Today in our article we will talk about such an important function, which is called cognitive functions. In fact, these are the most important functions in everyone’s life, because it is thanks to them that a person can think, compose meaningful speech, express his thoughts in writing, make plans and holistically perceive the world around him.

In other words, we will consider what distinguishes man from animals, making him human.

Definition

The term “cognitive” itself is a scientific term, so it is not very often found in everyday vocabulary. And yet, this term reveals such human abilities that are familiar to everyone. It is cognitive functions that help a person find connections with the environment and build his ideas about the world as a whole.

Cognitive functions, also known as cognitive functions, are brain processes, they are aimed at ensuring that the individual can interact with others.

Human life largely depends on such a unique and important skill as the ability to remember and store information. Of course, the point of view according to which only memory is included in this definition is erroneous.

Cognitive functions are a complex mechanism, it is the interrelation of complex mental processes, the level of which differs from person to person. different people.

It is important that they can be developed and trained, but it is also important to remember that these processes can be disrupted due to various factors and personality disorders.

Naturally, the ability to perceive, store and reproduce information is very important, but these processes are impossible alone; the interrelation of different processes is important here.

Higher brain functions

In order to better understand this issue, it is necessary to consider cognitive functions separately.

1. One of the most important functions is attention. It can be characterized as the ability to concentrate mental processes on a specific object. Each person has individually expressed characteristics of this process, such as:
   • Sustainability;
   • Concentration;
   • Way to switch;
   • Concentration;
   • Volume.

   All these characteristics change the quality of attention in different people. It is because of them that it turns out that some people easily remember something, while others cannot concentrate their attention. But all these characteristics can also be developed by working on yourself.

2. Another important function is human perception. It is compiled based on information that a person receives from the senses in the form of unified images. For this function, constancy is important, in other words, an object that is perceived by a person regardless of changing conditions is always perceived as the same. For example, a person can recognize an acquaintance no matter how he is dressed or where he is. Animals are deprived of this quality, which is why a dog cannot recognize its friend who will be standing in the dark or if he is wearing different clothes.
3. Gnosis is the ability to recognize, visually identify images and compare them to categories.
4. Memory - this cognitive function makes it possible to imprint, store and right time reproduce previously received information.
5. Intelligence is already the ability to “work” with the information received: to analyze, compare facts, evaluate, generalize, and so on.
6. Speech is a unique skill through which people can communicate using symbolic signs.
7. Praxis is a complex of abilities that form and include motor skills in a person’s activities and help him build, learn and automate the sequence of his movements.

Below we will look at some of the functions in more detail. Since they are deeper and broader concepts, it will also help to better understand the nature of cognitive impairment.

A few words about intelligence

Speech and intelligence can be distinguished as cognitive functions of the brain. After all, thanks to this, a person can pronounce meaningful sounds that develop into speech. The cognitive functions of the brain give an individual the opportunity to conduct a monologue even without a speech apparatus, only pronouncing words in his thoughts.

Using symbols that correspond to sounds in humans, appears and written language. And how rich a person is lexicon and whether he can construct more complex phrases is related to his intelligence. One could even say that it is a person's unified cognitive ability, which relies on human functions such as attention, perception, memory and representation.

It was intelligence that separated humans and animals. However, intelligence itself is general concept, the implementation of which requires a number of mental functions, such as: the ability to plan, predict various events, taking the environment and gained experience as a basis.

In order to determine a person’s intelligence, it is necessary to take into account such person’s abilities as: learning ability, logical thinking, ability to analyze various information, as well as compare and find patterns in different phenomena.

And to characterize intelligence, the breadth and depth of thinking, logic, flexibility of mind, criticality and evidence of one’s conclusions are taken as a basis.

One of the important components of intelligence is erudition. Many people mistakenly assume that erudition and intelligence are the same thing, but this is far from true. Since an erudite merely has a large stock of knowledge, however, without intelligence, a person cannot use this “baggage” in any way, draw logical conclusions, and so on.

In order to measure intelligence today there are a number of tests. These tests are created based on a proven pattern, which says that if a person can solve certain type tasks, then he will successfully cope with other tasks.

Praxis or unique human ability

Humans have a number of important and unique cognitive abilities, one of which is praxis. This is a person’s ability to maintain a conscious sequence of his actions and movements. Praxis is the ability that appears in a person in infancy by giving the baby a rattle on his hand, thereby the parents lay the foundation for this function.

