Among the symptoms indicating the presence of neurological disorders, the most common are cognitive disorders, which arise as a result of pathological changes in the structure and function of the brain.

This problem mainly occurs in older people. The high incidence of cognitive disorders in this category of patients is explained by age-related changes in the body, which negatively affect the functioning of the central nervous system.

Cognitive impairment refers to mental capacity and other intellectual functions. Such changes are identified by comparing current indicators with the individual norm.

Cognitive brain functions - what is it?

Cognitive (cognitive) functions are the most complex processes occurring in the brain. They provide a rational perception of the surrounding reality, an understanding of the events occurring around a person. Through the cognitive abilities of the brain, people find connections between themselves and what they encounter in everyday life.

Cognitive activity consists of the following functions:

Problems with memory and intelligence occur when any part of the brain is damaged. Violations of other cognitive functions occur when certain parts of the central nervous system are damaged (parietal, frontal, temporal and other lobes).

Three stages of cognitive impairment

Such violations are usually classified according to the severity of the consequences. Cognitive disorders may be of the following nature:

1. At lungs violations, minor changes are observed that fall within the established norms for a specific age group. Such disorders do not create problems for a person in everyday life. At the same time, people themselves or those around them may notice such changes.
2. For moderate disorders are characterized by changes in cognitive functions that go beyond existing norms. However, such violations do not affect the person’s condition and do not cause maladjustment in his everyday life. Moderate disorders usually manifest themselves as problems in performing complex intellectual tasks.
3. The most dangerous type of cognitive personality disorder is , or dementia. This condition is accompanied by significant changes in memory and other brain functions. Such disorders are pronounced and have a direct impact on a person’s daily life.

Complex of provoking factors

There are more than 10 different factors that can lead to cognitive disorders of brain function. The most common reason for the development of such disorders is considered. This pathology is accompanied by the gradual death of brain neurons, as a result of which its individual functions are suppressed.

The first and most striking sign of Alzheimer's disease is memory loss. At the same time, motor activity and other cognitive functions remain within normal limits for a long time.

In addition to Alzheimer's disease, a decrease in a person's intellectual capabilities is observed in the following neurodegenerative pathologies:

• corticobasal degeneration;
• and others.

Quite often, cognitive disorders can appear with. These include:

Clinical picture

The intensity of the clinical picture is determined by the severity of the lesion and the location of the pathological process in the brain. In most cases, several types of cognitive disorders of varying severity and intensity are observed.

Neurological diseases manifest themselves in the form of the following phenomena:

• problems with the perception of third-party information;

With dementia, patients lose the ability to critically assess their own condition, and therefore, when interviewed, they do not complain about the above symptoms.

The first sign indicating a cognitive deficit is memory loss. This symptom occurs even with mild forms of brain dysfunction. At the initial stages, the patient loses the ability to remember information that was received relatively recently. As the pathological process develops, he forgets events that happened in the distant past. In severe cases, the patient is unable to say his own name and identify himself.

Symptoms of disorders with moderate brain damage often go unnoticed. Such disorders are sluggish in nature and do not transform into dementia. The presence of moderate disorders can be determined by the following symptoms:

• difficulties in performing simple counting operations;
• problems repeating recently learned information;
• disruption of orientation in a new area;
• difficulty finding words during a conversation.

A mild form of cognitive impairment is indicated by:

• memory loss;
• problems with concentration;
• high fatigue when performing mental work.

Cognitive impairment must be differentiated from other forms of neurological disorders. In particular, to make a correct diagnosis, it is necessary to establish the presence or absence of pathological changes in a person’s behavior and emotional state.

Brain dysfunction in children

Children experience cognitive dysfunction due to a deficiency of certain vitamins.

Modern research has proven the relationship between cognitive impairment and a lack of beneficial microelements in the body. Vitamin deficiency negatively affects the ability to memorize new information, concentration, intensity of the thought process and other types of brain activity.

Pathologies caused by a lack of microelements occur in approximately 20% of children and adolescents. In most cases, problems related to speech and language functions are observed.

In addition to vitamin deficiency, neurological diseases in children occur for the following reasons:

In the latter case we are talking about:

• birth injuries;
• infection of the fetus during gestation.

In this regard, one of the main challenges facing modern medicine is the development of methods for early diagnosis of cognitive disorders in children.

Diagnostic criteria

Diagnosis of malfunctions in brain functions is carried out if the patient or his immediate relatives consult a doctor with complaints of memory loss and deterioration of mental abilities.

A study of a person's current state is carried out using a brief mental status assessment scale. In this case, it is important during diagnosis to exclude the presence of emotional disorders (depression), which lead to temporary memory impairment. In addition to screening scales, the patient’s mental status is assessed through dynamic monitoring of him and his behavior. Repeated examination is scheduled approximately 3-6 months after the first one.

To assess the degree of dementia, the patient is asked to draw a clock

To quickly analyze the patient’s mental state, the so-called Montreal Cognitive Impairment Rating Scale is used today. It allows you to test many brain functions in about 10 minutes: memory, speech, thinking, counting ability and more.

