RU2268723C1 - Method for treating cognitive disorders in patients with cerebrovascular diseases - Google Patents

Abstract

FIELD: medicine, gerontology.

SUBSTANCE: the present innovation deals with rehabilitation therapy of cerebrovascular diseases. One should introduce microcirculators and nootropic preparations to conduct training neuropsychological procedures. Moreover, microcirculatory and nootropic preparations should be introduced as intravenous infusions for 10 d, ten during 1 mo it is necessary to introduce tableted forms of the same preparations at simultaneous neuropsychological training directed to improving household skills valuable for a patient that deal with memorizing different names, important dates, names of medicinal preparations and location of domestic articles. On achieving a success the tasks should be complicated. Training should last for 30 min carried out thrice weekly: therapy course includes 12 trainings. The innovation widens the number of preparations for treating elderly and senile patients at discirculatory encephalopathy stage III and coarse cognitive deficiency.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

Description

The invention relates to medicine, for the rehabilitation treatment of elderly and senile patients suffering from stage III discirculatory and post-stroke encephalopathy with severe cognitive impairment and can be introduced into the practice of neurological hospitals and rehabilitation institutions.

Known methods of treating cerebrovascular pathology, depending on the disease, its period, severity of the clinical course and severity of symptoms and syndromes. Rehabilitation therapy is aimed at restoring impaired motor and speech functions, psychological and social adaptation of the patient, prevention of post-stroke complications and possible subsequent stroke. Rehabilitation measures include speech therapy, kinesitherapy, biocontrol methods, physiotherapy and reflexology, neuropsychological training to develop preserved cognitive abilities, psychotherapy (Damulin I.V. et al. Circulatory disorders in the brain and spinal cord. In the book: Diseases of the nervous system : hand-in for doctors: in 2 volumes of T.1. - M .: Medicine, 2001. - S.321-292).

Methods of neuropsychological testing are widely used in the practice of neurological, neurosurgical and psychiatric clinics to identify local brain lesions and their severity, evaluate the effectiveness of treatment and psychological correction of higher mental functions. It is generally recognized that only the early start of correctional and pedagogical work can lead to lasting positive results. The disadvantage of this method is that the greatest recovery effect is observed in patients under the age of 40 years (Shokhor-Trotskaya (Burlakova) MK, The strategy and tactics of speech recovery. - M .: EKSMO-Press, V. Sekachev, 2001. - 432 p .; Wasserman, L.I., Dorofeeva, S.A., Meerson, Ya.A. Methods of neuropsychological diagnosis.

There is a method of training memory in elderly patients with initial forms of cerebrovascular pathology (discirculatory encephalopathy of I and II stages). The disadvantage of this method is that it does not allow to achieve positive results in patients with stage III dyscirculatory encephalopathy with a pronounced neuropsychological defect (Shapovalova S.A., Grigoryeva V.N. Memory training in elderly patients with dyscirculatory encephalopathy. Clinical gerontology, 6 , 2002. - S.15-22).

A known method of treating cerebrovascular diseases with vasoactive drugs and neurotropic drugs. Vasodilators, reducing the resistance of cerebral vessels, contribute to better oxygenation of brain tissue, normalization of metabolic processes in it and improve the clinical condition of patients. Nootropic drugs, affecting metabolic and bioenergetic processes in the nerve cell, improving blood supply to the brain, activate higher integrative brain activity, restore impaired mnemonic and cognitive functions, disorders of the emotional-volitional sphere (Damulin I.V. et al. Circulatory disorders in the brain and spinal cord In the book: Diseases of the nervous system: hand-in for doctors: in 2 volumes T.1. - M .: Medicine, 2001. - P.321-292; Gusev E.I., Skvortsova V. I. Ischemia of the brain. - M .: Medicine, 2001. - P.187-327; Guzeva V.I., Mikhailov I.B. Farmakoter apia of nervous diseases in adults and children: a manual for doctors. - St. Petersburg: TOLIANT, 2002. - P.181-215).

The problem to which the invention is directed is to increase the effectiveness of the treatment of elderly and senile patients suffering from discirculatory and post-stroke encephalopathy of the III st. with severe cognitive deficit.