There are several types of praxis:

• Finger - when a person learns to use his fingers, then, as a result, gestures appear.
• Symbolic is already a complex of gestures that give an idea of ​​what a particular person wants to say. This is in some way reminiscent of the principle by which deaf people communicate: thanks to a set of special gestures, they can communicate without words.

Violation of this function in humans can lead to a number of undesirable consequences.

It’s probably no secret to anyone that each function is associated with a specific part of the brain. And this is natural, because every separate function has its localization in the brain. This represents separate areas of the brain that have a group of neurons, and they in turn are responsible for a certain type of nerve transmission.

For example, cognitive functions are located in the cerebral cortex. There are 3 sections:

1. Sensory – which processes signals emanating from the senses.
2. Motor – which is responsible for motor functions different parts human body.
3. Associative - it can be considered a kind of intermediary that provides communication between the sensory and motor areas.

The frontal lobes of the cerebral cortex are responsible for thinking, both logical and abstract, for speech, and planning one’s movements.

Processing of information obtained with the help of visual analyzers is carried out in the occipital lobe, while information received from hearing aids is analyzed in the temporal lobe.

There are more ancient areas of the brain that help provide basic skills for human survival.

Human memory, smell and emotions are expressed through the limbic system.

The thalamus provides redirection of impulses from different organs: vision, hearing, balance and tactile senses.
The hippocampus helps remember new information.

Awareness of one's own “I”, consciousness, in the adaptation of the individual and in the feelings of existence is an important role of the midbrain.

And all departments are closely connected with each other and interact by transmitting impulses by neurotransmitters: serotonins, dopamine, adrenaline, acetylcholine, etc. These neurotransmitters themselves can inhibit or accelerate cognitive tasks in humans.

From the above, it becomes clear that any disturbances: blood flow, brain damage or tumors in one area or another can cause cognitive disorders in a person.

Cognitive disorders

Even the slightest injuries can ultimately lead to various cognitive impairments. Naturally, these disorders vary in severity from mild to severe.

If you look closely at the reasons for the appearance of these violations, the factors leading to the violations can be divided into:

1. Degenerative diseases - Parkinsonism, Alzheimer's disease.
2. Vascular diseases - heart attack, stroke, atherosclerosis.
3. Metabolic problems - hypoglycemia, hepatic or renal encephalopathy, drug use (benzodiazepines, anticholinergics), hypo- or hyperthyroidism.
4. Neuroinfections.
5. Various brain injuries.
6. Brain tumor.

As for the type of violation, it will depend on the location of the influencing factor. However, this does not mean that if a violation occurs, you should give up. Not at all, because violations light form and even moderate severity, even in older people, can recover if correct and timely measures are taken and treated.

A few final words

Cognitive functions are abilities that are associated with the human brain and are dependent on human body generally. This is precisely the reason why in various violations, damage to the brain or body and under the influence of strong emotions, disruptions in the quality of cognitive functions are observed. When these failures reach noticeable limits, these decreases in quality are called cognitive impairment.

And this, in turn, affects a person’s entire life, affecting his various spheres: from simple everyday life to the social and professional spheres of the individual.

Fortunately, today there are many ways to combat cognitive impairment. Therefore, if you feel that you have some problems, minor impairments in cognitive functions: memory lapses, difficulties with perception, etc., then you need to fight it using one method or another.

Majority brain functions closely interconnected with the work of the central nervous system. It is these two elements that are responsible for controlling the body and mind. The interconnected work of these systems carries out the vital functions of the body. There are basic functions of the human body, such as sleep, the desire to reproduce, breathing and heartbeat. In addition, there are higher functions that “turn on” during conversation or memory. Each part of the brain is responsible for a specific functional set. Elements such as the cerebellum, pons and medulla oblongata are responsible for basic functions. The higher functions of the brain are controlled by the hemispheres and frontal lobes of the cerebral cortex.

The word “cognitive” is a scientific term and is not often found in everyday speech.

Having discussed how the human brain works, we can move on to the question of what cognitive functions are. This term is used to describe the mental processes through which a person gains the ability to perceive, transmit, analyze and remember various information. Thanks to these processes, a person gets the opportunity to interact with the world around him.

Daily human brain is in an active state. Cooking breakfast, reading books, driving and making small talk are carried out thanks to billions of complex calculations. Connections between neurons in different areas of the brain allow a person to establish contact with his environment. Thus, cognitive functions are responsible for communication contact not only between people, but also surrounding objects.

