Parkinson’s disease (PD) produces both motor and non-motor symptoms, and among these an important position is occupied by cognitive impairment. This article provides an overview of the spectrum of cognitive impairment in PD, with analysis of their pathomorphological and neurotransmitter basis. Risk factors, diagnostic criteria, and issues of complex therapy including both neurotransmitter and neurotrophic drugs and methods of physical and cognitive rehabilitation are discussed.

The review is focused on essential tremor (ET), the most common extrapyramidal system disorder. Current understanding of the disease pathogenesis is provided; issues of classification and differential diagnosis are discussed. Modern ET treatment methods include therapeutic approaches and surgical interventions. The benefits of the new ET treatment method, the magnetic resonance-guided focused ultrasound treatment (MRgFUS), are described; the world’s experience of using the method, indications and contraindications are summarized.

Multiple system atrophy (MSA) is a severe, orphan disease characterized by a steady increase in symptoms of parkinsonism, cerebellar disorders, and autonomic failure. In addition to autonomic failure, which is considered the defining symptom of this type of atypical parkinsonism, there are a range of other non-motor clinical manifestations, such as sleep disorders, pain syndrome, anxiety-depressive disorders, cognitive impairment (CI). CI, especially severe CI, has long been considered as a distinctive feature of MCA. Recently, there have been many clinical studies with pathomorphological or neuroimaging confirmation, indicating a high prevalence of cognitive disorders in MCA. In this article, we discuss the pathogenetic mechanisms of the development of MCA and CI in MCA, as well as the range of clinical manifestations of cognitive dysfunction.

This review examines the current state of the problem of movement disorders in Parkinson’s disease (PD). The most difficult issues – objective diagnosis and treatment and rehabilitation of patients with PD with postural instability – are discussed. Particular attention is paid to dopamine receptor agonists, especially piribedil, and the potential for its use in correcting these disorders.

Parkinson's disease manifests itself in both motor and non-motor symptoms, that occupies an important place among non-motor symptoms. The article provides an overview of the spectrum of cognitive disorders in this disease, examines their pathomorphological and neurotransmitter basis. Risk factors, diagnostic criteria, as well as complex therapy, including both neurotransmitter and neurotrophic drugs, methods of physical and cognitive rehabilitation, are discussed.

Intestinal dysfunction and microbiome changes are actively discussed in the modern literature as the most important link in the development of neurodegenerative changes in Parkinson's disease. The article discusses the pathogenetic chain «microbiome- intestine-brain», as well as factors that affect the development of intestinal dysbiosis. A promising direction for influencing microflora and inflammatory changes in the intestine is the use of polyphenols, primarily curcumin. The review of experimental, laboratory, clinical research proving the pleiotropic effect of curcumin, including its antioxidant, anti-inflammatory, neuroprotective effects, realized both through peripheral and central mechanisms is presented.

The article is of a review nature and is devoted to tremor, one of the maladaptive and difficult-to-treat symptoms of Parkinson's disease (PD). Along with the classic rest tremor, patients with PD may experience tremor of other modalities: postural tremor, kinetic tremor, which reflects a multimodal mechanism of tremor formation involving multiple neurotransmitter systems. The unpredictable response to therapeutic options, the ambiguous response to levodopa, also reflects the role of multiple underlying pathophysiological processes. Among the drug methods of tremor correction, preference is given to dopamine receptor agonists - due to the spectrum of their pharmaceutical action, high efficiency in relation to all leading motor and a number of non-motor manifestations. The evidence for advanced neurosurgical, non-invasive modalities is mixed, and there are insufficient comparative studies to assess their efficacy in patients with tremor-dominant forms of PD.

Conditions associated with asthenia are usually characterized by increased fatigue, impaired activities of daily living and decreased productivity. In clinical practice it is important to distinguish between idiopathic chronic fatigue (primary or functional asthenia) and chronic fatigue syndrome (CFS). Fatigue can also be classified by neuromuscular and/or cognitive and mental fatigue. The article discusses the neuroanatomical basis and focuses on the neurocognitive theory of pathological fatigue. In addition the relationship between mental stress, fatigue and cognitive impairments such as subjective cognitive impairment (SCI) and mild cognitive impairment (MCI) are also discussed. We discuss the rationale that for treatment of asthenic conditions accompanied by cognitive dysfunction it is justified to use combination therapy - fonturacetam and a preparation containing nicotinoyl-GABA and Ginkgo Biloba.

