RU2712070C1 - Diagnostic technique of cognitive disorders accompanying the neurosensory hearing loss associated with occupational exposure to aircraft noise - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, neuropsychology and occupational pathology, and can be used to detect signs of chronic occupational exposure to aircraft noise on workers' body. Neuropsychological examination of the state of higher mental functions is carried out and the following indices are determined: an index of object gnosis by the technique of "recognizing strikethrough and superimposed images", an index of visual gnosis by finger gnosis test (showing a given finger according to the sample and by name), indicator of analytic-synthetic thinking by arithmetic count test, indicator of conceptual thinking by method "selection of opposites in active plan". A discriminant function F is calculated, the obtained result is compared to a constant: if F is more than the constant, the patient is diagnosed with the signs of cognitive dysfunction associated with occupational exposure to aircraft noise, if F is less than or equal to a constant – no signs of cognitive dysfunction associated with occupational exposure to aircraft noise.EFFECT: method enables the inclusion of patients with sensorineural hearing loss associated with occupational exposure to aircraft noise in the risk group of developing cognitive disorders, reducing volume of paraclinical studies, time and material costs by using the minimum number of the most informative diagnostic indicators.1 cl, 1 tbl, 2 ex

Description

The invention relates to medicine, namely to professional pathology and neuropsychology, and can be used to identify signs of chronic occupational exposure to aircraft noise on workers.

Known methods for assessing the psychological status and cognitive deficit in patients with occupational sensorineural hearing loss (NST) using psychological testing. These methods allow detecting impaired memory, attention and working capacity, changes in anxiety levels, the presence of depression, and a decrease in the quality of life in patients with occupational hearing loss [1,2,3,4,5].

The study of mental conditions in professional NST was carried out using the Tsung scale (adapted by T.I. Balashova), the personal scale of manifestations of anxiety by J. Taylor, adapted by V.G. Norakidze (1975), questionnaire "Well-being, activity, mood." A study of personality traits included the Spielberger-Hanin test, the Mini-cartoon questionnaire, and the Luscher color test. In the study of temperament, it is known to use the techniques of PEN (G. and S. Eisenck), Strelau and Keirsi. When studying the needs, motivation, interests, professional inclinations, the questionnaire “Level of subjective control” was used. Psychophysiological parameters and performance were assessed by assessing a simple and complex response to a light signal, “Tapping test” [6].

According to electroencephalographic and psychological examination, the nature of changes in the psychological parameters of patients with HCT of professional origin is described, indicating the presence of signs of psychosomatic disorders, characterized by the formation of an imbalance between the mental and somatic state of the body against the background of increased anxiety, tension, increased neurotism and emotional disorders, changes in interhemispheric interaction . An emerging state of anxiety during professional HCT is a sign of a violation of adaptation mechanisms, and patients with professional HCT HCT are subjects with significant mental stress of adaptive and adaptive processes, leading them to a state of chronic stress [6,7].

The literature available to us does not establish the use of neuropsychological testing to identify the characteristics of cognitive activity in HCT of professional origin.

The objective of the invention is the development of a method for the diagnosis of cognitive impairment caused by dysfunction of various parts of the brain, with sensorineural hearing loss in pilots of civil aviation.

The problem is solved by identifying disorders of higher mental functions in patients with professional HCT using a number of neuropsychological tests with the determination of indicators characterizing the state of subject and visual gnosis, analytical-synthetic and conceptual thinking, calculation of discriminant function using the obtained indicators, and the subsequent assignment of the patient to the group with cognitive impairment associated with professional exposure to aircraft noise or to a group without signs of cognitive violations associated with occupational exposure to aircraft noise.

The method is as follows:

The patient undergoes a neuropsychological study with the determination of indicators of subject gnosis by the method of “recognition of crossed out and superimposed images”, visual gnosis by finger gnosis test (showing a given finger by sample and name), analytical and synthetic thinking by the test for arithmetic counting, conceptual thinking by the method “The selection of opposites in the active plan”; calculate the discriminant function according to the formula:

F = -1.1 + 1.15 × a ₁ -5.28 × a ₂ + 1.63 × a ₃ -1.92 × a ₄ ,

where F is the discriminant function;

-1.1 is a constant;

1.15; -5.28; 1.63; -1.92 - discrimination factors;

and _{1,2,3, 4} are the numerical values of the indicators of the survey;

a ₁ - an indicator of subject gnosis in points; and ₂ is an indicator of visual gnosis in points; and ₃ is an indicator of analytical-synthetic thinking in points; a ₄ is an indicator of conceptual thinking in points.

The result is compared with a constant: when F is more than a constant, the patient is diagnosed with signs of cognitive impairment associated with professional exposure to aircraft noise, with F less than or equal to a constant - no signs of cognitive impairment associated with occupational exposure to aircraft noise.

The authors have not identified methods for the diagnosis of cognitive impairment during occupational exposure to noise, so the proposed method meets the criterion of "novelty."