Quite often, when talking about higher cognitive functions, cognitive skills are mentioned, the purpose of which lies in interaction with the outside world. Although each of these skills is considered separately, most of them have strong relationships and various overlaps. Cognitive functions of the human brain include:

1. Attention– a rather complex process that covers many thought processes. It is difficult to give attention a clear and concise description and include it in a specific anatomical structure. Speaking figuratively, attention is a cognitive function with the help of which a person, among external (smells, sounds and images), as well as internal (thoughts and emotions) stimuli, selects those that will be useful in order to realize mental or motor activity. It is this formulation that allows us to most accurately characterize everything complex processes that participate in the work of other higher functions.
2. Memory– one of the most complex processes by which received information is encoded, stored and reproduced. The performance of this system plays a fairly significant role in Everyday life. This skill is closely intertwined with attention, since without it you can get full information impossible.
3. Executive processes– another complex system of a higher order. There is a sufficient number different definitions for this term, but most of them are characterized by the control of cognition and the regulation of the way of thinking, through the use of various processes that have little relationship. Executive processes are a collection of various abilities, among which we should highlight directed attention, elements of planning and programming, as well as the regulation of intentional behavior. The prefrontal cortex is responsible for executive functions.
4. Speech- a communication system through which communication between people occurs. Among the main functions of speech, in addition to establishing contact with people around us, we should highlight the construction of a competent structure of thinking. During speech processing, different parts of the brain are activated. The main interaction of various functional systems observed in the left hemisphere of the brain. Speech processing involves two cortical areas of the left hemisphere, which are responsible for the reception and expression of speech.
5. Visual perception– This set of higher skills includes functions that help a person to distinguish and recognize various stimuli. This set of skills allows you to categorize various objects and remember them. A properly constructed and adjusted system of visual perception allows a person to remember people’s faces, and gives the opportunity to find the differences between a screwdriver and a dress.

Cognitive functions are abilities that connect us with the world around us and allow us to form an idea of ​​it

Each of the above skills includes several subgroups that are closely interrelated.

How these functions are used

When examining the question of cognitive functions, what they are, special attention should be paid to the use of a set of these skills. Every day, the human brain takes part in a huge number of physical tasks. Each of these tasks requires millions of calculations that are performed in fractions of a second by different areas of the brain. As an example of the use of cognitive skills, let's consider the following situations:

Cooking involves multiple cognitive abilities. In order to prepare a meal, you need to remember the recipe and pay attention to the degree of readiness of the various ingredients. Thus, the brain competently distributes its activity and solves many incoming problems every second. Certain parts of the brain are responsible for communicating with other people. The ability to listen and understand the interlocutor is not all the cognitive skills that accompany a conversation. During a conversation between people, abilities such as concentration and attention are activated. It is thanks to these communication skills that a person has the opportunity to communicate with the people around him.

Driving a vehicle is a rather complex process that requires composure and increased concentration. The activation of this skill involves millions of neural connections that are responsible for a wide range of cognitive abilities. Many people think that relaxed automatic actions do not involve the use of cognitive skills. However, this opinion is wrong. These abilities are directly involved in this process, since without them a person would not be active in any way.

Cognitive impairment negatively affects a person’s achievements in various areas of his or her life.

How Cognitive Skills are Connected to Brain Regions

Let's move on to the question of how cognitive abilities are related to certain parts of the brain. This functionality is a special part of the brain that has its own group of neurons. The purpose of these neurons is to transmit certain nerve impulses. Decreased cognitive function can be caused by blood circulation disorders, traumatic brain injuries and malignant neoplasms in the brain.

Most cognitive skills are formed in the cerebral cortex. Scientists divide this department into three main zones:

1. Associative– responsible for ensuring the connection between sensory and motor skills. In addition, this zone determines the reaction of consciousness to impulses emanating from the sensory area.
2. Motor- responsible for various movements of the human body.
3. Sensory– responsible for processing signals coming from the senses.

The frontal lobes are directly involved in logical and abstract thinking, pronunciation and speech perception, as well as in planning movements. The occipital lobe is responsible for analyzing visual information, and the temporal lobe is responsible for auditory sensations. In the very center is a system that analyzes sensory feelings. There are certain parts of the brain that are responsible for skills necessary for survival. These skills include emotional expression, smell, and memory.

