Insulin resistance is an independent risk factor for ischemic stroke (IS). Insulin resistance contributes to thrombus formation and atherosclerosis development, participating in the main pathogenetic links of IS. Insulin resistance is also associated with some independent risk factors for stroke, such as hypertension, hypertriglyceridemia, and low levels of high-density lipoprotein. Insulin resistance negatively aff ects functional recovery and prognosis in patients with IS, regardless of whether the patient has diabetes, but the mechanisms behind this are not well understood. Insulin resistance therapy is an important component of secondary prevention of IS and includes non-pharmacological and pharmacological treatment. The article presents therapeutic approaches to insulin resistance, which allow for the development of new therapeutic strategies to improve the clinical prognosis of patients with IS.

   Background. The biggest risk factor for Alzheimer’s disease (AD) is aging, contributing to impaired clearance of tau and amyloid-beta (Aβ) proteins, microglial senescence, endoplasmic reticulum (ER) stress, lipid dysregulation, and excitotoxicity. Objective. This review investigates how aging speeds up the pathophysiology of AD and evaluates emerging geroscience-based interventions targeting biological aging mechanisms to delay or prevent cognitive decline.

   Material and methods. A narrative review of the literature from 2015 to 2025 was conducted, integrating longitudinal studies, meta-analyses, and preclinical models that examine the aging — AD interface. The MEDLINE, Embase, Cochrane, Google Scholar, and PubMed databases were searched using specifi cally related keywords, such as ageing, AD, AD pathology, anti-aging strategies, and AD therapies.

   Results. From the initial search, more than 150 studies were excluded, and only 100 studies were selected for this review. After revision also duplicated 30 studies were removed. Ultimately, the review comprised seventy studies. Most of these studies discussed aging-related mechanisms — glymphatic dysfunction, APOE ε4-associated lipid transport impairment, BDNF depletion, and glutamate excitotoxicity, and anti-ageing strategies such as lifestyle interventions (e.g., physical activity, sleep optimization, cognitive engagement) and medical and biological therapies for AD.

   Conclusion. Targeting aging mechanisms offers a paradigm shift in AD prevention and treatment; however, multidisciplinary collaboration is essential to translate geroscience into clinical practice. The integration of lifestyle and pharmacological strategies may yield synergistic neuroprotective benefi ts. Future research should focus on integrated, multimodal interventions that combine lifestyle modification with pharmacological and biological therapies. Tailored approaches — based on genetic risk profi les (e.g., APOE status), comorbidities, and individual aging trajectories — may optimize clinical outcomes. To evaluate the long-term safety and effectiveness of innovative treatments like senolytics, epigenetic modulators, and stem cell-based therapies in older populations, extensive, longitudinal clinical trials are also required. Developments in biological age biomarkers, machine learning, and systems biology have the potential to improve risk assessment and therapy customization.

   Background. Vascular myelopathy (spinal cord infarct) remains a diagnostically challenging condition with a high risk of disability. The pathogenetic role of lipid metabolism disorders in this condition remains poorly understood.

   The aim of the study was to evaluate laboratory parameters of lipid metabolism and atherogenesis in patients with vascular myelopathy and to determine their possible relationship with the period of the disease and functional outcomes.

   Material and methods. A single-center comparative study included 177 patients divided into two groups: the main group included 77 patients with confi rmed spinal cord infarct, the comparison group included 100 patients with non-vascular myelopathies. All participants underwent comprehensive laboratory testing, including lipid profile (total cholesterol, triglycerides, LDL, VLDL, HDL), lipoprotein(a) and adiponectin. Functional outcome at the end of the follow-up period was assessed using the modified Rankin Scale.

