35
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
35-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
The publication discusses the indicators of the study of vegetative tone, vegetative reactivity and vegetative security
of activity in elderly people with vegetative dystonia syndrome. 180 patients with CCI of the second stage were
studied, the average age was 67.4±6.1 years. The patients were divided into two groups. Group I consisted of 118
patients (62.2% of the total number of patients) with stage 2 chronic cerebral ischemia (CCI) with ADS, group 2
consisted of 62 patients (34.4%) with stage 2 CCI without ADS.
KEYWORDS
Autonomic nervous system, elderly, autonomic dystonia syndrome.
INTRODUCTION
The comorbidity of vegetative disorders with
cerebrovascular pathology has been proven. Stroke
and structural lesions of the brain lead to dissociation
of functional systems and autonomic dysregulation
[2,3]. Autonomic dysfunction in the acute period of
stroke, according to some authors, is an unfavorable
sign and indicates a poor prognosis; according to other
data, this is a transient failure of adaptation [2].
Research Article
AUTONOMIC NERVOUS SYSTEM RESEARCH INDICATORS IN THE
ELDERS
Submission Date:
January 07, 2022,
Accepted Date:
January 17, 2022,
Published Date:
January 27, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue01-05
Ismigul Abbosova
Andijan State Medical Institute, Andijan, Uzbekistan
Iroda Rustamova
Andijan State Medical Institute, Andijan, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
36
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
35-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Cerebral ischemia activates the sympathetic-adrenal
and hypothalamic-pituitary systems, as a result of
which the balance of the sympathetic and
parasympathetic parts of the ANS is disturbed, which
can lead to severe cardiac arrhythmias, sudden cardiac
arrest, stroke.
The development of vegetative disorders in patients
with chronic CVD is explained by a violation of the
mechanisms of autoregulation in the ANS due to
hypertension
and
atherosclerosis:
baroreflex
(atherosclerosis of the carotid arteries), reflexogenic
(impaired blood circulation in the vertebrobasilar
system) and central mechanisms (impaired circulation
of the suprasegmental structures of the ANS) [1,2 ].
Thus, the pathogenesis of the development of
autonomic dysfunction in elderly patients with
cerebrovascular pathology is complex and manifests
itself as symptoms of damage to suprasegmental and
peripheral structures, while the sympathetic nervous
system is more involved. The development of
autonomic disorders in patients with CVD and MS is
accompanied by cardiac complications, syncope, and
others, and has an unfavorable prognosis. In this
regard, their timely diagnosis and treatment are
extremely important.
THE PURPOSE OF THE STUDY
To identify features of autonomic nervous system
parameters in elderly patients with cerebrovascular
pathology.
MATERIAL AND METHODS
The clinical part of the work was carried out in the
advisory polyclinic of ASMI in the period from 2019 to
2022. 180 patients with CCI of the second stage were
under observation. The patients included 62 (37.8%)
men and 118 (62.2%) women. The age of the patients
ranged from 60 to 75 years, the average age was
67.4±6.1 years.
Group I consisted of 118 patients (62.2% of the total
number of patients) with stage 2 chronic cerebral
ischemia (CCI) with ADS (42 men (35.6%) and 76 women
(64.4%)), group 2 consisted 62 patients (34.4%) with
stage 2 CCI without ADS (26 men (41.9%) and 36 women
(58.1%)).
To study the presence of ADS in patients, the
questionnaire of A.M. Wayne (1987). The initial
vegetative tone (IVT) was determined using the table
A.M. Wayne et al. [1981], which recorded clinical,
electrophysiological and laboratory parameters. To
assess autonomic reactivity (VR), a clino-orthostatic
test (COP) is performed. Studying the clinical features
of headache (HA) using the original HA questionnaire.
The presence of depression was detected using the
HADS scale. Patients also underwent ECG studies and
ambulatory blood pressure monitoring (ABPM).
The research materials were subjected to statistical
processing using the methods of parametric and non-
parametric
analysis.
Accumulation,
correction,
systematization of initial information and visualization
of the obtained results were carried out in Microsoft
Office Excel 2016 spreadsheets. Statistical analysis was
carried out using the IBM SPSS Statistics v.23 program
(developed by IBM Corporation).
RESEARCH RESULTS
The majority of patients in both groups had a
permanent course of ADS (82.4%). Paroxysmal
vegetative states were observed in both groups.
Among patients with ADS, autonomic paroxysms in
history were in 32/118 (27.1%) people, and panic attacks
in 17/118 (14.4%). In the group without ADS, the
presence of vegetative crises was noted in 7/62 (11.3%)
37
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
35-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
patients, the combination with panic attacks in 9/62
(14.5%).
A characteristic feature was the combination of these
complaints and syndromes in 72% of all patients, the
monosyndromic nature of complaints was observed
only in 8% of patients with ADS. In both studied groups,
a high incidence of somatic complaints, neurosis-like
and affective disorders, and the severity of complaints
typical of asthenic syndrome were revealed.
Statistically significant differences were obtained in
these clinical groups. So, in group I, affective and
neurosis-like complaints were significantly more
common.
