Cognitive impairment or cognitive deficit

Many people are quite unpleasant about the fact that they have difficulties in perceiving various information, rapid fatigue and other manifestations of decreased intellectual abilities. To describe such brain disorders, the medical term “cognitive disorder” is used . It should be noted here that this disease does not pose a threat to human life. You can cope with this disease with the help of medication and psychotherapy sessions. The modern level of medicine makes it possible to achieve not only stable remission, but also completely reduce the likelihood of the disease manifesting itself.

Mild cognitive impairment is an initial disorder of higher brain activity, mostly in the area of ​​memory

How do cognitive impairments manifest?

Cognitive impairment, what is it? In order to answer this question, let's look at what cognitive functions are. This concept reflects the ability to perceive and assimilate received information . In addition, cognitive functions include intelligence, the ability to navigate time and space, competent expression of one’s thoughts and motor skills.

At a certain period of life, a person encounters a problem, which is expressed in various malfunctions in the functioning of the functions in question. Forgetfulness and absent-mindedness, which appear from time to time, are not yet indicators of the development of the disease. However, when a person regularly encounters the fact that certain personalities, events and names of objects “fly out of his head,” one should think about the presence of disturbances in brain activity. In order to confirm or refute the presence of a cognitive disorder, you should contact a neurologist.

Myers–Briggs personality typology: cognitive functions

The Givenchy Blue Label scent is not suitable for everyone, so before choosing a perfume, I recommend deciding on your personality typology and only then choosing your scent.