This problem is solved by the fact that the patient is prescribed drugs that improve cerebral blood flow, and neuroprotectors - initially in the form of intravenous infusions for 10 days; then the tablet forms of the same drugs for 1 month and at the same time, additionally, as a means aimed at improving the mnemonic functions, conduct an adapted neuropsychological training lasting 30 minutes 3 times a week in combination with exercises recommended as "homework" for self-study training.

The specified set of features allows you to give the object new properties and get a new technical result.

The proposed method was used in the treatment of 25 patients aged 60 to 80 years with stage III dyscirculatory and post-stroke encephalopathy, accompanied by severe neuropsychiatric disorders.

To assess the state of patients' memory, fatigue, and attention activity, the methods proposed by A.R. Luria (Luria A.R. Fundamentals of Neuropsychology. - M .: Academy, 2002. - 384 p .; Wasserman L.I., Dorofeeva S.A., Meerson Y.A. Methods of neuropsychological diagnostics. 1997. - 304 p.) In versions we modified:

1) Test "Memory". We ascertained the patient’s vocabulary and for the test we selected the words necessary in everyday life, which the researcher could speak. The stimulus material was a series of 10 unrelated simple words from the themes “Apartment”, “Kitchen”, “Street”, “Shop”, “Cleaning”, “Clothes”, etc. For example, a sofa, bread, a radio, a table, a shirt, a tree, a cashier, a rag, a telephone, a road. In the second experiment, the patient was presented with a pair of words that were interconnected by meaning, for example, tea - a cup, a purse - money, a phone - a call, trousers - a belt, etc.

2) Attention training using forms with simple geometric shapes - circle, oval, triangle, square, rhombus, star, etc.

3) The choice of subjects according to a generalized concept for people over 70 years of age with a slowdown in the processes of attention, thinking and worse assimilation was simplified to the choice of 2 pictures out of 5 offered. The “Extra Word” test was also simplified to 3 words, and then expanded to 4-5.

4) For "Playback of stories" used cards on which in large print, briefly, simply and clearly presented information about phraseological turns, convenient for retelling. For example,

“Do not spill water” - the expression means that people are very friendly, inseparable, always together. The turn goes back to the custom in Russian villages to water the fighting bulls with water to separate them.

“To take dirty linen out of the hut” - to talk about quarrels, troubles occurring between close people. According to the ancient Slavs, litter (garbage), taken out of the hut and scattered by the wind, brought trouble to the house. Therefore, the collected litter was not taken out, but burned in a furnace so that it would not go to evil people.

“Chasing two hares” - to do several things at once. “If you chase two hares, you won’t catch a single one,” the Russian proverb says. Its original meaning is clear. Catching two birds with one stone is a hopeless affair. After all, hares are not only agile and fast, but also cunning. And as applied to a person, this means: you should not take up several tasks at once - there will be little sense. Do one, then start another.

4) In case of sensory, sensorimotor and other types of aphasia, patients were offered to learn proverbs, sayings, short stories (for example, on the topics: “What I did today at home ...”, “What I saw while walking ...”, “What is the weather like today ...”) and short rhymes invented by us (for example,

Here is the pan, here is the spoon

Next to them is a cook.

We take a plate

Out of the pan

Pour soup into it ...

Or

This is my room:

Sofa, armchair, chair and table,

TV, telephone.

Here is the window -

Behind it is a balcony.

The door is open to the corridor ...

Training tasks were aimed at improving the most important everyday skills for patients related to memorizing names, important dates, medications, the location of household items, etc. As you progress - patients achieve success, tasks become more complicated.

The comparison group in the amount of 25 people was identical to the main one by gender, age, neurological defect and severity of the disease (p> 0.05). A total of 50 patients with stage III dyscirculatory and post-stroke encephalopathy participated in the comparative trial, including 29 men and 21 women.

Patients of both groups received basic therapy, including the vasoactive drug pentoxifylline and nootropiracetam in the form of solutions for intravenous infusions and tablets.

