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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.

Introduction. The COVD-19 pandemic caused by the SARS-CoV-2 continues from March 2020. The virus primarily affects the respiratory system. Moreover, there is new data about the various organ damage caused by COVID-19 such as heart, skin, kidney and central nervous system. That’s why it is necessary to investigate the neurological features of the COVID-19.The aim of the study. To investigate the effect of COVID-19 on the cognitive functions of hospitalized patients.Materials and methods. the PCR-positive patients hospitalized at the University Clinical Hospital No. 3 had been included in the study since March 2020 for May 2021. Thorax CT scan, physical and neurological examination, the biochemical blood test was provided for all patients. The neuropsychological examination was made by: MoCA, TMTA, TMTB, and emotional condition was tested by HADS.Results. 33 patients (21 (64.6%) women) were included; the median age was 73.0 [67.0; 76.0]. The average MoCA value was 22.64 points, median: 24.00 points [20.00; 25.00], median TMTA execution speed: 68 seconds [49.00; 84.00], TMTB: 194 seconds [153; 245.75]. HADS (depression) median: 7.0 [5.00; 9.00], for HADS (anxiety) median: 8.0 [4.00; 10.00]. A link between the olfactory disorders and low MoCA results (p = 0.015) was found according to the regression analysis. Moreover, the patient’s age, lung damage degree had a negative impact on the duration of TMTB (p = 0.001 and p = 0.049). The propensity score matching was made to confirm that the olfactory disturbances, regardless of other factors, are associated with a lower MoCA result (p = 0.012).Conclusion. The potential mechanisms, modality, defect duration and pharmacological response of cognitive disorders have a great interest. That’s why it is necessary to conduct clinical and experimental studies on patients, pathomorphological material and animal models.

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.

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.

Pathological post-anesthetic changes can be determined by the type and duration of anesthesia, the somatic and neurological status of the patient in the preoperative period, age, etc.Objective: to assess the severity of cognitive (CI), emotional and motor impairments in patients who underwent spinal surgery.Patients and methods. The clinical study included 60 patients aged 30-74 years who underwent spinal surgery under general anesthesia. The neuropsychological, emotional, somatic, and neurological status were assessed at the baseline and one week, 3, and 6 months after the surgery. Thirty patients underwent a course of cognitive training (main group), and 30 patients were included in a comparison group.Results and discussion. In the postoperative period, pain indicators decreased in both groups. There was an improvement in cognitive functions, emotional state, and quality of life (QoL) in the main group 3 and 6 months after surgery. The inclusion of cognitive training in the rehabilitation program for patients undergoing neurosurgical spinal surgery improved cognitive and motor functions and the QoL of patients. Evaluation and treatment of neurosurgical patients are discussed, which are helpful to improve the results of rehabilitation and QoL in the postoperative period.Conclusion. Additional positive impact of cognitive-motor training for pain regression in patients after spinal surgery was observed.

The paper reviews clinical trials evaluating the efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists used to treat various neurological diseases: neurodegenerative dementias, vascular cognitive disorders, including post-stroke cognitive impairment. It discusses the possibility of treating cognitive disorders with NMDA receptor antagonists in Parkinson's disease, traumatic brain injury, and some other diseases, as well as the potential possibilities of using drugs of this pharmacotherapeutic group in childhood. The paper describes a clinical case illustrating the use of akatinol memantine in a child with a delay in speech and mental development in the presence of fetal alcohol syndrome. The possibilities of using akatinol memantine in the treatment of childhood cognitive impairments are sure to be of particular interest; however, in view of the small amount of data, this aspect requires further clinical trials.

The review considers basic methods for non-drug correction of cognitive disorders, as well as a combined approach, including the use of drugs and cognitive-motor training in the rehabilitation of patients with impaired cognitive functions. The authors present their own data on the efficiency of non-drug therapies in patients with Alzheimer’s disease.

Aim. To test a hypothesis of hypoperfusion-induced white matter changes in patients with atrial fibrillation (AFib) and to present statistics to compute sample size for the upcoming studies.Material and methods. We included 30 inpatients with AFib and investigated them with magnetic resonance imaging (MRI) with standard sequencies and diffusion tensor imaging (DTI). DTI data were analyzed with conventional ROI analysis in the Olea Sphere software and with watershed areas (WSA) mask in the FSL toolbox after nonlinear transformation of images to the Montreal Neurological Institute (MNI) space. Wilcoxon test was used to compare diffusion characteristics across subgroups.Results. Median age of participants was 73 years (69-78), 18 (60%) patients had moderate signs of small vessel disease with Fazekas score of one. Twenty-one patients had paroxysmal AFib. Analysis of WSA revealed decreased white matter integrity in the parieto-occipital cortical WSA with a pattern of significantly increased mean diffusivity (p=0,039), and marginally significant decrease in fractional anisotropy (p=0,056). Rank-based effect size across areas under comparison was either small (0,2) or negligible, and with statistical power in the range of 0,05-1.Conclusion. Atrial fibrillation could have pathophysiologically feasible mechanism to affect white matter integrity in the watershed areas.