Have you ever determined your psychological personality type using the Myers-Briggs typology?
If you did this using online tests, then most likely you determined your personality type incorrectly. Online tests tend to produce inaccurate results; There are several reasons for this: 1) the questions are too abstract and unclearly formulated; 2) the manifestation of bias (bias and partiality) when assessing oneself from the outside, which greatly distorts the test results; 3) Most free online Myers–Briggs tests use letter dichotomies (Type I, E, F, or T) instead of the cognitive-based theory of psychological types. Cognitive functions are “the ways of processing and making decisions associated with your Myers-Briggs personality type.” Each type has four (out of eight possible) cognitive functions that are used in a specific order. Determining the functions and the order in which you use them is the most accurate way to find out what psychological personality type you belong to. Functions imply a four-letter type - and nothing else. Cognitive functions
Cognitive functions are divided into extroverted (oriented toward action and interaction with the outside world) and introverted (oriented toward analysis and reflection).
Regardless of whether you are an extrovert or an introvert, each of us has two extroverted (dominated by extroverts) and two introverted (dominated by introverts) functions. Cognitive functions can also be perceptual (focused on perceiving new information and exploring possibilities) and decision-based (focused on drawing conclusions and implementing plans). Each person has two perceptual functions and two decision-based functions. It turns out that you have one extroverted perceptual function, one introverted perceptual function, one extraverted decision-making function, and one introverted decision-based function. Of these functions, one is intuitive, another is sensitive, the third is thinking and the fourth is perceiving. Well, let's look at each of the eight cognitive functions in more detail. Perceptual functions 1) Extraverted intuition (Ne)
Extraverted intuition creates new possibilities, synthesizes abstract ideas and grasps connections in the external environment.
Extroverted intuition is able to simultaneously consider many conflicting ideas because it sees almost all sides of any situation. This is a future-oriented function that considers all possible scenarios for what might happen next. People with predominant extroverted intuition tend to be excitable, enterprising, and creative. They enjoy discussing new ideas; They are versatile people and perceive everything in life as a challenge. They are constantly thinking about what to do next. They find it difficult to focus on one specific idea or plan. 2) Introverted Intuition (Ni)
Introverted intuition forms an idea of ​​how the world works based on a careful, abstract analysis of past and current events.
It aims to identify the “essence” of ideas, theories, people and situations in order to further fit them into a more general scheme. Introverted intuition is a far-sighted function aimed at identifying the optimal or most likely outcome of future events. People who are dominated by introverted intuition are distinguished by perseverance and perseverance; they are too susceptible to contradictions arising in the external environment. They enjoy riddles, puzzles and puns. They often have moments of "epiphany". Their extreme foresight is the result of a subtle fusion of introverted, future-oriented intuition and mediocre extroverted perception. 3) Extraverted Sensing (Se)
Extraverted sensing involves accepting the world (sights, smells, sounds and general physical stimuli of the environment) as it is in the present moment.
Extraverted sensing lives and thrives in the moment more than any other function. People who have a predominant extroverted perception are naturally well-built. They are extremely impulsive and love to be exposed to constantly changing stimuli. They value aesthetics highly and have a passion for “beautiful things” in life. People with predominant extroverted perception are generally not interested in overanalyzing a situation. They exude a natural sense of confidence and always know what they want. 4) Introverted Sensing (Si)
Introverted sensing is associated with increased attention to detail and storage of information.
It takes note of facts, events and phenomena as they are and classifies them, much like an internal file system. Introverted perception is a past-oriented function; she is fixated on what was and often gives free rein to nostalgia. People who have a predominant introverted perception are distinguished by organization and composure. They believe that they are prepared for any failure and always follow the beaten path. People with predominantly introverted perception believe that the future repeats the past. Decision-Based Functions 1) Introverted Feeling (Fi)
Introverted Feeling is a comprehensive analysis of emotional processes and morality.
This function seeks to understand emotions as deeply as possible. It also develops a powerful internal system of right and wrong that guides one's decision making. Introverted feeling seeks deeper meaning in absolutely everything. People with introverted feeling are in close contact with their emotions and often perceive others' joy/pain as their own. People who are dominated by introverted feeling are empathetic, analytical, and often concerned with moral issues. They are creative and artistic people. They feel that others will not be able to understand who they really are. People with predominant introverted feelings carefully hide their emotions and rich inner world from others. 2) Extroverted Feeling (Fe)
Extroverted Feeling is extremely concerned with conforming to social norms and maintaining the peace.
This function strives to do what is best for society; she is always concerned about other people's emotions. It is mirror-like, that is, it can cause a person to have problems understanding his own feelings without the participation of other people. Extraverted feeling requires constant social interaction more than any other function. People who have predominant extroverted feeling react strongly to how other people feel. They tirelessly seek communication, because only when they are with loved ones do they feel happy and cheerful. Such people strive to maintain harmony and preserve peace at any cost. They cannot enjoy their life to the fullest if the people around them are sick and unhappy. 3) Extraverted Thinking (Te)
Extraverted thinking seeks to bring order to the external environment as efficiently and consistently as possible.
Above all, it values ​​productivity. Extroverted thinking is a results-based and action-oriented function. Extroverted thinking naturally implements concrete plans to achieve goals and is able to make decisions quickly. People who have a dominant extroverted mindset are sincere, determined, and highly productive. They are natural leaders because they are not afraid to take responsibility and put things in order. People with predominant extroverted thinking may appear bossy or overly self-confident to those who lack this function. 4) Introverted thinking (Ti)
Introverted thinking is a function based on the collection of information.
It seeks to form an understanding of how the world works on a concrete, tangible level. Introverted thinking is good at understanding systems and is quick to pick up on inconsistencies within them. Introverted thinking seeks a deep understanding of how things work. People with predominant introverted thinking are reasonable, planned and objective. They look for shortcuts to achieving goals that increase efficiency within a given system. Such people are too closed in themselves; they will not feel comfortable until they understand the essence of things. What functions are characteristic of one type or another?
It is important to note that cognitive functions operate in specific groups, some of which are mutually exclusive.
For example, you cannot have extroverted feeling and introverted feeling—only one of the two. Additionally, the order in which each function is used is incredibly important. When considering psychological types, think about which functions you use constantly, rarely, or occasionally. How do you know in what order you are using your functions?
You can easily get confused while figuring this out.
More often than not, we are aware of our secondary rather than primary functions. This happens because we are somewhat removed from our secondary functions and are able to evaluate them more objectively. Imagine that you are in a swimming pool and your primary (or “dominant”) function is water. She is everywhere. This is what you do automatically, without concentrating on the process. This is your natural first instinct in any situation, so you can easily overlook it. Your secondary (or "auxiliary") function is a water slide. You can choose whether you should use it or not. You are clearly aware of her presence. It cannot disappear at your will, but you can ignore it for a while. To get to it, you will have to swim on water. Your third (“tertiary”) and fourth (“lower”) functions are less accessible to you; they may not fully develop until you reach middle age. When you are young, the third and fourth functions usually appear in stressful situations. If you start to sink in the water, your third and fourth functions will become a life raft for you to cling to. Eventually, you can turn them into pool toys that you use on a regular basis. The order of cognitive functions in which they are used (for each psychological personality type): ENFP: Ne – Fi – Te – Si INFP: Fi – Ne – Si – Te INFJ: Ni – Fe – Ti – Se ENFJ: Fe – Ni – Se – Ti ISTJ: Si – Te – Fi – Ne ESTJ: Te – Si – Ne – Fi ISTP: Ti – Se – Ni – Fe ESTP: Se – Ti – Fe – Ni INTJ: Ni – Te – Fi – Se INTP: Ti – Ne – Si – Fe ENTJ: Te – Ni – Se – Fi ENTP: Ne – Ti – Fe – Si ISFJ: Si – Fe – Ti – Ne ISFP: Fi – Se – Ni – Te ESFJ: Fe – Si – Ne – Ti ESFP: Se – Fi – Te – Ni E – extraversion (Extraversion); I – introversion; S – common sense (Sensing); N – intuition (iNtuition); T – Thinking; F – feeling (Feeling); J – judgment (Judging); P – perception. Why is it important to have an understanding of what cognitive functions are?
Understanding cognitive functions is key to determining psychological type.
Four-letter dichotomies cannot explain the complexity of our personality. Cognitive functions allow us to understand when we use each function and how this influences our decision-making process. Cognitive functions also help us easily determine the psychological personality type to which we belong. Now you know that the seemingly similar ENFP and ENFJ types actually have different cognitive functions. Finally, a deep understanding of cognitive function helps us recognize how personality type can develop without actually changing (theoretically, types remain constant throughout life). INFPs may develop extraverted thinking in their thirties or forties, but this does not mean they are now INTPs. They simply became a more balanced version of their own type. Material prepared by Rosemarina - Muz4in.Net
Copyright Muz4in.Net © - This news belongs to Muz4in.Net, and is the intellectual property of the blog, is protected by copyright law and cannot be used anywhere without an active link to the source. Read more - “about Authorship”

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Clinical picture

Cognitive impairment syndrome manifests itself as a set of specific symptoms. Experts involved in the study of this disease say that the clinical picture of this disease is interconnected with the condition of certain parts of the brain.