The assessment is carried out by testing the patient. He is given tasks and a certain time to complete them. At the end of the tests, the doctor calculates the final results. A healthy person must score more than 26 points.

The MMSE scale is used in stroke to detect cognitive impairment

How to improve the patient's condition?

When selecting a treatment regimen for a patient, it is important to first establish the cause of the development of cognitive disorder. Therefore, after assessing the mental status, a comprehensive examination of the patient is carried out.

Treatment tactics for disorders are determined based on the severity of the disease and the cause of the brain dysfunction. In the treatment of mild to moderate dementia caused by Alzheimer's disease or vascular pathologies, acetylcholinesterase inhibitors or. However, the effectiveness of these drugs has not yet been proven. They are prescribed mainly to prevent further progression of the pathological process and the development of dementia.

In case of diagnosing vascular pathologies that provoke a failure of brain activity, the following are used:

• phosphodiesterase inhibitors promote vasodilation, which leads to normalization of blood circulation;
• α2-adrenergic receptor blockers suppress the actions of the sympathetic nervous system, which lead to the narrowing of blood vessels.

To restore the neurometabolic process, it is used. The drug increases the plasticity of brain neurons, which has a positive effect on cognitive functions.

In addition to these medications, in the presence of neurological disorders, various therapeutic tactics are used to correct the patient’s behavior. It takes a lot of time to complete this task, since such treatment involves a consistent transformation of the human psyche.

Tactics for managing a patient with impaired cognitive functions:

Prevention and prognosis

A general prognosis for cognitive disorders cannot be made. In each case, the consequences are individual. But provided that you seek help from a specialist in a timely manner and follow all medical instructions, it is possible to stop the development of the pathological process.

It is important to note that there are two types of cognitive impairment: reversible and irreversible. The first form can be corrected, but the second cannot.

Prevention includes measures aimed at reducing and increasing a person’s mental and physical activity. To avoid the occurrence of such disorders, it is recommended to regularly perform intellectual tasks from a young age.

In addition, in order to prevent dementia, vascular pathologies and liver diseases should be treated promptly, and the deficiency of B vitamins should be regularly compensated.

The central nervous system is responsible for the ability of the human brain to perceive, realize, study and process information coming from outside. Disruption of the activity of the higher nervous system causes cognitive brain disorder. In this case, a person’s personal individuality is lost. He becomes irritable. Behavioral characteristics change. Problems begin with the basic functions of awareness of the space around.

Cognitive deficit occurs due to a violation of a person’s intellectual characteristics. Gnostic, responsible for the perception of objects and phenomena and their awareness. Mnestic, responsible for reproducing information already processed by the brain. A decrease in these functions occurs in diseases of a neurodegenerative nature, diseases of the cardiovascular system, infectious diseases of the brain, or in the case of traumatic brain injury. The main mechanism of this process is the disconnected work of the cerebral cortex and subcortical structures.

People suffering from hypertension are at risk of developing this type of disorder. People who have suffered various types of heart attacks and are also predisposed to cognitive disorders.

There is a violation of the motor, or so-called, neurotransmitter system of the body. Dopaminergic neurons, which are responsible for motor activity and muscle contraction, die off. The activity of noradrenergic neurons is markedly reduced. In the body, the systems that transmit impulses – neurotransmitter connections – die off.

Our brain is divided into two hemispheres, one of which is responsible for logic and the other for creative aspects. If there is a disruption in the functioning of the left hemisphere, then the consequence will be a violation of logical thinking. Violations in the functions responsible for calculation, writing, reading. These are diseases such as apraxia, aphasia, agraphia, etc. There is a disorder in voluntary mental activity.

Violation of the right hemisphere of the brain is fraught with changes in visual-spatial perception. Lack of analysis of ongoing processes. Orientation in space. With such a violation, the ordered information about the organization of the body is disrupted. Emotionality of perception, the ability to fantasize and daydream are catastrophically reduced.

Damage to the frontal lobe can lead to loss of memory, will, planning, abstract thinking, and artistic expression.

The temporal region, if damaged, will deprive a person of hearing, smell, and vision. All sensory functions are at risk. At the same time, the use of previous experience based on memorization and emotional perception of the surrounding space will go beyond the norm.

Damaged parietal lobe of the brain can cause sensory or sensorimotor impairment of one half of the body, blindness in half of the visual field of both eyes, visual neglect of the opposite half of space, and disorientation in space. In some cases, it can cause the development of epileptic seizures.

The occipital lobe of the brain is responsible for visual perception. Lack of color separation, perception of color gamut, color shades, face recognition function.

If the cerebellar zone of the brain is affected, the coordination of human movements is impaired. The gait becomes non-linear. If part of the cerebellum is damaged, then there is a disruption in muscle activity on the damaged side. Damage to the cerebellum is also accompanied by muscle fatigue. In the autonomic system, sweating and vascular innervation are disrupted.