The most common clinical syndromes in patients with
ADS were cephalgic syndrome (82.4%), esophageal
dyskinesia (48%), gastric and intestinal dyskinesia
(76%), symptomatic arterial hypertension (44.5%) and
hypotension (6.2% ), neurogenic dysfunction of the
bladder (16.5%), vestibulopathic syndrome (12.4%),
neuroendocrine syndrome (12.2%), neurogenic syncope
(8.2%), autonomic crises - vagoinsular (8.5%),
sympathoadrenal (2.2%) - hyperhidrosis (5.0%),
angiotrophoneurosis (1.2%).
These syndromes were detected significantly more
often in the sympathicotonic type of autonomic
reactivity (VR) and arterial hypertension (AH).
Electrocardiographic changes were manifested by an
increase in the amplitude of the T wave (10.2% in group
I and 6.2% in group II) and the ST segment (8.2% and
4.2% respectively), sinus arrhythmia (32% and 22.4%
resp.), supraventricular extrasystole (28.4% and 13.4%
resp.).
Numerous gastroenterological manifestations in ADS
in the vast majority of cases (82%) were manifested by
esophageal dyskinesia (32% in group II and 42.4% in
group I), duodenogastric reflux (24.6% and 26%
respectively), intestinal dyskinesia ( 18.2% and 18%,
respectively), dysfunction of the hepatobiliary tract
with signs of cholestasis (32% and 38%, respectively).
According to the Wayne questionnaire in group I, the
average total score is above the norm in most patients
(in 94% of cases), and the average in the group was
35±16, which was comparable to group II. Thus, in
patients without ADS, signs of autonomic dysfunction
were observed in 75% of the examined patients, the
average score was 38±17.
With vagotonia in group I, endocrine pathology
(p<0.05), functional disorders of the gastrointestinal
tract were detected 3.7 times more often. Analysis of
the structure of concomitant neurological pathology
revealed that in group I, markers of more severe
neurological disorders were detected 2.8 times more
often, such as hypodynamic states (4.3 times),
depression (1.5 times more often) (p<0, 05).
Manifestations of sympathetic activation with an
increase in systolic blood pressure, mean blood
pressure and increased heart rate according to ABPM
were noted significantly in patients with ADS (table 1).
38
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
35-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Table 1
Blood pressure level and pulse rate in groups (ABPM)
Indicators
Group 1
Group 1
Maximum SBP (mm Hg)
163,2±28,4
157,3±15,1*
Maximum DBP (mm Hg)
105,7±17,1
101,6±18,2
Average blood pressure (mm.Hg.st)
90,5±9,3
86,7±8,4*
Pulse rate (bpm)
66,8±9,2
60,8±10,5*
Note: * - significance of differences, p < 0.05
In group I, psycho-emotional disorders were often
observed in the form of dysphoria, irritability,
demonstrative behavior, a decrease in the level of
attention and faster exhaustion when performing a
task. When objectifying psycho-emotional disorders
using the HADS scale, in group I, among patients with
CCI, persons with clinically pronounced depression
significantly predominated (score > 11), and, on
average, in the group, the average score for testing the
level of depression was higher compared to patients
without ADS (p < 0.05) (table 2).
Table 2
Psycho-emotional disorders (according to the HADS scale)
HADS
Group 1
Group 1
HADS anxiety score
6,8±4
6,8±3,8
HADS depression, score
7,5±3,7*
6,5±3,8
Note: * - significance of differences, p < 0.05
Psycho-emotional and vegetative disorders in the ADS
group correlated with metabolic parameters. Thus, the
presence of depression on the HADS scale significantly
correlated with an increase in div mass index (r =
0.41, p < 0.05), an increase in waist circumference (r =
0.36), a level of glycated hemoglobin (r = 0.26) and
duration arterial hypertension (r = 0.32), as well as the
total score on the autonomic change questionnaire (r
= 0.57).
The result of testing on the questionnaire of vegetative
changes had a direct relationship with the degree of
AH (r = 0.54) and blood glucose level (r = 0.54) in the
MS group. In the group without ADS, there was a
positive correlation between the score of autonomic
39
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
35-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
disorders and the level of anxiety on the HADS scale (r
= 0.49) and the degree of AH (r = 0.45) at p < 0.05.
It was found that the activity of psychosomatic
complaints positively correlated with the average
anxiety score (rij=+0.41, p<0.05). Based on the results
of a survey and examination of patients, a group of
somatic symptoms was identified that most often
correlated with psychosomatic distress, depression
and anxiety: headache (rij=+0.5, p<0.05), abdominal
pain (rij =+0.6, p<0.05), fatigue (rij=+0.3, p<0.05),
increased heart rate (rij=+0.4, p<0.05), “unsatisfied
breath” (rij=+0.3, p<0.05). Together, they represent a
somatovegetative symptom complex that aggravates
the course of the underlying chronic disease.
CONCLUSION
The combination of psycho-vegetative and somatic
manifestations, accompanied by constant emotional
stress, is a reliable diagnostic sign that allows assessing
the severity of the progression of cerebrovascular
pathology in the elderly. Time to take preventive
measures to eliminate a poor prognosis.
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