There are even brain sections that are involved in the redistribution of all incoming information, which contributes to the coordinated functioning of the whole organism.

The midbrain performs one of the main tasks and is responsible for awareness of one’s own personality. In addition, this department is responsible for adaptive behavior. The transmission of nerve impulses between departments is carried out using neurotransmitters. These elements include adrenaline, serotonin, acetylcholine and many other substances. It is these microelements that are responsible for the speed of various cognitive processes.

Cognitive performance is the ability to perform brain functions such as attention, memory, language, visuospatial perception, and executive functions

Various brain activity disorders

Impairment of cognitive functions can have varying degrees of severity. There are a number of specific factors that lead to changes in brain activity. These factors include traumatic brain injury, infectious and oncological diseases. In addition, they have a certain effect on the functioning of the brain. cardiovascular pathologies, such as atherosclerosis, stroke and heart attack.

An important role in the issue of cognitive impairment is played by degenerative diseases, such as Parkinson's or Alzheimer's disease. The development of various disorders in the functioning of the brain is facilitated by problems with metabolism and the functionality of the immune system.

Quite often, the type of violation depends on the form of exposure to certain factors. Some skills can be fully restored when the right approach to the treatment of the disease. However, the effectiveness of treatment directly depends on the timeliness of seeking medical help.

Man differs from animals in the presence of higher nervous activity. The ability to think, communicate using meaningful speech, express it in writing, as well as perform directed actions, plan and holistically perceive reality are combined into cognitive functions.

What do cognitive functions include?

Cognitive or cognitive functions are those brain processes that are aimed at interacting with other people and the world around us. Human life is extremely dependent on the ability to remember and store information, to correctly compare known facts, assume the consequences of their actions. The degree of development of such mental processes is individual; they can be trained, but can be disrupted under the influence of various factors.

It is a mistake to believe that cognitive functions are only memory (see). The ability to perceive, store and reproduce information is important, but it is impossible without other processes.

Attention is one of these functions, which is characterized by the ability to concentrate mental processes on a specific object. Each individual has the following characteristics:

• sustainability;
• switchability;
• concentration;
• concentration;
• volume.

The function of perception is the construction of integral images based on information received from the senses. Perception is characterized by constancy: an object is defined as the same regardless of changing external conditions. This ability is not typical for animals: a dog may consider a familiar person a stranger if he is in the shadows or wears unfamiliar clothes.

Find out why this happens with age: causes.

Cognitive abilities include praxis - the ability to produce a conscious sequence of actions or movements. The ability begins to be mastered as early as infancy when a rattle is placed in a child’s hand for the first time. Then finger praxis develops - the ability to manipulate one’s fingers, and gestures appear.

A special place is occupied by symbolic praxis - these are various gestures by which one can understand what a person wants to say, imitation of holding a telephone receiver, driving a car, drinking from a glass. The language of the deaf is roughly based on this principle: performing a special set of gestures allows you to communicate without words.

Connection of functions with parts of the brain

What are cognitive functions based on their location in the brain? They are thought of as special areas of the brain with groups of neurons responsible for a specific type of nerve transmission. Impaired blood supply, damage or tumor growths in these areas lead to impairment of the cognitive functions of the brain.

Cognitive functions are formed in the cortex. It is divided into three zones:

• sensory – involved in processing signals from the senses;
• motor – provides movement of different parts of the body;
• associative – provides a connection between the two previous ones, determines a behavioral reaction based on impulses from the sensory zone.

The frontal lobes of the cortex provide logical, speech, and movement planning. The centers for analyzing sensory sensations are located in the parietal region. The processing of data from the visual analyzer is carried out by the occipital lobe, and hearing in the temporal lobe.

Older parts of the brain provide basic survival skills. The limbic system is memory, smell, emotions. The thalamus is responsible for redirecting impulses from the organs of hearing, vision, balance and tactile sense. Memorizing new information occurs thanks to the hippocampus.

The midbrain plays a role in consciousness and self-awareness, feelings of existence, and adaptive behavior. The interaction of all departments and the transmission of impulses occurs thanks to neurotransmitters:

• serotonin;
• dopamine;
• GABA;
• adrenalin;
• acetylcholine.

It often happens that they slow down or speed up cognitive tasks.