The use of neuropsychological techniques according to the scheme of A.R. Luria with mathematical processing of indicators to identify the features of cognitive functions in patients with occupational diseases from exposure to physical and chemical factors [8-10, 11, 12-14].

A known method for the diagnosis of dysfunction of the cognitive-mnestic and affective-anxious areas under the influence of industrial local vibration, including neuropsychological tests: “Cognitive failure”, Mini Mental State Examination (MMSE), Digit Span, General Deterioration Scale (SHO), “Schulte Tables” , “Bourdon Corrective Test”, Frontal Assessment Battery (FAB), “Essential Characterization Technique”, Clock Drawing Test (CDT), “Remembering 10 Words”, “Memory for Images”, “Questionnaire for identifying signs of vegetative changes” [15 ].

The use of the proposed complex of indicators obtained using the proposed tests, followed by mathematical processing in order to identify signs of cognitive dysfunction in patients with HCT of professional origin, was not found in a patent information search. Thus, the proposed method meets the criterion of "inventive step". The developed method can be used both when examining patients of vocational centers, and conducting mass medical examinations in the diagnosis of workers who are subject to chronic occupational exposure to aircraft noise, cognitive impairment. Thus, the method meets the criterion of "industrial applicability".

As a result of the discriminant analysis to determine the diagnostic criteria for cognitive impairment in HCT of professional genesis by neuropsychological parameters, an optimal combination of 4 characters was obtained, at which the diagnostic accuracy was maximum.

The discriminant analysis was carried out in a group of patients with occupational HCT and in conditionally healthy patients who, by the specifics of their professional activities, were not exposed to the chronic occupational exposure to aircraft noise.

The discriminant function F is obtained by subtracting the discriminant functions in HCT of professional origin, and the absence thereof.

The reliability and contribution of the obtained informative indicators to the equation of canonical value are presented in the table.

The use of these neuropsychological tests allows us to judge the specifics of brain lesions and to identify the formation of signs of cognitive deficit with the fact of the professional impact of aircraft noise on the body of civil aviation pilots with a sufficient degree of accuracy (72%).

Example 1

Patient K. (age 46 years, work experience in the crew of a manned aircraft 11 years) complains of hearing loss in both ears, speech disturbance, tinnitus, recurring headaches, sleep disturbance, irritability and inattention, fluctuations blood pressure. On examination, it was diagnosed: whispering 1 meter, conversational 5 meters on both ears, according to audiometry, a decrease in bone and air conduction, from the central nervous system no pathology was detected. Neuropsychological testing was carried out with the determination of subject gnosis according to the method of “recognition of crossed out and superimposed images”, visual gnosis by the test of finger gnosis (showing a given finger by the sample and by name), analytical and synthetic thinking by the test for arithmetic count, conceptual thinking by the method of “selecting” opposites in the active plan ”and their numerical values are defined:

and ₁ - an indicator of subject gnosis - 1 point;

and ₂ - an indicator of visual gnosis - 2 points;

and ₃ - an indicator of analytical-synthetic thinking - 1 point;

and ₄ - an indicator of conceptual thinking - 1 point;

F = -1.1 + 1.15 × 1 - 5.28 × 2 + 1.63 × 1 - 1.92 × 1 = -10.8

F is less than a constant.

Conclusion: Patient K. has no evidence of cognitive impairment associated with occupational exposure to aircraft noise.

Example 2

Patient L. (age 54 years, work experience in the crew of a manned aircraft 20 years) complains of hearing loss, periodic tinnitus, irritability, constant fatigue, sleep disturbance due to unexplained anxiety, memory loss, distraction attention after the shift. A general clinical examination and examination of ENT organs did not reveal any pathology. Whisper speech of 0.5 meters, conversational speech of 2 meters in both ears. In an audiological study, bilateral sensorineural hearing loss with hearing thresholds of 50-55 dB at conversational frequencies, the audiometric curve has a downward character. The phenomenon of accelerated increase in volume is revealed according to the above-threshold tests and speech audiometry. Neuropsychological testing was carried out with the determination of indicators of subject gnosis by the method of “recognition of crossed out and superimposed images”, visual gnosis by the test of finger gnosis (showing a given finger by the sample and by name), analytical and synthetic thinking by the test for arithmetic counting, conceptual thinking by the method of “ selection of opposites in the active plan ”and their numerical values are defined:

a ₁ - an indicator of subject gnosis - 2 points;

and ₂ - an indicator of visual gnosis - 0 points;

and ₃ - an indicator of analytical-synthetic thinking - 2 points;

and ₄ - an indicator of conceptual thinking - 1 point;

F = -1.1 + 1.15 × 2 - 5.28 × 0 + 1.63 × 2 - 1.92 × 1 = 2.54

F is more than a constant.

Conclusion: Patient L. has signs of cognitive impairment associated with occupational exposure to aircraft noise.

Evaluation of the effectiveness of the proposed diagnostic method was carried out in the training and control samples. In the training sample (77 people), the correct recognition was 78% for patients with occupational HCT and 62% for “conditionally” healthy patients who, according to the specifics of professional activity, were not exposed to the chronic effects of aircraft noise (50 people) in the control sample.

