RU2607942C2 - Method for treating cognitive disorders accompanying chronic cerebral ischemia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology and gerontology, and can be used for treating cognitive disorders accompanying chronic cerebral ischemia. Method comprises laser exposure biosynchronization with phases of tissue blood filling increasing rhythms. Laser therapy is performed by means of laser diodes, wavelength of 0.98 mcm, pulse power of 70–100 W, average power density of 1–5 mWt/cm², radiation area of 20–30 cm². Exposure is epidermally performed within the course of 10–15 days before noon in zones of internal carotid arteries and vertebral arteries, projections of frontal and temporal lobes of both cerebral hemispheres, as well as upper cervical ganglion. Duration of exposure of each zone is 120 current pulse strikes of the patient, recorded during the session.

EFFECT: method allows to improve cognitive functions due to laser exposure biosynchronization with phases of tissue blood filling increasing rhythms, radiation of zones of internal carotid arteries and vertebral arteries, projections of frontal and temporal lobes of both cerebral hemispheres and upper cervical ganglion.

1 cl, 1 tbl, 3 ex

Description

The invention relates to medicine, namely to neurology and gerontology, and can be used in the treatment of cognitive impairment of atherosclerotic origin in the elderly. It also applies to the rehabilitation treatment of elderly people suffering from post-stroke encephalopathy with severe cognitive impairment, and can be introduced into the practice of the work of neurological hospitals and rehabilitation institutions.

Recently, the concept of vascular cognitive impairment has been actively discussed, uniting all cases of cognitive decline due to cerebrovascular insufficiency, including vascular dementia (Yakhno N.N. Cognitive disorders in a neurological clinic. // Neurologist. Journal. - 2006. - T. 11 , appendix 1. - S. 4-12.). The pathomorphological basis of vascular cognitive impairment is diffuse lacunar changes in the subcortical white matter of the brain due to damage to small penetrating arteries (Tanashyan M.M., Barkhatov D.Yu., Konovalov R.N., Fedin P.A., Guryev M. H. Moderate cognitive impairment in chronic cerebrovascular diseases on the background of metabolic syndrome: new approaches to therapy - Cerebrovascular pathology. New features of low-dose neuroprotection. St. Petersburg: Nauka, 2014. - P. 44-53.) It is proved that only biocontrol yaemaya hronofizioterapiya provides the normalization of blood microcirculation spectrum of rhythms and guaranteed enhancement plastic recovery processes. For this, effects must be synchronized with the phases of the rhythms of blood flow, increased energy supply of stimulated cells, which corresponds to increased blood supply to the tissue, opening of capillaries over active cells, increased transport of energy metabolites and oxygen diffusion in them. In automatic mode, this is possible only if there are control signals from the pulse and respiration sensors of the patient himself, i.e. in the rhythms of its central blood flow (Komarov F.I., Zaguskin S.L., Rapoport S.I. Chronobiological direction in medicine: biocontrolled chronophysiotherapy // Therapist, archive, N8. - 1994 - S. 3-6; Zueva M. V., Tsapenko I.V., Dnestrova G.I., Zaguskin S.L. Electroretinographic evaluation of the effectiveness of electrical stimulation of the retina by the method of biocontrolled chronophysiotherapy for Stargardt's disease // Vopr. Resortol. 1994., N5. - P. 13-15 ; Zaguskin S.L., Zubko Yu.N. Device for electrical stimulation, RF patent No. 2067461, 10.10.96; Slyusarev S.L., Rusakov V.I., Bubnova V.I., Zaguskin S.L. Biofeedback chronophysiotherapy of trophic ulcers of the lower extremities against the background of chronic venous insufficiency // Clinical Medicine, 1996, N6, P. 55-57; Barishevskaya T.I., Nyanchuk TB, Vasilyeva E.E., Zaguskin S.L. Pulsed infrared laser therapy of the median nerve neuritis in biofeedback mode // Vopr. Resort., 1996. N3, P. 26-28).

Known methods of physiotherapy and drug treatment of cognitive impairment due to hemorrhagic and ischemic brain damage (Technique and methods of physiotherapeutic procedures. Reference book. Edited by V. M. Bogolyubov. - M: Medicine, 1983. - 352 p .; Bogolyubov V.M. , Ponomarenko G.N. General physiotherapy. - M., St. Petersburg: SLP, 1997-480 s .; Karlov V.A. Therapy of nervous diseases. M: Medicine, 1987. - 512 p.). They are far from always effective, especially in the development of stage III discirculatory and post-stroke encephalopathy with severe cognitive impairment.

