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DESIGNING AN ALGORITHM FOR COGNITIVE MONITORING
IN CHRONIC HEART FAILURE PATIENTS
Maxmudov Kamoliddin Xamidovich
Samarkand State Medical University, Uzbekistan
Abstract.
Cognitive impairment in patients with chronic heart failure remains one
of the most pressing problems in neurology, and the urgency of the problem is
determined by the frequency of complications resulting from this pathology and the
lack of adequate effective treatment.
Keywords.
cardiovascular disease, Chronic heart failure, prevalence, etiology,
prognosis, mortality.
Chronic heart failure (CHF) is one of the most common and prognostically
uncomfortable complications of cardiovascular disease. (1.2). The problem of chronic
heart failure is becoming increasingly relevant in elderly patients. The trend of
increasing population in the elderly, new cases of patients with chronic heart failure is
constantly growing and requires the search for new approaches to optimize such
patients at different stages of care, both inpatient and in care. (4). The occurrence of
somatic and affective disorders in some patients, along with cardiac pathologies, makes
it difficult to make a correct diagnosis of the disease in a timely manner. The negative
impact of these diseases on the course and prognosis of the disease, adherence to
treatment, quality of life, the formation of an adequate response to the disease cause
additional difficulties in treatment and communication problems (6).
In his scientific work, Andrei Viktorovich (3.14) considered the development of a
program such as an outpatient training program for the treatment of chronic heart
failure as a new method of treating patients.
Chronic heart failure is an important medical, social, and economic problem,
representing a new epidemic of cardiovascular disease (SVD), affecting approximately
5.8 million people in the United States and more than 23 million citizens worldwide
(9). In Western countries, the prevalence of chronic heart failure varies from 1% to 2%
(5-10 people per 1,000) and is 10% or more among people over the age of 70 (12). In
our country, the prevalence of chronic heart failure detected on the basis of clinical
signs reached 11.7%, the variability in different regions ranged from 7 to 17%. In
hospitalized patients, the diagnosis was confirmed in 78.8% of cases (5). The main
clinical-epidemiological and economic indicators of chronic heart failure (prevalence,
etiology, prognosis, mortality) significantly affect the age, sex, ethnic and social
differences of the studied population. Thus, chronic heart failure is higher in developed
countries than in developing countries. However, by 2050, an increase in the number
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of cases of chronic heart failure will be clearly detected in underdeveloped
industrialized countries (12). The prevalence, prevalence, and mortality of chronic
heart failure remain high and the prognosis remains poor. According to the American
Heart Association (ANA), in 2008, chronic heart failure was identified as the leading
cause of death in 283,000 people (4). The economic costs associated with chronic heart
failure are estimated at billions of dollars per year. The results of modern
pharmacoeconomic analysis show that the cost of treating chronic heart failure in
Europe and the US ranges from 1% to 2% of the health budget, 5 times higher than the
cost of treating all forms of these safe pathologies, the frequency of hospitalization of
patients with chronic heart failure is sufficiently high and stable. continues. Increased
life expectancy, improved treatment of cardiovascular disease, as well as risk factors
for the development of ischemic heart disease (IBS), especially in countries with
transition economies, explain the increase in the prevalence and prevalence of heart
failure worldwide (11).
The need for repeated hospitalization due to decompensated chronic heart failure
significantly increases the financial cost of treating such patients (7.16). Thus, despite
all the achievements of modern medicine, chronic heart failure is a heavy burden both
in Uzbekistan and in the world health system. For the first time, chronic heart failure
began to be seen as a serious social problem. In 2003, U.S. hospital statistics set a
record: the number of patients with chronic heart failure exceeded 1 percent of hospital
admissions, and the frequency of initial diagnoses of chronic heart failure was 2 per
1,000 people. (13). In a Framing study (1970), it was found that the survival rate of
patients with newly diagnosed heart failure was 62% in men and 42% in women (9).
Chronic heart failure is now considered a disease that can lead to other diseases in
itself.
Talking about cognitive impairment in cardiovascular disease (CVD) It should be
noted that in chronic heart failure, cognitive functions are the most important process
of rational cognition of the complex functions of the brain. Symptoms of cognitive
health include changes in concepts such as real perception of human life, intelligence,
ability to concentrate on a problem, adequate self-esteem, and competence (19).
Cognitive disorders are manifested by disturbances of individual norms, such as
memory, speech, counting, spatial-temporal disturbances, decreased ability to abstract
thinking (17).