Causes of cognitive disorders

Cognitive impairment may be temporary if it occurs as a result of mechanical trauma to the brain or intoxication of the body. This disorder is curable and the body will return to normal within a certain time. If the disorders are caused by vascular diseases, Alzheimer's disease or, then the problem will be progressive.

Almost the most common cause of cognitive diseases is disorders of vascular origin. It is defined as pseudo-neurasthenic syndrome. This is reflected in many diseases, such as aneurysms that grow from congenital or acquired in the process of life, defects in the walls of blood vessels. Spontaneous stratification of the tissue of blood vessels, cardiac, weakening of the circulatory system due to a stroke condition - all this can lead to progression in the disease. Another causative factor may be a decrease in blood flow through the vessels.

Also, the reason for the development of cognitive impairment can be a disease of internal organs, poisoning or abuse of alcoholic beverages. It is necessary to pay great attention to the normal functioning of all body systems. Constantly monitor blood sugar and cholesterol levels. Because changes in their quantitative composition can cause other disorders in the functioning of the body.

Every person has ever experienced the above consequences. cognitive impairment: forgetfulness, visual impairment, inability to analyze. But if these cases in your life are isolated, then this is one thing. What if you constantly exhibit such symptoms? If people around you begin to pay attention to this, you need to sound the alarm. Don’t delay - consult a neurologist. If the disease is present and left untreated, it will progress. This can cause a lot of unpleasant and problematic sensations, including the development of dementia.

Testing for cognitive impairment

If you are nevertheless diagnosed with this type of disorder, then it becomes necessary to determine the initial level of systemic indicators. The testimony of relatives and personal memories of the patient will be useful. Many factors must be taken into account. Did anyone in your family have similar deviations? Is the patient susceptible to depression? The presence of head injuries, use of medications, and consumption of alcoholic beverages are relevant.

In order to assess the general condition of the patient, depending on the severity of the disease, tests are carried out by a psychiatrist. They are based on the use of special clinical scales. The analysis takes into account the behavioral, functional and emotional states of the subject.

The MMSE (Mini-mental State Examination) scale is the most commonly used. It includes thirty questions aimed at determining the patient's level in the functions of speech, orientation, reading, etc. On this scale, the result is determined in points. From 21 to 25 points – there are unprincipled disorders in the cognitive system. If the score is low from 0 to 10, then the violations are global and must be treated immediately. The normal state of the system is in the range from 26 to 30 points. When using this scale, it is necessary to know the starting educational threshold of the subject.

In the Clinical Dementia Rating scale - CDR, the level of disease is determined by increasing points. If the subject has no memory impairment, behavioral characteristics at home and at work are unchanged, and he is able to take care of himself, then the score will be zero. A score of 1 indicates a mild impairment, 2 indicates a moderate level. Ball three is a severe form of the disease.

A disorder is indicated by low FAB scores if the patient scores less than 11 points. At the same time, the MMSE test gives a relatively high result. In Alzheimer's disease, MMSE decreases to 20-24 points, and FAB is at its maximum level. In severe dementia, scores on two scales are low.

If damage to subcortical structures and the frontal part of the brain is suspected, a clock drawing test is performed. You need to draw a dial with hands fixed at a certain time.

If it turns out that the disease is caused by heredity, a laboratory examination is prescribed. Testing is required to determine the type of heredity. Computed tomography and magnetic resonance imaging are also widely used to visualize the state of the brain. Ultrasound Doppler effect is used to check blood vessels. An EEG is also prescribed to determine the state of the brain.

The patient is examined for the presence of chronic diseases of the pulmonary region and cardiovascular system.

Alzheimer's disease is difficult to identify and treat. Its process is smooth. Without any obvious violations. It is almost impossible to determine this condition in the early stages. This disease mostly affects older people.

Treatment of cognitive impairment

Treating dementia involves finding and eliminating the cause of the disorder. Many drugs are used: donepezil, galantamine, rivastigmine, memantine, nicergoline. The treatment regimen is selected for each case individually.

For treatment to be effective, the patient must, in addition to taking medications, follow a diet. Consume more vitamin B. Low-cholesterol foods are recommended: vegetables, fruits, low-fat dairy products, seafood. Avoid drinking alcohol and smoking.

Consultation with a neurologist on the topic of cognitive impairment

Active activity is good for the brain. We need to make it work. Count in your head, solve crosswords, draw, etc.

People suffering from absent-mindedness are at risk for cognitive diseases. They experience improper functioning of short-term memory and the speed of processing incoming information. There is a violation of spatial perception and the visual apparatus.

Some people wonder what “evoked cognitive potentials” are. These potentials are a kind of indicator of work in the brain. The essence of the method is to determine the processes occurring in the brain when reacting to a stimulus and the processes of remembering and reproducing the irritating aspect. The method is used in electroencephalography.