The effectiveness of the treatment was evaluated by 3 samples - “Long-term memory”, “Short-term memory”, “Corrective test”.

Materials on the effectiveness of the treatment of elderly and senile patients suffering from discirculatory and post-stroke encephalopathy of the III degree, using new and compared methods are presented in table 1, and are also illustrated by examples of specific case histories.

Example 1. Patient G., 74 years old, diagnosis: Post-stroke discirculatory (1990 - hemorrhagic stroke in the left hemisphere) encephalopathy III tbsp. Atherosclerosis of the aorta, cerebral vessels. Arterial hypertension III tbsp., IV tbsp. risk. Syndromes of right-sided hemiparesis with a decrease in muscle strength to 3 points, partial motor aphasia, intellectual and mnestic disorders.

During the examination in May 2000: data of short-term memory tests - 5, 4, 4, 4; long-term memory - 4; proof test - 60 errors.

The treatment was carried out from 06/01/00 to 07/15/00 according to the scheme: pentoxifylline 2% - 5.0 per 20.0 ml of physiological saline i / v slowly and piracetam 20% - 10.0 iv in 10 days , then the tablet form of the preparations - pentoxifylline-acre 0.1 × 3 times a day and piracetam 0.4 × 3 times a day for 30 days.

After treatment, these samples of short-term memory - 6, 5, 4, 4; long-term memory - 4; proof test - 56 errors.

During the examination in February 2001: data samples of short-term memory - 5, 5, 4, 4; long-term memory - 4; proof test - 58 errors.

The treatment was carried out from 02/28/01 to 04/11/01 according to the scheme: pentoxifylline 2% - 5.0 per 20.0 ml of physiological saline i / v slowly and piracetam 20% - 10.0 iv in 10 days . Then, the tablet forms of the preparations - pentoxifylline-acre 0.1 × 3 times a day and piracetam 0.4 × 3 times a day for 30 days in combination with adapted non-psychological training (“Simple analogies”, “Retelling of the story”, independent memorizing poems, short stories, proverbs, solving crosswords of varying difficulty) lasting 30 minutes 3 times a week, 12 lessons in total.

After treatment, these samples of short-term memory - 7, 7, 6, 6; long-term memory - 7; proof test - 40 errors.

Example 2. Patient M., 63 years old, diagnosis: Post-stroke dyscirculatory (1993 - hemorrhagic stroke in the left hemisphere) encephalopathy III tbsp. Atherosclerosis of the aorta, cerebral vessels. Syndromes of right-sided hemiparesis with a decrease in muscle strength to 3 points, partial motor aphasia, intellectual and mnestic disorders.

During the examination in July 2000: the data of the short-term memory test - 6, 5, 5, 4; long-term memory - 4; proof test - 68 errors.

The treatment was carried out from 10.07.00 to 08.20.00 according to the scheme: pentoxifylline 2% - 5.0 per 20.0 ml of physiological saline i / v slowly and piracetam 20% - 10.0 iv in 10 days , then tablet formulations - pentoxifylline-acre 0.1 × 3 times a day and piracetam 0.4 × 3 times a day.

After treatment, these samples of short-term memory - 6, 5, 5, 5; long-term memory - 5; proof test - 58 errors.

During the examination in May 2001: data of short-term memory samples - 6, 5, 5, 5; long-term memory - 5; proof test - 60 errors.

The treatment was carried out from 06.06.01 to 20.07.01 according to the scheme: pentoxifylline 2% - 5.0 per 20.0 ml of physiological saline i / v slowly and piracetam 20% - 10.0 iv in 10 days . Then, the tablet forms of the preparations - pentoxifylline-acre 0.1 × 3 times a day and piracetam 0.4 × 3 times a day for 30 days in combination with adapted neuropsychological training (“Simple analogies”, “Retelling of the story”, independent memorizing poems, short stories, proverbs, solving crosswords of varying difficulty) lasting 30 minutes 3 times a week, 12 lessons in total.

After treatment, these samples of short-term memory - 7, 7, 6, 6; long-term memory - 7; proof test - 44 errors.