Damage to the left hemisphere causes the patient to have difficulty reading, writing and counting. At certain stages of the disease, difficulties with logical thinking, computational abilities and analysis appear. Damage to the right hemisphere leads to difficulties with orientation in space. In addition, the patient has problems with creative abilities. The lack of the ability to dream, fantasize and show one’s own emotions leads to the fact that a person is completely locked in his own world.

Such disturbances can lead to problems with the perception of sounds and smells. Also, the frontal lobes of the brain are responsible for the emotional perception of the surrounding reality and for memories. In a situation where the disease is accompanied by damage to the parietal lobe, the patient experiences difficulty with orientation, reading and writing. The occipital lobes are responsible for visual perception, the ability to analyze, recognize people and surrounding objects. When the cerebellum is damaged, the patient suffers from speech impairment and often exhibits inappropriate behavior.

Symptoms of the disease increase with intense intellectual stress

What are cognitive impairments, their types and mechanism of development

What are cognitive impairments? These are deviations in the normal functioning of the brain. They occur for various reasons in adults and can also appear in children. The human brain is a complex mechanism that regulates all physiological and mental processes in the body. Cognitive or cognitive functions include:

• 
  attention;

• memorization;
• intellectual abilities;
• ability to perceive;
• speech activity;
• gnosis (awareness of objects and images and the ability to attribute them to one category or another);
• praxis (the ability to apply one’s knowledge and skills in practice).

Any violation of them can provoke a change in personality and turn a rational person into an animal that is guided only by instincts. How do such disorders develop? First of all, this is due to a disruption in the connection between the cerebral cortex and subcortical structures. Depending on the location of the damage, the following disorders are distinguished:

1. Agraphia (problems with writing), acalculia (inability to count), alexia (problems with reading), failure to recognize letters, impaired logical, analytical and mathematical abilities. This occurs when the functions of the left hemisphere of the brain are impaired.
2. Disorientation in space, problems with imagination and creativity. This is due to pathological processes in the right hemisphere.
3. Violations in the frontal parts lead to problems with memory, speech, thinking and volitional processes.

4. 
   Pathologies in the temporal parts of the brain deprive a person of the ability to distinguish smells, sounds, visual images, and also distort sensory perception.

5. In case of disturbances in the parietal part, an inability to perform purposeful actions and problems with orientation in space are observed (for example, they are confused about where the right is and where the left is).
6. With occipital pathologies, the functions of vision, color perception, and recognition of faces and objects are impaired.
7. Damage to the cerebellum is accompanied by suppressed emotions and inappropriate behavior.

Depending on the degree of damage, the following cognitive disorders are distinguished:

1. Lungs. They have virtually no effect on a person’s daily life, are not noticeable to others, and are difficult to identify using tests. They manifest themselves in some inhibition of mental activity. For example, it is difficult to switch attention, it is difficult to remember what did not cause problems before.

2. 
   Moderate. This is an intermediate state, which is characterized by more pronounced deviations in the cognitive sphere. Such disorders affect up to 20% of older people. They manifest themselves in significant deterioration of memory and attention, increased fatigue from performing intellectual tasks, and impaired speech functions.

3. Severe (dementia). This brain disorder is also called dementia or insanity. Most often observed in old people. This is complete or partial degradation of personality.

Brain activity is a very complex mechanism. Any violation of it contributes to the emergence of deviations that significantly affect human behavior.

Mild form of cognitive impairment

Mild cognitive impairment, what is it? This form of the disease is a kind of initial stage in the development of disturbances in brain activity. Most often, this form of the disease affects the patient’s memory. One of the main reasons for the formation of this pathology is age-related changes in the body. In addition, traumatic brain injury and encephalitis can lead to the development of mild cognitive impairment.

This type of disease is characterized by increased fatigue when performing activities that require constant concentration. In addition, the patient experiences absent-mindedness and problems performing goal-directed tasks. Quite often, patients experience difficulties with understanding the information received and problems with the correct verbal reflection of their own thoughts.

Psychology experts say that this process is completely reversible. Symptoms of the disease in question appear only in the case of prolonged mental stress. Adequate sleep and long rest are enough to completely get rid of the manifestations of the disease. But it is important to note that in order to prevent the possible progression of the disease, you should pay increased attention to your health.

Symptoms

Cognitive dysfunction manifests itself in a decrease in cognitive abilities. Memorization, short-term and long-term memory deteriorate (see Memory impairment in children). Problems arise with assimilation of information, its reproduction - retelling and answering questions from teachers. The severity of the manifestations depends on the degree of brain damage, as well as the educational neglect of the baby.

Mild cognitive impairment in a child is usually characterized by hyperactivity disorder and attention deficit disorder, arithmetic and agrammatic dyslexia, and speech disorder. Such individuals experience restlessness, irritability, inability to concentrate, and sometimes stuttering, which results in problems with their studies.

Mild decline in cognitive functions in children is usually mistaken by teachers and parents for weakness of will and bad behavior, which makes correction difficult. The first manifestations are observed at the age of 5-7 years, when the child enters school. This degree is quite easy to correct and the prognosis is favorable.

It is important to learn how to treat autism in children and stabilize their condition.

What is attention deficit disorder in children: signs, causes, treatment.

Moderate cognitive impairment in children is usually accompanied by cerebral palsy, epileptic syndrome and other neurological abnormalities. In this case, the child has a delay in psychomotor development. Speech learning is inhibited. There may also be problems with motor hyperactivity and increased nervous excitability.