There is also a close association between cognitive impairment and chronic heart
failure (14). The results of the analysis in patients with heart failure, although taking
into account all the additional factors of cognitive dysfunction (age, arterial
hypertension, cerebrovascular disease), on average, 1 point lower than in older people
with heart failure (12). In people with severe heart failure requiring a heart transplant,
the MMSE difference reaches 2 points, but cognitive impairment is significantly
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reduced after a successful transplant (18). It has also been reported that long-term (9
years) acute risk disease is associated with an 80 percent increased risk of dementia
and Alzheimer’s disease in particular. (16) The association between cognitive
dysfunction and heart failure is confirmed by the high rate of heart failure in patients
with cognitive impairment, in contrast to people with cognitive impairment (5). a
decrease in brain perfusion in heart failure leads to damage to the white matter of the
brain (leukoencephalopathy) or atrophy of the temporal lobes of the media, which may
be particularly sensitive to hypoxia and hypoperfusion. One study found that atrophy
of the temporal lobe of this media is best associated with cognitive impairment, but the
severity of depression and anxiety is associated with leukocenphalopathy (14).
Ischemic brain injury in patients with heart failure may be accompanied by a decrease
in cerebrovascular reactivity, neurohumoral disease, thromboembolism, and an
excessive decrease in blood pressure (QB) associated with the use of antihypertensive
drugs (12).
The most severe form of brain dysfunction that develops in patients with severe
heart failure is called cardiac encephalopathy. It manifests itself as cognitive
dysfunction with bradyphrenia, impaired attention and other regulatory processes,
apathetic syndrome (Zakharov V.V. 2005). In this case, Cognitive dysfunction is
usually detected when the discharge portion (BQ) of the left ventricle (CQ) is less than
30% (15). In this case, the mechanism of development of cognitive dysfunction may
be associated with a decrease in diastolic discharge of the heart, which leads to an
increase in pressure in the venous system and fluid retention in the div, which can
lead to an increase in intracranial venous sinuses and arteries. and its accumulation in
the subarachnoid spaces, cerebral hemispheres (external hydrocephalus), and
ventricles of the brain (internal hydrocephalus). In turn, this disrupts brain perfusion,
leading to a decrease in heart failure (8). An additional factor may be hypoxia as a
result of small-scale circulatory disorders (15). With removal of cerebrospinal fluid,
the condition of patients after lumbar puncture can improve rapidly. However,
continuous improvement in neurological function can only improve heart failure using
pharmacological agents or other methods (e.g., heart transplantation). Clinical
improvement may be accompanied by a decrease in the degree of hydrocephalus on
computed tomography or magnetic resonance imaging (11).
In studies, it has been found that vascular dementia in patients with chronic heart
failure persists primarily as amnesty and pseudoparalytic dementia (10). In the first
case, a clear impairment of memory for current events was noted. Clinically, this was
manifested by a clear “forgetfulness” of patients who could not remember the treatment
schedule, medication intake, and so on. In the second type of vascular dementia,
Cognitive dysfunction manifested itself in a relatively mild mnesticide disorder against
a background of monotonous flattering mood. But such a situation is associated with a
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significant decrease in critical ability. Thus, the tendency to minimize the severity of
the manifestation of chronic heart failure is reflected in cognitive changes (7). The risk
of cognitive impairment is high when combined with heart failure, arterial
hypertension, while affecting the general state of the cognitive process and individual
cognitive functions: memory, attention, regulatory processes are impaired (18).
The modern classification of cognitive disorders divides them into mild, moderate,
and severe (dementia). Criteria for identifying one or another type of disease are related
to the disorder of occupational, domestic, and social adjustment, taking into account
the patient’s age, social status, and level of education (14). Mild cognitive impairments
are detected only by the most sensitive neuropsychological tests and do not affect daily
activities, but, as a rule, they are subjectively aware and cause anxiety. (13) Cognitive
disorders of moderate severity are detected not only by special technical means, but
also by daily contact with the patient. They lead to difficulties in the most difficult
types of professional or social activities, and in general, such changes in patients
remain independent (20). Moderate cognitive impairment is an indicator of current
stress conditions that may indicate a serious and long-term prognosis (11).
Cognitive impairments can also be seen in the background of arterial hypertension.
Arterial hypertension is currently an important predictor of dementia and cognitive
impairment in general (3.5). Cognitive impairment in hypertension can only be due to
extensive ischemic injury of the brain and its multiple infarct status. Often their
development is followed by limited damage such as lacunar infarction in a strategically
important area. Functions that are important for cognitive function include the
following areas of the brain: frontal lobes; parieto-temporo-occipital regions; middle-
basal parts of the temporal lobe; anterior and middle parts of the visual cortex
associated with the frontal lobes and limbic system; the dentate nucleus of the
posterior-inferior-lateral region and cerebellar hemisphere, opposite the dominant
cerebellar hemisphere; pale nets (18).
Another morphological substrate of cognitive impairment in hypertension may be
diffuse injury of this white matter, cortical atrophy, and cerebral hypoperfusion caused
by specific structural changes in small intracerebral arterioles. Cortical (granular)
atrophy of the hemispheres develops due to the death of neurons, which explains the
functional disorders. Several small focal lesions in the deep parts of the brain,
spongiosis of the white matter, impairment of higher mental functions lead to scattering
of brain structures, particularly the temporal, parietal, as well as limbic-reticular
complex structures of the frontal regions (16).