Reasons for violation

The severity of the disorders can vary: from mild to severe. Factors influencing the development of pathology are:

1. Degenerative diseases: , Parkinson's.
2. Pathologies associated with blood vessels: heart attack and stroke, atherosclerosis.
3. Metabolic disorders: hypoglycemia, hepatic or renal encephalopathy, drug use (benzodiazepines, anticholinergics), hypo- or hyperthyroidism.
4. Neuroinfections.
5. Head injuries.
6. Brain tumors.
7. Pathology of cerebrospinal fluid outflow.

The type of violation will depend on the location of the damaging factor. Mild or moderate cognitive impairment, even after a stroke in the elderly, can recover with proper treatment.

Catad_tema Mental disorders - articles

Cognitive impairment in general clinical practice

A. Lokshina, Candidate of Medical Sciences, B. Zakharov, Doctor of Medical Sciences, MMA named after. THEM. Sechenov

Issues related to the relevance of studying cognitive impairment by doctors of different specialties are considered. Particular attention is paid to the diagnosis and treatment of non-dementia (mild and moderate) cognitive impairment, and the criteria for their diagnosis. The simplest neuropsychological methods for diagnosing cognitive impairment in old age are indicated, and the basic principles of treatment for such patients are described.
Keywords: cognitive functions, moderate cognitive impairment, mild cognitive impairment.

Cognitive Disorders In General Clinical Practice

A. Lokshina, MD; V. Zakharov, MD
I.M. Sechenov Moscow Medical Academy

The paper considers the problems concerning the topicality of a study of cognitive disorders by physicians of various specialties. Particular emphasis is placed on the diagnosis and treatment of non-dementia (mild and moderate) cognitive disorders and on their diagnostic criteria. The simplest neuropsychological methods for diagnosing cognitive disorders at old age are indicated. The basic principles in the treatment of such patients are described.
Key words: cognitive functions, moderate cognitive disorders, mild cognitive disorders.

Old age is the strongest and most independent risk factor for the development of disorders of higher brain (cognitive) functions. As the number of elderly people increases, the number of patients with cognitive disorders increases. Advances in the pathophysiology and neurochemistry of cognitive impairment, as well as new neuropharmacological data, now allow us to consider cognitive impairment as a partially curable condition. Therefore, timely diagnosis and as much early start treatment of cognitive impairment in older people, since when diagnosed late, these disorders often reach the level of dementia.

There are several reasons for late diagnosis of cognitive impairment. Firstly, there is insufficient understanding by both doctors and relatives of an elderly person of the nature of age-related forgetfulness. Many people believe that decline in memory and other cognitive functions is normal in aging and old age. That is why patients and their relatives do not go to the doctor or, when they do, they receive the answer: “this is age-related,” “what do you want at your age?” etc. Meanwhile, the effectiveness of treatment of cognitive impairment directly depends on the time of initiation of therapy. It is obvious that at the stage of extremely severe disorders, when patients lose self-care skills or cease to recognize others, the possibilities of providing assistance are very limited.

Another reason for late diagnosis is the insufficient knowledge of neurologists, psychiatrists, therapists, gerontologists and doctors of other specialties in its methods. The usual collection of complaints, anamnesis and clinical examination do not provide sufficient information about the state of cognitive functions. To identify cognitive impairment, neuropsychological methods are used, which are special tests and tasks to determine memory, attention, intelligence and other higher mental functions. Doctors of various specialties should use at least the simplest neuropsychological methods, such as the Mini-Cog test (see section “Diagnostics”) and other screening scales.

Timely detection of cognitive impairment is an important guarantee of the effectiveness of therapy, which can prevent or at least delay the onset of dementia. Adequate management of an elderly person with initial manifestations cognitive impairment significantly improves the quality of life of both the patient and his relatives.

Assessment of the state of cognitive functions and syndromes of their impairments
Cognitive (synonyms - higher cerebral, higher mental, higher cortical, cognitive) functions are among the most complex functions of the brain, with the help of which the process of rational cognition of the world is carried out and targeted interaction with it is ensured.