Severe cognitive impairment is the most difficult to correct. It is observed in babies with congenital genetic defects (Down's disease, glycogenosis). The following symptoms are noted:

1. Inability to self-care.
2. Severe speech development disorder.
3. Convulsions, prolonged hysterical crying.

Such children, after proper pedagogical correction, can adapt to life and socialize, but they require the help of relatives or guardians.

Moderate form of pathology

Moderate cognitive impairment is characterized by deterioration of brain activity that extends beyond the age group of the patient. The moderate severity of the disease is indicated by symptoms that do not reach the level of dementia. Often, the symptoms characteristic of this form of pathology appear closer to the age of sixty.

Failure to take timely measures can lead to the patient developing dementia in the next few years. According to statistics, approximately every third patient experiences slow disease progression. If at this moment there are problems with several cognitive functions at once, it is necessary to urgently consult an experienced doctor.

A decrease in cognitive productivity manifests itself in the areas of memory, thinking, speech, behavior

Severe cognitive impairment

This form of pathology is observed in patients in the older age group. Most often, the development of pathology causes the progression of Alzheimer's disease. This disease is characterized by the death of certain neurons. One of the first signs of AD progress is partial memory loss. Some patients lose memory of quite important life events. At certain stages of the disease, the inability to navigate in space and correctly express one’s own thoughts appears. Due to difficulties in everyday life, a sick person needs careful care and care from loved ones.

Cognitive impairment in cerebrovascular diseases is quite common. In this situation, it is not the memory itself that suffers, but the patient’s intellectual abilities. The patient has difficulty concentrating, the train of thought slows down and the ability to distinguish between received information disappears. A severe form of cognitive impairment is accompanied by a significant increase in muscle tone, which leads to a change in gait. The presence of the above symptoms is a kind of signal about the need for treatment and a neuropsychological examination.

Cognitive impairment in young and middle-aged patients: diagnosis and approaches to therapy

The article discusses the most common causes of cognitive impairment in young and middle-aged patients (depression, anxiety disorders, vascular cognitive impairment). The issues of diagnosis and differential diagnosis of cognitive impairment, including the use of neuropsychological research methods, are discussed in detail. Modern approaches to the treatment of cognitive impairment in young and middle-aged patients with anxiety-depressive and vascular cognitive impairment are outlined.

Table 1. Classification of cognitive impairment

Rice. 1. Causes of cognitive impairment in young (A) and middle-aged (B) patients

Table 2. Diagnostic criteria for depression according to the International Classification of Diseases, 10th revision

Rice. 2. Mechanisms of formation of cognitive dysfunction in depression

Table 3. “Cold” and “hot” symptoms of depression

Table 4. Methods for studying cognitive functions in anxiety and depressive disorders

Table 5. Dynamics of psychometric indicators before treatment, after two and eight weeks of treatment with Adepress

Rice. 3. Quality of life indicators in patients at the beginning and end of the course of treatment with choline alfoscerate according to the SF-36 questionnaire

Table 6. Dynamics of cognitive and neurological disorders while taking choline alfoscerate, points

Many young and middle-aged patients, when seen by doctors of various specialties, present cognitive complaints: deterioration of memory and performance, decreased concentration, increased distractibility, difficulties in learning and acquiring new professional skills, etc. [1–3]. Cognitive impairment in young and middle-aged people is a serious social problem, since these are the most able-bodied groups of the population. Timely diagnosis and selection of adequate treatment depending on the etiology of cognitive impairment can significantly improve the quality of life of patients and prevent or slow down the progression of cognitive disorders.

Cognitive disorder is defined as a decline from an individual's premorbid level in one or more higher brain functions, such as perception, memory, praxis, executive function, attention, language, and social intelligence [4]. Depending on the degree of severity, subjective, mild (moderate) and severe cognitive impairment are distinguished (Table 1) [5, 6].

Diagnosis of cognitive impairment in young and middle-aged patients

To clarify the cause of cognitive impairment in young and middle-aged people, their quantitative and qualitative characteristics should be assessed and the history of the development of cognitive impairment should be studied. To achieve this, all patients with cognitive complaints, in addition to assessing their neurological status, must undergo a neuropsychological examination [1]. In this case, specific neuropsychological techniques are selected individually depending on the characteristics of the clinical case. In young and middle-aged people, neurodynamic tests (Digit Symbol, Trail Making Test, etc.) have the greatest sensitivity.

Due to the fact that cognitive complaints in young and middle age often arise against the background of emotional disorders, it is necessary to carefully examine the emotional-behavioral sphere in all patients [1, 7, 8]. To objectify emotional and behavioral disorders, special psychometric scales can be used. These may be questionnaires that the patient fills out (Beck Depression Inventory, Hospital Anxiety and Depression Scale, Spielberger Anxiety Scale) or rating scales that assess the severity of symptoms by the attending physician (for example, the Hamilton Depression Scale) [1, 7–10].

When examining patients with cognitive impairment, it is important to identify potentially curable disorders associated with complications of various somatic and/or endocrine diseases (hypothyroidism, deficiency of vitamin B12 and folic acid, renal and liver failure, respiratory failure, chronic hypoxia of a different nature, etc.). With timely diagnosis, cognitive impairment as part of dysmetabolic encephalopathy can be completely reversible, and on the contrary, with a significant duration, dysmetabolic disorders can lead to irreversible structural damage to the brain. Therefore, patients with cognitive impairment should undergo a thorough physical examination, appropriate laboratory tests, and treatment of concomitant diseases [1, 11].