Objective: to investigate the effectiveness of cognitive and motor training as an additional method to basic therapy in patients with Alzheimer's disease (AD) and vascular cognitive impairment (VCI).Patients and methods. The investigation enrolled 41 patients (15 women and 26 men; mean age. 73.59+6.3 years), including 32 patients with AD (mean age 74.94+5.15 years) and 9 patients with VCI (mean age, 72.31+4.98 years). Cognitive impairment (CI) corresponded to mild dementia in 15patients (5 women and 10 men; mean age 74.6+2.8years) and to moderate dementia in 29 (10 women and 19 men; mean age 72.1+3.2 years). The patients were randomly assigned to individual, group, and mixed (individual and then group) cognitive training groups. Quantitative scales were used to assess changes in CI and emotional and behavioral disorders after 1.5, 3, and 6 months of therapy.Results and discussion. During cognitive and motor training, all the groups showed a significant decrease in the severity of CI (p < 0.05), depression, anxiety, and apathy. The effectiveness of the training was further influenced by the severity of concomitant cardiovascular disease, the degree of apathy, adherence to the training, and the early initiation of basic symptomatic therapy.The greatest positive changes in anxiety and depressive disorders were noted in the patients receiving group cognitive and motor training.Conclusion. The results of the investigation allow group cognitive and motor training to be recommended as a mainstay in the therapy of patients with CI concurrent with emotional disorders.

The article presents modern data on the causes of development, diagnostic methods and treatment approaches of Alzheimer’s disease. Special attention is given to pathogenetic and symptomatic therapy of this disease, as well as non-drug treatments.

In dementia with Lewy bodies (DLB) neurodegenerative processaffects not only central, but also peripheral nervous structures,most frequently, neurons of autonomic ganglia, which mayunderlay autonomic dysfunction, including peripheral autonomicfailure. The purpose of this study was to analyze autonomicregulation of cardiac functions in patients with DLB with theassessment of the heart rhythm variability. Twenty three patientswith probable DLB were enrolled in the study. A control groupwas composed of healthy individuals comparable by sex and age.In DLB peripheral autonomic failure occurred significantlymore frequently. Orthostatic hypotension manifested at alreadyearly stages of the disease in half of the patients. Spectral analysisof the heart rhythm in patients with orthostatic hypotensionshowed relative predominance of high-frequency waves on thebackground of decreased power of low-frequency waves of the spectrum, which suggests decrease of sympathic influence on theheart rhythm. Relative parasympathicotonia combined withheart rhythm abnormalities seen as supraventricular extrasystols.Analysis of the influence on the heart rhythm of drugs used forthe treatment of cognitive and motor disorders showed that levodopadecreased the heart rhythm variability and parasympathictonus because of stimulation of cardiac adrenoreceptors.Anticholinesterase medications do not influence the heartrhythm variability, but can decrease severity of orthostatic hypotension.

Early diagnosis of Alzheimer's disease (AD) is one of the most important tasks of modern medicine. Even before its obvious clinical symptoms develop, AD can be now identified from the data of functional neuroimaging, including that with the Pittsburgh compound, which can detect amyloid protein accumulation in the brain structures, and from those of an analysis of biomarkers in the cerebrospinal fluid. If there are clinical symptoms, a diagnosis can be established by the correct evaluation of mnestic disorders; the latter in BA are so-called hippocampal. Treatment for AD should be initiated as early as possible; methods for pathogenetic therapy are being actively developed. When treating AD, one should adhere to a comprehensive approach involving the use of drugs for basic symptomatic treatment and those enhancing its efficiency, and non-drug treatments (cognitive and motor training). It is important to timely identify and eliminate potentially reversible conditions and to work with caregivers and guardians.

The paper reviews the data available in the literature on the pharmacokinetic and pharmacodynamic properties of cyticolin and its use in cognitive impairments (CIs).It assesses trials investigating the effect of cyticolin on cognitive functions, including its possible role in increasing Sirtuin 1 (SIRT1) expression. The results of the latest multicenter trials of the drug used to treat dementia syndrome are analyzed in elderly patients with clinical presentations of mental confusion (the VITA trial) and mild vascular CIs (the IDEALE trial).Cyticolin is able to potentiate neuroplasticity and is a natural precursor of phospholipids, mainly phosphotidylcholine that serves as a source of choline in the metabolic pathways of acetylcholine biosynthesis. The VITA and IDEALE have shown that the parenteral and oral administrations of cyticolin are effective and safe in the treatment of moderate vascular CIs and dementia with clinical presentations of mental confusion. Cyticolin therapy is used to reduce the risk of side effects and to delay of loss of the therapeutic effects of levodopa preparations. Cyticolin has been noted to have a positive effect on cognitive functions in patients with Alzheimer’s disease if it is used as an additional therapy.

The article is devoted to pathogenesis and diagnosis of Alzheimer's disease. The possibilities of treatment are discussed. Efficacy data for the basic symptomatic treatment of Alzheimer's disease, the potential and prospects of nootropic therapy are described.

