Modern aspects of diagnosis and treatment of cognitive impairments (literature review)

The use of biological markers for Alzheimer's disease (AD) allows diagnosis at the stage of moderate cognitive impairment and atypical course of the disease. We present two clinical cases of patients with posterior cortical atrophy (PCA), characterized by progressive impairment of visual and spatial functions due to atrophy of the parietal and occipital lobes of the brain. A differential diagnosis was made between AD, corticobasal degeneration and other diseases in which PCA syndrome occurs. In the cases observed, the patients showed a significant decrease in the level of beta-amyloid in the cerebrospinal fluid, which allowed the diagnosis of AD to be made. Clinical manifestations, diagnosis and treatment of PCA syndrome are discussed. At present, the diagnosis of AD at the stage of moderate cognitive impairment and mild dementia is of practical importance, as anti-amyloid therapy can prevent the progression of AD.

Diagnosis of Alzheimer's disease by using biological markers in posterior cortical atrophy

Grishina,

Khayalieva,

Grinyuk

et al. 2024

Alzheimer's disease: diagnosis and treatment, errors in patient management

Parfenov,

Grishina,

Tyurina

2024

Alzheimer's disease (AD) is the most common degenerative disease of the brain leading to dementia. AD is the most common cause of disability among age-related diseases. The diagnosis of AD is based on clinical findings and is confirmed by the presence of positive biological markers of the disease, which reflect the pathological formation of beta-amyloid and tau protein in the brain. Magnetic resonance imaging of the brain shows brain atrophy in AD and helps to rule out other diseases. Psychosocial and behavioral approaches form the basis for the treatment of patients with AD; cognitive training in combination with regular physical exercise is recommended. Acetylcholinesterase inhibitors and the glutamate receptor blocker memantine are used as drugs that improve the cognitive functions of patients with AD. Dispersible forms of memantine are used to treat dysphagia in patients with AD. The efficacy and safety of pathogenetic therapy aimed at eliminating cerebral beta-amyloid by passive immunization is under discussion. Unfortunately, AD is rarely diagnosed in our country; doctors are not sufficiently informed about the diagnosis and modern treatment methods of AD. Many AD patients are observed with the misdiagnosis of chronic cerebrovascular disease and do not receive effective therapy. A clinical observation of a patient with early-onset AD is presented, reflecting typical errors in patient management. Issues for optimizing the management of AD patients are discussed.

Biological markers of Alzheimer's disease in cerebrospinal fluid: clinical and laboratory comparisons

Shevtsova,

Rozhkov,

Grishina

et al. 2024

Self Cite

Diagnostic hypothesis of Alzheimer's disease (AD) is based on the typical clinical picture of the disease and the exclusion of other diseases manifesting by cognitive and behavioural disorders by MRI scans of the brain and laboratory tests. For an accurate diagnosis of AD and exclusion of other diseases, detection of biological markers (biomarkers) of AD in the cerebrospinal fluid (CSF) is of great importance: a decrease in the level of beta-amyloid (Ав^ -42) and an increase in the level of phosphorylated tau protein. The analysis of AD biomarkers in the CSF of 63 patients (16 men and 47 women, mean age 72±8.7 years) with a typical picture of AD [30 patients in the moderate cognitive impairment (MCI) stage and 33 in the mild dementia stage] allowed us to confirm the diagnosis in 54 cases (85.3%) and to exclude it in the remaining nine patients (14.7%). We present a case of a 59-year-old patient with MCI in whom biomarkers typical of AD were detected in the CSF, confirming the diagnosis of AD. We also present the observations of two patients with possible AD, in whom the results of the CSF examination made it possible to rule out AD and indicated hippocampal sclerosis and tauopathy. At present, an accurate diagnosis of AD based on the study of biomarkers of the disease is of great practical importance, since at the stage of MCI and mild dementia it is possible to prevent the progression of AD with anti-amyloid therapy. Currently, AD is rarely diagnosed in our country, so it is of great importance to inform physicians about modern methods of diagnosis and treatment of AD.