scholarly journals The Post-COVID-19 cognitive impairment. A modern view of the problem, pathogenesis and treatment

Author(s):  
D. V. Zakharov ◽  
Y. V. Buriak

COVID-19 infection is a significant and poorly understood problem of modern world medicine. As the virus spreads, data on the clinical picture of the disease and damage to the nervous system are accumulating. Symptoms such as fatigue, anxiety, depression, sleep disturbances and many other neurological and somatic symptoms are often recorded, persist for a long time even after the acute infectious stage of the disease has been stopped, and make it difficult for the patient to fully recover. These symptoms occur even with a mild disease and persist for many months. One of the most common and disabling symptoms of post-COVID syndrome is cognitive impairment, in the formation of which, in addition to the direct ability of the virus to penetrate the nervous system and pathology of the microvasculature, various pathological mechanisms are involved, including dysregulation of cholinergic transmission. A comprehensive approach is important in the treatment of cognitive impairment; it is advisable to use both medication and non-medication methods. The main approaches to the treatment of secondary cognitive disorders are based on the hypothesis of replenishing the defect in mediator systems, including those associated with the death of cholinergic neurons. With these abnormalities, it is advisable to replenish acetylcholine. Among the precursors of choline, choline alfoscerate occupies a special place due to its proven efficacy in the treatment of neurodegenerative diseases, as well as due to data on its multifactorial action. The article presents the actual literature data on the mechanisms of development and features of the clinical manifestations of post-COVID cognitive impairment, as well as materials of experimental and clinical studies of the drug choline alfoscerate (Gliatilin).

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 812
Author(s):  
Guendalina Bastioli ◽  
Maria Regoni ◽  
Federico Cazzaniga ◽  
Chiara Maria Giulia De Luca ◽  
Edoardo Bistaffa ◽  
...  

Parkinson’s disease (PD) is the most common neurodegenerative movement disorder. The neuropathological hallmark of the disease is the loss of dopamine neurons of the substantia nigra pars compacta. The clinical manifestations of PD are bradykinesia, rigidity, resting tremors and postural instability. PD patients often display non-motor symptoms such as depression, anxiety, weakness, sleep disturbances and cognitive disorders. Although, in 90% of cases, PD has a sporadic onset of unknown etiology, highly penetrant rare genetic mutations in many genes have been linked with typical familial PD. Understanding the mechanisms behind the DA neuron death in these Mendelian forms may help to illuminate the pathogenesis of DA neuron degeneration in the more common forms of PD. A key step in the identification of the molecular pathways underlying DA neuron death, and in the development of therapeutic strategies, is the creation and characterization of animal models that faithfully recapitulate the human disease. In this review, we outline the current status of PD modeling using mouse, rat and non-mammalian models, focusing on animal models for autosomal recessive PD.


2011 ◽  
Vol 26 (S2) ◽  
pp. 158-158
Author(s):  
I. Ioancio ◽  
R. Trascu ◽  
I. Turcu ◽  
L. Spiru

BackgroundAlzheimer disease (AD) is one of the most common neurodegenerative disorders (prevalence boosts from 0.2% in patients aged 55-65 up to 27% in patients aged 85+ years. Clinical manifestations of psychiatric disorders accompanying hypo- and hyper-thyroid function can mimic cognitive impairment.ObjectivesOur study aimed at studying the relationship between thyroid pathology, anxiety disorder and Alzheimer disease (AD).MethodsOur longitudinal, prospective research followed 49 patients with thyroid disorders (aged 50-85 years, 93.5 females); 63.3% (n = 31) had coexisting dementia and thyroid disease while 36.7% (n = 18) were dementia-cleared (10 had mild cognitive impairment (MCI) and 8 - anxiety and/or depression); we cross/analyzed control (n = 18) and target (n = 31) groups.ResultsIn the target group, 64.5% (n = 20) had hypothyroidism, 22.6% (n = 7) had euthyroid function and 12.9% (n = 4) had hyperthyroidism. The prevalence of anxiety and depression was higher in the hypothyroidism + dementia group (55.5%, n = 11) than in the hypothyroidism-only group (44.4%, n = 8). Most controls (77.8%, n = 14) had hypothyroidism while 22% (n = 4) had normal thyroid function.ConclusionsAnxiety disorder had a greater prevalence both in the group with dementia + thyroid disease and in the MCI group. Hypothyroidism was the dominant thyroid disorder in both groups. The early diagnostic and treatment of thyroid disease is expected to improve prognosis and evolution of future cognitive disorders (MCI & AD).