The article is a review of literature on the etiology, pathogenesis, clinical manifestations of cognitive impairment in vascular pathology of the brain, as well as criteria for differential diagnosis of vascular and neurodegenerative cognitive impairment. Symptomatic and pathogenetic treatment of post-stroke cognitive impairment is discussed.

The article tells about current approaches to diagnosis and treatment of vascular cognitive impairment. The focus is on the administration of neurometabolic medicines.

The article is devoted to certain issues in the treatment of neurodegenerative dementias. The effectiveness of acetylcholinesterase inhibitors and drugs from other pharmacological groups, as well as combination therapy with inhibitors of acetylcholinesterase and choline alfoscerate, is highlighted.

The paper gives an update on the occurrence and development of Alzheimer’s disease (AD), a condition manifesting itself as a steady reduction in memory. AD is common in the modern population. The reason for its higher incidence rate is the specific features of the current information sphere. Genetic factors that both directly lead to the development of AD and indirectly influence its occurrence are also imperative. At the present time, the genetic bank of mutations associated with the development of AD contains information on more than 300 different mutations. Genetic predetermination of this disease has a negative impact on prognosis and prospects for patient treatment.Patients and methods. The distribution of hereditary forms of AD in a Russian population was analyzed at the Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University. The investigation enrolled 46 patients (13 men and 33 women) who met the international criteria for AD; all had its proven hereditary history. The patients' mean age was 73.7±8.3 years in the men and 73.4±8.5 in the women; the mean disease duration was 29.6±12.4 and 28.0±18.8 months, respectively. The incidence of AD was estimated depending on age, comorbidity, degree of cognitive impairments, and pattern of the disease. Its history was rated using a questionnaire. No genome mapping was carried out.Results and discussion. The patients were divided into two groups: 1) presenile AD (age at its onset less than 65 years; n=8) and 2) senile AD (age at its onset more than 65 years; n=38). There was a preponderance of patients with mild dementia in both groups; however, in the patients with senile AD, the latter was diagnosed at the stage of moderate cognitive impairments in 7.9% of cases. Comorbidity was mild in all the patients. Depression and behavioral disorders were noted in half of the patients with AD; at the same time, behavioral and emotional disorders were significantly more common in the presenile and senile AD groups, respectively. The prevalence of senile AD was shown to be 4.7 timesgreater than that of presenile AD, as shown by our data). The performed investigation could reveal some features of the course and clinical presentation of both genetically determined AD as a whole and its senile and presenile forms in particular.

The main issues of the epidemiology and the early and late clinical manifestations of Alzheimer’s disease (AD), the most common cause of dementia in the elderly, are discussed. Current data on the pathogenesis of, new treatment strategies for AD, and investigator’s altered views on the course of the disease are given. The fact that AD is a long-term, progressive disease that develops long before the occurrence of the first clinical symptoms is beyond question now. This necessitates the design of new diagnostic criteria and methods that allow the disease to be diagnosed as early as possible. The main aspects of basic symptomatic therapy for AD are discussed in detail. The basic principles of its correct treatment using new dosage forms that permit a complete therapeutic effect to be achieved are given.

This literature review outlines the role of glutamatergic disturbances in the pathogenesis of cognitive disorders. There is data on the effectiveness of the glutamate NMDA-receptors antagonist - memantine - in patients with various dementias: Alzheimer's disease, dementia with Lewy bodies, vascular and mixed dementia. The authors share own positive experience with the drug Akatinol Memantine at various dementias. Options for administration of the drug in patients with mild cognitive impairment are discussed; results of a multicenter regional study are provided. The efficacy and safety of Akatinol Memantine as a medication to improve cognitive function is highlighted.

Cardiac rhythm and its structure are indicators of the state of heart regulatory systems. Estimation of heart rhythm variability (HRV) makes it possible to detect cardiac autonomic regulatory impairments and to estimate their magnitude, by providing additional possibilities to examine autonomic disorders and to search for new differential diagnostic distinctions between Levy body dementia (LBD) and Parkinson's disease (PD).Objective: to analyze autonomic provision of cardiac performance in patients with LBD versus PD patients with and without dementia (PD+D and PD-D).Subjects and methods. The study enrolled 21 patients with probable LBD and 31 patients with PD (24 patients with PD-D and 7 with PD+D), who were matched for gender and age.Results and discussion. Resting heart rhythm analysis revealed no normal age-related abnormalities in patients with LBD as compared to those with PD+D who had a marked reduction in HRV. An orthostatic test in both patients with LBD and those with PD (mainly that with dementia) showed inadequate sympathetic effects on heart rhythm, which is suggestive of cardiac sympathetic dysregulation and favors the development of orthostatic hypotension. During the orthostatic test, the patients with LBD were found to have supraventricular premature contractions with the pulse being fixed, which were probably caused by the hypersensitivity of denervated receptors to humoral factors. As the denervation process became longer, receptor sensitivity was decreased, hence supraventricular premature beats and arterial hypertension were absent in the horizontal position in long ill patients with PD+D, in whom the adaptive properties were considerably lower.

Algorithm for the treatment of sleep disorders in patients with cognitive impairment