Alzheimer’s disease (AD), cerebrovascular disease and their combination are the most common causes of cognitive impairment (CI) and therefore disability in senior citizens. Mutual influences, manifestations and diagnostics of AD and vascular CI are analyzed. The presence of a vascular component in the development of CI indicates the possibility of their prevention. Treatment of CI is based on correction of vascular factors, non-drug and drug methods to improve cognitive functions. Psychosocial and behavioral methods, cognitive training, central acetylcholinesterase inhibitors and memantine are effective in dementia. The use of cerebrolysine in AD and vascular CI is discussed.

Chronic brain ischemia and chronic pain both appear to be an extremely wide-spread disease. The reasons of widespread comorbidity of ischemic brain disease and chronic pain are common risk factors: old age, decrease of physical activity, syndrome of systemic inflammation and emotional disturbances. Treatment of patients with cerebrovascular diseases and chronic pain should influence common mechanisms of these disorders. Correction of microcirculatory disturbances pays particular important role, because this is the mechanism not only of chronic cerebral ischemia but compressive-ischemic radiculo- and neuropathy also.

The article deals with the aspects of clinical definition of transient ischemic attack (TIA), the analysis of these risk factors for stroke after TIA and their etiopathogenetic relationship. The features of management of patients with high risk of stroke after TIA are discussed. The issues of interdisciplinary and multidisciplinary approach to medical rehabilitation (MR) of patients with TIA are covered. The results of our own studies of the effectiveness of the MR program in 351 patients with TIA with the inclusion of neurocytoprotectors (choline alfoscerate, Cerepro) are presented. Results and conclusion. Pathogenetically justified is the inclusion in MR of patients with TIA of drugs with neurocalibration effect. The high efficiency of choline alfoscerate (Cerepro) in the form of improving cognitive functions, reducing the severity of emotional disorders and reducing the number of cases of recurrent acute cerebrovascular event is shown.

The article describes epilepsy as a chronic disease of the central nervous system with a wide range of neuropsychiatric disorders, which include cognitive, affective and behavioral disorders. It is important to detect the presence of comorbid conditions in patients with epilepsy as early as possible to ensure early identification, diagnosis and proper monitoring of such co-morbidities. The most frequent manifestations of cognitive dysfunction in epilepsy include depression, impaired memory, attention, and bradyphrenia in the attack-free interval. Various factors play an important role in the pathogenesis of these disorders: organic brain damage, neuronal dysfunction, interictal epileptic activity, repeated seizures, and intake of certain anti-epileptic drugs. Various anti-epileptic drugs are considered from the point of view of influencing the cognitive functions, affective sphere and behavior of patients. Valproic acid preparations, which generally have a good cognitive profile, are presented in detail. A special attention is paid to Convulex, which has multi-dose presentations to provide further advantages in terms of dose flexibility.

Diabetes mellitus (DM) seriously and negatively affects the physical, mental and social well-being of patients. Among the complications of DM, neurological complications associated with both central and peripheral nervous system lesions are of great importance to the patient’s health. These include reduced cognitive function and neuropathy. A decrease in cognitive function associated with DM is observed in both patients with DM 1 and 2 types. There is a connection between the presence of diabetic retinopathy at baseline and changes in cognitive function over time in patients with DM2. Initial diabetic retinopathy and the severity of retinopathy are associated with a decrease in all cognitive functions and a decrease in the rate of information processing. The pathogenesis of diabetic polyneuropathy (DPN) is determined by metabolic disturbances in nerve and epithelial cells, which occur due to hyperglycemia and lead to impaired function of microcirculatory vessels and peripheral nerve fibers. Pathogenetic treatment of DPN is based on modern ideas about the mechanisms of its occurrence and progression. In particular, preparations with antioxidant effect are used, among which the efficacy of alpha-lipoic (thioctic) acid (ALA) in DPN is well proven, and one of such preparations is Berlithion («Berlin-Chemie», Germany). Among other effective drugs used in the treatment of neurological complications of DM, dipyridamole (Curantyl) is used, as the drug affects microangiopathy associated with DM.

Despite the developed criteria of essential tremor (ET) and Parkinson’s disease (PD), clinical practice shows a high percentage of misdiagnoses, especially in the early stages of the disease and during the patient’s initial contact with a neurologist. In addition, the same patient may have signs of ET and PD at the same time. For a correct diagnosis, a detailed clinical examination is necessary. The specific characteristics of tremor (frequency, amplitude, type, involvement of specific parts of the body), history, associated neurological signs, and concomitant non-motor symptoms help to recognize and distinguish these two diseases. In order to exclude the possible negative effect of concomitant medications on tremor, it is necessary to find out about the medication history. The article offers an algorithm of survey and inspection, as well as the interpretation of the data obtained. In diagnostically complicated cases, «trial» therapy is carried out. Additional information for differential diagnosis can be provided by the results of instrumental methods of investigation of transcranial sonography of black substance and single-photon emission computed tomography (DaTSCAN).

Clinical trials confirm alemtuzumab efficacy for multiple sclerosis treatment in terms of both conventional measures and combined criteria such as NEDA (no evidence of disease activity). However, established drug efficacy and convenient dosing schedule are balanced by the risk of serious adverse events. Therefore, it is necessary to inform physicians about the benefits of alemtuzumab therapy along with the pattern of its safety profile.The present review provides the analysis of alemtuzumab real-world studies in Europe, USA and other parts of the world. The information obtained can help physicians to prescribe and administer the drug properly and to perform effective safety monitoring for early detection of adverse events and saving the maximum treatment benefit for the patient.