Cognitive functions include:

gnosis - perception of information, the ability to connect elementary sensory sensations into holistic images; violation of gnosis - agnosia or, with a lesser severity of violations, dysgnosis; a patient with agnosia sees an object, can describe it, but does not recognize it, despite the absence of primary sensory disorders;

memory - the ability to imprint, store and repeatedly reproduce received information; memory impairment - amnesia or, with less severe impairment, dysmnesia;

intelligence - the ability to analyze information, identify similarities and differences, general and particular, main and secondary, the ability to abstract, solve problems, build logical conclusions;

speech - the ability to understand spoken speech and express one’s thoughts verbally; speech disorders - aphasia or, with less severity of disorders, dysphasia;

praxis - the ability to acquire and retain a variety of motor skills, which are based on automated series of movements; Prakis disorders - apraxia

or, with a lesser severity of disorders, dyspraxia; a patient with apraxia cannot perform one or another action due to the loss of a skill (“forgot how” to perform certain actions), despite the absence of paresis, coordination disorders and other primary motor disorders.

Monofunctional cognitive impairment, i.e. isolated aphasia, agnosia, amnesia or apraxia, usually occur with local lesions of certain parts of the cerebral cortex as a result of stroke, traumatic brain injury, tumor and other causes. At the same time, in old age, most chronic progressive brain diseases of a neurodegenerative or vascular nature are accompanied by multifunctional cognitive disorders, when there is simultaneous depression of several (or all) cognitive functions.

To establish a nosological diagnosis, choose patient management tactics and determine prognosis, it is important not only to establish the nature of cognitive impairment, but also their severity. According to the classification of Academician of the Russian Academy of Medical Sciences N.N. Yakhno (2005), distinguish between severe, moderate and mild cognitive impairment.

Severe cognitive impairment (SCI) refers to mono- or multifunctional disorders of cognitive functions that lead to a complete or partial loss of independence and self-sufficiency of the patient, i.e. cause professional, social and (or) everyday disadaptation. SCI includes, in particular, dementia of a degenerative or vascular nature. According to epidemiological data, at least 5% of people over 65-70 years old suffer from dementia. The presence of dementia or other types of SBO indicates significant brain damage, which usually develops as a result of long-term pathological process. The prognosis in most cases is unfavorable, since SBO is most often progressive, less often stationary.

Moderate cognitive impairment (MCI) is a mono- or multifunctional disorder of cognitive functions that goes beyond the average age norm, but do not cause maladjustment, although they can lead to difficulties in difficult and unusual situations for the patient. MCI is observed in the initial stages of cerebral pathology. In older adults, the prevalence of MCI is 11–17%. The prognosis depends on the nature of the underlying pathological process and patient management. Over 5 years of observation, in 50% of patients MCI transforms into severe, in the rest they can remain stable or regress.

Modified diagnostic criteria MCI syndrome (MCI-revised); J. Touchon, R. Petersen, 2004:

cognitive impairment (according to the patient and/or his immediate environment);

evidence of decline in cognitive abilities compared to baseline more high level received from the patient and/or his immediate environment;

objective evidence of memory impairment and/or other cognitive functions obtained using neuropsychological tests;

absence of disruption of the patient’s usual forms of daily activity with the possibility of disruption of complex activities;

absence of dementia.

Mild cognitive impairment (MCI) is stated in the case of a decrease in 1 or several cognitive functions compared to a higher initial level (individual norm); MCI does not affect everyday, professional and social activities, including its most complex forms. MCI may be due to physiological process aging or are noted at the most early stages organic brain disease. In most cases, adequate therapy can reduce the severity of MCI.

Age itself can only cause mild and non-progressive cognitive impairment. In the presence of moderate or severe impairment, as well as in the presence of noticeable progression of cognitive impairment over a short period we're talking about about a current brain disease. In such cases, it is necessary to establish an accurate nosological diagnosis, which is based on the clinical and psychological characteristics of the existing disorders, laboratory and instrumental methods research.

Diagnosis of cognitive impairment
Given the high prevalence of cognitive impairment in older age groups, when working with elderly patients it is necessary to have a certain caution in this regard. Cognitive testing in all elderly patients is not warranted. However, such a study, from our point of view, is very advisable when:

active (self-stated) complaints by the patient about memory loss or difficulty concentrating;

family reports of recent cognitive decline;

the inability for the patient to independently and fully state his medical history or correctly follow the doctor’s recommendations;

symptom of “turning head”: in response to a doctor’s question, the patient turns his head to the accompanying relative and redirects the question to him.

To study cognitive functions, the doctor can use any neuropsychological methods known to him. We recommend the “Mini-Cog” technique to doctors of various specialties (see diagram). This technique does not take much time, but at the same time is very sensitive. The inability to remember at least 1 word after a hint or errors when drawing a clock indicate the presence of clinically significant cognitive impairment. The severity of such disorders can be determined in a conversation with relatives, asking them questions about the degree of professional, social and everyday adaptation of patients.

