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SCREENING SCALES FOR THE ASSESSMENT
OF COGNITIVE DISORDERS
IN CHRONIC CEREBROVASCULAR PATHOLOGY
Gulova Munisakhon Afzalovna
Assistant of the Department of Clinical
Sciences at Zared University
Annotation. Currently, with the progressive trend towards an increase in
human life expectancy, the number of patients with various degrees of cognitive
impairment, including dementia, in the clinical picture of the disease has increased
significantly. These disorders have a significant impact on the quality of life of both
the patient and his relatives. Therefore, it is extremely important to identify and
differentiate cognitive defects as early as possible in order to start active treatment of
patients with cognitive disorders at the pre-dementia stage (mild and severe moderate
violations). For this purpose, it is advisable to use screening neuropsychological scales
in the examination of each patient with vascular pathology complaining of memory
and attention disorders.
Key
words:
encephalopathy,
cognitive
impairment,
dementia,
neuropsychological basic research, screening scales.
Introduction.
The condition, manifested by a progressive multi-focal disorder
of brain function caused by cerebral circulatory insufficiency, is defined as
dyscirculatory encephalopathy (DE) [1]. This term is widely used in our country both
in the medical literature and in clinical practice, but it is not included in the ICD 10th
revision (1995). Taking into account the etiological factor, in accordance with ICD 10,
this pathology can be interpreted as “cerebral atherosclerosis" (I67.2), “hypertensive
encephalopathy” (I67.4), “other specified lesions of cerebral vessels” (I67.8) and
others. The most important clinical manifestations of DE are cognitive impairment and
dementia, and therefore patients with DE are observed and treated by neurologists in
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the early stages of the disease, and by psychiatrists in the later stages of the disease.
Unfortunately, work is currently not actively underway to identify the initial
impairments in cognitive functions, allowing early targeted therapy to begin and
support the social activity of patients. Meanwhile, further decline cognitive functions
in patients are beginning to play a significant role among the causes leading to
permanent disability and social maladjustment. In 1974, V.C. Hachinsky proposed the
term “vascular cognitive disorders” to denote disorders of higher brain functions due
to cerebrovascular pathology. In 1997, R.S. Petersen proposed using the term “mild
cognitive impairment” (MCI) to describe
the meaning of cognitive impairment in the pre-dementia stages of organic
brain damage. To the present In the most general form, criteria for moderate cognitive
disorders are formulated by S. Gauthier and J. Touchon (2004):
• complaints of memory loss or other
cognitive problems on the part of the patient and/or people who know him;
• indications from people who know the patient that during the last year his
cognitive functions or functional capabilities have decreased compared to the previous
level; moderate impairments of memory and/or other cognitive functions (speech,
visual-spatial, regulatory, or others) detected during neuropsychological examination;
• the absence of the influence of a cognitive defect on daily activity (only mild
difficulties occur when performing the most complex daily activities);
• maintained general level of intelligence and absence of dementia (the result
of a Short scale of assessment of mental status of at least 24 points).
According to Russian researchers, along with the syndrome of moderate
cognitive impairment, it is advisable to distinguish the syndrome of mild cognitive
impairment. Such violations are invisible to others, but are felt by the patient himself
and they are confirmed by careful examination using sensitive techniques. Taking into
account the available literature data, the approximate correspondence of the level of
cognitive disorders to the stages of DE can be presented as follows.
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The first stage of DE usually corresponds to mild cognitive disorders, mainly
neurodynamic disorders in the form of slowness, decreased performance, exhaustion,
and fluctuations attention.
However, patients generally perform well on tests that do not take into account
the time they are performed. Such disorders go beyond the age norm, but they do not
limit the vital activity of patients. The second stage of DE most often corresponds to
moderate cognitive disorders, which, along with neurodynamic disorders, include
regulatory disorders (dysregulatory or subcortical frontal cognitive syndrome). In
patients, the performance of even those
neuropsychological tests is disrupted, in which no time limit was introduced,
but nevertheless The ability to compensate for a cognitive defect is less preserved,
which is reflected in preserved recognition and the effectiveness of mediating
procedures, in particular , prompts in tests of logical memory and abstract thinking.
Such a defect fully meets the criteria of a moderate cognitive disorder and, although it
does not lead to a limitation of the patient's household independence, it can make it
difficult to perform complex (usually instrumental) types of daily activities and
contribute to a decrease in the quality of life of patients.
The third stage of DE corresponds to pronounced dysmnestic and intellectual
disorders that form vascular dementia syndrome, which often comes to the fore in the
clinical picture. Undoubtedly, these correlations between the severity of cognitive
impairments and the stages of DE are not always revealed.