If you have identified any factors of brain dysfunction, do not self-medicate. Contact your doctor and he will give professional recommendations to eliminate the causes of your anxiety. After all, the problem may be larger than you imagine.

Symptoms of dementia include cognitive, behavioral, emotional and daily functioning disorders.

Cognitive impairment represents the clinical core of any dementia. Cognitive impairment is the main symptom of this condition, so its presence is mandatory for diagnosis.

Cognitive functions (from English. cognition- “cognition”) - the most complex functions of the brain, with the help of which rational knowledge of the world and interaction with it is carried out. Synonyms for the term “cognitive functions” are “higher brain functions”, “higher mental functions” or “cognitive functions”.

Typically, the following brain functions are classified as cognitive.

• Memory is the ability to imprint, store and repeatedly reproduce received information.
• Perception (gnosis) is the ability to perceive and recognize information coming from outside.
• Psychomotor function (praxis) - the ability to compose, store and execute motor programs.
• Speech is the ability to understand and express thoughts using words.
• Intelligence (thinking) - the ability to analyze information, generalize, identify similarities and differences, make judgments and conclusions, and solve problems.
• Attention is the ability to highlight the most important from the general flow of information, concentrate on current activities, and maintain active mental work.
• Regulation of voluntary activity - the ability to arbitrarily choose a goal of activity, build a program to achieve this goal and control the implementation of this program at various stages of activity. Lack of regulation leads to decreased initiative, stoppages of current activities, and increased distractibility. Such disorders are usually referred to as “dysregulatory disorders.”

By definition, dementia is a multifunctional disorder, so it is characterized by simultaneous insufficiency of several or all cognitive abilities. However, different cognitive functions are affected to varying degrees, depending on the causes of dementia. Analysis of the characteristics of cognitive disorders plays an important role in establishing an accurate nosological diagnosis.

The most common type of cognitive impairment in dementia of various etiologies is memory impairment. Severe and progressive memory impairment, first for recent and then for distant life events, is the main symptom of Alzheimer's disease. The disease debuts with memory disorders, then they are joined by disturbances in spatial praxis and gnosis. Some patients, especially those younger than 65-70 years, also develop speech disorders such as acoustic-mnestic aphasia. Disorders of attention and regulation of voluntary activity are less pronounced.

At the same time, disturbances in the regulation of voluntary activity become in the initial stages the main clinical characteristic of vascular dementia, dementia with Lewy bodies, as well as diseases with predominant damage to the subcortical basal ganglia (Parkinson's disease, Huntington's disease, etc.). Disorders of spatial gnosis and praxis are also present, but have a different nature and therefore do not lead, in particular, to disorientation on the ground. Memory impairments, usually expressed to a moderate degree, are also noted. Dysphasic disorders are not typical.

For frontotemporal lobar degeneration (frontotemporal dementia), the most typical combination of dysregulatory cognitive disorders and speech disorders such as acoustic-mnestic and/or dynamic aphasia. At the same time, memory for life events remains intact for a long time.

With dysmetabolic encephalopathy, the dynamic characteristics of cognitive activity are most affected: reaction speed, activity of mental processes, increased fatigue and distractibility are characteristic. This is often combined with sleep-wake cycle disturbances of varying severity.

Emotional disturbances in dementia are most common and pronounced in the initial stages of the pathological process and gradually regress in the future. Emotional disorders in the form of depression occur in 25-50% of patients with the initial stages of Alzheimer's disease and in most cases of vascular dementia and diseases with predominant damage to the subcortical basal ganglia. Anxiety disorders are also very common, especially in the early stages of Alzheimer's disease.

Behavioral disorders are a pathological change in the patient’s behavior that causes concern to himself and/or those around him. Like emotional disturbances, behavioral disturbances are not necessary for a diagnosis of dementia, but they are quite common (approximately 80% of patients). Behavioral disorders usually develop during the stage of mild or moderate dementia.

The most common behavioral disorders include the following.

• Apathy - decreased motivation and initiative, absence or decrease in any productive activity of the patient.
• Irritability and aggressiveness.
• Aimless physical activity - walking from corner to corner, wandering, shifting things from place to place, etc.
• Sleep disorders - daytime sleepiness and psychomotor agitation at night (the so-called sundowning syndrome).
• Eating disorders - decreased or increased appetite, changes in food preferences (for example, increased cravings for sweets), hyperoralism (constant chewing, sucking, smacking, spitting, eating inedible objects, etc.).
• Uncriticality - loss of a sense of distance, immodest or tactless questions and comments, sexual incontinence.
• Delusion is persistent false conclusions. The most typical are delusions of damage (relatives are stealing or planning something evil), jealousy, doppelgängers (the spouse has been replaced by an outwardly very similar ill-wisher), and delusions of the type “I’m not at home.”
• Hallucinations are often visual, in the form of images of people or animals, less often auditory.