   Results. Patients in the main group showed a statistically signifi cant atherogenic profile: elevated triglycerides (1.66 [1.15; 2.54] vs 1.22 [0.90; 1.58] mmol/L, p < 0.0001), VLDL (0.94 [0.60; 1.50] vs 0.70 [0.47; 0.78] mmol/L, p < 0.0001) and lipoprotein(a) (0.48 [0.32; 0.60] vs 0.10 [0.05; 0.17] g/L, p < 0.0001), along with decreased HDL (1.32 ± 0.34 vs 1.54 ± 0.33 mmol/L, p < 0.0001) and adiponectin (1.63 [1.51; 1.87] vs 2.04 [1.93; 2.20] pg/mL, p < 0.0001). No statistically signifi cant differences in the studied parameters were found between subgroups with favorable and unfavorable functional outcomes, as well as in subgroups based on the duration of vascular myelopathy.

   Conclusion. The results of the study indicate the presence of a pronounced atherogenic profile in patients with vascular myelopathy. Although a direct correlation between the identified changes and functional outcomes did not reach statistical signifi cance, the data obtained highlight the potential role of lipid disorders in the pathogenesis of spinal cord infarction. These results indicate the need to include an extended lipid profi le in the diagnostic algorithm of this patient’s category to improve diagnosis and secondary prevention approaches.

   Charles Bonnet syndrome (CBS) is defined as complex visual hallucinations (VH) in people with visual impairments who are awake, fully or partially aware of the unreality of the hallucinatory images they see, and who do not have cognitive or psychotic disorders. Auditory hallucinations (AH) associated with severe acquired hearing loss are called the “auditory analogue” of СBS. In rare cases, AH in patients with hearing loss are represented by musical fragments and are referred to as “musical ear syndrome”.The combination of classical СBS and its auditory analogue is considered a variant of atypical CBS (ACBS). This combination is rarely described, although in reality its prevalence may be
quite high.

   The aim of this study was to describe a clinical case of ACBS, manifested by a combination of CBS and its auditory counterpart, in an 82-year-old cognitively intact woman without psychotic disorders.

   The clinical features of this variant of AСBS are discussed taking into account the descriptions of 15 more patients published over the past 25 years. Current views on the pathogenesis of VH and AH in visually and hearing-impaired patients, as well as issues of their differential diagnosis and treatment, are outlined.

   Conclusion. Atypical Charles Bonnet syndrome, characterized by a combination of visual and auditory hallucinations in people with visual and hearing impairment, may be much more common than is believed, as many patients avoid reporting hallucinations, and doctors don’t always ask about them. Its timely diagnosis, based on a thorough examination of complaints and medical history, as well as the exclusion of other causes of perceptual disorders, helps to avoid ineff ective treatment and improve quality of life.

   This article describes a clinical case of Fabry disease (FD). This condition is associated with a defi ciency of the α-galactosidase A enzyme due to a mutation in the GLA gene, which leads to the accumulation of glycosphingolipids (Gb3 and Lyso-Gb3) in cells of the kidneys, heart, nervous system, and other organs. FD is inherited in an X-linked dominant pattern with incomplete penetrance in females. The average time from symptom onset to diagnosis reaches 20 years in the Russian Federation. Early diagnosis of FD is complicated by the diversity and nonspecifi city of its manifestations, including cerebrovascular accidents in young patients, as observed in this case.

   The heterogeneity of the clinical and neurophysiological presentation of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), the wide spectrum of conditions mimicking CIDP, and the absence of specific biomarkers significantly complicate timely diagnosis. The article provides a detailed description of the clinical, neurophysiological, and neuroimaging features of predominantly proximal motor CIDP, as well as a review of the causes of initial misdiagnosis of a primary neuromuscular disease in the patient.

   Glomus tumors (GT) are benign yet exquisitely painful neoplasms, with approximately 65 % occurring in the subungual region or fingertip. Primary manifestation is an intense neuropathic pain syndrome that is typically refractory to standard analgesic agents. A high rate of diagnostic errors (43–65 %) frequently leads to misdiagnosis, with diagnostic delays ranging from 3 to 15 years.

   The aim of this article is to present your own observations, literature data.

   Rationale. A high level of disability among patients who have suff ered an ischemic stroke (IS) continues to remain a significant medico-social problem worldwide. Malnutrition and the development of nutritional defi ciency in post-stroke patients are common occurrences that signifi cantly worsen the overall prognosis for survival and functional recovery. Nutritional support (NS) as part of a comprehensive post-stroke rehabilitation program has a positive impact on clinical outcomes; however, the number of studies in this area is limited and warrants further investigation.