2021 ◽  
Vol 33 (S1) ◽  
pp. 90-91
Author(s):  
Alena Sidenkova

IntroductionThe aging processes are accelerating in all regions of the world. The involvement of older people in production and social processes determines the need to maintain a high level of social and psychological adaptation, despite the progressive pathology of the brain caused by its aging. This increases the relevance of research related to the study of biological reserves of the brain and psychological and social mechanisms of human adaptation in late adulthood. The risk of developing cognitive disorders is not fatal. According to some observations, even in the hippocampal type of UKR, despite the content of amyloid in the brain, the functional and social activity of the elderly remains high. Prospective studies show that people with high cognitive reserve have a lower risk of developing dementia. Cognitive reserve is the brain’s resistance to damage. Cognitive reserve is the ability of the brain to cope with the consequences of damage caused by external influences, brain stroke, chronic brain ischemia, neurodegenerative diseases, and age-related changes. Cognitive reserve is the brain’s ability to functionally compensate for and minimize clinical manifestations of cognitive impairment. The mechanisms of cognitive reserve in normal and Alzheimer’s disease are different. In healthy older adults, a higher cognitive reserve correlates with larger brain sizes and effective strategies for performing cognitive tasks. In the early stages of Alzheimer’s disease and Alzheimer’s disease, the size of the brain decreases. But high brain activity helps preserve cognitive resources. Excessive brain activity in dementia is a compensatory mechanism. This is confirmed by the results of functional magnetic resonance imaging of the brain. Of course, the degree of brain atrophy is a predisposing factor for dementia, but it is not a mandatory factor for cognitive decline. So, the symptoms of dementia do not appear until you have crossed the critical border of damage to the brain substance. Progressive brain atrophy underlies the clinical manifestations of dementia in neurodegenerative diseases, but the correlation between the degree of brain damage and cognitive impairment is not linear.Research materials and methodsAn observational 10-year longitudinal study was conducted. In 2006, moderate cognitive impairment was found in 66 patients. The group of patients included 49 women and 49 men. Their average age in 2006 was 59.3±5.2 years. In 2006, the severity of cognitive decline was 26.2±1.9 points on the MMSE scale. This corresponds to indicators of moderate cognitive impairment. Research methods: clinical and psychopathological, psychometric, statistical. Questionnaire “Loss and acquisition of personal resources” (N. Vodopyanova, M. Stein), MMSE scale.Research resultIn 2006, amyloid was detected in the spinal fluid of all patients selected for the study group. If a patient developed dementia, they were given specific therapy. The dynamics of cognitive functions in patients was different. Mild dementia was formed in 53% of patients. Moderate dementia was formed in 10.6% of patients. Moderate cognitive impairment (pre-dementia) persisted in 36.4% of patients. Hereditary burden of dementia in patients with moderate dementia was detected 2 times more often. Back in 2006, we identified the leading sensory systems of patients. The master sensor system determines the modality of the main information flow. This is the most important part of the information that a person interacts with. This is the basis of interaction with reality. This is the basis of cognitive functions. Correlations of age-specific lesions of the corresponding sensory systems with the severity of cognitive decline were found in patients with the corresponding sensory modality (Spearman’s Correlation Coefficient-r, p<0.05): presbyacoussis – auditory r=0.667, presbyopia-visual r=0.705. The influence of psychosocial factors on the condition of patients was studied. In dementia, significant history of psychotrauma was found in 35.7%. Moderate stress was detected in the group of patients with moderate cognitive impairment in 33.3%. Moderate stress was detected in the group of patients with dementia in 83.3%. Stress of loss of life meaning was detected more often in patients with dementia 76.7%. It is important not only what stresses a person endures, but how they can cope with them. Dementia patients were statistically more likely to have unproductive coping strategies that did not help them cope adequately with stress.ConclusionsThe concept of cognitive reserve suggests possible causes of heterogeneity in the dynamics of cognitive decline in the initial stages of atrophic-degenerative brain diseases: biological causes and psychosocial causes. The concept of cognitive reserve helps to study and develop individual programs for the prevention of severe cognitive disorders.