A known method of training memory in elderly patients with initial forms of cerebrovascular pathology (Shapovalova S.A., Grigoryeva V.N. Memory training in elderly patients with discirculatory encephalopathy. // Clinical Gerontology, 6, 2002. - P. 15-22 ) The disadvantage of this method is that it does not allow to achieve positive results in patients with a pronounced neuropsychological defect.

A known method of treating elderly patients with stage III dyscirculatory encephalopathy and gross cognitive deficit, including the introduction of microcirculatory and nootropic drugs, as well as training neuropsychological studies (Zakharycheva T.A., Moroz E.V., Drozdova I.P. Method for treating cognitive impairment in persons with cerebrovascular diseases. Patent of the Russian Federation 2268723, 01/27/06). The disadvantage of this method is the addiction to the medicines used and the inevitable side effects. Treatment gives a temporary effect, since desynchronosis (mismatch of the rhythms of the vegetative status, including disturbances in the circadian rhythm) with these medications is not eliminated.

A known method of physiotherapy of cognitive impairment, in particular, by exposure to electric current using DENS-therapy (Kulishova T.V., Rovenskaya N.G. A method for the treatment of stage I dyscirculatory encephalopathy. RF patent 2452530, 10.06.12). This method reduces the severity of cerebral syndrome by improving cerebral hemodynamics. However, the elimination of cognitive impairment is also temporary in nature, since it does not normalize the hourly and circadian rhythms of vegetative status and does not eliminate sympathicotonia characteristic of these patients. The use of electrical stimulation of various types (Yasnogorodsky VG Electrotherapy. M .: Medicine, 1987. - 240 p.) Does not guarantee the predominance of strengthening recovery processes over destructive ones and eliminating cognitive impairments.

The closest analogue of the proposed method, taken as a prototype, is the method according to which patients with vascular cognitive impairment carry out biocontrolled laser therapy using the Rikta-05Bio device with an assessment of cognitive and autonomic indicators before and after treatment, while the effect is percutaneous on the zones internal carotid and vertebral arteries, as well as in the projections of the frontal and temporal lobes of both hemispheres (Bakuzova D.V., Zaguskin S.L. Reserves of regulation of cognitive functions in patients with dis irkulyatornoy atherosclerotic encephalopathy. // Herald of Ural Medical Academic Science. 2014. №2. pp 111-113).

The problem to which the invention is directed is to increase the effectiveness of treatment of elderly and senile patients suffering from impaired memory in the structure of manifestations of chronic brain ischemia.

This problem is solved in that the patient undergoes laser therapy with a matrix of laser diodes in a biosynchronization (biocontrol) mode, a wavelength of 0.98 μm, a pulse power of 70-100 W, an average power density of 1-5 mW / cm ² , an irradiation area of 20-30 cm ² , daily for 10-15 days in the first half of the day, cutaneously in the zones of the internal carotid and vertebral arteries, projections of the frontal and temporal lobes of both cerebral hemispheres, as well as the upper cervical ganglion with a duration of irradiation of each zone of 120 current pulse beats of the patient during session with the evaluation of the effectiveness of treatment to improve psychophysiological tests and to normalize the near-hour and near-daily rhythms and reduce sympathicotonia, in the case of persistent violations of the near-daily rhythm (namely, duplex, a sharp decrease in amplitude or a sharp shift in acrophase), appoint 1.5 mg of melaxen - 0.5 tablets 30 minutes before the expected onset of sleep daily for 10 days.

The technical result consists in obtaining a positive clinical response in the form of improved cognitive function.

