V. M. Mishchenko

Background. Chronic stress and martial law conditions in Ukraine significantly exacerbate sleep disturbances and psycho-emotional disorders in patients with dyscirculatory encephalopathy (DE). This underscores the importance of investigating the mechanisms of insomnia development under war-related stress. Purpose – to identify the characteristics of nighttime sleep disturbances in patients with DE under martial law and evaluate their relationship with clinical and psycho-emotional manifestations of the disease. Materials and Methods. Fifty-eight patients with DE of stages I and II of hypertensive and atherosclerotic origin were examined, forming a main group (n = 30) and a control group (n = 28). Patients in the main group underwent comprehensive clinical-neurological and psychodiagnostic assessment using the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) under martial law conditions. The control group was examined before the full-scale war. Results. Patients with DE under martial law demonstrated more pronounced neurological, asthenic, and psycho-emotional disturbances compared to the prewar period. According to PSQI data, sleep disturbances in the main group were more severe and polymorphic, particularly at stage I of the disease. Worsening insomnia contributed to the formation of a clinical picture characteristic of more advanced stages of DE, complicating the differentiation between stages I and II. A close relationship was observed between reduced sleep quality and increased levels of anxiety and depressive symptoms on the HADS, with these changes being more pronounced in patients with stage I DE. Conclusions. Chronic stress during wartime is a potent modifying factor in the course of DE, contributing to the intensification of insomnia and psycho-emotional disorders and diminishing clinical differences between disease stages. These findings underscore the need for a comprehensive approach to the diagnosis and management of patients with DE, considering their psycho-emotional status and sleep quality.

Background. The nervous system plays a key role in mediating adaptive responses of the body to external influences. Under conditions of martial law, particular attention should be given to the impact of chronic stress and combat-related factors on the central nervous system, especially on the development and course of cerebrovascular diseases, which significantly determine functional status and quality of life. Purpose – to investigate the clinical features of the development and course of cerebrovascular diseases under conditions of martial law. Materials and Methods. A total of 60 patients with chronic cerebral circulatory disorders (dyscirculatory encephalopathy stages I–II) were examined and constituted the main group, including 30 civilians and 30 military personnel. The mean age of patients was 45.2 ± 6.6 years. The comparison group consisted of 30 patients with dyscirculatory encephalopathy stages I–II examined in the pre-war period. Clinical and neurological, clinical and psychopathological, psychodiagnostic, and statistical research methods were applied. Results. Asthenic manifestations, neurocognitive impairment, and insomnia syndrome predominated in patients of the main group. Chronic psychoemotional stress and combat-related stress were identified as leading risk factors for the development of cerebrovascular diseases. Differences in disease course were observed depending on social status and the level of psychoemotional burden. Military personnel demonstrated an earlier disease onset, higher frequency of hypertensive crises, more pronounced atherosclerotic changes in the carotid arteries, elevated levels of proinflammatory cytokines, and a higher prevalence of anxiety-depressive disorders, sleep disturbances, and cognitive decline. In the civilian population, chronic forms of cerebrovascular pathology predominated, characterized by cognitive deficits, emotional lability, and asthenic syndrome associated with arterial hypertension and atherosclerosis. Conclusions. Prolonged war-related stress exceeding the adaptive capacity of the body contributes to the development and progression of cerebrovascular pathology combined with psychoemotional and cognitive disorders. The obtained results substantiate the need for differentiated treatment and neurorehabilitation approaches that consider the impact of war-related factors.

