We hypothesize that cerebral microbleeds (CMB) in patients with different neuropsychological profiles (amnestic or non-amnestic) and MRI features of vascular damage could provide important information on the underlying pathological process in early Alzheimer's disease. The study was performed at two trial sites. We studied 136 outpatients with cognitive decline. MRI was performed using a magnetic field of 1.5 and 3 T. Neuropsychological assessment included Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment scale (MoCA), Addenbrooke's Cognitive Examination (ACE-R), Cambridge Cognitive Examination battery (CAMCOG) (Part 3), Clock Drawing Test, fluency test and the visual memory test (SCT). CSF was examined for standard parameters such as tau, phosphorylated tau, amyloid-β 1-40 and 42 and Qalbumin, in accordance with established protocols and genotype. In 61 patients (45 %), at least 1 CMB was found. Most of the CMBs were described in the amnestic profile (67 %). In 86 % of the cases, multiple CMB were observed. The ratio of Aβ1-40/42 in non-amnestic patients with CMB was significantly lower (mean 0.6) than in patients without CMB (mean 1.2). A notable difference in the albumin ratio as an indicator of the BBB was observed between groups with and without CMB. In the CMP-positive group, the E2 genotype was observed more frequently, and the E4 genotype less frequently, than in the CMB-negative group. Based on the cerebrospinal fluid-serum albumin ratio, we were able to show that patients with CMB present several features of BBB dysfunction. According to logistic regression, the predictive factors for CMB in patients with cognitive decline were age, WMHs score and albumin ratio. We found a significant reduction in the Aβ-amyloid ratio in the non-amnestic profile group with CMB (particularly in the cortical region) in comparison to those without CMB. While this is an interesting finding, its significance needs to be assessed in a prospective follow-up.

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Anti-NMDA-R encephalitis is a relatively frequent form of autoimmune encephalitis. Initial clinical features of anti-NMDA-R encephalitis resemble those of schizophrenia exacerbation which resulted in hospitalization of patients to mental care facilities. Taking into account high lethality and potential curability, detection of this condition is an important clinical problem. The authors describe a case report of encephalitis with NMDA-R antibodies. This report is the first in the domestic literature. The difficulties of timely diagnosis, diagnostic criteria and treatment algorithm are presented.

Dementia is an important medical problem with the prevalence and significance growing year after year. Improvement of diagnostic methods facilitates early diagnosis and treatment. This year marks the 20th anniversary of memantine, one of the basic anti-dementia drugs, registration in Russia. It provided conditions for more efficient care of patients with dementia and development of memory clinics in Moscow and major regions of Russia used modern investigation technology and neuropsychological testing. Many multi-central studies involving 1250 patients with cognitive impairment were conducted A great number of educational activities, social projects that helped to increase awareness of dementia issues in medical community as well as society in general were implemented. Total screening programs for identification of cognitive impairment are being introduced, psychological support programs for caregivers of dementia patients are being implemented.

Резюме В статье обсуждается проблема, касающаяся связи депрессивных и когнитивных расстройств в аспекте механизмов их развития, клинических вариантов сочетания и рекомендаций по дифференцированной терапии в пожилом возрасте. Рассмот_ рены вопросы диагностического отграничения депрессии и деменции на разных стадиях развития последней, а также в молодом и пожилом возрасте, роли когнитивных нарушений как критериев диагностики депрессии в позднем возрасте и значение депрессии как фактора риска развития деменции, влияние других факторов риска (в частности, возраста), а также подходы к терапии на примере антидепрессантов и Церебролизина.