The minimum laboratory tests that should be performed in all patients with cognitive impairment include:

• general blood and urine analysis;
• biochemical blood test with determination of the concentration of creatinine, urea nitrogen, activity of liver enzymes (alanine and aspartate aminotransferases, gamma-glutamyl transpeptidase);
• lipid profile;
• laboratory testing of thyroid function (thyroid-stimulating hormone, triiodothyronine, thyroxine, antibodies to thyroid peroxidase and thyroglobulin);
• determination of plasma concentrations of vitamin B12 and folic acid [1, 12].

In some cases, a blood test for syphilis and determination of antibodies to the human immunodeficiency virus, hepatitis B and C are also necessary.

It is recommended to ask patients in detail about the medications they are taking, since many medications can worsen cognitive function (central anticholinergics, barbiturates, benzodiazepines, tricyclic antidepressants, typical antipsychotics). If cognitive impairment occurs, these medications should be avoided if possible.

Neuroimaging (magnetic resonance or computed x-ray tomography of the brain) is important for clarifying the etiology of cognitive impairment. Neuroimaging allows us to exclude a space-occupying process in the brain, ischemic and hemorrhagic stroke, chronic subdural hematoma, and normal pressure hydrocephalus [1, 11, 12].

The clinical nosological diagnosis of cognitive impairment is based on the characteristics of cognitive disorders, concomitant focal neurological symptoms and neuroimaging data.

In 2013–2014 on the basis of the Clinic of Nervous Diseases named after. AND I. Kozhevnikov First Moscow State Medical University named after. THEM. Sechenov conducted a study of non-dementia cognitive impairment in young and middle-aged patients. The nosological structure, clinical features of cognitive impairment, the relationship between cognitive and emotional impairment, and the effectiveness of the therapy were studied. The study included 87 patients aged 25–59 years. Of these, 31 were young patients (from 20 to 40 years, average age 34.61 ± 6.08 years) and 56 middle-aged patients (from 41 to 60 years, average age 54.05 ± 4.35 years), mostly women (83%) with non-dementia cognitive impairment. According to the data obtained, cognitive impairment was more often caused by anxiety-depressive spectrum disorders and cerebrovascular diseases (Fig. 1).

Cognitive disorders and anxiety-depressive spectrum disorders

According to the World Health Organization, about 450 million people worldwide suffer from neuropsychiatric disorders [13]. One of the most common neuropsychiatric disorders in the practice of doctors of various specialties is depression. Thus, according to the Russian epidemiological program COMPASS (2004), the frequency of depressive disorders in general medical practice varies from 24 to 64% [14–16].

Depression is commonly understood as a condition characterized by low mood, depression, a pessimistic view of the future, low self-esteem, guilt, motivational inertia, and decreased mental and physical activity [6]. The diagnosis of depression is based on the criteria of the International Classification of Diseases, 10th revision (Table 2).

Studies have shown that cognitive impairment is observed in 19% of patients with anxiety disorder and 21% of patients with depression [8]. The combination of emotional and cognitive disorders in depression and anxiety disorders significantly reduces the quality of life of patients, often leads to loss or deterioration of work ability, the emergence of family conflicts, and is generally characterized by large economic losses associated with both medical care and numerous social factors [3 , 7, 17].

Mechanisms of formation of cognitive impairment in depression

Both psychological and biological (neurochemical, morphological, pathophysiological) factors play a role in the development of cognitive dysfunction in depression (Fig. 2). Thus, the emotional state of a depressed patient can negatively affect the ability to correctly distribute attention (impaired selectivity of attention). For example, when such a patient is completely absorbed in an emotional experience, the perception, processing, analysis and memorization of other information that is not related to the content of the patient’s emotional experiences is naturally disrupted. The decrease in motivation that develops in patients with depression also has a negative impact on cognitive processes by weakening the activity of cognitive activity, which ultimately negatively affects the overall effectiveness of solving cognitive problems [18].

The decrease in the synthesis and activity of cerebral neurotransmitters (serotonin, norepinephrine, dopamine) described in depression is now considered the key neurochemical mechanism for the formation of emotional disorders (monoamine hypothesis of depression). However, the changes described above can lead not only to emotional, but also to cognitive dysfunction. In particular, the dopaminergic systems of the brain (mesocortical dopaminergic pathway) play an important role in the distribution and switching of attention and the implementation of cognitive control of the implementation of the intended program (the so-called executive functions of the brain). Activation of the noradrenergic system is necessary for more efficient memory of information coming from the senses. The serotonergic system of the brain is involved in the formation of motivation for cognitive activity. Thus, a decrease in the synthesis and activity of the above neurotransmitters, observed in depression, can be considered as a neurochemical substrate for the formation of cognitive syndrome [19].

Depression also promotes activation of the hypothalamic-pituitary-adrenal axis, which leads to increased activity of steroid hormones. The latter negatively affects the processes of neurogenesis and neuroplasticity of the brain and promotes the activation of age-related cerebral atrophic changes [20].

One of the important complications of depression is sleep disturbance. Secondary insomnia (associated with emotional distress) may also contribute to cognitive dysfunction in depression, since sleep completes the processing and consolidation of information received during the day. Lack of sleep leads to a decrease in activation of the cerebral cortex from the brainstem-subcortical structures, which will be clinically manifested by a decrease in concentration, activity and rate of cognitive activity [21].

