One of the latest achievements in the field of medicine is the introduction into practice of technologies using computerized training and training in Virtual Reality (VR), which create new opportunities for prevention, as well as treatment for people suff ering from various cognitive impairments.

Purpose of the study. The aim is to investigate classical (conventional), computerized and VR training using neural interfaces focused on the prevention and rehabilitation of functional changes in higher nervous activity.

Methods. In March 2022, a search was made for scientifi c full-text publications using the electronic databases of the RSCI, PubMed and Google Scholar. The following keywords and their combinations were used for the query: “dementia”, “aging” and “virtual reality”. Articles of interest for this review had to be peer-reviewed, published no later than 2015, and written in English or Russian.

Results. The key methods of non-drug interventions in people suff ering from various cognitive impairments, the advantages and disadvantages of the techniques used were considered. It also shows the main advantages of VR technology as a simple, safe and eff ective tool. VR has great potential for personalized cognitive trainings.

Aim of the work was to analyze the content of factors with neuroprotective, neurotoxic and apoptotic eff ects in the blood of patients with prolonged disorders of consciousness (pDOC), depending on the level of consciousness disorder and neuroprotective therapy.

Material and methods. Research included 53 patients with pDOC, who were divided into 2 groups. Group 1 included 19 vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients, group 2–34 minimally conscious state (MCS “minus” and “plus”) patients. Firstly at admission and then at the end of treatment course (after 1 month on average), plasma concentrations of brain neurotrophic factor (BDNF), apoptosis antigen (APO-1), apoptosisinducing ligand (Fas-L) and glutamate were studied. Control group consisted of 16 patients without measured once.

Results. Decrease of BDNF serum level was revealed in patients with pDOC,which was less pronounced those who had TBI as a etiological factor of pDOC. BDNF level signifi cantly increased after a month against the background of neuroprotective therapy. Glutamate level was higher in the fi rst group (VS/UWS). No signifi cant diff erence in the content of apoptosis factors was observed.

Conclusion. In patients with pDOC, decrease serum BDNF level was observed, less pronounced in TBI as etiology of pDOC. In patients who matched MCS criteria at the admission, there was a signifi cant increase of BDNF serum level during treatment course, which could indicate that patients with a higher initial level of consciousness have better potential for realizing the eff ect of neuroprotective therapy. Levels of apoptosis factors did not correspond to the consciousness level.

Relevance. Multiple sclerosis (MS) is a chronic demyelinating autoimmune disease of the central nervous system with progressive course. High-dose chemotherapy (HDCT) with autologous haematopoietic stem cell transplantation (AHSCT) is a promising course of treatment-refractory MS. The study aimed to assess the effi cacy and safety of treating MS patients with HDCT + AHSCT.

Material and methods. Were studied 10 people (5 women and 5 men) with relapsing-remitting (30%), secondary progressive (60%) and primary progressive MS (10%). Patients underwent AHSCT using cyclophosphamide + rituximab chemotherapeutic regimen.

Results. In 90% of cases, at least a stabilizing eff ect is shown after the procedure. Only 10% was showed signs of demyelinating activity on MRI of the spinal cord 2 years after HDCT + AHSCT. All patients had a response to therapy according to median Expanded Disability Status Scores (EDSS). We found a positive dynamics of the average EDSS score: before treatment — 5.9 points, 6 months and 1 year after treatment — 5.1 points. There was shown a positive eff ect on dynamics of neurological status, quality of life and emotional state of patients. No treatment-related mortality and uncontrolled complications were revealed.

Conclusion. Timely AHSCT contributes to minimizing the level of disability and signifi cantly improves the quality of life of patients.

Background. Parkinson’s disease (PD) is one of the most common neurodegenerative diseases and aff ects 1% of the population above 60 years. The leading pathological features of PD include degeneration of neuromelanin (NM) containing dopaminergic neurons and iron deposition in the substantia nigra (SN) of the midbrain. Various neuroimaging methods sensitive to NM and iron can be clinically important for diagnosing and monitoring disease progression. Examples of such neuroimaging methods include transcranial sonography (TCS) and neuromelanin-sensitive magnetic resonance imaging (NM-MRI) fi rst and foremost.

Aims. To compare the diagnostic signifi cance and eff ectiveness of TCS and NM-MRI in diff erentiating patients with PD from the norm and to elucidate the magnetic resonance- (MR-) morphological representation of the hyperechogenicity (HE) on midbrain during TCS by NM-MRI.

Material and methods. 40 patients with PD were included in the main group, and 20 healthy volunteers of gender and age comparable with the main group were included in the control group. In the case of HE detection during TCS, this area was manually traced and automatic calculated. NM-MRI images were pre-processed using image processing program Image-J (USA) with subsequent automatic calculation of SN area. Based on the data obtained, clinical, demographic and neuroimaging correlations were estimated.

