Aging is accompanied by a significant increase in the number of age-associated diseases, which has a serious impact on the individual and society. Against the background of a steady increase in the number of elderly people, the concept of frailty is now actively used in medicine. It implies increased vulnerability to various health problems associated with a decrease in physiological reserves against the background of aging, including accelerated aging in neurodegeneration. Psychosocial, environmental and age-related biological factors contribute to the decline in physical and cognitive abilities. Their culmination leads to the condition known as physical frailty, in addition to which a lot of researchers are emphasizing the phenomenon of cognitive frailty as a manifestation of cognitive impairment on the background of increasing physical weakness. The review presents an up-to-date analysis of the literature on frailty as a multidimensional and dynamic process, focusing on the role of cognitive reserve in aging. Evidence from cross-sectional and longitudinal studies is reviewed, showing that cognitive frailty is associated with increased risk of disability, impaired quality of life, hospitalizations, mortality, and neurocognitive disorders. This emphasizes the importance of introducing this concept into the clinical practice of geriatricians and neurologists. The article reviews data on the epidemiology, diagnostic approaches used, and perspectives.

Purpose of the study was to identify potential predictors of functional outcome of patients in the acute period of ischemic stroke, who did not receive reperfusion therapy, based on discriminant analysis.
Materials and methods: 193 patients diagnosed with ischemic stroke (IS) in the carotid basin, who did not receive reperfusion therapy, were examined. The evaluation of 35 parameters was used to create a mathematical prediction model: demographic parameters; comorbidity; localization of IS; degree of white matter hyperintensity (WMH); focal size; degree of internal carotid artery stenosis; NIHSS; cognitive status (IQCODE, MoCA, Stroop, Bourdon, Luria tests); severity of motor, sensory and speech impairments, presence of hemineglect; IS subtype; serum concentrations of cytokines IL-1b, IL-16, TNFα, CXCL10, CXCL11, CXCL9, CXCL1, CXCL6, CCL11, CCL24, CCL15, CCL23. Disability scores (modified Rankin Scale, mRS) and severity of cognitive deficit (Dementia Rating Scale, CDR) on day 14 from the development of IS were considered as functional outcome (FO) parameters. The Python programming language and SciPy library were used for statistical processing.
Results: the number of patients with unfavorable/ relatively unfavorable outcome at day 14 from the development of IS according to mRS was 51 (26.4%), according to CDR scale — 65 (33.6%) people. Statistical analysis revealed correlations of FO index on the mRS scale with the presence of diabetes mellitus, localization of IS, IL-1b, CCL24 and CCL23 concentrations; on the CDR scale — with the degree of IQCODE, WMH, CXCL10 level, impaired memory, speech and perception functions.
Conclusion: perceptual, mnestic and speech disorders along with the presence of premorbid cognitive deficit, WMH, left-sided localization of IS in the middle cerebral artery basin, changes in IL-1b, CCL23, CCL24 and CXCL10 concentrations were identified as independent predictors of adverse functional outcome of the patient in the acute period of ischemic stroke, who did not receive reperfusion therapy.

Introduction. The competencies of physicians are the clinical and organizational basis for managing the stable course of chronic cardiovascular diseases (CVD) in terms of identifying risk factors and preventing complications, including socially significant ischemic stroke (IS).
Purpose of the research: to research the competence-based activity of physicians of various specialties at the primary health care level in terms of identifying risk factors for IS.
Material and methods: a retrospective, multicenter, anonymous research was in 2021-2024. Objects: physicians (n = 165) of surgical (n = 79) and therapeutic (n = 86) specialties; patients (n = 2145). The big data of the initial consultation were copied from the electronic medical records of patients. The competence activity of physicians was assessed based on the performance of medical social processes: examination of blood pressure (BP) on one/both shoulders, pulse rate and rhythm, body mass index (BMI), frequency of nocturia and lower limb edema, family and personal history of CVD, patient adherence to drug therapy and participation in consultation of a family member. The author's method of scoring the competence activity of physicians was applied: high degree (7 points) - physicians examine all medical social processes; average (3–7 points) — physicians examine only blood pressure in one shoulder, pulse rate and rhythm, swelling of the lower extremities, family and personal history of cardiovascular disease, low (<3 points) — all other cases. Research methods: content analysis, statistical, comparative analysis, mathematical, expert.
Results: in identifying risk factors for IS, a high degree of competence activity was found in 1.8% of physicians — 2.5% of surgical and 1.1% of therapeutic specialties (p = 0.09), an average degree in 41.2% of physicians — 20.3% of surgical and 48.8% of therapeutic specialties (p = 0.025), a low degree in 57.0% of physicians — 77.2% of surgical and 38.4% of therapeutic specialties (p = 0.02).
Conclusion: the research established mainly an average and low levels of physicians’ competence activity in identifying risk factors for IS, which may explain the persistent negative epidemiological trends in CVD. Continuous medical education and mentoring can contribute to the development of physicians’ competence activity based on induced motivation for professional development.