A theory of “hypoperfusion dementia” has also been developed. The urgency of its
occurrence depends on the complex set of changes in blood vessels and brain structure
that are detected in patients with hypertension, including those associated with
atherosclerosis. Specific hypertensive changes in cerebral vessels are accompanied by
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a decrease in perfusion, primarily in the frontal and parietal regions of the brain, and
later in the temporal regions. Separate hypoperfusion is located in the deeper parts of
the brain (white matter of the semi-oval center). However, in patients with cerebral
circulatory disorders caused by hypertension, blood pressure levels directly affect the
blood supply to the brain, and a relatively small decrease in blood pressure in cases of
impaired cerebral blood flow autonomy leads to exacerbation of perfusion disorders
and exacerbation of neurological disease. Stenotic injury of the main arteries is more
pronounced in patients with intracranial vascular pathology than in patients with
isolated hypertension (15).
REFERENCES
1.
Samadova S. I., Ibragimova M. K. Improvement of Complex Treatment of Red
Lichen Planus of the Oral Mucosa //Annals of the Romanian Society for Cell
Biology. – 2021. – Т. 25. – №. 1. – С. 5072-5080.
2.
Sobirov S. S., Khabibova N. N., Samadova S. I. Clinical effectiency of application
of the combined method of treatment of the red plane lichen in mucous cavity of
mouth //Journal of Natural Remedies. – 2021. – Т. 22. – №. 1 (2). – С. 128-131.
3.
Самедова С. И. Показатели качества жизни у пациентов с кариесом и
заболеваниями пародонта различной степени интенсивности и тяжести
//Клиническая стоматология. – 2020. – №. 1. – С. 94-98.
4.
Хамраева Д. Ш., Самадова Ш. И. Сравнительная оценка у больных
пародонтитом отягощенной геперлипидемией //Теория и практика
современной науки. – 2018. – №. 4. – С. 726-727.
5.
Хабибова, Н. Н., Д. Ш. Хамроева, and Ш. И. Самадова. "оптимизация
эффективности лечения генерализованного пародонтита у больных
ожирением."
Международный журнал прикладных и фундаментальных
исследований
12-9 (2015): 1628-1632.
6.
Hamroeva D. S. Factors affecting the dental status of the popu lation //Journal For
Innovative Development in Pharmaceutical and Technical Science (JIDPTS). –
2021. – Т. 4. – №. 3.
7.
Sh, Hamroeva D. "Comparative Analysis Of The Effectiveness Of The Treatment
Of Parodontitis In Patients With Obesity." International Journal of Progressive
Sciences and Technologies International Journal of Progressive Sciences and
Technologies
(IJPSAT) ISSN
: 2509-0119.
8.
Mukhsinova L. A., Sharopov S. G. Immunological status in sick children with
congenital cleft upper lip and palate //Euro-Asia Conferences. – 2021. – Т. 4. – №.
1. – С. 135-136.
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–78_Issue-3_June-2025
196
196
9.
Mukhsinova L. A. et al. Cytokine Profile in Patients with Congenital Cleft Upper
Lip and Palate //European Journal of Research Development and Sustainability. –
Т. 2. – №. 4. – С. 91-93.
10.
Mukhsinova L. A., Sh I. A. Physiological and Pathological Aspects of Teeth
Cutting and Formation of Bits in Children (Literature Review) //American Journal
of Medicine and Medical Sciences. – 2020. – Т. 10. – №. 9. – С. 674-678.
11.
Sh, Inoyatov A., and L. A. Mukhsinova. "Peculiarities of the identification and
early diagnostics of the pathology of cultivation of teeth and formation of the chest
in children." Proceedings of the VI International Scientific and Practical
Conference. International Trends in Science and Technology. Warsaw, Poland.
2018.
12.
Эргашов А. Р. Характеристика острой травмы грудопоясничного отдела
позвоночника //central asian journal of medical and natural sciences. – 2021. – С.
150-153.
13.
Эргашов, А. Р. "Отдаленные Результаты Хирургического Леченияпри Острой
Травме Грудопоясничного Отдела Позвоночника."
Central asian journal of
medical and natural sciences
3.2 (2022): 256-260.
14.
Мехриддинов, М. К. "Современный Взгляд На Проблемы Этиопатогенеза И
Лечение Деструктивных Форм Пневмонии У Детей." C
entral asian journal of
medical and natural sciences
3.2 (2022): 248-255.
15.
Мехриддинов, М. К. "Роль Иммунологических Факторов В Патогенезе
Развития Деструктивных Форм Пневмоний У Детей." C
entral asian journal of
medical and natural sciences
3.2 (2022): 234-238.