Background. The global increase in the prevalence of arterial hypertension (AH) and associated neurocognitive disorders, as well as the lack of effective evidence-based treatment strategies, contribute to the increasing demand for biomarkers for early diagnosis and prediction of the development of cognitive dysfunction. The potential use of such biomarkers is of great clinical importance in the prevention of the development of neurocognitive disorders in young people with AH. Purpose – to identify prognostically significant biomarkers of the development of neurocognitive disorders in young people with AH based on a comprehensive assessment of key indicators of the patientʼs health state, as well as biochemical markers of endothelial dysfunction and inflammation. Materials and Methods. Total of 91 young patients with AH took part in the study. Patients were divided into 2 groups depending on the presence of neurocognitive disorders. To achieve the goal, all patients underwent a standard general clinical examination, an assessment of neurological status and cognitive function, ambulatory blood pressure monitoring (ABPM), clinical and laboratory blood tests with lipid and glycemic profile assessment, as well as an assessment of the biochemical marker of endothelial dysfunction (endothelin-1 (ET-1)) and inflammation markers (interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP)). Results. Within the framework of studies there were identified biomarkers that have prognostic significance for the development of neurocognitive disorders in young people with hypertension. It was found that in a young person with hypertension with diurnal pulse blood pressure (PBP) above 65.5 mm Hg, neurocognitive disorders can be expected with a sensitivity of 79.5% and a specificity of 59.6%. The threshold values for predicting the development of neurocognitive disorders for blood glucose levels were ≥4.75 mmol/L with a sensitivity of 76.9% and a specificity of 57.7%, for total cholesterol (TC) levels – ≥6.25 mmol/L with a sensitivity of 53.8% and a specificity of 100.0%, for low-density lipoprotein (LDL) levels – ≥4.15 mmol/L with a sensitivity of 82.1% and a specificity of 61.5%, for hypertension duration – ≥7.5 years with a sensitivity of 84.6% and a specificity of 65.4%. Calculation of threshold values for markers of endothelial dysfunction and inflammation showed that at a serum IL-6 level ≥9.5 pg/ml with a sensitivity of 70.6% and a specificity of 89.5%, the development of neurocognitive disorders in a young person with hypertension can be expected. For the ET-1 marker, such a threshold level was ≥11.5 pg/ml with a sensitivity of 82.4% and a specificity of 89.5%, and for hsCRP – ≥13.5 mg/l with a sensitivity of 100% and a specificity of 73.7%. Conclusions. According to the results of the study, it was found that the levels of laboratory indicators such as ET-1, IL-6, hCRP, TC, LDL-C, blood glucose, as well as the diurnal PBP and the duration of the disease are of practical importance for predicting the development of neurocognitive disorders in young people with hypertension.

Background. Armed conflicts have a profound impact on the physical and mental health of affected populations, particularly on the functioning of the nervous system. Psycho-emotional stress, traumatic experiences, and chronic tension caused by war lead to the development of severe neurological and psychoneurological disorders. Special attention is given to the consequences of chronic stress for the brain, including post-traumatic stress disorder (PTSD), cognitive impairments, and cerebrovascular pathology. Purpose – of this article is to analyse the main mechanisms through which war affects the nervous system, to explore the psychoneurological aspects, and to consider possible methods of therapy and rehabilitation. Materials and Methods. This study is based on the analysis of scientific publications, clinical observations, and empirical research related to the effects of war on the nervous system. Methods of content analysis, comparative analysis, and neuropsychological and neurophysiological approaches were used to assess the functional state of the nervous system under conditions of prolonged stress. Results. It was found that chronic stress, typical in wartime conditions, contributes to the development of PTSD, cognitive impairments, dysregulation of cerebral circulation, and the progression of neurodegenerative processes. Structural changes were observed in brain regions responsible for emotional regulation and memory (such as the hippocampus, amygdala, and prefrontal cortex). Neuroplasticity was identified as a key adaptive mechanism, which may promote both recovery and pathological changes. Conclusions. War acts as a powerful neuropsychological stressor, causing multifaceted changes in the nervous system. Understanding these mechanisms is crucial for the development of effective treatment and rehabilitation strategies for individuals affected by military conflict. These approaches should consider both neurobiological and psychosocial factors.

Background. Recent studies have shown that COVID-19 infection leads to the development of neurological diseases or causes exacerbation and progression of existing neurological diseases. However, despite the large number of studies conducted on this issue, our knowledge of the mechanisms of development and progression of neurological disorders is far from complete and requires further study. This is especially true for cerebrovascular diseases (CVD), the prevalence of which has increased significantly during and after the COVID-19 pandemic. Purpose – of our study was to investigate the clinical and pathogenetic mechanisms of CVD development in patients with COVID-19, to identify risk groups and biomarkers of their development and progression. Materials and Methods. We examined 48 patients aged 42 to 74 years with CVD. The main group consisted of patients with clinical and paraclinical signs of chronic cerebral ischaemia who had documented COVID-19. The comparison group (control) consisted of 48 patients of the same age with chronic cerebral ischaemia without COVID-19. It was found that the structure of clinical manifestations of chronic cerebral ischaemia was dominated by asthenic, cephalgic, vestibulo-ataxic syndromes, cognitive and psychoemotional disorders, and severe autonomic disorders. Results. The most significant factors in the development of CVD in patients after COVID-19 are age, history of arterial hypertension, diabetes mellitus, obesity, severity of the acute period of COVID-19 and vascular endothelial condition. Conclusion. On the basis of the conducted studies, the mechanisms of CVD formation in patients with COVID-19 were proposed. The presence of cardiovascular risk factors in patients and the prolonged course of the acute period of coronavirus infection lead to the development of neuroinflammation, coagulation disorders, endothelial dysfunction, cerebral hypoperfusion, and, as a result, the development of acute and chronic cerebrovascular disorders.