2019 ◽  
Vol 4 (2) ◽  
pp. 27-31
Author(s):  
Fatenkov OV ◽  
Simerzin VV ◽  
Krasovskaya MA ◽  
Sytdykov IKh

The review article describes the characteristics of curable involutive cognitive impairment in the elderly. It is noted that mild cognitive impairment is predominantly neurodynamic in nature, but over time it can transform into a syndrome of moderate cognitive impairment, which, sometimes, is a precursor of dementia. Special attention is given to the clinical manifestations of mild and moderate cognitive impairment, diagnostic criteria, the course of the disease, and its medical and social impact.


2021 ◽  
Vol 13 (1) ◽  
pp. 4-12
Author(s):  
A. A. Kulesh ◽  
A. Yu. Emelin ◽  
A. N. Bogolepova ◽  
O. B. Doronina ◽  
V. V. Zakharov ◽  
...  

The paper presents experts' opinion on the clinical manifestations and diagnosis of chronic cerebrovascular disease (CVD) (chronic cerebral ischemia (CCI) and dyscirculatory encephalopathy (DEP)) at the pre-dementia stage. It is noted that DEP/CCI is a common diagnosis in Russian neurological practice, the criteria for which have not been updated for a long time. DEP/CCI most often develops in the presence of cerebral small artery (CSA) disease (cerebral microangiopathy (CMA)), the severity of which can be quantified by magnetic resonance imaging. The main clinical manifestation of DEP/CCI is cognitive impairment that may be subjective or moderate at the pre-dementia stage. Emotional disorders (apathy, depression, anxiety) and instability are considered as possible manifestations of CSA disease. It is noted that headache and vestibular vertigo are not caused by chronic CVD; while in patients with CMA, they are usually associated with other diseases (primary headache, peripheral vestibular vertigo, and vestibular migraine). The diagnosis of DEP/CCI should be based on the presence of cognitive impairment, reliable neuroimaging signs of CVD, and the exclusion of another cause of cognitive impairment.


2020 ◽  
pp. 83-87
Author(s):  
K. Yu. Lytvyn ◽  
L. R. Shostakovych-Koretska ◽  
Z. O. Chykarenko ◽  
O. A. Kushnierova ◽  
I. V. Budaeva ◽  
...  

A retrospective analysis of medical records of 451 patients with HIV infection showed that the most common clinical manifestations of cerebral tuberculosis are as follows: headache, fever ≥ 38.0 °C, meningeal symptoms; in toxoplasmosis encephalitis these are headache, paresis of cranial nerves and extremities, incoordination, cognitive disorders, dysarthria, fever ≥ 38.0 °C and convulsions; in mycotic lesions of the CNS they are headache, coordination disorders, positive meningeal symptoms, disturbances of consciousness, cognitive disorders, visual disorders, cranial nerve deficiency, convulsions and dysarthria. The clinical picture of bacterial (exacted) meningitis was dominated by positive meningeal symptoms, headache, fever, impaired consciousness. At the same time, in such neurological manifestations of central nervous system lesions as cranial nerve paresis, mono− and hemiparesis, visual, coordination and speech disorders, which mostly accompany cerebral toxoplasmosis, cerebrovascular diseases, brain tumors, encephalitis of unspecified etiology. Thus, the analysis suggests that the clinical manifestations of various etiologies of lesions of the central nervous system are often nonspecific and probably are stipulated with common morphological changes in brain tissue, which may be associated with the neuropathological effects of HIV, as well as a large impact co−infection. Key words: HIV infection, opportunistic infections, central nervous system, main symptoms.


2018 ◽  
pp. 5-29 ◽  
Author(s):  
L. M. Grigoryev ◽  
V. A. Pavlyushina

The phenomenon of economic growth is studied by economists and statisticians in various aspects for a long time. Economic theory is devoted to assessing factors of growth in the tradition of R. Solow, R. Barrow, W. Easterly and others. During the last quarter of the century, however, the institutionalists, namely D. North, D. Wallis, B. Weingast as well as D. Acemoglu and J. Robinson, have shown the complexity of the problem of development on the part of socioeconomic and political institutions. As a result, solving the problem of how economic growth affects inequality between countries has proved extremely difficult. The modern world is very diverse in terms of development level, and the article offers a new approach to the formation of the idea of stylized facts using cluster analysis. The existing statistics allows to estimate on a unified basis the level of GDP production by 174 countries of the world for 1992—2016. The article presents a structured picture of the world: the distribution of countries in seven clusters, different in levels of development. During the period under review, there was a strong per capita GDP growth in PPP in the middle of the distribution, poverty in various countries declined markedly. At the same time, in 1992—2016, the difference increased not only between rich and poor groups of countries, but also between clusters.


