Cerebral microangiopathy (CMА), also known as cerebral small vessel disease (CSVD), is characterized by impairment of multiple cognitive functions, including executive functions, processing speed, memory and behavior condition. These impairments are primarily associated with disruption of frontal-subcortical networks resulting from white matter damage. An additional contribution to cognitive deficit is made by vascular lesions of subcortical structures, such as the thalamus and basal ganglia. Citicoline is one of the promising and pharmacologically substantiated drugs for the treatment of cognitive impairment (CI) in СМА. Efficacy of сiticoline is due to impact on key mechanisms of brain damage. Citicoline stabilizes cell membranes by inhibiting the activity of phospholipases – enzymes that trigger apoptosis (programmed cell death) under conditions of ischemia and hypoxia. This effect is particularly important in СМА, as chronic impairment of cerebral blood flow causes the death of oligodendrocytes, which are responsible for myelin formation, and neurons. The results of clinical studies confirm the ability of Citicoline to improve cognitive functions, primarily information processing speed and executive functions. Furthermore, longterm use of Citicoline stimulates endogenous mechanisms of neurogenesis and regeneration of nervous tissue. This article presents a clinical case of CMA with CI. The patient’s main complaints were poor concentration, fatigue and memory impairment. In addition to standard therapy, including antihypertensive, lipid-lowering and antiplatelet drugs, the patient was prescribed сiticoline: initially intravenously at 1000 mg/day for 10 days, then orally at 1000 mg/day for 6 months. After 6 months of taking сiticoline, the patient reported an increase in the ability to work and improvement in memory recall. A follow-up examination also revealed positive dynamics: an improvement in cognitive status measured by the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination (ACE) scales. The obtained data indicate the high efficacy of сiticoline in the correction of CI and allow to recommend its inclusion in the complex therapy of patients with CMA.

Introduction. Post-stroke anxiety, depression, and pain are relevant to medical practice, since they represent a significant obstacle to the effective rehabilitation of patients. Information related to post-stroke anxiety and depression is analyzed in the literature, data on the level of central sensitization (CS) which also indicates the presence of comorbid disorders are insufficient. Furthermore, such studies have not been conducted in samples of native speakers of various languages of the Russian Federation until recently due to the lack of diagnostic tools in these languages.

Aim. To compare the levels of СS, anxiety, and depression in patients after ischemic stroke in the early recovery period, using the same instrument in different languages in comparable samples.

Materials and methods. The authors analyzed the level of CS, anxiety, and depression in 4 groups. Study groups: 1) Russian-speaking patients who had suffered ischemic stroke (30 people, early recovery period); 2) Tatar-speaking patients who had suffered ischemic stroke (30 people, early recovery period). Comparison groups: 1) Russian-speaking informants without neurological deficit (30 people); 2) Tatar-speaking informants without neurological deficit (30 people). The Central Sensitization Inventory (CSI, Russian and Tatar versions) and the Hospital Anxiety and Depression Scale (HADS, Russian and Tatar versions) were used to assess the level of CSI, depression, and anxiety.

Results. Analysis of CSI data revealed statistically significant differences between the study and comparison groups in the subclinical CS parameter. Among stroke patients, the subclinical variant of CS is less common than in healthy controls; clinically significant variants predominate. Statistically significant differences were found in HADS anxiety subscale and HADS depression subscale for both the Russian-speaking and Tatar-speaking study and comparison groups.

Conclusion. The data were obtained in samples of native speakers of different languages; the results are comparable, which confirms the universality of the diagnostic scales CSI and HADS for use in the diagnosis of anxiety, depression and CS in post-stroke patients.

Migraine is a common neurological disorder in clinical practice. Its burden is largely determined by the presence of chronic, maladaptive patterns that are often resistant to traditional therapeutic approaches. Migraine progression is associated with many poor health outcomes such as an increasing number of comorbidities, primarily anxiety and depression, potential for abuse of analgesics, as well as worsening of functional impairment and decreased quality of life. Prophylactic treatment of migraine is a key patient management strategy which may modify the maladaptive course of the disease and which is required by approximately 40% of patients. The evolution of preventive approaches has enabled a qualitative shift from empirical methods to the use of targeted therapy strategies. The preventive effect of many drugs that are traditionally used to treat migraine was discovered accidentally, as they were developed for other diseases. In recent years, the landscape of pharmacological approaches used for the preventive treatment of migraine has been expanded to include calcitonin gene-related peptide (CGRP)–targeted drugs, which play a key role in the pathophysiology of migraine. Since 2018, anti-CGRP monoclonal antibodies (mAbs) targeting either the CGRP ligand or its receptor have been used for migraine prevention. Unlike the traditional oral agents, this new class of targeted therapy offers distinct advantages in practical use: high efficacy, rapid onset of prophylactic effect, and high tolerability. Certain advantages are also associated with a long half-life and absence of the need for drug titration. Results of clinical trials of the efficacy and safety of anti-CGRP mAbs demonstrated their high efficacy in treating occasional and chronic migraine in patients with heavy use of analgesics, prior preventive treatment failure, and in patients with comorbid emotional and affective disorders. The preventive effect of anti-CGRP mAbs manifests itself as a beneficial disease-modifying effect during the long-term use.