Background. Gender differences in the epidemiology of CVD depend on the patient’s age, as the influence of gender on the risk of CVD and its outcome varies throughout life. In childhood and early adulthood, males have a higher incidence of CVS and have worse functional outcomes than females. In middle age, the frequency of CVS in women begins to increase simultaneously with menopause and the loss of female sex hormones. After middle age, the incidence of CVD in women continues to increase, with reports of a higher incidence of acute CVD in older women (age > 85 years) compared to older men. The problem of an in-depth study of the gender specifics of the Centers for Disease Control and Prevention in the context of the recent global pandemic of COVID-19, which has had severe socio-economic consequences, is very relevant. Purpose – to study the clinical and neurological features of cerebrovascular diseases in men who suffered from COVID-19 during dynamic observation. Materials and Methods. A clinical and neurological examination was conducted in the dynamics of 24 men who had a history of verified CVS and during the last 12 months suffered from COVID-19 of varying degrees of severity. Mathematical processing of the results was carried out using the «Statistical Package for the Social Sciences-2020» using the Smirnov homogeneity test, Fisher’s point test, and the non-parametric Wilcoxon signed rank test. Results. Dynamic observation of clinical and neurological manifestations in men with cerebrovascular disease and documented transmission of COVID-19 within 12 months was carried out. Issues such as distribution by age, severity of COVID-19 and age-dependent features of indicators of the severity of the previously transmitted disease, commitment to vaccination, dynamics of risk factors for cerebrovascular disease, distribution of stages of chronic brain ischemia in the group of men were studied, as a result of which statistically significant changes in clinical – neurological manifestations in the form of increased vestibulo-atactic, vegetative disorders and changes in the psycho-emotional sphere. This will make it possible to develop rehabilitation measures, to improve the methodologies of primary and secondary prevention of acute vascular disasters in a group of men with cerebrovascular diseases who previously suffered from COVID-19 of varying degrees of severity. Conclusions. Most of the researched were in the middle-aged group, had a mild course of the transferred COVID-19, there were fewer vaccinated men. Hypertension, diabetes, dyslipidemia, obesity, and insomnia were the most common risk factors for cardiovascular disease in patients, in descending order. There is a statistically significant increase in complaints within the framework of manifestations of vestibular, vegetative disorders and changes in the psycho-emotional sphere with an increase in complaints of irritability in comparison with the data of 2022 and 2023.

Relevance. Chronic insomnia is one of the most common forms of nighttime sleep disorders. It leads to a decrease in human performance, the development of social maladjustment, and even changes in the personal sphere. Chronic insomnia can become a trigger for decompensation of somatic, neurological and mental diseases, which determines the need to find ways to overcome it. Objective. To determine the efficacy and safety of the dietary supplement Alpha-Melatonin Relax in the treatment of chronic insomnia in patients with chronic cerebral ischemia. Materials and methods. The study involved 30 patients (18 women and 12 men) with chronic cerebral ischemia of stage I and II, the average age of which was 46.12 ± 4.98 years. The course of treatment consisted of 30 days of taking Alpha-Melatonin Relax, 1–2 tablets 30–60 minutes before bedtime. Clinical and neurological symptoms were assessed and tested using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Daytime Sleepiness Scale, and the Hospital Anxiety and Depression Scale (HADS) in dynamics. Results and their discussion. The study results showed that 30-day administration of Alpha-Melatonin Relax provided a significant p≤0.05 improvement in the subjective assessment of the quality of night sleep, a decrease in the time to fall asleep, an increase in sleep duration, a decrease in the severity of emotional disorders and daytime dysfunction. Clinical and neurological follow-up of patients during the treatment course revealed a significant reduction in the severity of chronic insomnia, asthenia, and anxiety-depressive symptoms, which allows us to recommend the use of the dietary supplement Alpha-Melatonin Relax in clinical practice. Conclusions. Based on the data of a clinical-neurological and psychodiagnostic study, the statistically significant effectiveness of the dietary supplement AlphaMelatonin Relax in correcting the symptoms of chronic insomnia in patients with the initial stages of chronic brain ischemia has been proven.