Clinical manifestations of cognitive impairment in depression

Cognitive disorders in depression can be not only objective, but also predominantly subjective. Patients with depression usually present cognitive complaints such as increased fatigue during mental work, difficulty concentrating or maintaining an appropriate level of attention for the required time, difficulty switching attention, and increased forgetfulness, which can interfere with work, daily household activities, and learning. Currently, there are “cold” (cognitive disorders when working with emotionally indifferent information) and “hot” cognitive symptoms of depression (Table 3) [22, 23].

Clinical manifestations of cognitive impairment in anxiety spectrum disorders

Anxiety is a negatively colored emotion with excessive, tense anticipation of negative events, a feeling of unmotivated fear, poorly controlled anxiety, a feeling of internal tension, often accompanied by vegetative manifestations [6]. The prevalence of anxiety spectrum disorders is high – up to 30% of the population [24]. The following anxiety conditions are most significant for clinical practice: generalized anxiety disorder, post-traumatic anxiety disorder, panic disorder, obsessive-compulsive disorder, social phobias. Anxiety and depression often co-occur. According to a number of authors, depressive symptoms accompany anxiety spectrum disorders in 54–83% of cases [25, 26].

Cognitive impairments in anxiety disorders, as well as in depression, can be predominantly of both objective and subjective nature. Patients most often complain of difficulty concentrating on any activity, difficulty concentrating, decreased performance, and fatigue when performing cognitive tasks. In addition, patients report increased forgetfulness, irritability and impatience. Cognitive complaints of patients with anxiety disorders are usually exaggerated and do not correspond to the severity of objectively detected disorders [6].

The only method for objective assessment of cognitive functions is neuropsychological testing. Taking into account the clinical characteristics of cognitive impairment in depression and anxiety spectrum disorders, it is preferable to use neuropsychological techniques such as the literal association test, the Symbols and Numbers test, the number-letter connection test, tests for memorizing and reproducing verbal and visual material (Table 4) [6, 27].

Treatment of cognitive impairment in anxiety and depressive disorders

Both medicinal and non-medicinal methods are used to treat cognitive impairment in anxiety and depression. Among non-drug methods of treating cognitive and emotional disorders, an important place is occupied by cognitive training, various psychotherapeutic techniques (for example, cognitive behavioral therapy, which focuses on correcting the thinking characteristics of patients suffering from psycho-emotional disorders), lifestyle optimization (sufficient sleep, increased physical activity, balanced nutrition and etc.). Antidepressants are the main medications used to treat cognitive impairment caused by emotional disorders. When choosing an antidepressant, it is important to consider its effect on the cognitive sphere. Therefore, patients with anxiety-depressive disorders and cognitive impairment are preferably prescribed selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors.

A highly effective drug from the SSRI group, paroxetine, has antidepressant and anti-anxiety (anxiolytic) effects. The anxiolytic effect of paroxetine is superior to other SSRIs [28–30]. Its effect on muscarinic, alpha and beta adrenergic receptors is insignificant, which determines the extremely weak severity of anticholinergic, cardiovascular and sedative side effects. Many clinical studies have proven the effectiveness and good tolerability of paroxetine in the treatment of anxiety and depressive disorders, including in patients with somatic diseases [10, 29, 30].

There are several paroxetine preparations on the Russian pharmaceutical market, including Adepress, which is completely equivalent to the original drug. In 2009, psychiatrists conducted a comparative open study of the therapeutic equivalence of the original paroxetine and Adepress. The study showed that the drugs actually have equivalent clinical efficacy in patients with depressive disorders and equally reduce depression, anxiety, apathy, hypochondriacal and insomnia disorders [31]. Adepress, like the original drug, was well tolerated and rarely caused adverse events.

T.G. Voznesenskaya and N.M. Fokin studied the clinical effectiveness of Adepress in patients with mild and moderate anxiety-depressive disorders and psychovegetative syndrome [32]. The time of onset and sufficiency of the antidepressant, anxiolytic and vegetostabilizing effect, the tolerability of the drug, the spectrum of adverse events were assessed, and the optimal dose was determined. The study included 30 patients with psychovegetative syndrome and anxiety-depressive disorders of mild to moderate severity. The average age of the patients was 43.3 ± 8.5 years (from 25 to 55 years). The examination was carried out on an outpatient basis and included specific methods and indicators:

• clinical neurological examination and anamnesis data;
• Physician General Clinical Impression Scale;
• Patient Global Impression Scale;
• Autonomic Disorders Rating Scale;

Visual analogue scale for assessing the severity of headaches, well-being, and severity of side effects;

• Epworth Sleep Disorder Questionnaire and Daytime Sleepiness Questionnaire;
• quality of life questionnaire;
• Beck Depression Inventory;
• Spielberger anxiety scale;
• Munsterberg scale to determine the level of attention;
• Holmes and Rey Life Events Scale.

Patients were examined before the start of the study, after two and eight weeks of taking Adepress in monotherapy at a dose of 10–20 mg/day once in the morning. Side effects were observed only in the first two weeks of therapy in nine (30%) patients and resolved spontaneously; no dose adjustment or discontinuation of the drug was required. According to the results of the study, after eight weeks of treatment, the level of depression, personal and reactive depression, sleep disturbances, daytime sleepiness, autonomic disorders, the number of errors in the attention test decreased, well-being on the Visual Analogue Scale improved, and the quality of life increased. According to the results obtained, significant positive dynamics were noted after the first two weeks of therapy and increased by the end of the eighth week (Table 5).