Management of patients with vertigo is based on rapid relief of vertigo, which reduces the risk of comorbid disorders, increases patient adherence to vestibular rehabilitation, and improves quality of life. Many patients with vertigo develop emotional disturbances such as panic and fear, and often require urgent admission to neurology departments. Incorrect management strategies – such as misdiagnosis of stroke and the use of ineffective therapy in the acute phase of dizziness – lead to persistent postural perceptual dizziness, headaches, neck pain, gait instability, and reduced quality of life. Two case reports are presented demonstrating the effectiveness of identifying the true cause of vertigo and providing appropriate treatment. The first case describes a patient with benign paroxysmal positional vertigo (BPPV), which was mistakenly diagnosed as a transient ischemic attack, leading to the development of comorbid disorders and a significant decline in quality of life. Identification of BPPV and associated emotional disorders, followed by effective treatment, resulted in a positive outcome. The second case presents a patient with migraine-associated vertigo (MAV) and comorbid emotional disturbances that significantly impaired quality of life. Educational counseling and training in rapid and effective relief of acute vertigo attacks greatly improved quality of life. In both cases, a fixed combination of cinnarizine and dimenhydrinate was used as pharmacotherapy, which is effective in reducing vertigo and autonomic symptoms across various causes of vertigo. Identification and effective treatment of common causes of vertigo, such as BPPV and MAV, can significantly reduce the severity of dizziness and improve patients’ functional status.

Migraine is a prevalent and socially significant neurological disorder that requires a comprehensive approach to both treatment and prevention. Non-pharmacological methods of migraine prevention are discussed. Particular attention is given to behavioral and lifestyle interventions such as trigger management, sleep and dietary hygiene, regular aerobic exercise, weight control, and cognitive-behavioral therapy (CBT). These approaches form the basis of non-pharmacological tactics in routine practice. In addition, methods targeting the neurobiological mechanisms of migraine are reviewed, including acupuncture, nutraceuticals (magnesium, riboflavin, coenzyme Q10, vitamin D, etc.), dietary interventions (ketogenic and DASH diets), and non-invasive neuromodulation (high-frequency transcranial magnetic stimulation, transcranial direct current stimulation, trigeminal and vagus nerve stimulation, and remote electrical neuromodulation). Non-pharmacological prevention significantly broadens the therapeutic arsenal for migraine. However, key challenges remain in the standardization of neuromodulation protocols, harmonization of outcome measures and follow-up durations, and validation of nutraceutical efficacy. In clinical practice, the most consistent preventive outcomes are achieved through an individualized approach emphasizing lifestyle modification, patient education, and CBT. A comprehensive approach is considered a promising strategy for managing patients with migraine. The synergistic effect of combining behavioral, physical, and instrumental techniques exceeds the results of their isolated use, making a comprehensive multimodal approach the most promising and reasonable tactic for achieving sustainable control over migraine, minimizing disability, and improving patients’ quality of life in the long term.

Primary headaches (PH) are among the most common disorders in clinical practice. Despite the development of diagnostic and treatment principles, patient management remains unsatisfactory. Comorbid mental disorders are among the most significant factors complicating timely diagnosis and hindering effective treatment of patients with PH. Anxiety and depression are well-established risk factors for the chronicity of PH, particularly migraine and tension-type headache. They also significantly contribute to the clinical presentation of the disease, altering the headache phenotype and complicating the verification of the type of headache. Furthermore, comorbid mental disorders significantly reduce patients’ quality of life, lead to prolonged persistence of the headache syndrome, and require independent treatment. Among mental disorders, anxiety occupies a leading position not only due to its high prevalence in patients with PH, particularly migraine and tension-type headaches, but also due to the development of specific clinical manifestations and behavioral characteristics, sometimes specific to individual forms of headache. Among the most disabling phenomena for patients is cephalalgophobia, which is particularly characteristic of patients with migraine and significantly impairs their daily functioning. Equally severe in patients with PH are manifestations of kinesiophobia and cognitophobia. Given the significance of anxiety disorders in the development of symptoms and the course of PDPH, the use of anxiolytics in these patients is necessary. The choice of anxiolytic in general clinical practice, especially in patients with comorbidity, is often made in favor of nonbenzodiazepine drugs. Among these, one of the optimal agents is etifoxine, which has polymodal effects, which, when taken into account, may provide advantages for the treatment of patients with PH and comorbid anxiety.