To eliminate cognitive impairment of atherosclerotic genesis in the elderly, the most effective was the infrared laser irradiation with a matrix of laser diodes in the biosynchronization mode. According to the results of our studies, in all patients with cognitive impairment determined by neuropsychological testing, sustained sympathicotonia and disturbances in the near-hour and near-daily rhythms of R-R ECG intervals were found. The restoration (normalization) of these rhythms and a decrease in sympathicotonia, as shown by our studies, were a condition for improving cognitive functions. We have studied the mechanism of this connection: physiotherapeutic (laser) action in the rhythms of central blood flow using signals from the patient’s pulse and respiratory sensors normalizes the parameters of the circadian rhythms of the tissue at the site of the pathology, and the synchronization of these circadian rhythms restores the phase and period of the circadian rhythm, thereby eliminating pathological desynchronosis ( Zaguskin S.L. Cell rhythms and human health.Rostov n / D, Southern Federal University, 2010. - 292 p .; Zaguskin S.L., Grinchenko S.N., Brodsky V.Ya. Interconnection of hourly and circadian rhythms: cyberneti eskaya model // Proceedings of the USSR Academy of Sciences, biologist Sir N6, 1991. -... pp 965-969).

Comparison of the proposed method with the closest analogs allows us to judge the compliance with the criterion of "novelty", and the absence of distinctive features of the claimed method in known analogs indicates compliance with the criterion of "inventive step". The specified set of features allows you to give the method new properties and get the best clinical effect, using it in medical practice, the criterion of "industrial applicability".

New in the proposed method are:

1) the use of biofeedback mode by laser exposure according to signals from the patient’s pulse and respiration sensors for biosynchronizing it with the phases of the rhythms of increasing blood supply during inspiration and heart systole;

2) the use of laser therapy with a matrix of laser diodes: a wavelength of 0.98 μm, a pulsed power of 70-100 W, an average power density of 1-5 mW / cm ² , the irradiation area of 20-30 cm ² ;

3) cutaneous laser irradiation of zones of the internal carotid and vertebral arteries, frontal and temporal lobes of both hemispheres of the brain and upper cervical ganglion;

4) the use of a biological timer with a duration of 120 pulse beats per zone, since it was found that such a period is sufficient for the transition process of changes in blood microcirculation in the tissue and the response of formed elements and blood plasma for 4 zones of vertebral and carotid arteries;

5) an assessment of the degree of cognitive impairment, not only by generally accepted psychophysiological tests, but also by the presence of disturbances in the near-hour and near-daily rhythms of the R-R ECG intervals of Holter cardiac monitoring and sustained sympathicotonia;

6) control of individual treatment effectiveness not only according to generally accepted psychophysiological tests, but also to restore the near-hour and near-daily rhythms of R-R ECG intervals and reduce sympathicotonia;

7) intake of exogenous melatonin daily for 10 days in cases of difficulty in restoring the circadian rhythm of R-R ECG intervals during biocontrolled laser therapy.

Detailed description of the method

Patients are diagnosed with cognitive impairment of atherosclerotic genesis based on neuropsychological testing, disturbances in the near-hour and near-daily rhythms of RR intervals of Holter monitoring ECG, changes in EEG and sustained sympathicotonia, as well as neuroimaging methods to exclude other causes of intellectual deficiency. 10 daily sessions of laser therapy are conducted in the synchronization mode of irradiation with the phases of inspiration and systole according to the signals recorded from the patient’s pulse and respiratory sensors (device according to the patent of the Russian Federation 2186584) using a matrix of laser diodes: wavelength 0.98 μm, pulse power 70-100 W, average power density 1-5 mW / cm ² , irradiation area 20-30 cm ² , irradiation duration 120 pulse beats. Irradiation is performed percutaneously in the zones of the internal carotid and vertebral arteries, as well as in the projections of the frontal and temporal lobes of both hemispheres and the upper cervical ganglion. In the case of maintaining sustained sympathicotonia and violations of the circadian rhythm rhythm of the RR intervals of the ECG, exogenous melatonin is prescribed (1.5 mg melaxen - 0.5 tablets 30 minutes before the expected onset of sleep). The effectiveness of treatment is assessed by tests of the level of cognitive functions and by normalizing the hourly and circadian rhythms and reducing sympathicotonia.

The proposed method was tested in the treatment of 22 patients aged 60 to 80 years with severe cognitive impairment of atherosclerotic genesis, established using magnetic resonance imaging, including. Irradiation was carried out percutaneously in the zones of the internal carotid and vertebral arteries, as well as in the projections of the frontal and temporal lobes of both cerebral hemispheres and the upper cervical ganglion, while in 7 patients the circadian rhythm of heart rate was not restored, and therefore they were prescribed exogenous melatonin (Melaxen was used in a dose of 1.5 mg - 0.5 tablets 30 minutes before the expected onset of sleep) daily for 10 days.

