Anxiety and Cognitive Disorders in Patients with Metabolic Syndrome: Clinical and Neuroimaging Diagnostics, Treatment
AbstractObjective: to study cognitive, psychoemotional state and brain neuroimaging in middle-aged patients with chronic forms of cerebrovascular diseases on the background of the metabolic syndrome; to explore the clinical efficacy, safety, effects on cognitive performance, anxiety of Vitaxon® national drug in patients with chronic forms of cerebrovascular diseases on the background of metabolic syndrome. Materials and methods. An open controlled study involved 60 patients aged 42 to 61 years (Me = 52 [Q1 = 54; Q3 = 60]) with metabolic syndrome. Patients of the main group (n = 30) received Vitaxon® in addition to the standard treatment. In the control group (n = 30), patients received only basic therapy. The criterion for inclusion in the study was the presence of anxiety and cognitive disorders in patients with І–ІІ degree dyscirculatory encephalopathy against the background of metabolic syndrome. There was performed clinical and laboratory examination and neuropsychological testing by scales: МoСА; Spielberger; Beck; Schulte tables. Using volumetric method, on MRI scanner Toshiba Vantage Titan 1.5 we have evaluated the state of the brain in 41 patients. A correlation analysis has been conducted between indicators of cortical volume and white matter of the frontal and temporal lobes and cognitive and anxiety disorders in patients with metabolic syndrome and without it. Results. After 24 days of treatment, there was an improvement of cognitive functions by MoCA scale in both groups (in the main group before and after the treatment: by 1.5 points; in the control one — by 0.5 points), in the group, in which patients received Vitaxon®, the results achieved probability (p < 0.05). Indicators of reactive anxiety by Spielberger scale improved in the intervention group (42.4 ± 3.4 points and 24.6 ± 2.8 points on day 24), in the control the figures did not differ significantly (41.2 ± 3.2 points and 39.1 ± 2.1 points). Analysis of the results of testing by Schulte tables showed a probable decrease in task performance after treatment in the group received Vitaxon® (p < 0.05). Indicators of depression by HADS scale improved after treatment in both groups, but the degree of statistical probability is not reached. The analysis of volumetric studies showed a deterioration of cognitive functions by MoCA scale while reducing the volume of the cortex in the frontal and temporal lobes. There has been determined the correlation between indicators of cortical volume of frontal and temporal lobes and the results of cognitive function evaluation by MoCA scale. The index of correlation (r) was 0.49 for temporal lobe and 0.43 — for frontal lobes. Modules of correlation coefficients were of medium strength. Conclusions. Patients with metabolic syndrome showed a reduction in the volume of gray matter in the frontal and temporal lobes, which correlated with cognitive deficit by MoCA scale. These data suggest in a greater degree a mixed cognitive impairment — vascular and degenerative. Volumetric research in combination with neuropsychological one allows to predict subsequent development of the disease on the stage of mild cognitive impairment. The presence of neurotropic positive effect on cognitive and anxiety symptoms and no significant side effects enables to recommend Vitaxon® for the treatment of chronic cerebrovascular diseases in patients with metabolic syndrome.
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