The review presents current data on the peculiarities of the neurodegenerative process in the early stages of Parkinson’s disease (PD) and considers the hypothesis of the presence of body-first and brain-first subtypes of the disease onset. The earliest manifestations of the disease include symptoms such as parasomnia, constipation, hyposmia, anxiety-depressive disorder, daytime sleepiness, color perception changes, cognitive dysfunction, and mild motor manifestations. The diagnosis of PD can be made when characteristic motor manifestations occur: hypokinesia, rest tremor, muscle rigidity. Substantia nigra ultrasound, magnetic resonance imaging in SWI mode, and functional neuroimaging methods are used as confirmatory methods. The approach to the treatment of early stages of PD is age dependent. Patients over 70 years of age are recommended to start therapy with levodopa; younger patients – with dopamine receptor agonists (ADR), amantadines, MAO-B inhibitors. The mechanisms of ADR action, the possibility of their influence on the motor and non-motor symptoms of PD are analyzed. A special place is given to piribedil, which, due to the dual mechanism of action, has a positive effect on cognitive functions, depression, apathy, as well as a minimal effect on daytime sleepiness.

Болезнь Паркинсона (БП) является хроническим и прогрессирующим нейродегенеративным заболеванием, развивающимся в результате повреждения и гибели дофаминергических нейронов в чёрной субстанции. Клинический диагноз БП определяют спустя много лет от начала развития заболевания, когда значительная часть пула нигростриатных дофаминергичеких нейронов погибает. Возможно, с этим связана относительная низкая эффективность применяемой заместительной терапии в виде леводопасодержащих препаратов. В связи с этим главным приоритетом исследователей является поиск диагностических средств выявления БП на доклинической (продромальной) стадии. Учитывая, что одним из главных механизмов повреждения и смерти нигральных дофаминергических является окислительный стресс, целью данной работы было изучение изменений показателей окислительного стресса в крови пациентов группы риска развития БП, которые могли бы считаться потенциальными диагностическими биомаркёрами на продромальной стадии заболевания. Материалы и методы. В исследовании приняли участие 26 пациентов группы риска развития БП и 20 лиц соответсвующего возраста в качестве группы контроля. Главным критерием включения пациентов в группу риска развития БП явилось наличие расстройств поведения во время сна, нарушение обонятельной функции, вегетативная дисфункция кишечника (запор), а также неврологические и психические расстройства. Общий окислительный статус, общий антиоксидантный статус в плазме крови пациентов группы риска развития БП и группы сравнения определяли спектрофотометрическим методом. Результаты. Показано, что в крови пациентов группы общего риска повышен индекс окислительного стресса и уровень общего окислительного статуса, а также снижен уровень антиокислительного стресса. Заключение. Предполагается, что параметры окислительного стресса могут быть использованы в качестве диагностических биомаркёров на продромальной стадии БП. Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease that results from damage and death of dopaminergic neurons in the substantia nigra. The clinical diagnosis of PD is determined many years after the onset of the disease, when a significant part of the pool of nigrostriatal dopaminergic neurons die. This may be due to the relative low effectiveness of the replacement therapy used in the form of levodopa-containing drugs. In this regard, the main priority of researchers is to search for diagnostic tools for detecting PD at the preclinical (prodromal) stage. One of the main mechanisms of damage and death of nigral dopaminergic neurons is oxidative stress (OS). The purpose of this work wasto study changes in the oxidative stress index, as an integrative parameter of oxidative stress in the blood of patients at risk for developing PD, which could be considered potential diagnostic biomarkers at the prodromal stage of the disease. Methods: The study involved 26 patients at risk of developing PD and 20 age-matched individuals as a control group. The main criterion for including patients at risk for developing PD was disturbances in sleep behavior, olfactory function, autonomic intestinal dysfunction (constipation), as well as neurological and mental disorders. Total oxidative status, total antioxidant status in the blood plasma of patients at risk for developing PD and the comparison group were determined by the spectrophotometric method. Results. It has been shown that in the blood of patients at risk, the index of oxidative stress and the level of total oxidative status are increased, and the level of antioxidant status is reduced. Conclusion. It is assumed that oxidative stress parameters may be candidates for the role of diagnostic biomarkers at the prodromal stage of PD.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

MR-guided focused ultrasound (MRg-FUS) is a new noninvasive method for the treatment of contralateral disabling and pharmacoresistant tremor. Clinical studies have confirmed the high efficacy and safety of using MRg-FUS in patients with essential tremor and Parkinson's disease, in short and long-term studies. Advantages of this method in comparison with currently used invasive and noninvasive technics, potential brain target areas, the possibility of bilateral intervention, indications and contraindications are discussed.

