Currently, the number of patients with heart failure (HF) and cognitive impairment (CI) is growing. In this regard, it is necessary to screen for CI in patients with HF. The Mini-Сog test is one of the screening tests, but more research is needed to examine the feasibility of using it on a cohort of cardiac patients.

Aim of the study. The aim of the study is to assess the sensitivity and specificity of the Mini-Сog test in identifying patients with CI among patients aged 65 and over with HF.

Materials and methods. From March 2021 to March 2023, 149 people aged 65 and older with chronic heart failure

(CHF) were selected from a separate structural unit of the Russian Gerontology Research and Clinical Center of the Pirogov Russian National Research Medical University. Cognitive status was assessed using the Montreal Cognitive Assessment Scale and the Mini-Mental State Examination. All patients underwent the Mini-cog testing. Statistical analysis was performed using ROC analysis.

Results and conclusions. The prevalence of cognitive impairment among patients with CHF aged 65 or older, according to our study, is 67.8%. A cutoff value of 2 points or less points on the Mini-Cog test (AUC 0.856; CI 95% 0.7750.936, p < 0.001) indicates the presence of severe cognitive impairment with a sensitivity of 61.5% and a specificity of 92.1%. A score of 3 points or lower (AUC 0.828; CI 95% 0.762-0.894, p < 0.001) indicates mild cognitive impairment (MCI) with a sensitivity of 55.4% and a specificity of 93.7%, and dementia with a sensitivity of 80.8% and a specificity of 69.1%.

Aim. To examine the relationship between vitamin D levels and the prevalence and severity of depression in people aged ≥90 living in the nursing homes.

Materials and methods. A cross-sectional study was conducted on 351 people (25% men) aged 90-104, with a median age of 92, who were permanently residing in Moscow nursing homes. The Geriatric Depression Scale (GDS-15) was used to detect depression, with possible depression diagnosed at a score of 5. Vitamin D (25-hydroxycalciferol) levels were determined in blood serum using chemiluminescence analysis on microparticles, with normal levels ranging from 30 to 100 ng/ml.

Results. Depression is diagnosed in 67,2% of the oldest old. Vitamin D levels range from 3 to 36 ng/ml (median 6, interquartile range 5-8), and less than 1% of those with the highest vitamin D levels have a vitamin D deficiency. The absolute median difference in vitamin D between the oldest with and without depression is 2 ng/ml (p<0.001). A single-factor regression analysis shows that vitamin D in the institutionalized oldest old has a protective effect on depression: increasing vitamin D levels per 1 ng/ml reduces the chance of depression by 14% (OR 0,86; 95% CI 0,81-0,92; p<0,001). After adjusting for age, sex, children, education, and physical activity in the regression model, the association between vitamin D and depression remains significant for both vitamin D and high levels of physical activity as predictors of depression with protective effect: vitamin D (OR 0,86; 95% CI 0,80-0,93; p<0,001); high level of physical activity (OR 0,47; 95% CI 0,27-0,81; p=0,007). ROC analysis confirms a correlation between vitamin D and depression. Vitamin D levels ≤12 ng/ml predict depression levels with 71% sensitivity, 70% specificity, and 71% diagnostic accuracy. The ROC-curve area below 0.666 indicates a satisfactory model quality. The single-factor regression analysis shows that the chances of depression are 5,6 times higher at vitamin D levels of ≤12 ng/ml (OR 5,60; 95% CI 2,47-12,70; p<0,001).

Conclusion. Associations between vitamin D and the presence and severity of depression among the oldest old living in the nursing homes in Moscow have been identified.

Background. For screening of cognitive impairment (CI) in older and oldest-old patients, the GPCOG test seems promising.

Aim. The aim of this study was to validate the Russian version of GPCOG and to test it for significant CI screening in older and oldest-old patients.

Materials and methods. CI testing in geriatric patients involved the use of MMSE, Mini-Kog, and the Russian version of GPCOG. Validation process for the Russian version of GPCOG included testing its reliability, convergent and discriminant validity, as well as sensitivity and specificity. As part of the GPCOG testing, the results of CI screening were analyzed in various demographics, including male and female participants, individuals of varying ages, and those with different education levels. The data was analyzed using a variety of statistical techniques, including pairwise comparisons, ANOVA, correlation analyses, and ROC-analysis.

Results. The analysis was performed in a sample of 180 older and oldest-old patients and their informants. The Russian version of GPCOG demonstrated satisfactory internal consistency, with a Cronbach's alpha value of 0,785 for GPCOG-1 and 0,772 for GPCOG-2. The association between MMSE and Mini-Kog scores and the components of GPCOG varied depending on the degree of CI, providing further evidence of its validity. The sensitivity of the GPCOG-1, GPCOG-2, and GPCOG total scores were 82%, 87%, and 84%, respectively, which better than similar scores for MMSE and Mini-Kog. Comparable results were obtained when testing male and female individuals for all GPCOG components. The GPCOG testing outcomes were worse in patients of older age, as well as in patients without higher education (p < 0.05).

Conclusion. The Russian version of GPCOG has proven to be reliable, valid and informative tool and may be recommended for screening for significant CI in geriatric patients.

