Diagnosis of cognitive dysfunction in the military with mental and behavioral disorders due to alcohol use associated with depression

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with depression and carrying out a correction of cognitive dysfunction by additional administration of cytoflavin. Conclusion: Based on a battery of diagnostic tests, accurate and adequately comparable indicators were obtained, which allowed to establish an objective picture of cognitive impairment, their correlation with depression, which significantly affected the outcome of treatment. Correction of cognitive dysfunction was performed by additional administration of cytoflavin 2 tablets 2 times a day PO for half an hour before meals. Key words: psychological tests, cognitive disorders, alcoholism, depression, cytoflavin.
Topicality. According to the literature, CI occurs in 50-70% of cases in patients who abuse alcohol, 80% of patients have symptoms of depression, alcoholic dementia is from 5 to 10% of all dementias [3,5,6]. Due to the importance of the impact on health of mild cognitive impairment (lasting from several months to several decades), which has not yet reached the level of dementia, but went beyond the age norm, today included in ICD-10 as an independent diagnostic unit -"Moderate cognitive disorders". This term can be used as a diagnosis, as was done in our study.
Materials and methods. With informed consent, the study involved 86 patients with mental and behavioral disorders due to alcohol consumption aged 21 to 59 years, who were hospitalized at the Military Medical Clinical Center of the Western Region of Lviv, Department № 16. According to informed consent, all patients underwent a neuropsychological examination to determine cognitive impairment. Short-term and longterm memory, orientation in time and space were studied using the Mini Mental State Examination (MMSE) scale [10]. This technique is now used both to assess the degree of cognitive impairment as a screening, and to assess the dynamics of improvement or stabilization of the condition on the background of treatment.
The scale consists of 9 items with a maximum score of 30 points. A lower total score indicates more serious cognitive impairment: 28-30 points -the norm; 24-27 points -obvious cognitive impairment; 20-23 pointsmild dementia; 11-19 points -moderate dementia; 0-10 points -severe dementia. On the plus side, it takes 10 minutes to complete such a scale. In addition, the technique is standardized, easy to apply and process the results, is characterized by good prognostic reliability, informative in the assessment of intellectual disability and can analyze all major cognitive components. Some authors [5] believe that the sensitivity of this technique is negligible, especially when it refers to a cognitive impairment of a mild degree. Therefore, to identify these violations more accurately, we used a battery of tests. Next was a clock drawing test.
The patient draws the clock independently and correctly places the hands on the dial to detect spatial-visual and regulatory violations. In the study of auditory functions, we used the method of "10 words", which was proposed in 1962 by A.R. Luria. The patient was asked to memorize 10 simple words, different in meaning, without semantic connection. After that, the number of correctly reproduced words and the number of repetitions were counted as points. The norm was 4-5 words from the first time, and all 10 words after 3-5 repetitions. Methodology of A.R. Luria is based on the hypothesis of "predominant lesions of the anterior parts of the brain" (dominance in alcoholism signs of damage of the frontal lobes of the brain), which explains the neuropsychological defect in the disease [2]. The assessment of the depression level was established on the scale of prehospital diagnosis of Tsung's depression, which included 20 variants of patients' independent responses. Each question had 4 answers: "never", "sometimes", "often", "constantly", which were used to assess the level of depression in patients and determine the degree of depressive disorder. The scale is characterized by high sensitivity and specificity, avoids additional economic and time costs. The number of points is: 25-49 normal, 50-59 mild depression, 60-69 moderate depression, 70 and above severe depression. The Spielberger-Hanin questionnaire, which includes 2 scales, was used to determine reactive and personal anxiety. Each part of the questionnaire contained 20 statements. The peculiarity of the scale is that it allows you to simultaneously measure anxiety as a stable individual feature of a person and as a state of anxiety that characterizes subjectively experienced emotions. Characteristically, in our study, low anxiety on the Spielberger-Hanin scale correlated with signs of depression. Low anxiety, in our case, indicated a depressed state with a low level of motivation [3]. Pain syndrome was determined by 10-point VAS and G. Eisenko's questionnaire, which is the implementation of a typological approach to the study of personality. Dynamic registration of the pupil diameter (pupillometry) was used to determine the human autonomic response by objectively assessing the pain response [13].
The principle of systematic selection of tests was to obtain accurate and adequately comparable indicators that would objectively assess cognitive impairment and in further treatment inhibit and, in some cases, prevent the development of severe cognitive impairment. To objectify the existing level of cognitive impairment, patients were examined in the dynamics (before and after the regression of symptoms), which increased the sensitivity of research methods in repeated studies.
Mathematical processing of the study results was carried out using the statistical software package "EXCEL" and "STATISTICA". Parametric characteristics were given as M ± m, where M is the mean value, m is the standard error of the mean value. Student's T-test was used to assess the significance of intergroup differences in the studied quantitative indicators.