Ocrelizumab (Ocrevus®) is a humanized anti-CD20 monoclonal antibody approved for the treatment of adults with relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS). The article presents data on the clinical and MRI efficacy and safety profile of ocrelizumab for the long-term use in patients with MS of various forms of the course. The authors performed the search, systematization and analysis of the pooled data of clinical studies and real clinical practice. Five-year follow-upof ocrelizumab therapy showed a compelling and clinical ly significant advantage in reducing the disease progression in patients with PPMS. After five-year ocrelizumab therapy in patients with PPMS, the study showed a reduction of the proportion of patients with disease progression and degree of brain atrophy, and more frequent achievement of the disease inactivity status (NEDA) as compared to patients with two- year delayed initiation of ocrelizumab therapy. The safety profile of the drug corresponds to the results obtained in the controlled periods of clinical trials.

The article is devoted to the study of bone mineral density in patients with systemic scleroderma (SSD) and the identification of persons, who needs the anti-osteoporotic treatment. A total of 170 postmenopausal women were examined: 103 patients with SSD and 67 patients without inflammatory rheumatic diseases. Osteoporosis (OP) was detected in 49.5% in the patient group and in 31% in the control group (p <0.05). The correlation relation between the bone mineral density (BMD) and body mass index was found to be direct, and the one between BMD and the duration of the disease and the cumulative dose of glucocorticoids was found to be inverse. The blood vitamin D level (25(OH)D) was significantly lower in patients than in controls (19.3 ± 7.4 ng/ml and 23.3 ± 8.6 ng/ml, respectively), and among individuals with SSD it was significantly lower in patients with OP than in patients without OP (p <0.05). 85% examined patients with SSD needed the anti-osteoporotic therapy. Treatment with the generic alendronate in the form of effervescent tablets to prepare Binosto buffer solution was effective and safe in patients with SSD with esophageal hypotension.

The problem of osteoarthritis treatment appears especially relevant today due to high prevalence of the disease and unsafety of drugs used by patients to relieve pain. Knee joints are affected most often. The chronic pain and joint functional disorder worsen dramatically the patients’ quality of life and result in destabilization of coexisting diseases. Topical drugs are commonly used in the combination treatment of osteoarthritis. The article presents research results of efficacy of Theraflex Chondrocream Forte in the combination treatment of knee lesions. The use of the drug results in a more rapid and effective relief of pain and improvementof knee joints function in osteoarthritis.

Aim. Study of spectrum, frequency and risk factors of comorbid infections in rheumatic diseases (RD) in the stationary contingent of patients hospitalized in the FSBI RIR named after V.A. Nasonova within 1 year.

Patients and methods. The study included 245 patients with RD: 122 patients suffered from rheumatoid arthritis, 62 - systemic lupus erythematosus, 61 - systemic scleroderma. All patients were interviewed by a doctor-researcher and filled in a questionnaire. If necessary, additional information was obtained during the analysis of medical records.

Results. In the spectrum of infections in patients with RD, respiratory tract and ENT infections prevailed. The frequency of serious infections (SI) during RD in the studied cohort was 23.7–38.1%. The frequency of certain infections, including SI, is influenced by the duration and variant of RD, comorbid diseases and immunosuppressive therapy.

Conclusions: the data obtained indicate the importance of infections in rheumatology. A high percentage of RD exacerbation against the background of infection, the prevalence of respiratory tract infections, including SI, dictate the need for vaccine prophylaxis at the early stages of RD.

Review of literature on the analysis of current data on the efficacy of belimumab (BLM) in systemic lupus erythematosus (SLE). It provides data on the high efficacy of BLM in high and medium activity of SLE in patients with joints damage, skin lesions and high immunological activity. The paper describes clinical cases of a rituximab and belimumab combination therapy in SLE patients.

Knee and hip joint pain is the first and most common symptom that forces a patient to visit the doctor. Osteoarthritis (OA) treatment is aimed «primarily» at managing symptoms of the disease, i.e. reducing pain, improving the functional state of the joints, and finally at improving the patients’ quality of life. The Russian and international organizations have developed numerous guidelines for the treatment of OA, which include non-pharmacological and pharmacological methods, among which symptomatic slow-acting drugs are of special interest. These drugs are currently recommended to prescribe as the first-line drugs to treat OA. Analgesics and NSAIDs that rarely cause adverse effects, especially in older people and in patients with co-morbidities, who receive concomitant medications, are the most commonly prescribed medications for pain relief. This creates a problem when the drugs affect one another’s exposure and can limit the prescription of a range of drugs, which determines an increase in interest in other drugs called sustained-release symptomatic drugs, which are widely recognized in arthrology.

The article presents the results of studies of Artra and Artra MSM Forte in patients with hip and knee OA, which were conducted in Russia.

Back pain (dorsopathy) is one of the common syndromes, which is specific to the whole group of diseases with similar clinical presentations. Ankylosing spondylarthritis (Bechterew’s disease) with a distinct clinical course evolving not only spinal and sacroiliac lesion, but also visceral changes is discussed using the example of a clinical case. The authors discuss Nimesulide, a drug from NSAID (non-steroidal anti-inflammatory drugs) group, in the treatment of inflammatory presentations of the disease and evaluate its efficacy.

The article discusses the main problems of safety of non-steroidal anti-inflammatory agents (NSAIDs). The results of randomized clinical studies, pharmacoepidemiological studies and meta-analyses suggesting higher safety of aceclofenac compared to diclofenac and other widely used NSAIDs are presented. Special attention is paid to the new pharmaceutical form of aceclofenac – tablets with modified release, manufactured by Clanza technology, registered under the trade name Aceclagin. It is intended for a single injection per day, which allows to increase adherence to therapy.