NEUROPSYCHOLOGICAL DIAGNOSTICS IN MEN WITH GAIT DISORDERS
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Abstract
Chronic disorders of the cerebral circulation (dyscirculatory encephalopathy (DE)) are one of the most common diagnoses in the practice of a neurologist; they have complex pathomechanisms of development and lead not only to physical but also to mental maladaptation and to disability of patients and, accordingly, to a decrease in the quality of life. In addition, in recent years the number of patients with chronic venous insufficiency has increased. Methods. 69 patients with DE were examined (49 patients with venous insufficiency of the legs, 20 patients with Leriche syndrome, mean age 53±5.9). All patients underwent: a clinical and neurological examination, blood biochemistry (extended); EEG, ECG, blood pressure monitoring, MRI of the head and neck, ultrasound dopplerography of the vessels of the lower extremities and the small pelvis, transcranial and duplex scanning of the brachiocephalic vessels; an ophthalmologist's examination (with a study of the state of the fundus vessels), the MoCa test. Results. Analysis of the quality of walking in the patients showed the presence of intermittent claudication, pain and swelling in the legs, convulsive twitching in the legs (at night time), and a disturbance of the "restless legs" syndrome in 100% of cases. The clinical and neurological examination revealed motor and sensory shifts of varying frequency, from insignificant small-focal signs to significant changes, in 99% of cases. According to vascular sonography data, a decrease in the blood flow velocity was noted both in the carotid and in the vertebrobasilar basins. When comparing the disturbed changes of the blood flow of the peripheral blood supply and the main one, a correlation was revealed, which is of important significance for the preconditions of chronic and acute disorders of the cerebral circulation. Analysis of the result on the MoCa scale showed that in 56% of patients with venous insufficiency a mild degree of cognitive impairment was revealed, whereas in patients with Leriche syndrome a moderate degree of cognitive impairment was revealed in 60% of cases, which directly correlates with the indicators confirming stenosis of more than 30%. Conclusion. Men over 45 years of age with complaints of fatigue, decreased attention and memory, gait disturbance and discomfort in the area of the vascular bifurcation should be assigned to the risk group and be recommended to undergo preventive examinations in order to exclude vascular pathology and to prevent the development of chronic cerebral ischemia and acute disorders of the cerebral circulation.
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