Impairments in daily activities are an integral result of the cognitive and behavioral symptoms of dementia, as well as other neurological impairments associated with the underlying brain disease. The term “impairment of daily activities” refers to disorders of the patient’s professional, social and everyday adaptation. The presence of disturbances in daily activities is indicated by the impossibility or significant difficulties at work, when interacting with other people, performing household duties, and in severe cases - during self-care. The presence of disturbances in daily activities indicates a greater or lesser loss of independence and autonomy by the patient, with the need for outside assistance.

The sphere of daily activities includes the following types of activities:

• professional - the ability to effectively continue to perform one’s work;
• social - the ability to interact effectively with other people;
• instrumental - the ability to use household appliances;
• self-care - the ability to dress, perform hygiene procedures, eat, etc.

The timing of development and the sequence of occurrence of certain symptoms of dementia are determined by the nature of the underlying disease, but some of the most general patterns can be traced.

As a rule, dementia is preceded by a stage of mild cognitive impairment (MCI). Moderate cognitive impairment is generally understood as a decrease in cognitive abilities that clearly exceeds the age-related norm, but does not significantly affect daily activities.

Modified diagnostic criteria for mild cognitive impairment syndrome (Touchon J., Petersen R., 2004)

• Cognitive impairment according to the patient and/or his immediate environment (the latter is preferable).
• Signs of recent decline in cognitive abilities compared to the individual's individual norm.
• Objective evidence of cognitive impairment obtained using neuropsychological tests (a decrease in the results of neuropsychological tests by at least 1.5 standard deviations from the average age norm).
• There are no disturbances in the patient's usual forms of daily activity, but there may be difficulties in complex activities.
• There is no dementia - the result of the brief mental status assessment scale is at least 24 points,

At the stage of moderate cognitive impairment, the patient complains of memory impairment or decreased mental performance. These complaints are confirmed by data from a neuropsychological study: objective cognitive impairment is revealed. However, cognitive disorders at this stage are expressed to a small extent, so that they do not significantly limit the patient’s usual daily activities. At the same time, difficulties in complex and unusual activities are possible, but patients with moderate cognitive impairment retain their ability to work, they are independent and independent in social life and everyday life, and do not need outside help. Criticism of their condition is most often preserved, so patients, as a rule, are adequately alarmed by changes in their cognitive status. Mild cognitive impairment is often accompanied by emotional disorders such as anxiety and depression.

The progression of disorders and the appearance of difficulties in the patient’s usual activities (regular work, interaction with other people, etc.) indicate the formation of mild dementia syndrome. At this stage, patients are fully adapted within their apartment and the surrounding area, but experience difficulties at work, when navigating in unfamiliar areas, driving a car, performing calculations, making financial transactions and other complex activities. Orientation in place and time, as a rule, is preserved, but due to memory disorders, erroneous determination of the exact date is possible. Criticism of one's condition is partially lost. The range of interests is narrowing, which is associated with the inability to support more intellectually complex types of activity. Behavioral disorders are often absent, while anxiety-depressive disorders are very common. The sharpening of premorbid personal characteristics is very typical (for example, a thrifty person becomes greedy, etc.).

The occurrence of difficulties within one's own home is a sign of transition to the stage of moderate dementia. First, difficulties arise when using household appliances (so-called violations of instrumental daily activities). Patients forget how to cook food, use TV, telephone, door lock, etc. There is a need for outside help: first only in certain situations, and then most of the time. In the stage of moderate dementia, patients are usually disoriented in time, but oriented in place and their own personality. A significant decrease in criticism is noted: patients in most cases deny the presence of any memory impairment or other higher brain functions. Behavioral disorders that can reach significant severity are very typical (but not obligatory): irritability, aggressiveness, delusions, inappropriate motor behavior, etc. As the pathological process further progresses, difficulties in self-care (dressing, performing hygiene procedures) begin to appear.

Severe dementia is characterized by the patient’s almost complete helplessness in most everyday situations, which necessitates the need for constant outside help. At this stage, delusions and other behavioral disorders gradually regress, which is associated with increasing intellectual disability. Patients are disoriented in place and time, there are pronounced disturbances of praxis, gnosis and speech. The significant severity of cognitive disorders makes differential diagnosis between various nosological forms of dementia very difficult at this stage. Neurological disorders, such as disorders of gait and pelvic functions, are also added. The final stages of dementia are characterized by loss of speech, inability to walk independently, urinary incontinence, and neurological symptoms of decortication.

The main stages of the development of dementia:

• mild cognitive impairment;
• disruption of professional and social activities;
• reduction of criticism, personality change;
• impairment of instrumental activities of daily living;
• formation of behavioral disorders;
• violation of self-care;
• loss of speech, pelvic disorders, urinary incontinence;
• decortication.

Characteristics of the main stages of cognitive deficit

Catad_tema Mental disorders - articles

Cognitive impairments in general clinical practice

A. Lokshina, Candidate of Medical Sciences, B. Zakharov, Doctor of Medical Sciences, MMA named after. THEM. Sechenov

Issues related to the relevance of studying cognitive impairment by doctors of different specialties are considered. Particular attention is paid to the diagnosis and treatment of non-dementia (mild and moderate) cognitive impairment, and the criteria for their diagnosis. The simplest neuropsychological methods for diagnosing cognitive impairment in old age are indicated, and the basic principles of treatment for such patients are described.
Keywords: cognitive functions, moderate cognitive impairment, mild cognitive impairment.