The proposed method makes it possible to select patients with HCT, associated with the professional impact of aircraft noise, at risk of developing cognitive impairment using the minimum number of the most informative diagnostic indicators, and thereby reduce the amount of paraclinical studies, time and material costs.

Literature:

1. Dyakovich M.P., Pankov V.A., Kazakova P.V., Kuleshova M.V., Tikhonova I.V. Quality of life for civilian flight personnel affected by industrial noise. Hygiene and sanitation. 2018. No. 10. S. 887-893. DOI: 10.18821 / 0016-9900-2018-97-10-887-893.

2. Zhdanko I.M., Zinkin V.N., Soldatov S.K., Bogomolov A.V., Sheshegov P.M. Fundamental and applied aspects of the prevention of adverse effects of aircraft noise. Aerospace and environmental medicine. 2014.V. 48. No. 4. S. 5-16.

3. Kosarev V.V., Babanov S.A. Professional sensorineural hearing loss. Russian medical journal. 2012. No. 31. S. 1556.

4. Nekipelov M.I., Nekipelova O.O., Shishelova T.I., Maslova E.S. The effect of noise on the opponent's psychophysiological systems of human memory. The successes of modern science. 2005. No9. S. 98-100.

5. Sheshegov P.M., Zinkin V.N., Slivina L.P. Aviation noise as a leading factor affecting the incidence and occupational risks of the aviation engineering staff. Aerospace and environmental medicine. 2018. No3. S. 62-68.

6. Petrova N.N. Psychological characteristics of a person with professional hearing loss. Russian otorhinolaryngology. 2010. No3 (46). S. 125-129.

7. Drozdova T.V., Laskova I.I., Fomicheva E.V. Features of interhemispheric interaction in professional sensorineural hearing loss according to coherent analysis of EEG // Sovr. high technology. technol. 2006. No8. S. 38-40.

8. Borzunova Yu.M. Assessment of cognitive deficit in patients with vibrational disease from the effects of local vibration based on neuropsychological testing. Bulletin of the Ural Medical Academic Sciences. 2009. No3 (26). S. 48-50.

9. Borzunova Yu.M., Fedorov A.A. Psychoemotional status and cerebral circulation in miners with vibro-hazardous occupations. Ural Medical Journal. 2012. Vol. 10. No. 102. S. 66-68.

10. Ganovich E.A., Semenikhin V.A. Cognitive-mnestic sphere dysfunction in case of vibration illness in miners of Kuzbass. Occupational medicine and industrial ecology. 2011. No. 12. S. 43-48.

11. Katamanova E.V., Rukavishnikov B.C., Lakhman O. L., Shevchenko O. I., Denisova I. A. Cognitive impairment in toxic brain damage. Journal of Neurology and Psychiatry. Korsakova. 2015.V. 115. No. 2. S. 11-15.

12. Tretyakov S.V., Khabarova E.A., Ermakova M.A. Cognitive impairment in occupational diseases in the late post-exposure period in combination with cardiovascular pathology. Occupational medicine and industrial ecology. 2011. No. 10. S. 27-32.

13. Filippov V.L., Filippova Yu.V. To the problem of the norm and pathology of mental health in preventive occupational pathology. Emergency medicine. 2015. T. 1. No. 51. S. 8-16.

14. Shevchenko O.I., Katamanova E.V., Yeschina I.M. Features of changes in the mental sphere in patients with initial manifestations of neurointoxication, depending on the exposure to vinyl chloride. Occupational medicine and industrial ecology. 2017. No9. S. 215-216.

15. Ganovich E.A. et al. A method for diagnosing dysfunction of the frontal lobes of the brain in patients with vibrational disease. Patent RU No. 24577810. 2012.

Claims (7)

A method for the diagnosis of cognitive impairment in sensorineural hearing loss associated with the occupational exposure to aircraft noise, including neuropsychological testing and determination of subject gnosis indicators using the “recognition of crossed out and superimposed images” method, visual gnosis by finger gnosis test: showing a given finger by sample and name, analytical-synthetic thinking by the test for arithmetic counting, conceptual thinking by the method of “selection of opposites into an asset nom plan ", calculate the discriminant function F according to the formula F = -1.1 + 1.15 × a ₁ -5.28 × a ₂ + 1.63 × a ₃ -1.92 × a ₄ , where F is the discriminant function; -1.1 is a constant; 1.15; -5.28; 1.63; -1.92 - discrimination factors; and _{1, 2, 3, 4} - the numerical values of the indicators of the survey; a ₁ - an indicator of subject gnosis in points; and ₂ is an indicator of visual gnosis in points; and ₃ is an indicator of analytical-synthetic thinking in points; a ₄ - indicator of conceptual thinking in points; the result is compared with a constant: when F is more than a constant, the patient is diagnosed with signs of cognitive impairment associated with professional exposure to aircraft noise, with F less than or equal to a constant - no signs of cognitive impairment associated with occupational exposure to aircraft noise.