M. S. Novikova

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучение предикторов эффективности нелекарственной мультимодальной терапии в лечении сосудистых когнитивных нарушений умеренной степени выраженности. МАТЕРИАЛ И МЕТОДЫ Тридцать пациентов с умеренными сосудистыми когнитивными нарушениями под наблюдением врача проходили обучение комплексу нелекарственных методов лечения в течение 1 мес, включая когнитивный тренинг, детальные рекомендации по физической активности и планированию питания. РЕЗУЛЬТАТЫ После окончания курса лечения улучшения по Монреальской шкале оценки когнитивных функций (MoCa) достигли 22 (73%) пациента, которые составили 1-ю группу. Остальные 8 пациентов не получили эффекта от лечения (2-я группа). В 1-й группе динамика теста MoCa в среднем составила 1,7±0,9 балла, во 2-й группе — –0,4±0,5 балла. Пациенты 1-й группы имели достоверно более низкий уровень образования (10,9±2,3 года), чем во 2-й группе (14,9±2,0 года), более высокий исходный балл по тесту MoCa и менее выраженное поражение белого вещества по шкале Fazekas. После проведения регрессионного анализа достоверными предикторами оказались уровень образования (B –0,999, pp При применении нелекарственной мультимодальной терапии в лечении сосудистых когнитивных нарушений умеренной степени выраженности достоверными предикторами эффективности лечения являются более низкий уровень образования и меньшая степень сосудистого поражения белого вещества.

Emotional-affective disorders often accompany vascular cognitive impairment. Currently, there is insufficient data on the impact of non-drug treatment of cognitive impairment on the emotional sphere.The aim of the study was to evaluate the effect of non-drug methods (meal planning, exercise, cognitive training) on anxiety and depression in patients with mild cognitive impairment of vascular etiology.Material and methods. The study included 60 patients aged 45 to 88 years (mean age 63.9 ± 9.7, 26 males and 34 females) with mild cognitive impairment of vascular etiology. 30 patients (study group, 18 women, 12 men, mean age 63.7 ± 8.8 years, Montreal Cognitive Assessment (MoCA) score 22.5 ± 2.4) received a set of non-drug methods for 1 month, including cognitive training, detailed recommendations on physical activity and meal planning. Patients in the control group (n = 30, 16 women, 14 men, mean age — 64.2 ± 10.7 years, MoCA score — 21.7 ± 2.4 points) were once informed by the attending physician about the expediency of a physically and cognitively active lifestyle and the basic principles diets, however, systematic training with them was not carried out. Anxiety and depression were assessed at the stage of inclusion in the study, after 1 month, after 6 months, and one year after the start of observation using the Beck Depression Scale, the Spielberger–Khanin Anxiety Scale.Results. 1 month after the start of the study, along with a significant (p < 0.05) improvement in cognitive functions according MoCA, a significant decrease in the severity of anxiety was noted in the study group (p < 0.05). In patients with mild and moderate depression (n = 13), a significant (p < 0.05) regression in the severity of depression was recorded after a month of using non-drug methods. However, in the process of long-term follow-up (1 year), the differences with the initial visit for these indicators lost statistical significance. In the control group, a month after the start of the study, there were no significant differences in the MoCA test (p > 0.05), while the indicators of anxiety and depression worsened throughout the entire observation period. The study group significantly (p < 0.05) outperformed the control group in the MoCA test immediately after treatment and after 6 months. Differences of anxiety level were significant only immediately after treatment.Conclusion. A complex of non-drug methods is effective in the treatment of vascular MCI and reduces anxiety in patients. In patients with mild and moderate depression decrease of depression symptoms was observed also. However the effect of the monthly course was not stable.