Low back pain is considered a major public health issue. Radiculopathy describes irritation of nerve roots which can be a result of various pathologies, including disc herniation, bone spurs, spinal instability, and trauma. As regards lumbar radiculopathy, which develops due to disc herniation, it should be noted that this is a pathology, in which any changes in the intervertebral disc are caused by tears of the outer annulus and protrusion of the nucleus pulposis. Clinical manifestations include impaired pain, thermal, vibratory, and other sensitivity (including paresthesia, hyperor hypoalgesia, allodynia, and hyperpathy) in the respective dermatome, decreased or absent tendon reflexes which act through the specific spinal cord segment, as well as hypotonia and weakness of the muscles innervated by the root. Studies show that the prevalence of lumbar radiculopathy is up to 5%, and it is more common in men aged 30 to 50 years. The most important risk factors for radiculopathy with underlying intervertebral disc herniation include age, acute trauma, heavy lifting, twisting, bending, driving, smoking, pregnancy, diabetes, high body mass index, hypertension, hypercholesterolemia, and a family history. Given the pathophysiology and etiology of the disease, a clinical interview and a series of diagnostic tests are highly relevant to confirm the presence of this clinical condition. Many types of non-pharmacological, pharmacological, or surgical treatments are available for patients with this condition. Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first-line management for pain relief.

The trends of population aging, “rejuvenation” of chronic diseases and their accumulation in the population contribute to the increase in the significance of the problem of pain syndrome, the spread of chronic forms of pain, as well as pain relief issues. Features of therapy of elderly patients with chronic pain syndrome are associated not only with various mechanisms of pain occurrence and regression of physical and functional capabilities of the body associated with the natural aging process, but also with cognitive, emotional status. The most significant barriers in this regard are: low level of compliance and treatment discipline, social isolation, accompanied by the risk of developing mental disorders. To ensure an integrated approach to pain therapy, there is a wide spread of medical prescriptions for non-drug therapy and rehabilitation methods, including physiotherapy and therapeutic physical culture, massage sessions, manual therapy, balneotherapy and therapeutic taping, as well as various forms of psychotherapy that help to better control the symptoms of concomitant diseases and achieve the desired level of compliance. The key component of chronic pain relief is drug therapy. Conventional pharmacological methods of treating noniceptive pain include nonsteroidal anti-inflammatory drugs, analgesic and antipyretic; anticonvulsants and antidepressants are used to treat neuropathic pain. For the optimal choice of a drug for adequate pain relief of the patient, it is necessary to take into account the individual characteristics of the patient (comorbidities and polypharmacy) and use the STOPP/START criteria when prescribing analgesics. The key barrier in the treatment of chronic pain syndrome in the elderly is a significant number of side effects when using existing groups of analgesics. The most significant of them are: hepatotoxicity (paracetamol); the risk of developing aplastic anemia and agranulocytosis (metamizole drugs); gastropathy, hemorrhagic phenomena, increased blood pressure, acute kidney injury (nonsteroidal anti-inflammatory drugs); depression of the respiratory center, risk of addiction and overdose (opioid analgesics). The existing spectrum of adverse events, as well as the growing need for pain relief in older patients and the accumulation of chronic diseases in the population, actualizes the search for more effective and safe alternatives to new drug developments for the scientific medical community.

Introduction. Chronic non-specific neck pain (CNNP), or cervicalgia, is often caused by facet joint (FJ) pathology, for which radiofrequency denervation (RFD) can be an effective treatment. The long-term outcomes (over 6 months) of RFD on pain intensity and emotional distress in patients with cervicalgia remain understudied.

Аim. To assess the effect of cervical RFD on pain and anxiety-depressive symptoms in patients with CNNP over a 6-month follow-up period.

Materials and мethods. The study included 30 patients (21 women, 9 men, mean age 63.7±15.8 years) with chronic cervicalgia caused by FJ pathology, confirmed by a positive diagnostic block. Pain intensity was assessed using the Numerical Rating Scale (NRS), and symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) before RFD, and at 3 and 6 months after the procedure.

Results. Following RFD, pain intensity on the NRS decreased from 7.5 to 2 at 3 months and to 3.5 at 6 months (p < 0.0001). RFD efficacy (pain reduction >50%) was observed in 73% of cases at 3 months and in 57% at 6 months. According to the HADS, the median anxiety score decreased from 9 to 8 at 3 months and to 7.5 at 6 months, while the median depression score decreased from 7 to 6 at both 3 and 6 months. A moderate positive correlation was found between pain intensity and symptoms of anxiety (r = 0.525) and depression (r = 0.605) at 6 months after RFD.

Conclusion. RFD for facet joint-mediated cervicalgia leads to a reduction in pain intensity and an alleviation of anxiety and depression symptoms. To improve outcomes for cervicalgia accompanied by emotional disturbances, further research is needed to evaluate comprehensive treatment programs combining RFD with therapy for anxiety and depression.