Objective: analysis of clinical features of non-Wilsonian hepatocerebral degeneration.

Material and methods: a systematization and analysis of data from domestic and foreign literature on the pathogenesis, clinical picture, diagnosis and treatment of a rare variant of chronic encephalopathy against the background of metabolic disorders — non-Wilsonian hepatocerebral degeneration were carried out.

Results. Our own clinical observation is presented. The main aspects of pathogenesis and risk factors are listed. The conditions and diseases that require differential diagnostics in case of suspected hepatocerebral degeneration are systematized: Wilson-Konovalov disease, non-Wilsonian hepatocerebral degeneration associated with nitrogenous base metabolism disorder, chronic manganese intoxication.

Conclusion. Due to the rare occurrence and non-specific clinical manifestations, the availability of information on the pathogenesis, clinical picture, differential diagnostics and treatment of hepatocerebral degeneration of various etiologies remains low. Improvement of the differentiated choice of diagnostic methods by a specialist, in particular magnetic resonance imaging, laboratory methods for assessing metabolic disorders, as well as gene diagnostics options contribute to the improvement of detection and differentiation of these conditions.

Clinically significant oculomotor disorders are not typical for amyotrophic lateral sclerosis (ALS). A case of simultaneous development of classic symptoms of ALS and progressive supranuclear palsy in the form of vertical gaze palsy, dementia and extrapyramidal features is presented. Potential mechanisms of the development of oculomotor disorders in ALS are discussed.

Introduction. Chemotherapy is one of the key methods of treatment in oncology. Cytostatics do not have selective activity to tumor cells and have a toxic effect on healthy tissues. A negative side effect of cytostatics is damage to the nervous tissue. The most common are post–chemotherapeutic polyneuropathy and cognitive impairment.
Aim. To analyze the relationship between the development of cognitive disorders in cancer patients and the occurrence of polyneuropathy.
Material and methods. The work was carried out in the chemotherapy department and is based on the results of examination of 60 patients with malignant neoplasm of the breast. The study included women aged 32 to 58 years, in whose anamnesis there were no other diseases and conditions capable of provoking disorders of the peripheral and central nervous system. The patients were divided into 2 groups: those who had undergone less than 10 courses of chemotherapy and more than 10 courses of chemotherapy. The Neuropathy Symptom Score (NSS) scale was used to assess the severity of polyneuropathy symptoms. The severity of cognitive disorders was assessed using the Mini- Mental State Examination (MMSE) scale.
Results. Statistically significant differences were found between the two groups on the NSS scale (p < 0.05). According to the MMSE scale, there were no statistically significant differences between the first and second groups. A positive correlation was found between the onset of polyneuropathy and cognitive disorders (p = 0.8975).
Conclusions. Chemotherapeutic drugs have a systemic effect on nervous tissue and the earlier they damage peripheral nervous tissue, that is, the earlier polyneuropathy occurs, the sooner damage to the central nervous system (encephalopathy) manifests itself.

The review is devoted to the classification, recovery mechanisms, electroneuromyographic and ultrasound diagnostics of nerve injury. In particular, the article is devoted to the parameters of sensory and motor conduction, needle electromyography, ultrasound examination of the degree of nerve damage, prognosis of restoration of nerve function and tactics of treatment of nerve injury. The mechanisms of muscle function recovery in case of nerve injury may include remyelination, axonal sprouting, axon growth from the site of injury and muscle hypertrophy. Muscle strength recovery usually takes 18–24 months after nerve injury. When diagnosing a nerve injury by the neurotmesis type, the patient should be immediately referred to a surgeon for surgery and rapid muscle reinnervation.

Nikolay Semenovich Misyuk is a doctor of medical sciences, professor, corresponding member of the USSR Academy of Medical Sciences, chief neuropathologist of the Ministry of Health of the Byelorussian SSR. This article attempts to tell his life story in honor of the 105th anniversary of his birth. Nikolay Semenovich made a significant contribution to healthcare of both the USSR as a whole and the Byelorussian SSR, in particular: he was the first to perform stereotactic operations on the thalamus, one of the first in the USSR to formulate the principles of endovascular surgery and performed a series of operations for arterial hypertension, the founder of medical forecasting in clinical neuropathology, the creator and first head of the Belarusian Republican Center for Forecasting Cerebral Strokes. He went through the Great Patriotic War as a doctor and commander of medical units, and was awarded medals and orders. N.S. Misyuk trained more than one generation of doctors, working at the Department of Nervous Diseases of the Leningrad State Institute for Advanced Medical Studies, and later heading a similar department at the Arkhangelsk State Medical Institute and the Minsk State Medical Institute. Professor N.S. Nikolai Semenovich did not forget to devote time to his hobby: playing chess, collecting icons, writing various literary works (for example, the story “Night Challenge”). N.S. Misyuk is an outstanding person, a doctor, an organizer, who is remembered by descendants, colleagues, friends!