НЕКОТОРЫЕ КЛИНИЧЕСКИЕ АСПЕКТЫ СИНДРОМА ЭМОЦИОНАЛЬНОГО ВЫГОРАНИЯ У ПЕДАГОГОВ ОБЩЕОБРАЗОВАТЕЛЬНЫХ ШКОЛВинокурова А.С

The paper summarizes the literature and author's data on the development of early (preclinical) diagnosis of Parkinson's disease (PD). Implementation of this diagnosis will promote the use of preventive therapy and change investments in diagnosis and treatment of patients. The paper declares that at present the only approach to early diagnosis of PD is positron-emission tomography of the nigrostriatal dopaminergic system, but it cannot be used for preventive examination due to its high cost. The authors consider that a less specific, but more promising approach to the development of early diagnosis of PD is the search for markers in body fluids, mainly in the blood, in patients at the prodromal stage of PD. Indeed, a number of markers as changes in the level of metabolites of monoamines, sphingolipids, urates, and indicators of oxidative stress were found in patients selected for the risk group of the prodromal stage of PD, according to characteristic premotor symptoms. In addition, it is assumed that the search for blood markers at an earlier - pre-prodromal stage is possible only in animal models of PD at the early preclinical stage. This approach can also be used to verify blood markers identified in patients at the clinical stage of PD. It is also evident that the complex socio-economic factors influencing the incidence of PD is different in developed versus developing countries. The societal and medical costs of Parkinson's are huge and efforts to improve early preclinical diagnosis of PD will lead to considerable economical and societal benefits. For instance this will allow efficient selection of patients for preclinical diagnostic tests. To assess the effectiveness of this strategy considering the uncertainty of socio-economic issues, a modification of the «cost-utility» analysis is proposed. For the first time, a Markov model of PD including preclinical diagnostic tests and possible neuroprotective therapy was developed and studied. Analytical outcomes of this process suggest that the idea of developing a new multimodal strategy is promising from a socio-economic point of view.

We set and solved the problem of identifying socioeconomic determinants of Parkinson's disease (PD) by comparing the characteristics of different countries. Econometric analysis of panel data on 117 countries for 2010-2013 showed that the nature of the impact of a number of factors depends on whether a country belongs to the set of developed or developing economies. For both groups, the incidence of Parkinson's disease increases with life expectancy and decreases with the share of smokers. In addition, for developed countries, the incidence drops with increasing per capita consumption of fish and seafood and increases with amounts of fertilizer applied to the soil per hectare of arable land. For developing countries, the share of rural populations and per capita consumption of alcohol and vegetables are significant factors, with the incidence of PD decreasing with the first factor and increases with the last two. There is also reason to believe that in developing countries, the incidence of PD increases with the level of education; this is due to a decrease in physical activity of the representatives of the professions concerned. The findings are compared with the known results based on the study of patient samples for individual countries, and allow improving them. The results of this work can be used in patient selection procedures for early diagnostics of PD and are particularly important for developing countries where evidence-based recommendations have not yet been available.

OBJECTIVE:To identify features of cognitive impairment in patients with toxic (mercury or alcohol) encephalopathy.MATERIAL AND METHODS:The study involved 36 patients with chronic mercury intoxication and 30 people with chronic alcoholism. A control group included 30 age-matched healthy men who were not exposed to toxic substances and alcohol abuse. All patients underwent neuropsychological examination, which involved a set of neuropsychological Luria rated memory status, praxis, gnosis and speeches. MMSE and FAB were used for the diagnosis of moderate cognitive impairment. Computer electroencephalography and cognitive evoked potentials method were used as well.RESULTS AND CONCLUSION:The diffuse brain injury in toxic encephalopathy (alcohol and mercury) on EEG, and according to the results of neuropsychological testing was identified. Changes in analytical and synthetic thinking, audio-verbal, long-term, visual memory, reciprocal coordination, finger gnosis, impressive speech were observed in mercury encephalopathy. Functional failure of the frontal lobe and the premotor area of the left hemisphere were revealed in alcoholic encephalopathy.

To assess severity of cognitive disorders in chronic mercury intoxication, the authors performed claster and discrimination analysis of neuropsychologic and neurophysiologic research data from workers exposed to mercury during long length of service, from patients with early and marked stages of chronic mercurial intoxication. Cognitive disorders in chronic mercurial intoxication have three severity degrees, in the light degree disorders patients demonstrate lower amplitude of cognitive evoked potentials, poor long-term memory and associative thinking. Moderate cognitive disorders are characterized by decreased visual, long-term memory, concentration of attention, poor optic and spatial gnosis. Marked cognitive disorders with chronic mercurial intoxication present with more decreased long-term, short-term, picturesque memory, poor intellect, optic and spatial gnosis and associative thinking.

The character of disorders of higher mental functions in patients with toxic (mercury) and vascular (discirculatory) encephalopathy testifying a dysfunction of the subcortical-frontal systems which take part in regulation of cognitive functions has been shown in this work. Along with comparison of the disease clinical picture with the use of a discriminative analysis, there has been performed an assessment of the most informative correlations of the neurophysiological and neuropsychological indices allowing to use the differential approach to diagnostics of the brain injuries after exposure to neurotropic chemical substances and the vascular factor which in turn may promote a decrease in volume of paraclinical studies.

We have studied 154 men (mean age 61,4+/-4,1 years) with the first hemispheric ischemic stroke. Clinical and laboratory studies have revealed the androgenic deficit in 66,3%, with its frequency higher in patients with diabetes mellitus type II (50 and 26,3%, respectively). Forty-two men with diabetes mellitus type II and acquired androgenic deficit received replacing treatment with testosterone undecanoate in dose 1000 mg intramuscular. The treatment was started one week after the development of stroke, the next injections were given after 6 weeks and then every 12 weeks during 2 years. The control group included 30 males who did not receive androgens. After 2 years from the beginning of treatment, there were the decrease in clinical severity of androgenic deficit, the increase of total and free testosterone levels, and muscle power in the main group compared to the controls. Body mass index, glicated hemoglobin, cholesterol, triglycerides, low density lipoproteins have decreased as well. Secondary stroke has developed in 3 (7,1%) patients of the main group and in 5 (16,6%) controls; 12 (28,6%) patients returned to work in the main group compared to 2 (6,6%) in the control group. The treatment with androgens has a positive effect on risk factors of secondary ischemic stroke. It is an effective method for improvement of social adaptation of men survived after the stroke.