Introduction. Anxiety disorders are among the most common mental disorders in the world, having a significant impact on psychological health and social functioning, including adolescents and young adults. These disorders usually manifest themselves at the age of 10–24 years and lead to serious health problems.

Aim. To study the clinical features of anxiety disorders within generalized anxiety disorder (GAD), identify the leading manifestations and additional pantomimic, gestural and behavioral marker symptoms, and evaluate the effectiveness of the anxiolytic maritupirdine (Aviandr®) for the treatment of these conditions.

Materials and methods. 142 patients with diagnosed clinical-psychopathological and experimental-psychological methods of GAD were examined. Criteria for inclusion in the study: age 18–24 years, patient’s compliance with the criteria of GAD according to DSM-5. Exclusion criteria: the presence of a clinically relevant somatic or neurological disease, pregnancy or pregnancy planning (in women), taking psychotropic drugs during the month preceding inclusion in the study. The Mini-SMILE test, the Spielberger–Khanin test, and the Beck test were used. Patients were prescribed the anxiolytic Aviandr® 20 mg twice daily for 6 weeks.

Results. Among the examined young patients with GAD, 6 groups of GAD manifestations and a number of behavioral markers were identified. A statistically significant decrease in scores was noted in the domain of emotional manifestations, on the scales of mental manifestations and symptoms of stress, in the behavioral domain, in somatic manifestations. The largest relative decrease was found on the Beck scale, with situational anxiety in second place in sensitivity to Aviandr®, personal anxiety, and Mini-MIL scores decreased by more than a third.

Conclusion. Aviandr® had a positive effect in reducing the severity of GAD.

More than 56% of the world’s population suffers from insomnia, 25% of whom are of working age. Moreover, the number of cases in which patients have two or more chronic diseases, one related to the musculoskeletal system and the other related to sleep disorders, has increased. According to 2024 statistics, the prevalence of insomnia among people with musculoskeletal disorders was significantly higher than in the population without musculoskeletal disorders. Pain and sleep disorders share common pathogenic mechanisms, creating a vicious cycle: poor sleep quality, on the one hand, increases the prevalence of chronic pain; on the other, chronic pain triggers sleep disorders. Current understanding of the mechanisms of musculoskeletal pain is based on the interrelationships of various functional systems: the opioid, monoaminergic, orexinergic, immune, melatonin, and endocannabinoid systems, the hypothalamic-pituitary-adrenal axis, and adenosine and nitric oxide signaling pathways. These systems also play an important, if not decisive, role in sleep disorders. For patients with musculoskeletal pain and any comorbidity, a comprehensive diagnostic and treatment algorithm is necessary. This includes a comprehensive assessment of symptoms, polypharmacy and pharmacotherapy management, psychological assessment and support, physical rehabilitation, and cognitive behavioral therapy. Insomnia in patients with musculoskeletal pain requires early diagnosis and a comprehensive approach to treatment. Early administration of pain medications and hypnotics can improve patients’ quality of life and prevent the transition from acute to chronic pain. The first-line treatments for sleep deprivation correction in these cases are short courses of medications for the treatment of acute insomnia.

The health of elderly is a priority issue of modern healthcare. Emotional disorders such as anxiety, depression, apathy, and anhedonia are very common in this age range. Emotional problems are quite common in the elderly people. On the one hand, this may be due to a large number of possible factors: loss of loved ones, leaving work and social isolation, loneliness, a large number of diseases, each of which can lead to the development of anxiety and depression. However, this is not the only explanation for the high prevalence of affective disorders in people over 60 years of age. Modern studies using neuroimaging techniques demonstrate a close relationship between anxiety and depression with late onset and the severity of both neurodegenerative and vascular changes in the brain. This suggests that the key cause of affective spectrum disorders in the elderly is organic brain damage. Given that the development of anxiety and depression in old age is often based on progressive diseases, late-onset affective disorders do not respond well to standard therapy, which forces doctors to constantly increase doses and combine different groups of drugs, which in the end not only does not help, but can also worsen the condition of patients. This review discusses the key mechanisms by which progressive neurological diseases can lead to the development of primary mood disorders and the formation of pathological anxiety. An algorithm for the differentiated assessment of elderly patients with anxiety disorders de nova will be proposed, which will optimize approaches to identifying the primary cause of these symptoms and form the right therapy strategy.