Adepress is usually prescribed in a standard dose of one tablet (20 mg) once a day (in the morning). Adepress has a minimum of drug interactions and can therefore be taken with other drugs. It should be emphasized that the clinical effect of any antidepressant, including Adepress, does not occur immediately, but develops after several weeks of regular use. The anti-anxiety effect usually appears in the second or third week of therapy and increases as treatment continues. Therefore, at the initial stages of treatment, you can additionally prescribe alprazolam or clonazepam for two to three weeks. It is recommended to prescribe Adepress, like other antidepressants, for a long term, at least six months. No addiction or dependence develops. It is advisable to discontinue Adepress gradually over a month.

Cerebrovascular diseases and cognitive impairment

According to our data, the second most common cause of cognitive impairment in middle-aged people is cerebrovascular diseases. Vascular cognitive impairment is impairment of cognitive functions of varying severity, formed as a result of stroke and/or chronic progressive non-stroke vascular lesion of the brain. The following stages of vascular cognitive impairment are distinguished: asymptomatic vascular disease of the brain, mild and moderate vascular cognitive impairment and the final stage - vascular dementia. Among the most common causes of vascular cognitive impairment are arterial hypertension, diabetes mellitus, diseases of the cardiovascular system with a high risk of embolism in the brain (for example, cardiac arrhythmias, heart valve pathology, coronary heart disease), vasculitis, genetic vascular diseases (CADASIL , CARASIL, Fabry disease, etc.).

Clinical manifestations of vascular cognitive impairment

We can talk about vascular cognitive impairment if the patient has cognitive impairment that goes beyond the age norm, there is cerebrovascular disease, and a cause-and-effect relationship between cognitive impairment and vascular brain damage is determined. Despite the highly variable clinical picture, vascular cognitive impairment in the vast majority of cases is represented by a decrease in concentration of attention (fluctuation) and rate of cognitive activity (bradyphrenia), a violation of the executive functions of the brain (planning and control) in combination with visuospatial and mild mnestic disorders. Vascular cognitive impairment is also characterized by a frequent combination of cognitive and emotional-behavioral disorders: depression, apathy or affective lability. To make a diagnosis of vascular cognitive impairment, the presence of vascular changes identified on a magnetic resonance imaging scan of the brain is required: cerebral infarctions and/or severe leukoencephalopathy [33].

Treatment of patients with vascular cognitive impairment

Management of patients with vascular cognitive impairment primarily includes treatment of the underlying vascular disease that led to brain damage, secondary prevention of stroke, and improvement of cognitive function.

Currently, in domestic neurological practice, drugs with neurometabolic action, such as choline alfoscerate (Cerepro), are actively used for vascular cognitive impairment. Being a precursor of acetylcholine, the drug increases the content of this mediator in the brain, and also has a membrane-protective effect and enhances metabolic processes in brain neurons.

Cerepro is a compound that contains 40.5% protected choline, which is electrically neutral. The mechanism of action of the drug is based on the fact that when it enters the body under the action of enzymes, it is split into choline and glycerophosphate. The resulting choline is electrically neutral, due to which it penetrates the blood-brain barrier and enters the brain, where it serves as the basis for the formation of acetylcholine (the deficiency of which in the brain is of pathogenetic significance in neurodegenerative and vascular diseases accompanied by memory disorders and other cognitive functions). Choline also stimulates the synthesis of acetylcholine in the brain and improves the transmission of nerve impulses in cholinergic neurons. Glycerophosphate, as a precursor of neuronal membrane phospholipids, stimulates the formation of phosphatidylcholine, which restores the phospholipid composition of neuronal membranes and improves their plasticity.

Research by N.V. Pizova was devoted to assessing the effect of choline alfoscerate not only on cognitive functions, but also on indicators of quality of life (a specific questionnaire for assessing the patient’s quality of life - Short Form - 36, SF-36), as well as on the level of anxiety and depression (Hospital Anxiety and Depression Scale). depression) [34]. The study included 25 patients aged 45 to 59 years (mean age 53.8 ± 1.3 years) with moderate cognitive impairment of vascular etiology. All patients were prescribed the drug at a dose of 1000 mg in 200 ml of saline for 15 days, and then treatment continued on an outpatient basis - 400 mg (one capsule) three times a day for three months. During therapy, the severity of cognitive impairment decreased: the score on the Brief Mental Status Assessment Scale increased from 25.6 to 28.7. There was a statistically significant decrease in the severity of anxiety and depression and a significant improvement in the quality of life of patients. Subjectively, the therapeutic effect was determined already in the first week (from the fifth to sixth day), and from the 15th day it was recorded using objective research methods (Fig. 3).

The effectiveness of the use of choline alfoscerate in patients with moderate cognitive impairment of vascular origin was also studied in the work of T.N. Batysheva et al. [35]. The authors observed 46 patients (19 men and 27 women) aged 39 to 59 years (average 43.8 ± 7.2 years) with moderate cognitive disorders of vascular origin on an outpatient basis. The drug was administered at a dose of 1000 mg/day intramuscularly for 15 days. Good tolerability of the drug, subjective improvement in the patients' condition, and a statistically significant improvement in cognitive function indicators assessed using the Brief Mental Status Assessment Scale (an average increase of 1.5 points) were noted (Table 6). It should be emphasized that the drug was well tolerated and was characterized by a low incidence of side effects.