Example 3. Patient D., 67 years old, diagnosis: Post-stroke discirculatory (1997 - ischemic stroke in the basin of the left middle cerebral artery) encephalopathy III tbsp. Atherosclerosis of the aorta, cerebral vessels. Syndromes of right-sided hemiparesis with a decrease in muscle strength to 3 points, partial motor aphasia, intellectual and mnestic disorders.

During the examination in April 2001: the data of the short-term memory test - 5, 5, 4, 4; long-term memory - 4; proof test - 59 errors.

The treatment was carried out from 04/18/01 to 02/02/01 according to the scheme: pentoxifylline 2% - 5.0 per 20.0 ml of physiological saline i / v slowly and piracetam 20% - 10.0 iv in 10 days , then tablet formulations - pentoxifylline-acre 0.1 × 3 times a day and piracetam 0.4 × 3 times a day.

After treatment, these samples of short-term memory - 5, 5, 5, 5; long-term memory - 5; proof test - 57 errors.

During the examination in December 2001: data samples of short-term memory - 5, 5, 5, 4; long-term memory - 4; proof test - 54 errors.

The treatment was carried out from 01/03/02 to 02/06/02 according to the scheme: pentoxifylline 2% - 5.0 per 20.0 ml of physiological saline i / v slowly and piracetam 20% - 10.0 iv in 10 days . Then, the tablet forms of the preparations - pentoxifylline-acre 0.1 × 3 times a day and piracetam 0.4 × 3 times a day for 30 days in combination with adapted neuropsychological training (“Simple analogies”, “Retelling of the story”, independent memorizing poems, short stories, proverbs, solving crosswords of varying difficulty) lasting 30 minutes 3 times a week, 12 lessons in total.

After treatment, these samples of short-term memory - 7, 6, 6, 5; long-term memory - 6; proof test - 40 errors.

Comparison of the effectiveness of the proposed method with the effect of only pathogenetic drug therapy on the course of cerebrovascular diseases showed that piracetam and pentoxifylline therapy contributed to a slight improvement in short-term, long-term memory and attention, however, statistically significant results were not obtained (p> 0.05).

The use of rehabilitation therapy, including medications, neuropsychological testing and training tasks, helped to improve the attention of patients, as evidenced by the data of the corrective test (Table 1) - the number of errors decreased by an average of 30%.

Thus, the proposed method allows to increase the effectiveness of the treatment of elderly and senile patients suffering from discirculatory and post-stroke encephalopathy III tbsp. with cognitive deficits, stabilize or reduce the severity of intellectual-mnestic disorders and ultimately accelerate the social rehabilitation of patients.

The method is recommended for use in neurological hospitals and rehabilitation institutions.

Table 1
The effectiveness of various treatment regimens for elderly and senile patients with discirculatory and post-insulin encephalopathies of the III st. Samples Characterization of higher mental processes in patients during therapy Microcirculants, nootropics (n = 25) Integrated using neuropsychological testing (n = 25) Original (1) After treatment (2) Original (3) After treatment (4) 1. "Long-term memory" 3.15 ± 0.4 3.27 ± 0.5 2.95 ± 0.5 3.24 ± 0.5 2. “Short-term memory” 3.89 ± 1.2 4.12 ± 1.6 3.75 ± 1.5 4.02 ± 1.7 3. "Corrective" 58.3 ± 0.2 60.1 ± 0.1 59.8 ± 0.1 42.4 ± 0.8 * Note: * - differences between 2 and 4 are significant (p <0.05)

Claims (1)

A method for the treatment of elderly and senile patients with stage III dyscirculatory encephalopathy and severe cognitive deficit, including the introduction of microcirculatory and nootropic drugs, as well as neuropsychological training sessions, characterized in that the microcirculatory and nootropic drugs are administered as intravenous infusions for 10 days, then within 1 month, tablet forms of the same drugs are administered and neuropsychological training is carried out at the same time, aimed at improving significant For the patient, household skills related to remembering names, important dates, medications and the location of household items, with the complication of tasks as the patients achieve success; training lasting 30 minutes is carried out 3 times a week; The course of treatment includes 12 lessons.