Borderline personality disorder is a diagnosis that exists in our professional field already more than 30 years and according to numerous epidemiological studies has higher incidence than schizophrenia. However in Russian healthcare we still have difficulties with its adequate diagnostic and treatment. It can be explained by the symptoms polymorphism of borderline personality disorder itself and it’s high comorbidity with anxiety depression and substance abuse, on the other hand this diagnosis doesn’t have any analogies in the works of Russian classical psychiatrists. Nowadays bod has the greatest evidence base of psychotherapy efficiency among personality disorders, the efficient psychoharmacotherapy is still a challenge for future study. In the routine practice the majority of borderline personality disorder patients gets psychopharmacotgerapy. In the described case study the difficulties to maintain routine activity made an impact for borderline personality disorder decompensation. The treatment choice has been made according to the Russian guidelines for diagnostic and treatment of personality disorders and individual symptoms profile: free floating anxiety irritability and subdepressive mood, it determined the prescription of anxyolitic with seritoninergic and dofaminergic mechanism of action as treatment choice. Significant improvement has been shown as well as the digital assistance use as self help tool. Case study base analysis as the one published in this article can be served as the source for the borderline personality disorder psychopharmacological treatment guidelines elaboration in the real world studies paradigm that can help to bridge the gap between research and practice.

Introduction. Osteopenia in postmenopausal women is frequently accompanied by sleep disturbances, increased anxiety, and autonomic dysfunction, which substantially reduce quality of life and exacerbate clinical manifestations. Given the role of glycine and zinc in neurometabolic regulation and bone metabolism, their combination represents a pathogenetically justified approach to correcting these disorders.

Aim. To evaluate the efficacy and safety of the glycine-zinc combination (Metabovit® Healthy Sleep) in women with postmenopausal osteopenia and sleep disturbances.

Materials and methods. A prospective randomized controlled study was conducted, including 60 women aged 45–65 years. The intervention group (n = 30) received the dietary supplement in addition to standard therapy for 21 days. The following parameters were assessed: sleep quality (Pittsburgh Sleep Quality Index, PSQI), anxiety (Spielberger – Khanin State–Trait Anxiety Inventory, HADS), autonomic dysfunction (Veyn questionnaire), quality of life (SF-36), and safety indicators.

Results. In the intervention group, a significant reduction in PSQI total score was observed (from 9.0 ± 4.0 to 4.8 ± 3.1; p < 0.001), with sleep normalization achieved in 53% of patients (vs. 3% in controls). State anxiety decreased by 6.2 points and trait anxiety by 3.7 points (p < 0.001). According to HADS, anxiety decreased by 2.3 points (p < 0.001) and depression by 1.6 points (p < 0.001), remaining within normal and subclinical ranges. Marked improvement was also noted on the Veyn scale (-10.2 points; p < 0.001) and across all SF-36 domains, including physical and mental health components. The supplement was well tolerated, with no adverse events reported.

Conclusions. The glycine–zinc combination exerts multidirectional beneficial effects, improving sleep, reducing anxiety and autonomic dysfunction, and enhancing the quality of life of women with postmenopausal osteopenia. Its use is pathogenetically justified and represents a safe adjunct to standard therapy.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a heterogeneous clinical picture and an unfavorable prognosis. A lot of data has been accumulated on the pathogenesis, risk factors for ALS, and diagnostic criteria for the disease have been formulated, but treatment options for this pathology are limited. Timely diagnosis and initiation of therapy play a key role in improving the course of the disease. The article presents a clinical case of a 69-year-old patient with a sporadic form of ALS, who had been experiencing increasing muscle weakness in her legs, fasciculations, and bulbar disorders (dysarthria, dysphagia) for 9 months. The diagnosis was established in accordance with modern diagnostic criteria based on a combination of clinical signs of damage to the central and peripheral motor neurons and the results of needle electromyography, which confirmed a generalized neurogenic process, and the absence of data for other diseases. The key condition for the diagnosis was the progressive deterioration of motor function, while excluding other causes. The drug riluzole (Teglutik) in the form of an oral suspension was prescribed as pathogenetic therapy. Against the background of four months of therapy, stabilization of the condition was achieved: the indicator on the ALSFRS-R functional scale remained at the same level (35 points at the initial examination, 34 points at the examination after 4 months), there was no progression of symptoms. The absence of negative dynamics on the ALSFRS-R scale in the first months of treatment is considered as a clinically favorable sign. At the moment, riluzole is the only drug in the Russian Federation with proven efficacy that has a reliably confirmed effect on the life expectancy of patients with ALS. The presented case demonstrates the effectiveness of early administration of riluzole (Teglutik) to slow the progression of ALS as part of an integrated approach to patient management.

Introduction. Transcranial direct current stimulation (tDCS) is a novel adjunctive method for treating Parkinson’s disease (PD) symptoms. However, its efficacy and safety in patients with early-onset PD remain insufficiently studied.

Aim. To evaluate the effect of a course of anodal tDCS on motor, cognitive, and affective functions in patients with earlyonset PD.