2020 ◽  
pp. 27-34
Author(s):  
A. Nikitina ◽  
A. Rusanova ◽  
A. Zhilenkova

HIV infection is a significant problem in the modern world, because there are more and more infected people every year. This article will consider: the clinical picture, diagnosis and treatment of this disease in different countries. Based on these data, the following conclusions will be made to help doctors in their future practice correctly approach the diagnosis and treatment of patients with this disease.


2019 ◽  
Vol 72 (8) ◽  
pp. 1437-1441
Author(s):  
Pavel Dyachenko ◽  
Igor Filchakov ◽  
Anatoly Dyachenko ◽  
Victoria Kurhanskaya

Introduction: Viral encephalitis accounts for 40-70% of all cases worldwide, central nervous system infections pose a diagnostic challenge because clinical manifestations are not typically pathognomonic for specific pathogens, and a wide range of agents can be causative. The aim: To assess the diagnostic value of intrathecal synthesis of specific antibodies in patients with inflammatory lesions of the central nervous system. Materials and methods: Within the framework of the study, two groups of 90 people in each were formed from the patients with neuroinfections admitted to our Center. Intrathecal synthesis (ITS) of total (unspecific) IgG in members of one of group (group of compare) was determined. Brain synthesis of specific antibodies (Ab) to some neurotropic pathogens (herpes simplex virus 1/2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, rubella virus, Borrelies) was studied in the second group of patients (group of interest). There were no statistically significant differences between groups by gender and age. Encephalitis and encephalomyelitis prevailed among patients of both groups Results: ITS of total IgG was established in 30 (33.3 ± 6.1 %) patients of the first group with IgG index more than 0.6 indicating on inflammatory process in CNS and no marked changes of CSF. ITS of specific Ab was determined in 23 of 90 (25.6 ± 4.6 %) patients included into group of interest. In more than half of cases Ab to several infectious agents were detected simultaneously. ITS of various specificity, in particular, to measles and rubella viruses, and VZV, known as MRZ-reaction, is characteristic of some autoimmune lesions of CNS, multiple sclerosis first of all. In fact, further research of 5 patients with MRZ-reaction confirmed their autoimmune failure of CNS. Detection of ITS in the CSF samples didn’t depend on concentration of specific Ab in serum and CSF and wasn’t followed by HEB dysfunctions which were observed with the same frequency in patients with or without ITS (13.0 % and 13.6 % respectively). Conclusion: Specific Ab synthesis to several neurotropic pathogens in the CSF of significant part of examined patients was established. Thus, diagnostic value of ITS of specific immunoglobulins seems to be limited to cases in which autoimmune damage of the CNS is suspected.


2020 ◽  
Vol 19 (2) ◽  
pp. 14-18
Author(s):  
E. V. Sharipova ◽  
I. V. Babachenko ◽  
M. A. Shcherbatyh

Long time the main pathogens associated with the development of community-acquired pneumonia were bacteria. However, in recent years in the Russian Federation, like all over the world, the view of the damage of lower respiratory tract changed, including a unique approach to community-acquired pneumonia as a bacterial infection, and respiratory viruses have become seen as a direct cause of lower respiratory tract damage, or as part of a viral-bacterial co-infection. These studies became possible since the widespread introduction of PCR techniques in the clinical setting, identification of respiratory viruses has increased and new microorganisms such, one as human bocavirus have been discovered. Objective: to study the features of respiratory tract damage in acute bocavirus infection in children of different ages. Materials and methods: A retrospective analysis of 97 medical hospital documentation of children with acute bocavirus infection, detected confirmed by PCR in nasopharyngeal aspirate. Results: In this work, it was shown that human bocavirus spread throughout the year with an increase in the incidence of clinically significant forms in the autumnwinter period, including during the period of an increase in the incidence of influenza. HBoV infection requiring hospitals is most significant in the first three years of life. In 74.2% of hospitalized children, bocavirus infection occurs with lower respiratory tract infections in the form of bronchitis — 77.8%, pneumonia — 28.9% and rarely bronchiolitis and is complicated by the development of respiratory failure in 28.9% of cases. Changes in the blood test are non-specific, and the level of C-reactive protein in children with various clinical manifestations of HBoV infection generally does not exceed 50 mg / l. An x-ray of the chest organs does not objectively reflect the existing volume and nature of the inflammatory process in the lungs.


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