Cognitive Disorders In General Clinical Practice

A. Lokshina, MD; V. Zakharov, MD
I.M. Sechenov Moscow Medical Academy

The paper considers the problems concerning the topicality of a study of cognitive disorders by physicians of various specialties. Particular emphasis is placed on the diagnosis and treatment of non-dementia (mild and moderate) cognitive disorders and on their diagnostic criteria. The simplest neuropsychological methods for diagnosing cognitive disorders at old age are indicated. The basic principles in the treatment of such patients are described.
Key words: cognitive functions, moderate cognitive disorders, mild cognitive disorders.

Old age is the strongest and most independent risk factor for the development of disorders of higher brain (cognitive) functions. As the number of elderly people increases, the number of patients with cognitive disorders increases. Advances in the pathophysiology and neurochemistry of cognitive impairment, as well as new neuropharmacological data, now allow us to consider cognitive impairment as a partially curable condition. Therefore, timely diagnosis and the earliest possible initiation of treatment for cognitive impairment in older people seem extremely important, since when diagnosed late, these disorders often reach the level of dementia.

There are several reasons for late diagnosis of cognitive impairment. Firstly, there is insufficient understanding by both doctors and relatives of an elderly person of the nature of age-related forgetfulness. Many people believe that a decline in memory and other cognitive functions is normal in old age. That is why patients and their relatives do not go to the doctor or, when they do, they receive the answer: “this is age-related,” “what do you want at your age?” etc. Meanwhile, the effectiveness of treatment of cognitive impairment directly depends on the time of initiation of therapy. It is obvious that at the stage of extremely severe disorders, when patients lose self-care skills or cease to recognize others, the possibilities of providing assistance are very limited.

Another reason for late diagnosis is the insufficient knowledge of neurologists, psychiatrists, therapists, gerontologists and doctors of other specialties in its methods. The usual collection of complaints, anamnesis and clinical examination do not provide sufficient information about the state of cognitive functions. To identify cognitive impairment, neuropsychological methods are used, which are special tests and tasks to determine memory, attention, intelligence and other higher mental functions. Doctors of various specialties should use at least the simplest neuropsychological methods, such as the Mini-Cog test (see section “Diagnostics”) and other screening scales.

Timely detection of cognitive impairment is an important guarantee of the effectiveness of therapy, which can prevent or at least delay the onset of dementia. Adequate management of an elderly person with initial manifestations of cognitive impairment significantly improves the quality of life of both the patient and his relatives.

Assessment of the state of cognitive functions and syndromes of their impairments
Cognitive (synonyms - higher cerebral, higher mental, higher cortical, cognitive) functions are among the most complex functions of the brain, with the help of which the process of rational cognition of the world is carried out and targeted interaction with it is ensured.

Cognitive functions include:

Monofunctional cognitive impairment, i.e. isolated aphasia, agnosia, amnesia or apraxia, usually occur with local lesions of certain parts of the cerebral cortex as a result of stroke, traumatic brain injury, tumor and other causes. At the same time, in old age, most chronic progressive brain diseases of a neurodegenerative or vascular nature are accompanied by multifunctional cognitive disorders, when there is simultaneous depression of several (or all) cognitive functions.

To establish a nosological diagnosis, choose patient management tactics and determine prognosis, it is important not only to establish the nature of cognitive impairment, but also their severity. According to the classification of Academician of the Russian Academy of Medical Sciences N.N. Yakhno (2005), distinguish between severe, moderate and mild cognitive impairment.

Severe cognitive impairment (SCI) refers to mono- or multifunctional disorders of cognitive functions that lead to a complete or partial loss of independence and self-sufficiency of the patient, i.e. cause professional, social and (or) everyday disadaptation. SCI includes, in particular, dementia of a degenerative or vascular nature. According to epidemiological data, at least 5% of people over 65-70 years old suffer from dementia. The presence of dementia or other types of SBO indicates significant brain damage, which usually develops as a result of a long-term pathological process. The prognosis in most cases is unfavorable, since SBO is most often progressive, less often stationary.

Moderate cognitive impairment (MCI) is a mono- or multifunctional disorder of cognitive functions that goes beyond the average age norm, but does not cause maladjustment, although it can lead to difficulties in complex and unusual situations for the patient. MCI is observed in the initial stages of cerebral pathology. In older adults, the prevalence of MCI is 11–17%. The prognosis depends on the nature of the underlying pathological process and patient management. Over 5 years of observation, in 50% of patients MCI transforms into severe, in the rest they can remain stable or regress.