Normalization of the hierarchy of central blood flow rhythms, near-hour and near-daily rhythms of R-R ECG intervals when using biocontrolled laser therapy with a simultaneous decrease in sympathicotonia was accompanied by an improvement in cognitive functions in the elderly according to neuropsychological tests (Table 1).

Table 1. The dynamics of the cognitive functions of patients during biocontrolled laser therapy and exogenous melatonin (group 1 - 15 people - laser therapy only; group 2 - 7 people - laser therapy and exogenous melatonin)

Example 1. Patient K., 70 years old, being hospitalized in the neurological department of the clinic of the Rostov State Medical University from 05.20.13 to 05.06.13 with a diagnosis of chronic cerebrovascular insufficiency with moderate cognitive impairment syndrome. Violations of the near-hour and near-daily rhythms of the R-R ECG intervals of Holter cardiomonitoring and sustained sympathicotonia were observed throughout the day. A 10-day course of biocontrolled laser therapy. The restoration of near-hourly and near-daily rhythms, a decrease in sympathicotonia with normotonia in the evening were found. According to the results of neuropsychological testing (MoSa-test), an improvement of mnemonic functions by 5 points was revealed due to the improvement of memory, speech activity, and spatial functions.

Example 2. Patient K., 74 years old, being hospitalized in the neurological department of the clinic of the Rostov State Medical University from 09.25.13 to 09.10.13, with a diagnosis of chronic cerebrovascular insufficiency with moderate cognitive impairment syndrome. Violations of the near-hour and near-daily rhythms of the R-R ECG intervals of Holter cardiomonitoring and sustained sympathicotonia were observed throughout the day. A 10-day course of biocontrolled laser therapy. The restoration of near-hourly rhythms, a decrease in sympathicotonia with normotonia in the evening were found. However, circadian rhythms were not restored, therefore, melatonin was added to the therapy according to the scheme, after which the entire hierarchy of rhythms was normalized. According to the results of neuropsychological testing (MoSa-test), an improvement in cognitive functions of 5 points was revealed due to improved memory, speech activity, orientation, and spatial functions.

Example 3. Patient P., 75 years old, being hospitalized in the neurological department of the clinic of the Rostov State Medical University from 02/11/13 to 02/25/13 with a syndrome of moderate cognitive impairment of a mixed nature. Violations of the near-hour and near-daily rhythms of the R-R ECG intervals of Holter cardiomonitoring and sustained sympathicotonia were observed throughout the day. A 10-day course of biocontrolled laser therapy. The rhythms of vegetative status were not restored, sympathicotonia persisted. According to the results of neuropsychological testing (MoSa-test) revealed a slight improvement in cognitive functions (1 point). In the course of further observation and examination of the patient, the final diagnosis was established - Alzheimer's disease, which explained the ineffectiveness of the use of therapy due to the pathogenetic characteristics of the disease.

The proposed method can be used in the treatment of cognitive impairment of atherosclerotic genesis in the elderly, during rehabilitation measures in people who have had a stroke and who suffer from moderate and severe cognitive impairment, including in cases of inefficiency of known methods of therapy. The method can be implemented in the practice of neurologists, psychiatrists, physiotherapists.

Claims (2)

1. A method for the treatment of cognitive impairment in chronic cerebral ischemia, including biosynchronization of laser exposure with phases of rhythms of increasing tissue blood supply, characterized in that laser therapy is carried out using a matrix of laser diodes, wavelength 0.98 μm, pulse power 70-100 W, average power density 1-5 mW / cm ² , irradiation area 20-30 cm ² , exposure is carried out for 10-15 days in the first half of the day, cutaneously in the zones of the internal carotid and vertebral arteries, projections of the frontal and temporal lobes of both cerebral hemispheres brain, as well as the upper cervical ganglion, while the duration of irradiation of each zone is 120 current beats of the patient’s pulse recorded during this session. 2. The method according to p. 1, characterized in that after completion of the course of treatment, its effectiveness is evaluated to improve psychophysiological tests and to normalize the hourly and circadian rhythms and reduce sympathicotonia and, while maintaining circadian rhythm disturbances, use melaxen at a dose of 1.5 mg - 0 , 5 tablets 30 minutes before the expected onset of sleep daily for 10 days.