“MINI-COG” technique

1. Instructions: “Repeat 3 words: lemon, key, ball.” Words must be pronounced as clearly and intelligibly as possible at a speed of 1 word per second. After the patient has repeated all 3 words, we ask: “Now remember these words. Repeat them one more time." We try to ensure that the patient remembers all 3 words on his own. If necessary, present the words again - up to 5 times.
2. Instructions: “Please draw a round clock with numbers on the dial and hands.” All numbers should be in place, and the arrows should point to 13.45. The patient must independently draw a circle, arrange numbers and draw arrows. Hints are not allowed. The patient should also not look at a real clock on his hand or on the wall. Instead of 13.45, you can ask to set the hands at any other time.
3. Instructions: “Now let’s remember the 3 words that we learned at the beginning.” If the patient cannot remember the words on his own, you can offer a hint. For example: “You memorized some fruit... an instrument... a geometric figure.”

Treatment of cognitive impairment in old age
Therapy of cognitive impairment in old age has 2 main goals: preventing the progression of impairments and reducing the severity of existing disorders in order to improve the quality of life of patients and their relatives. Treatment should be, whenever possible, etiotropic or pathogenetic. In all cases, the following measures are advisable:

comprehensive examination of the patient, achieving the maximum possible compensation for cardiovascular and other somatic diseases;

control of vascular risk factors: arterial hypertension, hyperlipidemia, taking antiplatelet drugs, combating obesity and physical inactivity;

assessment of the patient’s emotional state and prescribing, if indicated, antidepressants that do not provide an anticholinergic effect (Coaxil, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors);

optimization of microcirculation and cerebral metabolic processes;

neurotransmitter replacement therapy to optimize synaptic transmission processes.

One of the most important areas of treatment for cognitive impairment is the use of drugs that affect cerebral neurotransmitter systems. Cognitive functions are integrative functions of the brain, i.e. they are formed as a result of its holistic (integrated) activities. Obviously, in the process of such integration, optimal functioning of synapses between neurons is necessary, which depends on the activity of cerebral neurotransmitters.

The choice of strategy for influencing cerebral neurotransmitter systems depends on the severity of cognitive impairment. Thus, the use of acetylcholinergic and glutamatergic drugs is currently the “gold standard” for the treatment of most of the most common forms of dementia. In case of MCI and MCI, it is more appropriate to influence other neurotransmitter systems, primarily dopaminergic and noradrenergic.

The dopaminergic and noradrenergic systems undergo significant changes during brain aging. Positron emission tomography studies of the brain indicate that up to 40% of dopaminergic neurons in the brainstem and limbic system die with age. This is accompanied by a significant decrease in the density of dopamine receptors in frontal cortex, which correlates with age-related cognitive decline. With age, the activity of noradrenergic mediation decreases, although the number of noradrenergic neurons does not decrease. With pathological aging, changes in the dopaminergic and noradrenergic systems significantly exceed physiological ones.

In clinical practice, among the dopamine agonists that are used for the treatment of age-related memory and attention disorders that do not reach the severity of dementia, piribedil (Pronoran, Servier) has proven itself to be the most effective. This drug combines the properties of a dopamine receptor agonist and a presynaptic α2-adrenergic receptor antagonist, increasing the activity of both the dopaminergic and noradrenergic systems. In addition, Pronoran has a vasoactive effect, improving cerebral and peripheral microcirculation.

The effectiveness of Pronoran in MCI was proven in a double-blind study. The work of D. Nagaradja and S. Jayshree (2001) demonstrated that with the use of the drug, cognitive improvement is achieved 2 times more often than with placebo (see figure).

Use of Pronoran for MCI (D. Nagaragja et al., 2001); The numbers indicate improvement on the KSHOPS scale (in%)

In Russia, the effectiveness of Pronoran in the treatment of cognitive impairment that does not reach the severity of dementia was studied in 2005-2007. within the framework of the “Prometheus” program (program for studying the effectiveness of Pronoran in the syndrome of mild cognitive impairment within the framework of dyscirculatory encephalopathy).

Part 1 of the Prometheus study showed a statistically significant positive effect of Pronoran administered at a dose of 50 mg/day for 12 weeks in 543 patients with MCI or MCI of age or age. vascular nature. The effect was determined by the results of such screening neuropsychological scales as the Mini-Mental Status Scale (MMS) and the Clock Drawing Test.