Modified diagnostic criteria for MCI syndrome (MCI-revised); J. Touchon, R. Petersen, 2004:

Mild cognitive impairment (MCI) is stated in the case of a decrease in 1 or several cognitive functions compared to a higher initial level (individual norm); MCI does not affect everyday, professional and social activities, including its most complex forms. MCI can be caused by the physiological process of aging or observed in the earliest stages of organic brain disease. In most cases, adequate therapy can reduce the severity of MCI.

Age itself can only cause mild and non-progressive cognitive impairment. In the presence of moderate or severe impairments, as well as a noticeable progression of cognitive impairment over a short period, we are talking about an ongoing brain disease. In such cases, it is necessary to establish an accurate nosological diagnosis, which is based on the clinical and psychological characteristics of the existing disorders, data from laboratory and instrumental research methods.

Diagnosis of cognitive impairment
Given the high prevalence of cognitive impairment in older age groups, when working with elderly patients it is necessary to have a certain caution in this regard. Cognitive testing in all elderly patients is not warranted. However, such a study, from our point of view, is very advisable when:

To study cognitive functions, the doctor can use any neuropsychological methods known to him. We recommend the “Mini-Cog” technique to doctors of various specialties (see diagram). This technique does not take much time, but at the same time is very sensitive. The inability to remember at least 1 word after a hint or errors when drawing a clock indicate the presence of clinically significant cognitive impairment. The severity of such disorders can be determined in a conversation with relatives, asking them questions about the degree of professional, social and everyday adaptation of patients.

“MINI-COG” technique

1. Instructions: “Repeat 3 words: lemon, key, ball.” Words must be pronounced as clearly and intelligibly as possible at a speed of 1 word per second. After the patient has repeated all 3 words, we ask: “Now remember these words. Repeat them one more time." We try to ensure that the patient remembers all 3 words on his own. If necessary, present the words again - up to 5 times.
2. Instructions: “Please draw a round clock with numbers on the dial and hands.” All numbers should be in place, and the arrows should point to 13.45. The patient must independently draw a circle, arrange numbers and draw arrows. Hints are not allowed. The patient should also not look at a real clock on his hand or on the wall. Instead of 13.45, you can ask to set the hands at any other time.
3. Instructions: “Now let’s remember the 3 words that we learned at the beginning.” If the patient cannot remember the words on his own, you can offer a hint. For example: “You memorized some fruit... an instrument... a geometric figure.”

Treatment of cognitive impairment in old age
Therapy of cognitive impairment in old age has 2 main goals: preventing the progression of impairments and reducing the severity of existing disorders in order to improve the quality of life of patients and their relatives. Treatment should be, whenever possible, etiotropic or pathogenetic. In all cases, the following measures are advisable:

One of the most important areas of treatment for cognitive impairment is the use of drugs that affect cerebral neurotransmitter systems. Cognitive functions are integrative functions of the brain, i.e. they are formed as a result of its holistic (integrated) activities. Obviously, in the process of such integration, optimal functioning of synapses between neurons is necessary, which depends on the activity of cerebral neurotransmitters.

The choice of strategy for influencing cerebral neurotransmitter systems depends on the severity of cognitive impairment. Thus, the use of acetylcholinergic and glutamatergic drugs is currently the “gold standard” for the treatment of most of the most common forms of dementia. In case of MCI and MCI, it is more appropriate to influence other neurotransmitter systems, primarily dopaminergic and noradrenergic.

The dopaminergic and noradrenergic systems undergo significant changes during brain aging. Positron emission tomography studies of the brain indicate that up to 40% of dopaminergic neurons in the brainstem and limbic system die with age. This is accompanied by a significant decrease in dopamine receptor density in the frontal cortex, which correlates with age-related cognitive decline. With age, the activity of noradrenergic mediation decreases, although the number of noradrenergic neurons does not decrease. With pathological aging, changes in the dopaminergic and noradrenergic systems significantly exceed physiological ones.

In clinical practice, among the dopamine agonists that are used for the treatment of age-related memory and attention disorders that do not reach the severity of dementia, piribedil (Pronoran, Servier) has proven itself to be the most effective. This drug combines the properties of a dopamine receptor agonist and a presynaptic α2-adrenergic receptor antagonist, increasing the activity of both the dopaminergic and noradrenergic systems. In addition, Pronoran has a vasoactive effect, improving cerebral and peripheral microcirculation.

The effectiveness of Pronoran in MCI was proven in a double-blind study. The work of D. Nagaradja and S. Jayshree (2001) demonstrated that with the use of the drug, cognitive improvement is achieved 2 times more often than with placebo (see figure).

Use of Pronoran for MCI (D. Nagaragja et al., 2001); The numbers indicate improvement on the KSHOPS scale (in%)

In Russia, the effectiveness of Pronoran in the treatment of cognitive impairment that does not reach the severity of dementia was studied in 2005-2007. within the framework of the “Prometheus” program (program for studying the effectiveness of Pronoran in the syndrome of mild cognitive impairment within the framework of dyscirculatory encephalopathy).

