular CIs, therapy should be aimed primarily at modifying risk factors and eliminating or reducing chronic brain ischemia. The prevention of progressive CI encompasses antihypertensive and antithrombotic therapies and surgical correction of atherosclerotic great artery stenosis. Control of hyperlipidemia, hyperglycemia and treatment of other somatic diseases are also of great importance. Such patients are usually given cetylcholinesterase inhibitors, acetylcholine precursors, antiglutamatergic agents, and metabolic and vascular drugs. By taking into account brain ischemia/ hypoxia in the above diseases, it is shown to be advisable to use antioxidants, cerebral active agents in particular, which have a complex neurometabolic effect

Potential use of dimensionhydrinate/cinnarizine combination in the treatment of vertigo

Vertigo is a fairly common complaint with which patients present to physicians of various profiles, and especially to general practitioners, neurologists, and otorhinolaryngologists. Vertigo is a condition where a person has the illusion of movement or of surrounding objects moving when they are not. Vertigo is a symptom of a wide range of diseases, both benign and life-threatening. Vertigo can have a variety of causes, and the suggested treatment should depend on the cause. Due to the multifactorial etiology of medical care, many patients receive inadequate treatment under the primary healthcare scheme, especially during initial presentation. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, vestibular migraine, and cerebrovascular diseases. Patients with other disorders, such as depression and hyperventilation syndrome, may present with complaints of nonrotary vertigo. Differential diagnosis of vertigo can be made using easy-to-perform tests during physical examination, including assessment of nystagmus, Dix-Hallpike maneuver, and blood pressure measurements with head-up tilt table tests. Treatment of patients with complaints of vertigo includes drug and non-drug therapy, depending on the established nosological form. However, due to the multifactorial etiology, many patients receive inadequate treatment under the primary healthcare scheme, especially during initial presentation. The dimensionhydrinate/cinnarizine combination is one of the drugs for the symptomatic treatment of vertigo of various origins in adults

Post-stroke cognitive impairments: diagnosis and therapeutic approaches

Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI). Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients

Role of lipoprotein (a) in the development of ischemic stroke and other cardiovascular diseases

The paper gives the data available in the literature on the role of a level of elevated lipoprotein (a) (Lp (a)) in the development of ischemic stroke and other cardiovascular diseases. It shows the normal level of Lp (a) and the typical distribution of its concentration for people of European origin and representatives of other races. There is evidence on the genetic determination and variability of the Apo (a) gene. The paper presents the results of the recent large survey of 8000 patients with coronary heart disease and 8000 control persons, which has studied candidate genes for cardiovascular diseases. It indicates the role of Lp (a) as a risk factor for early atherosclerosis and describes main pathomorphological mechanisms. The propositions that it is necessary to screen Lp (a) in different risk groups, its target level, and possible methods for correcting the elevated Lp (a) level are given

CAROTID CHEMODECTOMA: DIFFERENTIAL DIAGNOSIS ACCORDING TO ULTRASOUND DATA

Carotid chemodectoma (“chemodectoma caroticum”, a carotid glomus tumor) is a benign slow-growing, vascularized tumor that is one of the most common paragangliomas of the head and neck. The ultrasound examination of 18 000 patients referred for various reasons revealed 2 cases of carotid chemodectoma verified by angiography. The paper gives the current ideas of the rate, etiology, pathomorphology, and clinical manifestations of chemodectoma, as well as its major ultrasound differential diagnostic criteria

GENE EXPRESSION PROFILING AFTER ANGIOGENESIS INHIBITOR TREATMENT

The angiogenic process can be summarized as cell activation by a lack of oxygen releases angiogenic molecules that attract inflammatory and endothelial cells and promote their proliferation. Several protein fragments produced by the digestion of the blood-vessel walls intensify the proliferative activity of endothelial cells. Acetyl salicylic acid is often used as an analgesic drug to relieve minor aches and pains, a drug with antitumour activity and an anti-inflammatory medication. In our experiments we propose using the angiogenesis model and photodynamic therapy (PDT) for observing changes in angiogenesis after treatment, and also for increasing the effect of PDT by addition of angiogenesis inhibitors

Cognitive impairments in epilepsy

Cognitive impairments in epilepsy are a current problem in neurology. The basis of the idea on the pathogenesis of higher nervous system dysfunctions is the interaction of a few factors that include the form and duration of the disease, gender differences, and the impact of antiepileptic therapy. The role of interattack epileptiform changes in the development of cognitive deficit in adults and epileptic encephalopathies in children is discussed. Up-to-date neurophysiological and neuroimaging diagnostic methods allow the detection of new features in the course and progression of higher nervous system dysfunctions in epilepsy