Materials and methods. In this prospective study, five patients (aged 37–49 years) with clinically confirmed PD (mean disease duration 3.3 ± 4.7 years) were included. All patients received standard antiparkinsonian therapy and a course of 10 anodal tDCS sessions (2 mA, 20 min each, daily for 2 weeks). Motor function (UPDRS-III), cognitive status (MoCA, FAB, TMT-A/B), and affective measures (Beck Depression Inventory, State-Trait Anxiety Inventory, Apathy Scale) were assessed before and after the course.

Results. After completing the tDCS course, the mean UPDRS-III score significantly decreased by 19–20 % (p < 0.05), indicating improved motor function. Cognitive (MoCA, FAB, TMT) and affective (BDI, STAI, Apathy Scale) scores improved slightly but not significantly. No adverse events or dropouts occurred, the procedures were well tolerated by all participants.

Conclusion. These results suggest potential efficacy and a high safety profile of anodal tDCS as an adjunctive therapy in earlyonset PD. As a non-invasive, easily administered technique, tDCS is a promising tool for neuromodulation and rehabilitation in PD. However, further larger randomized trials with long-term follow-up are warranted to confirm these findings.

This review focuses on the application of electroencephalography for the early diagnosis of Alzheimer’s disease and assesses its potential as an accessible screening tool for cognitive impairment. The objective of this work is to summarize and analyze existing approaches to the application of electroencephalography methods for the diagnosis and monitoring of Alzheimer’s disease, as well as to identify key features of bioelectrical activity associated with cognitive impairment in AD compared to normal aging processes. The review examined 64 original studies (1998–2024) focused on the diagnosis of Alzheimer’s disease using electroencephalography, primarily employing spectral analysis, coherence analysis, event-related potentials, and graph theory. Data synthesis was performed using a descriptive method. Collectively, contemporary methods for analyzing electroencephalographic data demonstrate significant potential for identifying neurophysiological markers of Alzheimer’s disease. Specifically, spectral analysis reveals an increase in delta and theta rhythm power alongside a decrease in alpha activity and individual alpha frequency, reflecting neurodegenerative processes and impaired cognitive regulation. Coherence analysis indicates a disintegration of functional connections between cortical regions, manifested as reduced coherence in the alpha and beta bands and a compensatory increase in slow rhythms. Event-related potential analysis, particularly of the P300 and N400 components, points to slowed information processing and reduced efficiency of cognitive mechanisms. Graph theory methods, specifically small-world network analysis, complement this picture by demonstrating a disrupted balance between local specialization and global integration of neural networks. In turn, the application of machine learning algorithms based on these metrics opens avenues for enhancing diagnostic accuracy, predicting the progression of cognitive impairment, and developing automated systems for the early detection of Alzheimer’s disease. Quantitative electroencephalography analysis methods hold considerable promise for the early screening of Alzheimer’s disease by revealing characteristic patterns of brain activity. But for the effective utilization of EEG, the standardization of recording protocols, unification of analytical methods, and integration with machine learning algorithms are essential.

Introduction. It is known that cerebral palsy is often associated with intraventricular hemorrhages and cerebral leukomalacia suffered in the neonatal period in very premature infants. Neuregulin-1, which is involved in the processes of cerebral ischemia and systemic inflammation, may become one of the predictors of its formation.

Aim. The study was to study the concentration of neuregulin-1 in the blood of very premature infants in order to clarify the risk factors for the development of cerebral leukomalacia (P91.2) in them.

Materials and methods. A single-center cohort study was conducted. A total of 83 very premature infants were examined. The group with leukomalacia included 7 children, the group with perinatal neurological damage without signs of leukomalacia included 76 premature infants. Additionally, the content of neuregulin-1 in venous blood was determined on the 1st day of life.

Results. The concentration of neuregulin-1 in the blood of deeply premature newborns is statistically significantly lower in children from mothers with preeclampsia, gestational diabetes mellitus, colpitis, and polyhydramnios. The most significant risk factors for cerebral leukomalacia are the degree of respiratory failure (Silverman score ≥ 6 points; OR = 58.805, 95% СI 5,195–665,678; p < 0.001), severe asphyxia at birth (OR = 9,321, 95% CI 1.084–80.135; p < 0.042). The concentration of neuregulin – 1 in the blood of deeply premature newborns on day 1 of life is a predictor of the development of grade III cerebral ischemia and cerebral leukomalacia. A method has been developed for predicting cerebral leukomalacia by calculating the prognostic index D, taking into account the head circumference, the Apgar score, the Silverman score, and the level of neuroregulin-1 on the first day of life.

Conclusion. The predictor of cerebral leukomalacia in deeply premature infants is neuroregulin-1, a universal cytoprotector involved in the anti-inflammatory and antioxidant protection of neurons. A method has been proposed for predicting cerebral leukomalacia based on the level of neuroregulin-1 on the first day of life.