Introduction. Cognitive impairment significantly reduces the quality of life. This occurs already in the early stages of the disease. At present, the effect of non-drug treatment on mild cognitive impairment and the quality of life of patients has not been sufficiently studied.Aim. To evaluate the effect of a combination of non-drug treatments on the quality of life of patients with non-demented vascular cognitive impairment.Materials and methods. 60 patients with moderate cognitive impairment of vascular etiology were included in an open randomized trial. Patients of the first group (n = 30, mean age 63.7 ± 8.8) received a combination of non-drug methods (cognitive training, physical activity, meal planning) for one month. Patients of the second group (n = 30, mean age 64.2 ± 10.7) were informed about the advisability of a healthy diet and maintenance of mental and physical activity. Neuropsychological testing was carried out at the stage of inclusion, immediately after the course of treatment, after 6 months and one year after the start of the study.Results. Patients of the first group showed a statistically significant improvement in the quality of life (p < 0.05) one month after the start of the study. After 6 months and after a year, there were no significant differences with the first visit. When comparing the indicators of the second group with the initial visit, a decrease in the quality of life was noted throughout the follow- up (p < 0.05). The differences were statistically significant when comparing the two groups with each other at the time of the second visit, but at the third and fourth visits they lost statistical significance.Conclusion. The results obtained indicate that the use of a complex of non-drug methods of treatment for moderate vascular cognitive impairment improves the quality of life of patients.

Efficacy of a combination of non-drug therapies in patients with non-dementia vascular cognitive impairment

Currently, cognitive impairment is a determining factor in the decline in adaptation in the elderly. Damage to the cerebral vessels is one of the most common causes of the development of cognitive deficits. Patients with severe cognitive impairments are not easily treatable, require outside help, and have significant limitations in daily activities. In most cases, this stage is preceded by a period of mild cognitive impairment. As a rule, mild cognitive impairments often remain undiagnosed, since they do not cause restrictions in daily activities for a long time and are detected only thanks to highly specific neuropsychological tests. But it is precisely the timely diagnosis and treatment of cognitive impairment without dementia, that make it possible to achieve longterm remission of the disease, to delay the onset of pronounced cognitive deficit. Among the correction methods, non-drug methods and pharmacological therapy are distinguished. Of no small importance is the impact on vascular risk factors such as arterial hypertension, diabetes mellitus, hyperlipidemia, smoking, alcohol abuse, etc. Nutrition planning, dosed exercise and cognitive training are the most common non-pharmacological strategies for correcting cognitive impairment. Pharmacological treatment includes anticholinesterase and neurometabolic drugs, as well as drugs aimed at correcting risk factors. A growing number of researchers agree that complex therapy, including lifestyle modification and the use of pharmacotherapy, is preferable. The article discusses the most commonly used methods of treating non-demented cognitive impairments, presents the results of large randomized clinical trials devoted to this problem, presents our own experience of both exclusively non-drug effects on patients and the use of complex treatment using a neurometabolic drug.

Nowadays, the novel coronavirus infection (COVID-19) pandemic is one of the most important global health problems. There is increasing evidence that COVID-19 affects central and peripheral nervous system as well. The paper presents a clinical case of a 47 old patient with the ApoE ε4 haplotype and family history of Alzheimer’s disease who developed cognitive impairment after acute COVID-19. Before the infection the patient has no cognitive complaints and preserved everyday activity. After novel coronavirus infection, which was observed in mild form, the patient had started to complain on constant excessive forgetfulness. Neuropsychological assessment confirmed the presence of pre-mild cognitive impairment of predominantly single domain amnestic type. However, brain MRI showed only subtle periventricular white matter changes usually attributed to small vessel disease. Memory complaints were observed for 3 months of follow up despite intensive cognitive training, optimization of lifestyle and therapy with choline alphoscerate. Probable links between coronavirus infectious and cognitive impairment manifestation are discussed. There is data that ApoE ε4 haplotype is associated with increase of microglia mediated neuro-inflammation and it can be significant for accelerating of progression of neurodegenerative diseases after COVID-19. Further follow up of the patient is necessary for determination of nosological diagnosis explaining manifested predominantly amnestic type pre-mild cognitive impairment.