Results. The sensitivity and specifi city of TCS in diff erentiating PD from the norm were 70 and 100% respectively, the sensitivity and specifi city of NM-MRI were 90.0 and 92.5% respectively. An analysis of the relationship between the HE area and the area of the SN according to NM-MRI data on the ipsilateral side showed a noticeable inverse correlation (for the right side: ρ = –0.606, p < 0.001; for the left side: ρ = –0.550; p < 0.001). Thus, in the case of an increase in the HE area, a decrease in the area of SN measured using NM-MRI is expected.

Conclusion. TCS and NM-MRI are reliable biomarkers allowing highly eff ective diff erentiation of PD from normal. The pathophysiological and neuroimaging correlates of PD changes in neurodegenerative process remain not completely clear and require further clarifi cation in multicenter prospective studies.

Introduction. In the context of the search for new migraine therapy options, strict control of their eff ectiveness by means of objective examination methods is required.

Objective. Objective assessment of the eff ectiveness of TMS in patients with migraine on the basis of functional magnetic resonance imaging (fMRI) data.

Material and methods. Resting-state fMRI before and after a fi ve-day course of TMS of the junction of the inferior frontal and temporal lobes bilaterally was performed in 19 patients with migraine. Changes in functional connectivity (FC) of the main neuronal networks of the brain, as well as clinical parameters of pain and quality of life of the patients were assessed before and after the course of TMS.

Results. A decrease in pain intensity and anxiety scores, as well as a decrease in the number of acute pain medications taken, was observed against the background of the therapy. Changes in FC aff ected three main networks: the default mode network, the salience and visual networks. At the same time, decreased effi cacy of therapy was noted in patients with higher severity of depressive symptoms and presence of neuroimaging criteria of depression.

Conclusion. The study suggests the effi cacy of TMS in patients with migraine based on neuroimaging criteria. It is worth paying special attention to the presence of depressive symptoms in migraine patients.

Determining the potential mechanisms underlying cryptogenic ischemic stroke is essential to guide diagnostic discovery and personalize secondary prevention.

Purpose is to study the phenotypes of embolic stroke of undetermined source (ESUS) based on ultrasound diagnosis and determination of the serum concentration of pro-natriuretic N-terminal peptide B-type (N-Terminal Pro-brain Natriuretic Peptide, NT-proBNP).

Materials and methods. 141 patients with ESUS were examined. In addition to the standard examination aimed at fi nding the cause of stroke, the functional characteristics of the left atrium were assessed using the emptying fraction (left atrial emptying fraction, LAEF) and the functional index (left atrial function index, LAFI), and the concentration of NT-proBNP in blood serum was also measured.

Results. The most common potential sources of embolism were atherosclerotic plaques in the stroke-associated carotid artery with stenosis in 30–49% (31.9% of patients) and atrial cardiopathy with a decrease in LAEF < 51.8% (24.8% of patients). An analysis of combinations of potential sources showed that 46.1% of patients had a negative phenotype, 21.3% of patients had a cardiac phenotype, 19.1% of patients had an atherosclerotic phenotype, and 13.5% of the examined patients had a mixed phenotype. Patients with a cardio-atherosclerotic phenotype diff ered from patients with a negative phenotype by higher disability on the Rankin scale at discharge from the hospital.

Conclusion. The main potential embolic sources in patients with ESUS are non-stenosing carotid atherosclerosis and atrial cardiopathy with decreased LAEF. Cardiac and atherosclerotic phenotypes are determined in a quarter of patients, a mixed phenotype is found in every seventh patient, while in almost half of the patients no sources of embolism are found.

MRI-guided high-intensity focused ultrasound (MRgFUS) is a new emerging and promising procedure applied in a wide range of clinical fi elds in modern medicine. This innovative treatment method follows is an important step towards the ideal surgery of the future: non-invasive, targeted, safe, controlled, eff ective and ambulatory. Randomized studies show high effi cacy in the treatment of tremor for Parkinson disease and essential tremor. Safety is also having similar profi le with other surgical procedures and has a mostly transient character of complications. Such advantages as a non-invasive treatment, controlled eff ect and the safety profi le of the procedure made it popular in the treatment of movement disorders. This article demonstrates a clinical case of the fi rst using of MRgFUS for the treatment of Parkinson’s disease tremor at the Federal Center for Brain Research and Neurotechnologies of the Federal Medical and Biological Agency of Russia in Moscow. The 54-year-old patient with Parkinson disease, 2 Hoehn–Yahr, admitted to our hospital. Severe tremor of right upper extremity impaired his life. Neurosurgical procedure was considered due to medication failed. Patient underwent focused ultrasound thalamotomy with totally tremor relief. No additional neurological impairment was noted, only bradykinesia and rigidity were improved. Patient discharged on 3rd day after the procedure.

Conclusions. MRgFUS is an innovative surgical procedure. Advantages of these methods such as non-invasive manner, controlled, safety allowed to be priority procedure for patients with unilateral tremor.

