COGNITIVE AND HALLUCINATORY-PARANOID DISORDERS IN VASCULAR DEMENTIA (CLINICAL AND PSYCHOPATHOLOGICAL STRUCTURE AND DIAGNOSTIC CRITERIA)
DOI:
https://doi.org/10.32782/2226-2008-2025-2-8Keywords:
vascular dementia, hallucinatory-paranoid disorders, cognitive disorders, psychopathological structure, diagnostic criteriaAbstract
The aim of the study is to investigate the clinical and psychopathological structure of cognitive and hallucinatory-paranoid disorders in patients with vascular dementia (at different stages of the pathological process).Materials and methods. The work was based on the results of the study of 75 patients with vascular dementia (VD) and hallucinatory-paranoid disorders (HPD), who made up the main group. As a control group, 63 patients with VD without predominant HPD participated in the study. The complex of research methods included clinical and psychopathological, psychometric, psychodiagnostic and mathematical statistical methods.Results. The results of the study showed that the characteristics of HPD and cognitive disorders (CD) depend on the stage of VD development. The clinical and psychopathological structure of HPD in patients with VD in the middle stage of development (MSD) was characterized by the predominance of paranoid disorders with systematic ideas of damage, robbery, theft, which occurred in the form of paranoid delusional disorder.In patients with HPD with VD in late stage of development (LSD), the in clinical picture hallucinations were dominated (visual, auditory and tactile), which occurred in the form of hallucinosis.With the transition of VD from MSD to LSD, the frequency of cognitive disorders of praxis, gnosis, attention, language, orientation increased and thinking disorders deepened.Clinical manifestations of HPD in VD were formed in the structure of cognitive disorders, the transformation of which was determined by the stage of development of the pathological process.In this work, a categorical and dimensional analysis of HPD in patients with VD of different stages of development was carried out, their clinical, psychopathological and phenomenological structure, the interaction of cognitive and non-cognitive components, and types of courses were determined. The data obtained made it possible to form diagnostic criteria for different stages of VD development, which are the basis for increasing the VD treatment effectiveness.
References
Alzheimer's Disease International. Dementia statistics. https://www.alzint.org/about/dementia-facts-figures/dementia- statistics/ (accessed July 22, 2024).
Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024; 404: 572–628. DOI: 10.1016/S0140-6736(24)01296-0.
Nichols E, Vos T. The estimation of the global prevalence of dementia from 1990–2019 and projected prevalence through 2050: An analysis for the Global Burden of Disease (GBD) study 2019. Alzheimer's & Dementia 2021; 17(S10): e051496. https://doi.org/10.1002/alz.051496.
Omar SH. Unravelling the Threads: A Brief Insight into Vascular Dementia. J. Vasc. Dis. 2023; 2: 419–437. https://doi.org/10.3390/jvd2040033.
Borda MG, Landi F, Cederholm T et al. Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice. Lancet Healthy Longev. 2025 Jan; 6(1): 100666. DOI: 10.1016/j.lanhl.2024.100666.
Kalashnikov VY, Stoyanov OM, Vastyanov RS, Mirzhuraev EM, Sysun LA, Kolesnik OO. Assessment of the status of cognitive functions and autoregulation of cerebral blood circulation in patients with cerebrovascular pathology against the consequences of COVID-19. Clinical and Preventive Medicine. 2024; 6: 58–63 (in Ukrainian). https://doi.org/10.31612/ 2616-4868.6.2024.08
Akhter F, Persaud A, Zaokari Y, Zhao Z, Zhu D. Vascular Dementia and Underlying Sex Differences. Front. Aging Neurosci. 2021; 13: 720715. DOI: 10.3389/fnagi.2021.720715.
Liang CS, Li DJ, Yang FC, et al. Mortality rates in Alzheimer's disease and non- Alzheimer's dementias: a systematic review and meta-analysis. Lancet Healthy Longev. 2021; 2: e479–e488. PMID: 36097997. DOI: 10.1016/S2666-7568(21)00140-9.
Shevchenko-Bitenskyi KV. Risk factors for the development of hallucinatory- paranoid disorders in patients with vascular dementia. Medychna psykholohiia. 2019; 2: 70–73. https://doi.org/10.35339/ic.6.3.174-178.
Shevchenko-Bitenskyi KV. Social functioning of patients with hallucinatory- paranoid disorders in severe vascular dementias. Visnyk problem biolohii i medytsyny. 2019; 4(1(153)): 169–173. DOI: 10.29254/2077-4214-2019-4-1-153-169-173.
Maruta NO, Shevchenko-Bitenskyi KV. Program of comprehensive personalized psychosocial rehabilitation of patients with hallucinatory-paranoid disorders in vascular dementia. Visnyk problem biolohii i medytsyny. 2019; 4(2(154)): 144–149. DOI: 10.35339/ekm.2019.85.04.07.
Bachynskaia NYu, Kopchak OO. Cholinergic strategy in the treatment of cognitive impairment in elderly and senile patients. Mizhnar. nevrol. zhurn. 2014; 2: 84–92. https://doi.org/10.22141/2224-0713.2.64.2014.80563.
Maruta NA, Shevchenko-Bytenskyi KV, Kalenskaia HIu. Therapy of psychopathological and cognitive disorders in patients with hallucinatory-paranoid disorders in vascular dementia. Psykhyatryia, psykhoterapyia y klynycheskaia psykholohyia. 2020; 11(1): 213–223. DOI: 10.34883/pi.2020.11.1.021.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: a comprehensive assessment of psychopathology in dementia. Neurology. 1994. Dec; 44(12): 2308–14. DOI: 10.1212/ wnl.44.12.2308. PMID: 7991117.
Reisberg B, Auer SR, Monteiro IM. Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. Int Psychogeriatr. 1996; 8 Suppl 3: 301–8; discussion 351–4. DOI: 10.1097/00019442-199911001-00147. PMID: 9154579.
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry. 1984 Nov; 141(11): 1356–64. DOI: 10.1176/ajp.141.11.1356. PMID: 6496779.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov; 12(3): 189–98. DOI: 10.1016/0022-3956(75)90026-6. PMID: 1202204.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr; 53(4): 695–9. DOI: 10.1111/j.1532-5415.2005.53221.x.
World Health Organization. WHO psychiatric disability assessment schedule (WHO/DAS: with a guide to its use. World Health Organization. Geneva; 1988: 88. https://iris.who.int/handle/10665/40429.