The care of a patient with Alzheimer's disease (AD) is considered from the perspective of an ecosystem, that is, a systemic approach describing effective partnership, collaboration and research aimed at creating value, involving all participants in the AD patient journey. The effectiveness of this ecosystem is only possible with the involvement of all stakeholders in its development, including patients, healthcare professionals at all levels, government agencies, private companies, and patient organizations. The unmet health care and information needs of patients with AD are a consequence of barriers in the AD ecosystem. Key barriers for the patient include low awareness and stigmatization of the disease in society, lack of quality epidemiological data, difficulties in timely diagnosis, lack of prevention programs, unpreparedness of most physicians to conduct AD patient rehabilitation, and other factors. Based on the analysis of the ecosystem of AD and the patient pathway, 10 main directions (strategies) necessary for the formation of the ecosystem were identified: conducting research in the diagnosis and epidemiology of AD, creating and implementing a cognitive health program, forming a legal framework, raising public awareness, optimizing patient routing for timely diagnosis, organizing a network of memory clinics/laboratories, creating a register of patients with dementia, developing digital solutions and supporting social projects.

The authors describe dynamic MRI and clinical data after non-invasive treatment of tremor in the upper extremity. Thalamotomy by high-intensity focused ultrasound under MR-guided navigation was performed. A 57-year-old patient with Parkinson's disease underwent treatment with focused ultrasound. MRI of the brain was performed 1 and 48 hours, 47 days, 3 and 6 months later. Features of natural course of focal brain changes after treatment, data of MR tractography necessary for correction of target zone are described. The authors conclude that MR changes are characterized by presence of a focus in the area of focused exposure. Peak severity is observed on the second day after procedure with subsequent regression. MR-based analysis of predictors is promising to forecast treatment outcomes.

Constipation is one of the most common non-motor symptoms of Parkinson's disease. The pathogenetic mechanisms of constipation, diagnostic criteria, approaches to investigations and treatment are discussed in the paper.

This paper presents interdisciplinary consensus on the use of protocols of high-intensity magnetic stimulation for the treatment of pelvic floor muscles dysfunction with anal incontinence in Russia. AIM: to highlight the discussion and the decision-making on the basis of an interdisciplinary consensus on the use of a new algorithm of peripheral and transcranial magnetic stimulation in the treatment of pelvic floor muscles dysfunction with the clinic of anal incontinence. RESULTS: the adoption of this consensus can serve as a basis for further research of this problem and optimize the results of treatment of patients with pelvic floor muscle dysfunction with anal incontinence. The data may be interesting for a wide range of medical specialists: general practitioners, gastroenterologists, coloproctologists, surgeons, neurosurgeons, gynecologists, urologists — anyone who encounter with manifestations of this disorder in a routine practice and chooses diagnostic and treatment options. CONCLUSION: protocols for the treatment of anal incontinence using high-intensity magnetic stimulation aimed at improving the quality of treatment of patients with anal incontinence are based on the Russian experience of using the methods discussed and the analysis of the results obtained are validated.

The article presents data from recent studies on the mechanisms of action and clinical efficacy of amantadines, and also describes a possible protective effect against COVID-19.

Comorbidities of extrapyramidal disorders and multiple sclerosis (MS) are rare. The chance of a combination of MS and Parkinson's disease (PD) is less than 1 in 12.5 million. In total, 42 cases of joint development of these disorders are described in the literature. All described patients had no initial changes in the basal ganglia on MRI, and the development of MS was diagnosed after 1-8 years. Possible common links in the pathogenesis of neurodegenerative disease and MS, as well as the cumulative effect of the two diseases on the severity of axonal degeneration and neuronal loss are discussed. A description of a clinical case of a combination of early onset PD and relapsing-remitting multiple sclerosis is presented.

Restless legs syndrome (RLS) is seen widely in clinical practice. RLS commonly occurs at night time and presents with unpleasant or uncomfortable sensations in the legs that causes an urge to move them. This article describes the epidemiology, risk factors and pathophysiology of RLS. There is a detailed description of clinical presentations, diagnostic criteria and also management of RLS.