SCREENING SCALES FOR THE ASSESSMENT OF COGNITIVE DISORDERS IN CHRONIC CEREBROVASCULAR PATHOLOGY

Аннотация

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 Выпуск журнала №-26 Часть–7_ Май –2025 116 MODERN EDUCATION AND DEVELOPMENT 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. Выпуск журнала №-26 Часть–7_ Май –2025 117 MODERN EDUCATION AND DEVELOPMENT 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 diso