Conclusion

In young and middle-aged patients, cognitive complaints are predominantly associated with emotional disorders. In middle-aged patients, vascular cognitive impairment also plays an important role among the causes of cognitive impairment. When assessing cognitive functions in patients with anxiety and depressive disorders, it is advisable to conduct tests on neurodynamics and executive functions. In the treatment of such patients, both medicinal and non-medicinal treatment methods should be used. Correction of emotional and cognitive disorders in young and middle-aged patients is important for normalizing daily functioning.

Causes of the disease

Experts divide the causes of the development of the disease in question into two categories:

• organic;
• functional.

Functional mental disorder is closely related to prolonged emotional stress, stress and overexertion. The influence of these factors can lead to the development of the disease in a person of any age. In most cases, such factors lead to the development of a reversible form of the disease that does not require medical intervention.

Most often, proper rest and sleep normalize the patient’s condition.

Cognitive disorders often occur in older people.
Organic disorders of brain activity are a consequence of the effects of various diseases on the body. In most cases, such changes appear in older people and are sustainable. Despite this, there are modern methods that allow not only to achieve a positive result, but also to completely solve this problem. Experts have identified a whole list of different factors that cause various forms of severity of cognitive disorder:

1. Insufficient nutrition of certain parts of the brain. This category includes cardiovascular pathologies, hypertension and stroke. In order to reduce the severity of the symptoms of the disorder, the patient should pay increased attention to the level of blood pressure, as well as cholesterol and blood sugar.
2. Alzheimer's disease and brain atrophy. In this situation, the clinical picture progresses in stages, developing over many years. Timely therapy allows you to stabilize the patient’s condition and reduce the severity of the disease.

In addition to the above pathologies, cognitive impairment can be caused by metabolic disorders, cardiovascular failure, alcohol abuse and severe poisoning with toxic substances.

Why does cognitive dysfunction develop?

The etiological factors for the occurrence of cognitive disorders are classified into two groups: functional, which are also called temporary, and organic, provoked by a certain pathology in the brain.

Functional factors

Temporary cognitive impairments are not associated with changes in brain structures and therefore are not permanent. The etiological factors of this group are considered to be: psycho-emotional stress, prolonged exposure to stress, physical overload and the accumulation of a large number of negative emotions.

Cognitive deficits in this group can develop at any age and are not considered dangerous to humans. Symptoms of disorders become less pronounced or disappear completely after the cause of the problem is eliminated.

Organic pathologies

Cognitive disorders of an organic nature are more common in the adult population and can be caused by impaired blood supply to the brain, traumatic brain injury, metabolic or age-related changes.

Causes of cognitive deficits due to impaired blood supply include:

1. Hypertension.
2. Vascular atherosclerosis.
3. Pathologies of the cardiovascular system such as coronary heart disease or heart attack.
4. Strokes.

Pathological metabolic disorders are caused by:

• endocrine diseases: hypothyroidism and diabetes;
• kidney or liver failure;
• reduced intake or incomplete absorption of vitamin B12 and folic acid;
• frequent drinking of alcohol;
• smoking;
• taking drugs and certain medications.

Age-related changes in the brain are caused by atrophy, the causes of which may be Alzheimer's disease or Parkinson's syndrome.

Pathology in childhood

Cognitive impairments in children are recorded quite rarely and are a consequence of diseases that affect the central nervous system. The development of the disease in question may be associated with birth trauma or infectious diseases suffered during pregnancy. In addition, there is a possibility of congenital disorders in the functions of the nervous system.

In infancy, recognizing signs of cognitive impairment is quite difficult. It is the complexity of diagnosis that can explain the lack of positive dynamics in most cases in the disease in children. Timely measures taken allow not only to obtain a positive result, but also to consolidate it, which will avoid relapse of the disease.

Cognitive impairment in older people

Age-related changes in the body affect not only internal organs, but also the brain itself. According to experts, upon reaching the age of thirty, the brain mass begins to gradually decrease. By about age eighty, the average person has lost up to fifty percent of their neuronal mass. The remaining neurons change their functions, which leads to external changes . It is these changes that manifest themselves in the form of cognitive impairment.

Cognitive deficits are accompanied by increased irritability, a high degree of resentment, memory problems and limited thinking. Patients often exhibit mood changes and feelings of anxiety. Along with this, symptoms such as dissatisfaction with the behavior of surrounding people and disorientation in the social sphere are observed. If therapy is not started at this stage, further progress of the disease can lead to more catastrophic consequences.

Cognitive disorders take a major toll on memory

Diagnostic methods and therapy

Diagnosis of cognitive disorder is based on the collection of medical history and assessment of the patient’s condition by his immediate environment. In addition, the doctor’s task is to determine the neurological status using special testing methods. Along with this, various hardware studies are carried out to determine the state of the brain. To determine depression in a patient, a special Hamilton technique is used.

Therapy for the disease in question includes the use of drugs belonging to the neurometabolic group. Such medications include Pyritinol and Piracetam. In addition to them, various medications are used to treat asthma. From this category of medicines, Ipidacrine and Memantine should be highlighted. Complex treatment includes the use of combined agents, the action of which is aimed at increasing brain activity. Most often, the treatment strategy and prescription of drugs is carried out on an individual basis and is based on the form of the disease.

How to prevent the development of cognitive impairment

In order to avoid such problems associated with impaired brain activity, you should pay increased attention to your own health. Many experts recommend paying as much attention as possible to physical activity, communication with other people and memory training.

In order to reduce the risk of developing cognitive impairment, you should monitor your diet, stop drinking alcohol and stick to a proper diet. Today, many experts recommend treatment with herbal medicines for prevention purposes.