Introduction. Gout is a chronic auto-inflammatory disease associated with the deposition of sodium monaurate crystals on the background of hyperuricemia. Despite clear international and national clinical guidelines, diagnosis is delayed by an average of 4–5 years from the first attack. The effectiveness of treatment directly depends on the timely diagnosis of the disease, as well as on the correct appointment of urate-lowering therapy.

Aim. The purpose of this study was to evaluate approaches to the diagnosis and treatment of gout among primary care physicians based on anonymous questionnaires.

Materials and methods. An anonymous survey of 190 district internists and general practitioners working in state medical institutions of the Chuvash Republic was conducted.

Results. The survey results showed a lack of awareness among respondents about diagnostic issues. Only 53.7% of the doctors’ responses met modern requirements for the diagnosis of gout. Many doctors (46.3%) mistakenly consider the presence of only one sign (for example, hyperuricemia) sufficient for diagnosis, underestimate the importance of conducting polarization microscopy of synovial fluid (75.8%), and are practically unfamiliar with alternative instrumental methods such as ultrasound and dual-energy computed tomography. Significant disadvantages have also been identified in the treatment of gout. 78.4% of doctors used only nonsteroidal anti-inflammatory drugs to treat an acute attack of arthritis, while only 5.3% of respondents used colchicine. The appointment of urate-lowering therapy was accompanied by errors: more than half of the doctors (52.6%) limited the maximum dose of allopurinol to 300 mg/day (with an acceptable 900 mg/day), 36.8% did not focus on the target uric acid level (<360 mcmol/l), and 53.2% did not carry out therapy on an ongoing basis. Only 11.6% of the respondents prescribed preventive anti-inflammatory therapy at the start of urate-lowering therapy.

Conclusions. Thus, the study demonstrates certain shortcomings in the diagnosis and treatment of gout at the primary health care level. According to the survey, despite the existence of clearly regulated and accessible clinical recommendations, their provisions are not fully implemented by primary care physicians, which underscores the need for additional education of outpatient doctors to improve the quality of care for patients with gout.

Viral infections are a widespread cause of acute or prolonged arthritis, often accompanied by fever, skin rashes, and general symptoms. Although current knowledge about the pathogenesis of virus-associated arthritis has a number of gaps, it is believed that these diseases develop as a result of several complementary mechanisms, including direct viral exposure, immunocomplex inflammation, induction of proinflammatory cytokine synthesis, and the development or intensification of autoimmune disorders through a number of mechanisms, including molecular mimicry, bystander activation, or epitope spreading. Some of the viral arthritis induced, for example, by parvovirus B19, rubella virus, hepatitis B, and SARS-CoV-2, can mimic early rheumatoid arthritis, but are treated without consequences within a few weeks in the absence of specific therapy. Others, such as tropical alphaviruses, are more likely to lead to prolonged, respectively, chronic arthritis, which at the moment in temperate latitudes may pose a major diagnostic problem for tourists who have fallen ill and returned to their homeland. Arthritis or arthralgia is the main clinical symptom indicating a serious infection of an epidemic nature (for example, alpha-virus-induced arthritis, HIV-associated arthritis). In view of the above, rheumatologists (as well as clinicians of other specialties) should remain vigilant about the viral etiology of acute arthritis. At the same time, it is very important to distinguish between virus-mediated arthritis and systemic rheumatic disease in a timely manner, since the latter may require the early appointment of specific diseasemodifying drugs. This review presents the main characteristics of the most common viruses and the features of damage to the musculoskeletal system in these infections.

Introduction. Joint hypermobility (JH) is a heterogeneous condition that is considered as an isolated condition and in combination with connective tissue dysplasia (CTD), nevertheless, patients with JH have high risks of developing associated conditions, but do not receive proper treatment and appropriate prevention due to difficulties in diagnosis and classification.

Aim. Conduct phenotyping of the JH in order to optimize diagnostics.

Materials and methods. The study involved 262 young men (n = 35) and women (n = 227); the average age was 21.86 ± 0.22 years. JH was determined on a 9-point Beighton scale (1998). Phenotypic signs of CTD were determined by the point‒quantitative method (T.I. Kadurina), JH and control groups were formed. Statistical data processing was carried out in Microsoft Excel 2021, Statistica 13, R Studio. The association search was carried out using the Fisher criterion X2, with the Yates correction. To perform cluster analysis (CA), the R Studio environment, the k-medoids algorithm, the “pam” function in R, the libraries “cluster”, “tidyverse”, “factoextra”, “NbClust”, for validation “clValid” were used.

Results. JH was associated with phenotypic signs of CTD, such as dolichostenomelia, joint crunch, hyperkyphosis/hyperlordosis, low body mass index (BMI), skin’s hyperelasticity, ptosis of internal organs, hypotension, severe myopia. Next, a survey was conducted, as a result of which three clusters were identified. Cluster No. 1 included JH, hyperkyphosis/hyperlordosis, and low BMI. Cluster No. 2 includes JH, hyperelasticity of the skin and low BMI, and the third group includes subjects without JH, ptosis, hyperelasticity of the skin, hyperkyphosis/hyperlordosis and with a BMI >18.5.