Part 1 of the Prometheus study showed a statistically significant positive effect of Pronoran administered at a dose of 50 mg/day for 12 weeks in 543 patients with MCI or MCI of an age-related or vascular nature. The effect was determined by the results of such screening neuropsychological scales as the Mini-Mental Status Scale (MMS) and the Clock Drawing Test.

Part 2 of the Prometheus study involved 2058 patients (1447 women and 611 men), with an average age of 64.9±8.3 years, diagnosed with dyscirculatory encephalopathy stages I and II and MCI or MCI. Patients took Pronoran at a dose of 50 mg/day for 12 weeks. In addition, concomitant use of other vascular and metabolic drugs was allowed in 49% of patients. Satisfactory tolerability and safety of Pronoran were revealed. During therapy with it, the majority (at least 85%) of patients showed moderate or significant clinical improvement according to the Clinical Global Impression Scale. A study using neuropsychological scales and the Clinical Global Impression Scale did not reveal statistically significant differences between patients receiving Pronoran monotherapy and combination therapy. This suggests that combination therapy is acceptable in terms of safety and tolerability, but does not provide additional benefit in terms of effects on cognitive impairment.

The results of this study confirmed the high prevalence of cognitive impairment in everyday outpatient neurological practice. Up to 70% of elderly patients who consulted a neurologist had some degree of cognitive impairment. This once again emphasizes the importance of timely diagnosis and initiation of treatment for cognitive impairment as one of the symptoms most common in neurological practice.

General understanding of the pathophysiology and neurochemistry of cognitive disorders and the results of clinical studies indicate the advisability of using the dopaminergic and noradrenergic drug “Pronoran” for disorders that do not reach the severity of dementia. The recommended dosage of Pronoran is 50 mg/day, the minimum duration of treatment is 3 months.

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The life of any person is unthinkable without knowledge. Even people without formal education have to adapt to reality, acquire skills and form reactions. Of course, this does not exhaust the cognitive functions of the brain, but these skills are very important for adaptation to the environment and survival.

In modern neurophysiology, it is believed that the region of the cerebral cortex is mainly responsible for cognitive functions. And the disclaimer here is because many do not occur without the participation of the emotional brain, the limbic system. This is where motivation is born, this is where reality is given a sensual coloring. Without the work of this system, a person would lose all impulses to action.

Cognitive functions of the brain include memory, planning, speech, mechanisms for processing mathematical information, and In order not to forget anything, let's start in order, with memory.

Memorization is the translation of the information we encounter into a kind of “code” of the brain. Moreover, not everything is remembered, but only what is significant, and here it comes into its own. Often, emotionally charged events are remembered throughout one’s life, but the necessary information seems banal to the emotional brain - and is not remembered. This is how emotions control us. All areas of the brain are responsible for memory, depending on what type of information we are trying to remember. Moreover, much more information is stored in memory than is necessary - this is sometimes “pulled out” from memory by hypnotists. A person who had difficulty remembering a drawing often still recognizes it among hundreds of similar ones. So it’s a sin to complain about memory - we simply don’t know how to work with it. And if it suffers, other cognitive functions, such as planning, suffer.

The anterior lobe of the cortex is in charge of planning. Neurophysiologists are confident that this is where consciousness “lives.” And self-control. Therefore, people with damage to this part of the brain became uncontrollable, impulsive individuals who were never able to fit into society. Moreover, professional knowledge was not affected. Intuition and premonition live in the right lobe, while the left lobes make a person an analyst. Due to the work of the right lobe, we experience negative emotions, but the left one makes us happy. And indeed, as soon as a person starts planning something, his fears go away. And without analyzing the situation, they intensify. This is how you switch between these zones.

Every little child is a genius linguist. He is able to create a mental model of his native language or even several languages ​​in the first three years. By the way, about languages. The term “cognitive function of language” is sometimes used. This concept comes from linguistics, and it means that language becomes a code, a means for a person to understand the world. Recent research proves that creating and understanding speech requires not only the right. Otherwise, a person will not be able to understand the general meaning of a joke or a story from the life of friends. He understands individual phrases, but he can’t figure out what to laugh at.

Cognitive functions include mathematical abilities. Many people consider themselves untalented and give up, trusting calculators. As a result, many adults cannot even roughly calculate the amount of purchases in a store or check a bill issued at a restaurant. Cunning market traders take advantage of this. However, not everything is so sad; you can regain lost cognitive functions if you can force yourself to exercise regularly. It's like fitness - the more time spent, the brighter the results, although everyone has their own standards.

And finally, about spatial thinking. Some people work well with a compass and a map, instantly noting all the features of the terrain, they even seem to be able to draw accurate maps themselves. And for others it’s even difficult to find the right street. What to do if this cognitive function is not up to par? Remember the school drawing course, come up with fancy objects, draw them from different angles, and then give them for testing to a person who “can draw maps.”

So, no matter what state your cognitive functions are in, the situation can be changed for the better with the help of work.