The basis for conducting a neuropsychological examination is complaints of
memory loss or decreased mental performance. These complaints may come from the
patient himself, so it is from his relatives, friends, colleagues. Information from this
circle of people is an important diagnostic tool for I am familiar with it, since the
patient's assessment of the state of his cognitive functions is not always objective.
As a rule, in clinical practice , neuropsychological research can be limited to
simple screening scales, such as the Mini mental state examination (MMSE). However
, approximately half of the patients with active With complaints of memory loss, the
use of simple screening scales does not confirm the presence of cognitive impairment.
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The most common cause of subjective complaints of memory loss in the absence of
objective confirmation are emotional disorders in
the form of increased anxiety or decreased mood background. Therefore, all
patients with complaints of memory loss should carefully evaluate the emotional
sphere. Depression is especially likely in young or middle-aged people who complain
of memory loss.
Another reason is that when active complaints of memory loss lack objective
evidence of cognitive impairment, and the lack of sensitivity of neuropsychological
screening scales. Therefore, in addition to assessment and drug correction of the
emotional state in such cases, dynamic monitoring of the patient and repeated clinical
and psychological studies with an interval of 3-6 months are advisable. Along with
MMSE, the following diagnostic scales are used: Frontal Dysfunction Battery (Dubois
et al., 1999), Global deterioration scale, Reisberg B. et al., 1982), clinical dementia
rating scale, 5-word test, clock drawing test. The clock drawing test is a very simple
and highly informative test, including for mild dementia, which makes it one of the
most commonly used tools for diagnosing this clinical syndrome.
The minimum time the doctor takes is the test A Mini Cog consisting of 3
consecutive items: repeating 3 words, drawing a clock, remembering 3 words.
Significant difficulties in drawing a clock or difficulty playing with a hint though
at least one word indicates the presence of clinically significant cognitive
impairments. This test can be used even at an outpatient appointment. The integrated
use of scales makes it possible to expand the possibilities of early detection of cognitive
disorders and increase the differential diagnostic value of the study. It should be borne
in mind that cognitive disorders do not always become a manifestation of a primary
brain disease. It is not uncommon for dementia or less severe disorders occur as a result
of systemic metabolic disorders, which, in turn, complicate various endocrine or
somatic diseases.
Most often, cognitive disorders of a dysmetabolic nature are associated with
hypothyroidism, liver or kidney diseases, and vitamin deficiency. B12 or folic acid.
Therefore, the detection of dementia or less severe cognitive impairments requires a
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comprehensive assessment of the patient's health status and treatment of concomitant
somatic and endocrine diseases.
RECOMMENDED LITERATURE
1. Diseases of the nervous system: A guide fordoctors / Edited by N.N. Yakhno, D.R.
Shtulman. M.: Medicine, 2002. pp. 231-302.
2. Zakharov V.V., Yakhno N.N. Memory disorders: A reference guide for doctors.
Moscow: Geotar Med, 2003.
3. Levin O.S., Sagova M.M., Golubeva L.V. Factors influencing the life factors of
patients with dyscirculatory encephalopathy with moderate cognitive impairment //
Russian Medical Journal. 2006. № 2. pp. 25-28.
4. Yakhno N.N., Zakharov V.V., Lokshina A.B. Syndrome of moderate cognitive
impairment in dyscirculatory encephalopathy. neurol. psychiatrist named after S.S. 5.
Korsakov. 2005. Vol. 105. No. 2. pp. 13-17. Blass J.B. Metabolic dementias // Aging
of the Brain and dementia. Aging. V. 13 / Ed. by L. Amaducci
et al. N.Y.: Raven Press, 1980. P. 261–270.
6. Gauthier S., Touchon J. Subclassification of maid cognitive impairment in research
and in clinical practice // Alzheimer’s Disease and Relate Disorder Annual / Ed. by S.
Gauthier et al. L.: Martin Dunitz, 2004. P. 61–70.
7. Hachinsky V.C., Lassen M.A., Marshal J. Multiinfarct dementia. A case of mental
deterioration in the elderly // Lancet. 1974. V. 2. P. 207–210.
8. Oswald W.D., Tritt K. Cognitive deterioration in old age and in the course of
dementia // New Trend in the Diagnosis and Therapy of Alzheimer’s Disease / Ed. by
K.A. Jellinger et al. Wien; N.Y.: Springer-Verlag, 1994. P. 105–114.
9. Petersen R.S., Smith G.E., Waring S.C. et al. Aging, memory and mild cognitive
impairment // In. Psychogeriatr. 1997. V. 9. P. 37–43.