One of the common problems associated with aging is vitamin B12 (cobalamin) deficiency. According to some reports, it is present in every third person over the age of 60. Cobalamin is involved in numerous biologically important reactions, and its deficiency manifests itself in a range of disorders, including hematological and gastrointestinal symptoms, as well as pathology in various parts of the nervous system. The article discusses clinical variants of neurological disorders related to vitamin B12 deficiency, such as damage to both the peripheral and the central nervous systems. The relationship between cobalamin deficiency and the development of cognitive and other neuropsychiatric disorders in older individuals is discussed. Data on specific causes of vitamin B12 deficiencies in older individuals, including iatrogenic factors, are presented. Modern approaches to the diagnosis and correction of cobalamin deficiency are outlined, taking into account the characteristics of the geriatric population.

Type 2 diabetes mellitus (T2DM) is one of the most common chronic non-communicable diseases, and the rate of increase is higher than predicted. This is an age-associated disease that is more common among older patients, whose proportion is also increasing in both absolute and relative age groups. Despite advances in the treatment of T2DM and a wide range of hypoglycemic drugs, complications of this disease, primarily micro- and macrovascular, remain a public health problem. It is also known that T2DM is a risk factor for the development of dementia. Furthermore, there remains a significant prevalence of hypoglycemia among patients with T2DM who are undergoing hypoglycemic therapy. This poses a potential threat to older patients, increasing their risk for cardiovascular events and exacerbating cognitive impairments, because glucose is the primary energy substrate for the nervous system. Understanding the impact of hypoglycemia on the development of dementia in older patients and how these events interact, as discussed in this review, can further assist in developing prevention and risk minimization strategies.

This paper reviews the data on cerebrovascular changes in arterial hypertension obtained by magnetic resonance imaging (MRI). These include white matter hyperintensities (WMH), lacunar infarcts, cerebral microbleeds, enlarged perivascular spaces, and brain atrophy. Microstructural white matter changes precede WMH, and can be detected using diffusion tensor MRI (DTI), which allows the analysis of fractional anisotropy (FA), indicating white matter lesions in the early stages of hypertension.

Introduction. The problem of safe pharmacotherapy for vascular cognitive impairment (VCI) in patients aged 60 and over is a leading one due to the increasing life expectancy of the population. VCI associated with cerebrovascular diseases is common among geriatric syndromes. Due to multimorbidity, patients of the “silver age” often experience polypharmacy, which can lead to decreased activity in daily life, side effects and adverse drug interactions. Additionally, age-related involutive processes in older patients require increasing drug dosages and constant monitoring of vital signs and laboratory findings. Therefore, it is important to use drugs with a favorable safety profile and good tolerability in older and oldest-old patients in real clinical practice. A review of the results of multicenter, double-blind, placebo-controlled, randomized clinical trials on the safety of Prospekta for the treatment of VCI in patients over 60 confirmed the absence of significant differences in the number of adverse events (AEs) and serious AEs when taking Prospekta and placebo. No clinically significant deviations were found in laboratory parameters, nor were there any negative effects of Prospekta on vital signs, and no negative drug interactions with other basic therapies have been recorded for Prospekta.

Conclusion: Prospekta is a safe drug for the treatment of VCI in older and oldest-old patients and can be recommended in geriatric practice without the risk of negative impact on geriatric syndromes.

Background. Currently, there is no standardized method for assessing risk before cardiac surgery in older individuals. Recognized operative risk scales do not consider the features of older patients.

Aim. To create a scale that can forecast early postoperative outcomes after coronary artery bypass grafting in patients aged over 75 by conducting a comprehensive geriatric assessment.

Materials and methods. The study enrolled 83 patients aged 75 and older who required myocardial revascularization, with emergency surgery cases as the exclusion criteria. In addition to the standard screening, all patients underwent comprehensive geriatric assessment, including frailty screening, cognitive assessment, depression screening, grip strength, and short physical performance battery test (walking speed, sit-to-stand performance, standing balance).

Results. Six mathematical models predicting coronary artery bypass grafting outcomes were developed: duration of mechanical ventilation (р=0,012), length of stay in intensive care unit (р<0,001), duration of bed rest after surgery (р<0,001), duration of inotropic support (р<0,001), risk of acute cerebrovascular accident (р=0,015), postoperative length of stay (р=0,003). Within Microsoft Excel, mathematical models were used to devise the «Geriatric prognostic scale» for anticipating early postoperative outcomes post coronary artery bypass grafting. To estimate the risk, the following data must be entered: walking speed (m/s), grip strength (kg), sit-to-stand performance (sec), standing balance (sec), total score on the Brief Physical Functioning Test Battery, and total ejection fraction using the Simpson method (%).

Conclusion. The developed method allows for the early prediction of outcomes in coronary artery bypass grafting for patients over 75 based on functional status. This is a significant addition to traditional risk scales, which do not consider the features of older patients. The method is straightforward to implement and can be applied independently by the patient's treating physician.

Alzheimer's disease (AD) is one of the most prevalent neurodegenerative diseases worldwide. It is the leading cause of dementia in both older and oldest old population. The standard treatment for AD dementia is based on two groups of drugs: cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and NMDA glutamate receptor modulator memantine. At moderate and severe stages of dementia, it is often necessary to use both a cholinergic inhibitor and memantine simultaneously. This review discusses current capabilities, efficacy and safety of combined therapy for Alzheimer's. It also covers details the features of using fixed combinations of donepezil and memantine in clinical practice.