   Aim of the Study. To analyze the effectiveness and feasibility of using an algorithm of continuous nutritional support utilizing specialized enteral products as part of comprehensive therapy for patients with primary moderate severity IS during the acute and early recovery periods, in comparison with the current approach to nutrition using standard hospital diets.

   Material and Methods. A post-registration, open-label, multicenter, prospective, low-intervention, two-arm randomized study “CENTRIS” (C-clinical E-eff ectiveness N-nutrition T-therapy in R-rehabilitation after I-ischemic S-stroke). The material consisted of data from examinations of patients with an acute ischemic stroke (IS) at 4 research centers, obtained during 5 visits (B1-B5). Inclusion criteria: age 45–75 years; fi rst ischemic stroke, acute phase; Rehabilitation Routing Scale (RRS) score ≤ 3-5; Glasgow Coma Scale (GCS) score ≥ 13 points; presence of post-stroke dysphagia grades 1-4; nutritional deficiency identifi ed at baseline or during observation. The total duration of observation was 90 days. The observation period (90 days) included stages I and II of the acute periods (inpatient setting, 30 days) and stage III (outpatient setting, the fi rst 60 days of the early recovery period). Initially, all patients, after randomization, were divided into two groups: the intervention group (IG) and the control group (CG). In the IG group (n = 60), for the initial 30 days of hospitalization, patients received NS (nutritional support) in the form of specialized enteral nutrition (EN) products, administered according to their calculated daily energy requirements. If tube feeding (TF) was necessary, Nutrison Protein Advance was used; in the absence of the need for tube feeding, Nutridrink (totaling 600 kcal/day, 24 g protein/day) was administered orally via sipping in addition to the main diet. To correct post-stroke dysphagia and reduce the risk of aspiration, a method of thickening liquids and food was employed, involving the selection of a safe consistency (viscosity) for meals and beverages using the product Nutilis Clear. On day 30 (at discharge), patients in the IG group were randomized into two subgroups. Subgroup IG-1 (n = 32) continued a 60-day nutritional support (NS) regimen using the product Nutrison Advanced Nutridrink (200 ml, 300 kcal, 12 g protein per day, which corresponds to the nutritional value of 1 pack of Nutridrink 200 ml) as a supplement to their standard diet, utilizing the product Nutilis Clear for the correction of dysphagia via liquid and food thickening. Patients in subgroup IG-2 (n = 28) were transitioned to their usual home diet. In the control group (CG, n = 30), nutrition adhered to calculated requirements and management standards throughout the entire observation period. For the assessment of clinical effi cacy, the following indicators were used in the study groups: Nutritional status (weight measurement, concentrations of total protein, serum albumin, absolute blood lymphocyte count, Prognostic Nutritional Index (PNI)); Functional indicators and specialized scales: assessment of eating behavior (the Eating Assessment Tool-10, or EAT-10); swallowing ability and aspiration risk (the Mann Assessment of Swallowing Ability scale, or MASA);Assessment of daily activity and quality of life: muscle strength and endurance using hand-grip dynamometry; indicators of functional activity (the Barthel Index); the Rivermead Mobility Index (RMI); assessment of health-related quality of life using the EQ-5D-3L scale (TTO and VAS).