Research results and their discussion. According to the principles of biomedical ethics, we conducted a study of 44 patients aged 22 to 59, whose average age was (38.79 ± 7.52) -the main group. The control group without signs of depression consisted of 42 patients aged 21 to 59, mean age (40.92 ± 7.68). The clinical and psychopathological picture of adaptation disorders at the beginning of the study was characterized by a predominance of 100.00% in all patients with a low mood. In 95.21% of patients psychopathological manifestations were accompanied by anxiety and had the character of general neurotic symptoms: irritability -87.12%, tearfulness -67.54%, emotional lability -71.12%, demonstrative behavior -37.6% and somatic complaints: headache -41.13%, shortness of breath -18.5%, pressure fluctuations -64.2%.
The data of clinical and psychopathological analysis were confirmed by the results obtained due to the dynamics of psychopathological symptoms. Assessment of psychopathological manifestations included sleep disturbances, mood swings, anxiety, fear, irritability, psychomotor agitation, chronic pain (Table 1).
In our study, it was important to study the mental state of patients with mental and behavioral disorders due to alcohol consumption, considering the impact of depressive symptoms on the functioning of the cognitive sphere.
Carrying out the design of the study, which consisted of a double examination of patients, revealed in 95.21% moderate cognitive impairment, in 75% depressive disorders of mild and moderate severity (table 1).
Analyzing the results of our research, we can say that the basis of cognitive disorders are emotional and behavioral reactions to certain events that are a direct result of thoughts about these events. Thus, in patients of group I at the end of the study there was an improvement in mood from 2.9 ± 0.07 to 0.80 ± 0.06 points (p <0.05); decrease in the frequency of awakening during sleep -normalized sleep (the beginning of the study had 2.47 ± 0.09 points, while at the end of the study, respectively, 0.60 ± 0.07 points) (at p <0.05); 2.90 ± 0.06 to 0.38 ± 0.02 points, significantly decreased emotional lability from 2.6 ± 0.05 to 0.41 ± 0.06 points (at p <0.05).
The results of the MMSE test corresponded to mild and moderate cognitive impairment (24.0 ± 6.60 and 27.10 ± 6.94), which according to the ICD-10 classification we diagnosed as "Moderate cognitive disorders". There was no statistically significant difference between MMSE values in the groups (24.0 ± 6.60 and 24.31 ± 6.70). Deviations from the norm were observed in almost all patients, indicating cognitive dysfunction. Most often, patients complained of sleep disturbances, memory impairment, lack of concentration, headache. Most patients showed a combination of impaired attention, memory, speed of information processing, which indicated the diffuse nature of cognitive impairment. The analysis of indicators for determining the level of depression by the above methods showed the following: the average score on the Tsung scale in both comparison groups was (46.68 ± 1.92 points and 47.35 ± 1.57 points, respectively). The level of anxiety was observed in 38 (88.4%) patients of group I and 37 (88.1%) patients of group II of comparison (p> 0.05).
Mental anxiety and affective tension in patients of both groups at the beginning of the study manifested itself in the form of sudden anger, rage and ended in physical weakness. Complaints of frequent headaches (3 points) were noted at the beginning of the study in both groups, which indicates an increase in withdrawal symptoms. Depressive disorders in the main group were characterized by polymorphism of clinical manifestations and comorbidity of depressive symptoms with other forms of pathology. Thus, in patients with signs of depression, autonomic crises began with chills, accompanied by rapid heartbeat, often with a feeling of numbness or lowering the temperature of the extremities, i.e. the symptoms were probably sympathoadrenal.
According to the results of the analysis of the Spielberg-Hanin scale, it was found that during treatment, anxiety decreased in the control group: personal anxiety after treatment was 19.12 ± 0.87 points against 21.34 ± 1.27 points and reactive anxiety was 10.63 ± 0.96 points against 26.54 ± 1.47 points. In the main group, the indicators of anxiety were reduced by 1.6 times during the observation, while in the control group the decrease was noted by 2.5 times, although this group of patients had no history of comorbid pathology in the form of depression. The nature of depression was significantly influenced by the dynamics of the level of anxiety, which for a long time in our study remained at the same levels, which is explained by a pronounced withdrawal syndrome. Removal of signs of depression and the prevention of severe manifestations of cognitive dysfunction we see in the use of the drug cytoflavin. Treatment with cytoflavin was performed in both groups. Thirty days after the end of treatment, most soldiers showed moderate levels of reactive anxiety and signs of mild depression. We see the prospect of further research in the development of effective methods of physical and psychological rehabilitation of soldiers to increase their adaptive capabilities.
Conclusion. In the study, we found a functional relationship between cognitive impairment and depression, and the pharmacological safety of the phyto-metabolic drug cytoflavin. Patients with mental and behavioral disorders due to alcohol consumption comorbid with depression were offered a comprehensive treatment (according to the protocol) metabolic drug cytoflavin 2 tablets 2 times a day for half an hour before meals, lasting 30 days. With a significant reduction in symptoms of cognitive dysfunction and signs of depression, the prescribed treatment was regarded as effective.