Introduction. Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. A signifi cant part of oldest old are feel lonely, need care and live in long term care facilities (institutionalized). Disability and institutionalization are associated with an increased risk of cognitive impairment in oldest old. The cognitive status in this group has been studied insuffi ciently in Russia. Determination of diagnostic standards for cognitive functions assessment scales in oldest old is important both for clinical practice and for scientifi c research.

Objective: to evaluate cognitive functions and to determine diagnostic value for various psychological tests in persons aged ≥ 90, who live in long term care facilities (LTCF).

Material and methods. The persons aged ≥ 90 years that live in LTCF (boarding houses or nursing homes) in Moscow were examined. All patients passed neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fl uency tests. In addition, original questionnaire was used for cognitive impairment screening.

Results. Dementia was found in 69% of oldest old, who live in LTCF; frontal dysfunction in 89.1% and “hippocampal type” of memory disorders in 57.5%. The results of phonemic verbal fl uency test were normal in 6.7% only and of semantic verbal fl uency test in 8.1%. For diagnosis of dementia in institutionalized subjects sensitivity of MMSE ≤ 23 points was 97% and specifi city was 90.9%. For the FAB optimal sensitivity/specifi city ratio (98/83.7%) was at score of ≤ 14. The clock-drawing test sensitivity for dementia was 91.9% and specifi city was 69.7% at total score ≤ 6 .

Conclusion. Institutionalized persons aged ≥ 90 years have a high prevalence of dementia. The above mentioned tests can be used for oldest old examination. Further studies of the relationship of cognitive impairment with other geriatric disorders in oldest old are needed.

The benign monomelic amyotrophy of the lower limb is a slowly progressive disease that is clinically manifested by muscle atrophy in only one lower limb. This disease is quite rare, while it is most common in Asian countries (about 80 cases have been described). According to the literature a total of 16 cases of benign monomelic amyotrophy of the lower limb were described in Europe by 2000. Etiology and pathogenesis have not been reliably studied now. The article presents a clinical case of the development of this disease in a 42-year-old patient. The patient was admitted with complaints of weakness in the right leg and its decrease in volume. During the period of hospitalization, diff erential diagnosis was carried out with amyotrophic lateral sclerosis, progressive muscle atrophy, Hirayama disease, vascular and paraneoplastic processes. According to the results of a comprehensive laboratory and instrumental examination, the diagnosis was fi rst established: benign monomelic amyotrophy of the lower limb. The father of a patient who had atrophy of the muscles of the left lower limb would also be examined. According to the data of hereditary anamnesis, an assumption was made about the presence of the phenomenon of anticipation in the inheritance of benign monomelic amyotrophy of the lower limb. This article describes for the fi rst time a case of benign monomelic amyotrophy of the lower limb in the domestic literature, as well as a familial case of this disease all over the world.

Reccurent painful ophthalmoplegic neuropathy (the Tolosa–Hunt syndrome) occurs due to a nonspecific granulomatous infl ammation of the walls of the cavernous sinus and the intracavernous segment of the internal carotid artery. It consists of one or more oculomotor nerves dysfunction associated with peri- and retroorbital pain; spontaneous remissions and relapses are typical. Oculomotor nerve disorders may coincide with the onset of pain or follow it within a period of up to 2 weeks. Demonstration of granulomatosis in the walls of the cavernous sinus and the intracavernous segment of the internal carotid artery, superior orbital fissure or orbit by MRI or biopsy confi rms the diagnosis of Tolosa–Hunt syndrome (THS). Corticosteroid therapy leads to rapid (within 72 hours) pain relief and recovery of oculomotor nerve function. Here, we report a case of reccurent THS in 47-year-old men. Neuroimaging schowed a nonspecific inflammation in the superior orbital fissure-cavernous sinus region on left side and contrast-enhanced thickening dura mater.

The article presents a case of acute uremic neuropathy. Without any visible cause, a 71-year-old patient felt weakness in legs and numbness in feet. Her neurological status assessment on admission to the hospital showed peripheral tetraparesis and impaired sensitivity of the polyneuropathic type. Neurological symptoms appeared due to renal dysfunction, which had been confi rmed with laboratory test. Electroneuromyography revealed signs of acute demyelinating polyneuropathy. Аt the hospital, the patient was diagnosed Alzheimer’s disease. The treatment provided at the hospital led to normalization of her laboratory parameters and complete restoration of motor functions. The peculiarity of the presented clinical case is that the patient started violating drinking regime due to her cognitive impairment which resulted in renal dysfunction and acute uremic neuropathy. The other peculiarity of the case is that it was enough to correct the water-electrolyte disorders to fully restore the patient’s motor functions within a month, without the use of dialysis. Finally, the article discusses the issue of pathogenesis and diff erential diagnosis of other types of polyneuropathies.