   Results. Over the observation period B1-B3 (30 days, inpatient), statistically significant advantages of the IG (intervention group) were identifi ed compared to the CG (control group) for the following indicators: Dynamics of improvement in the Prognostic Nutritional Index (PNI): (3.03 ± 5.14 vs –2.49 ± 4.728, p < 0.001); Increase in muscle strength and endurance via handgrip dynamometry data: (3.37 ± 4.47 vs 0.20 ± 6.46, p = 0.0225); Reduction in aspiration risk using the MASA scale (Mann Assessment of Swallowing Ability): (21.38 ± 11.604 vs 15.33 ± 15.535, p = 0.0408);Improvement in functional activity indicators (Barthel Index): (46.92 ± 26.539 vs 35 ± 22.819, p < 0.0386). A study of the results within the full 90-day observation period (V1-V5) allowed us to find convincing evidence of the superiority of the study group over the control group. Thus, weight loss was observed in both groups, but it was signifi cantly less in the IG compared to the CG according to the following indicators: calculated weight (–0.58 ± 2.9 kg vs –2.14 ± 2.69 kg, p = 0.0182) and measured weight (–0.32 ± 1.9 kg vs –1.9 ± 2.4 kg, p = 0.0015), respectively. Statistically significant advantages were identified in the IG compared to the CG in terms of increasing the growth of the following indicators: total protein (3.8 ± 5.7 g/L vs –1.32 ± 4.3 g/L, p < 0.001), serum albumin (2.2 ± 3.4 g/L vs –1.4 ± 3.7 g/L, respectively, p < 0.001), absolute blood lymphocyte count (0.5 ± 0.71 × 10^9/L vs 0.14 ± 0.67 × 10^9/L, p = 0.0233), and improvement in PNI dynamics (4.75 ± 4.93 vs –0.65 ± 5.57, p < 0.0001), respectively. The dynamics of the decrease in the level of indicators of dysphagia and its associated complications (EAT-10 scale) in the IG (intervention Group) was more pronounced compared to the CG (Control Group) (–13.25 ± 7.90 vs –9.73 ± 6.64, p = 0.048), which indicates the importance of using xanthan gum-based thickeners during the 90-day follow-up period. The Rivermead Mobility Index (RMI) (B5-B1) increment rates in the IG group were 18.3 % higher than in the CG (8.65 ± 2.661 vs 7.2 ± 2.809, p = 0.0189), with a positive growth trend of indicators in the subgroup (IG-1) by 25.24 % compared to the CG by day 90. The assessment of functional activity using the Barthel Index (specifically the “dependency” parameter) revealed that 37 % of patients in the intervention group (IG) were able to care for themselves independently without assistance by the end of the study (p = 0.0073). In the control group (CG), none of the patients could manage without constant or partial external assistance (p = 0.0386). The patients’ quality of life, as measured by the EQ-5D-3L questionnaire, improved in terms of quantitative scores, showing a significant leading increase of 28.95 % in the IG group (p = 0.0404)) compared to the CG over the period V5-V1. Quality of life of patients over the period from baseline (B1) to B5, according to the EQ-5D-3L questionnaire, improved in terms of quantitative assessment indicators with a reliable outstripping growth of 28.95 % in the IG group (p = 0.0404) compared to the CG, and a statistically significant indicator on the scale (EQ-5D-3L, VAS): the difference in the subjective assessment of quality of life improvement was 45.11 % (p = 0.0016) in favor of the IG (38.5 ± 19.964 vs 24.33 ± 18.41 in the CG). The obtained results confirm the effectiveness of an integrated approach to stroke therapy with the use of NS.

   Conclusion. The study results confirm the clinical efficacy of the developed algorithm for additional prolonged nutritional support (NS) compared to the standard protocol for patients with moderate ischemic stroke (IS). The use of specialized enteral nutrition (EN) products during the acute and early recovery periods (up to 90 days) statistically signifi cantly improves indicators of functional recovery and quality of life of patients.

   Prion diseases (PDs) are rare neurodegenerative disorders caused by abnormal forms of the PrP protein, which can induce conformational changes in normal proteins and lead to progressive degeneration of nerve tissue. These diseases are characterized by a long incubation period and high mortality. The importance of studying PDs stems from the need to develop diagnostic and preventive methods, as well as the search for eff ective therapeutic agents. The article presents information on the mechanisms of damage to the nervous system, on the key forms of PDs (Creutzfeldt–Jakob disease, Gerstmann–Straussler–Scheinker syndrome, fatal familial insomnia, and others), presents modern diagnostic methods with an indication of their sensitivity and specifi city, and also considers promising areas of therapy (antisense oligonucleotides, antibodies, aggregation inhibitors, activation of autophagy, gene therapy).