Actuality: Arterial hypertension (AH) is one of the most common diseases among diseases of the circulatory system and, together with other cardiovascular diseases, ranks first in the world and in Ukraine in terms of mortality rates. About 45% of patients do not know that they have hypertension. The scale of this problem in the world is evidenced by the fact that hypertension is found in every third adult. This disease occurs more often in the elderly, but its development often begins at a young age, and sometimes even in childhood. The intensive development of neuroimaging methods (CT and MRI) in recent decades makes it possible to detect various changes in the brain at early preclinical stages, which is of great importance for the implementation of adequate differentiated primary prevention of the development and progression of cerebrovascular disease and such unpleasant manifestations as cognitive deficits, dementia and ischemic stroke. The purpose of the study: to reveal the nature of structural changes in the brain in young patients with clinically confirmed hypertension. Material and methods: a study of structural changes in the brain was conducted based on the MRI examination data (1.5 T) of 54 young patients (18-44 years old) with hypertension of various degrees. Statistical analysis was carried out by the IBM SPSS Statistics 20 license program using the criterion of agreement with the test of static significance (Fisher's exact test -F). Results: Differences in brain structural changes were obtained in patients depending on the degree of hypertension. A significant difference according to the χ² criterion (р<0.05) was found in the frequency of occurrence of mixed, external and internal hydrocephalus in patients with hypertension of the first and second century. Differences in the incidence of external and internal hydrocephalus in patients with AH I and AH III, AH II and AH III not detected by the χ² criterion (p< 0.05). There are differences in the frequency of leukoaraiosis of the 0th, 1st, 2nd, and 3rd stages. according to the Fazekas scale between groups of patients with 1st stage hypertension, 2nd stage hypertension, and 3rd stage hypertension reliable according to the χ² criterion (р< 0.05). Differences in the frequency of lacunar foci at different degrees of hypertension were not reliably detected. The analysis of the results of the assessment of structural changes of the brain by age showed that the main differences in the occurrence of mixed and external hydrocephalus are characteristic of all age groups. There is no difference in the frequency of internal hydrocephalus, mild and moderate leukoaraiosis in the groups of men and women. The frequency of occurrence of mixed, external hydrocephalus, the absence of leukoaraiosis and the presence of severe draining leukoaraiosis (in men, the severity of these changes prevails) is significantly different. No difference in the frequency of lacunar foci was found in the groups of men and women. Conclusions: Thus, hypertension is an age-dependent disease. No differences were found in the frequency of complaints of noise in the head, decreased attention and cognitive activity, sleep disturbances, and gender differences in the examined patients with hypertension of various degrees of severity. The main structural changes of the brain in the examined patients are various types of hydrocephalic manifestations, signs of leukoaraiosis (characteristic for the older age of 36-44 years) of one degree or another. Some gender specific features of brain structural changes in the examined patients were revealed (increased manifestations of hydrocephalus syndrome in men and absence of leukoaraiosis in them compared to women).

Actuality: Increasing the frequency of hypertension among the young population is a socially significant problem. The insidiousness of hypertension in young people is that it has the character of a disease with few symptoms. Since hypertension plays one of the main roles in the pathogenesis of chronic disorders of cerebral blood circulation, including both arterial and venous systems, the search for pathogenetically determined medicinal approaches to the elimination of cerebrovascular disorders, especially at a young age, continues. The purpose of the study: to study the effectiveness, tolerability and safety of the combination of Flego and Cognitium in young patients with chronic cerebral ischemia (CMI) on the background of hypertension. Methods: clinical-neurological, psychodiagnostic (asthenic state scale (ASS), anxiety scores according to the Spielberger-Hanin scale and Beck depression scale, Montreal scale of cognitive function assessment (MoCA)), ultrasound examination, general scale of clinical impression, statistical. Results: 52 patients (28 men and 24 women) at a young age with AMI on the background of hypertension were examined. The median age of the examined patients was (37.7 ± 4.6) years; among them, 23 patients suffered from hypertension of the 1st century. and 29 patients with hypertension of the second stage. Patients were randomly divided into two groups - the first - 23 (44.2%) patients (received only hypotensive drugs), the second - 29 (55.8%) patients (in addition to the standard hypotensive therapy received a combination of Phlego and Cognitium). Dynamic monitoring of patients after 2 months of treatment did not show significant changes in the distribution structure of objective clinical and neurological symptoms. However, positive dynamics of indicators of cognitive functions and the psychoemotional state of the subjects were observed, as well as a statistically significant decrease in the blood flow rate in the direct sinus at the end of the 2-month course using the combination of Phlego and Cognitium (decreased from 36.27±2.84 cm/s to 25.65±1.47 cm/s.). Conclusions: The introduction of the combination of Phlego and Cognitium into the treatment of young patients with arterial hypertension and chronic brain ischemia had a positive effect on the subjective state, on indicators of asthenia, emotional and cognitive state of the patients. A significant positive effect was noted in the dynamics of venous blood flow indicators (speed of blood flow in the direct sinus). Such treatment was well tolerated by patients, had few side effects and was combined with other drugs