Conclusion. The heterogeneity found by CA among the subjects with JH suggests that the phenotypes of JH in the general sample may be close to subtypes of Ehlers-Danlos syndrome or represent their incomplete clinical forms.

Introduction. The treatment strategy for rheumatoid arthritis (RA) patients involves strict monitoring of disease activity and regular consultations with a rheumatologist throughout treatment. In real clinical practice, not all patients are able to visit a doctor as frequently as necessary. Remote monitoring appears to be a promising tool for improving access to medical care.

Aim. To assess the dynamics of RA activity according to DAS28 during 12 months treatment using remote digital condition monitoring and traditional in-person observation.

Materials and methods. The study included 70 patients with RA. Patients were divided into two equal groups: remote monitoring (RM) and in-person monitoring (IPM). Patients in the RM group were assessed remotely by a rheumatologist using questionnaires in the remote monitoring program every month, as well as face-to-face visits after 6 and 12 months. In case of deterioration or insufficient positive dynamics of indicators, patients had the opportunity for remote or face-to-face consultation with a doctor and treatment adjustment. Patients in the IPM group visited a physician according to clinical guidelines at 3, 6, and 12 months. After 6 and 12 months, a comparative assessment of the dynamics and final levels of RA activity according to the DAS28 was conducted.

Results. The treatment outcomes of the RM and IPM groups were compared. Significant differences were found in the proportion of patients who achieved control of RA activity (remission and low activity) according to the DAS28 after 12 months of treatment. The remote observation group showed an advantage: 33 (94.3%) patients achieved control of RA activity, compared with 26 (74.3%) patients in the IPM group (p = 0.045).

Conclusion. The combination of remote and in-person observations in a condition monitoring was associated with a significant reduction in RA disease activity score DAS28.

Introduction. The development of delirium in intensive care units (ICUs) increase total hospitalization days, and mortality. In recent years, the use of virtual reality (VR) to prevent delirium has been discussed.

Aim. To evaluate the efficacy and safety of using VR for the prevention of delirium in patients in the intensive care unit.

Materials and methods. A randomized, controlled, single-center study was conducted at the Veresaev City Clinical Hospital in Moscow. Ninety patients admitted to the intensive care unit (ICU) were divided into two groups: Group 1 received standard delirium prevention, while Group 2 additionally received VR stimulation using special helmets as part of early rehabilitation. The primary endpoint was the incidence of delirium. Secondary endpoints included the duration and severity of delirium.

Results. VR was well tolerated, all patients in group 2 completed the full course of VR. Delirium developed in 12 patients (26.7%) in the standard therapy group and in 7 patients (15.6%) in the group with additional use of VR, which indicated a positive trend, but had no statistically significant differences (p = 0.302). Delirium in the control group of patients was more severe than in the group using VR stimulation (p < 0.05). The severity of delirium according to the DRS-R-98 scale was significantly less in the VR group (p < 0.05). The duration of delirium was 42 hours in group 1 and 24 hours in group 2, which indicated a positive trend, but had no statistically significant differences (p = 0.153).

Conclusions. Virtual reality can be considered as an additional tool for non-drug prevention of delirium development in patients in intensive care units.

Stroke is a major cause of disability for adults. Stroke-related disability can be categorized into motor and non-motor impairments. Motor impairments, such as hemiplegia, are the most noticeable sequelae. However, non-motor impairments, such as cognitive deficits, speech impairment, visual disorders, dysphagia, mood disorders, and pain can cause far greater decreases in quality of life. This article presents a case of patient S., 59 years old, admitted to the Rehabilitation Department for patients with central nervous system dysfunction. The patient was hospitalized one month after recurrent basilar artery ischemic stroke, which resulted in the severe dysarthria, severe dysphagia, right hemiplegia, and hemihypesthesia. Due to severe dysphagia and failure of food passage from the mouth to the stomach, the patient had an existing NG tube in place when he was admitted to the Rehabilitation Department. On the fifth day of admission to the Rehabilitation Department, the patient underwent ultrasonography-guided Botulinum neurotoxin type A (BoNT-A) injections into the submandibular and parotid glands bilaterally. As a result of the comprehensive treatment (speech and physical rehabilitation, botulinum therapy, drug therapy), the patient showed improvement in swallowing function: an increase in the swallowed bolus volume, a decrease in the number of choking sensations when swallowing, enhancement of the cough reflex and restoration of the pharyngeal reflex, ability to spontaneously cough up mucus, improvement of soft palate phonation, reduction in dysarthria severity, and expansion of his motor activities.