Part 2 of the Prometheus study involved 2058 patients (1447 women and 611 men), average age who were 64.9±8.3 years old, diagnosed with dyscirculatory encephalopathy stages I and II and MCI or MCI. Patients took Pronoran at a dose of 50 mg/day for 12 weeks. In addition, concomitant use of other vascular and metabolic drugs was allowed in 49% of patients. Satisfactory tolerability and safety of Pronoran were revealed. During therapy with it, the majority (at least 85%) of patients showed moderate or significant clinical improvement according to the Clinical Global Impression Scale. A study using neuropsychological scales and the Clinical Global Impression Scale did not reveal statistically significant differences between patients receiving Pronoran monotherapy and combination therapy. This indicates that combination therapy acceptable in terms of safety and tolerability, but does not provide additional benefit in terms of effects on cognitive impairment.

results this study confirmed the high prevalence of cognitive impairment in everyday outpatient neurological practice. Up to 70% of elderly patients who consulted a neurologist had some degree of cognitive impairment. This once again emphasizes the importance timely diagnostics and the beginning of treatment for cognitive impairment as one of the symptoms most common in neurological practice.

General understanding of the pathophysiology and neurochemistry of cognitive disorders and results clinical trials indicate the advisability of using the dopaminergic and noradrenergic drug “Pronoran” for disorders that do not reach the severity of dementia. The recommended dosage of Pronoran is 50 mg/day, the minimum duration of treatment is 3 months.

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Cognitive functions include the most complex processes controlled by the brain.
These are memory, speech, intelligence, praxis (performing purposeful actions)and gnosis (holistic perception of reality).

With their help, knowledge of the surrounding world is accomplished and purposeful interaction with it is ensured.

Thanks to cognitive functions, information is perceived, processed and analyzed, memorized, stored,constant exchange between individual parts of the brain, development of a specific program of action, its implementation and monitoring of results.

Sometimes, under certain circumstances, more often - in case of any illness or traumatic brain injury - there may be a deterioration in cognitive performance compared to the individual baseline level.

This occurs due to a decrease in one or more of its components (memory, praxis, gnosis, speech).

If cognitive decline is due to cerebrovascular disease ( encephalopathy, ), then the obstructed functioning of higher cortical functions is called vascular cognitive disorders.

The location and extent of brain damage determine the severity and nature of cognitive decline.
White matter dysfunction frontal lobes, which contains neuronal processes, leads to a decrease in cortical afferentation. As a result, the number of nerve impulses reaching the frontal cortex decreases, which means it receives less information.

If the deep parts of the brain suffer (both gray and white matter), secondary dysfunction of its anterior sections occurs.

Due to the fact that cognition is ensured by the coordinated activity of the entire brain at the same time, it does not have strict local connections with specific brain structures.

But different parts of the brain are not equal participants in this process. Each structural unit of the brain makes its own individual contribution, depending on the role it plays.

Accordingly, the brain is divided into
three large functional blocks.

1. First - neurodynamic - consists of the ascending part of the reticular formation, nonspecific nuclei of the thalamus and limbic system. These brain formations are considered structures of the first level of cognitive function.
They provide the brain with an optimal level of wakefulness, promote concentration and stability of attention, and create motivational and emotional accompaniment of higher brain activity.

2. Second functional block - secondary and tertiary zones of the cortical analyzers of hearing, vision, sensitivity. These include the temporal, parietal and occipital lobes of the brain. These areas of the brain receive and process various information.

3. Third , the highest functional level is formed by the premotor and prefrontal cortex. They are located in the frontal lobes,regulate voluntary human activity, are responsible, on the basis of the information received, for determining and setting goals, plan actions, carry them out and monitor the results obtained.

Therefore, damage to any of the listed anatomy - functional levels, leads to disruption of certain - or several or all cognitive processes.

Our brain has multimillion-dollar interneuron connections, it resembles a huge labyrinth, has a large . Connections between neurons form and change throughout life. Due to the multimillion-dollar and billion-dollar connections between various neurons and their groups, cognitive functions exist.

Formation of long-term memories and the brain's ability to retrieve them life experience occurs throughout life. The hippocampus is responsible for storing long-term memories. The more connections there are between neurons in the brain, the smarter and more experienced the brain is.