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Objective: To study of nerve structures in the aortic wall in atherosclerosis using a complex of immunohistochemical markers., Material and Methods: The objects of the study were excised fragments of the wall of the thoracic and abdominal aorta along with visually determined unstable atherosclerotic plaques. To study nerve structures on paraffin sections, immunohistochemical reactions were performed for the PGP 9.5 protein, tyrosine hydroxylase, and synaptophysin., Results: It has been established that pronounced pathological changes are observed in the nervous structures of the aortic wall near unstable atherosclerotic plaques. Reactive, dystrophic, and severe degenerative changes in neurocytes, nerve fibers, and glial cells are described in the elements of the nervous apparatus of the adventitia (microganglia, nerve trunks, and nerve plexuses). It was found that only sympathetic neurons and their postganglionic fibers remain in the intramural ganglia, while the structures of the parasympathetic nervous apparatus undergo degeneration. Destruction of perivascular nerve plexuses and vasa vasorum in the adventitia, as well as degeneration of varicose axons of the main terminal synaptic plexus at the border of adventitia and superficial smooth muscle layer of the media were demonstrated., Conclusion: It is assumed that the presence of inflammatory infiltrates in the adventitia and intima, denervation and death of vasa vasorum can serve as factors determining the development of the atherosclerotic process.

Objective: To study the impact of COVID-19 on the onset and course of mental disorders in hospitalized elderly patients., Material and Methods: We studied 67 inpatients, aged 50 to 95 years, with various mental illnesses in accordance with the ICD-10 criteria, who underwent COVID-19 from February 2020 to December 2021. Forty-six people were previously mentally ill, in 21 cases the disease developed for the first time., Results: The group of primary diseased patients was dominated by depressive episodes (F32, (42.9%), including psychotic episodes (9.5%). In 28.6% of cases, organic disorders were diagnosed in the form of emotional lability (F06.6), organic depression (F06.3), mild cognitive impairment (F06.7) and delirium (F05.86). In 23.8% of patients, neurotic disorders were observed in the form of depressive reactions (F43), panic (F41.0) and generalized anxiety disorder (F41.1). In one case (4.8%), acute polymorphic psychosis with symptoms of schizophrenia (F23.1) was diagnosed. The diagnoses of the previously mentally ill group were: affective disorders (F31, F32, F33 - 45.7%); organic disorders, including dementia (F06.3, F06.7, F00.1, F00.2 - 26.1%); schizophrenia spectrum disorders (F25, F21, F22, F20.01 - 19.6%), and neurotic somatoform disorders (F45 - 8.7%). In the acute and subacute periods of COVID-19 (≤3 months), acute psychotic states (APS) developed in both groups of patients (in 23.3% and 30.4%, respectively) in the form of delirium, psychotic depression, or polymorphic psychosis. APS were more common in mentally ill patients with organic (50%) and schizophrenia spectrum (33.3%) disorders with a predominance of delirium. In the long-term period of COVID-19, mentally ill patients more often than primary diseased patients (60.9% and 38.1%) developed cognitive impairment (CI), especially in schizophrenic (77.8%) and organic (83.3%) disorders. CI developed twice as often after APS (89.5% and 39.6%, p <0.001), reaching the degree of dementia in 15.8% of cases. APS were significantly associated ( p <0.05) with the development of CI (0.567733), the age of patients (0.410696) and the presence of previous cerebrovascular insufficiency (0.404916)., Conclusion: The age-related features of the mental consequences of COVID-19 are the occurrence of APS in the acute period of infection and the deterioration of cognitive activity at a remote stage. The mentally ill, especially those of the organic and schizophrenia spectrum, were found to be more vulnerable to the effects of COVID-19. In them, the occurrence of APS was a risk factor for the development of dementia, while in primary diseased, affective and neurotic patients, CI was reversible or had the character of a mild cognitive disorder.

Objective: To analyze clinical parameters and effectiveness of therapy in depressed patients of late age with different activity of enzymes of energy, glutamate metabolism and antioxidant glutathione system in platelets and red blood cells., Material and Methods: The study included 53 hospitalized patients (41 women and 12 men), aged 60 to 86 years (median - 66 years), with a depressive episode of mild to marked severity within the framework of recurrent depressive disorder, bipolar affective disorder or a single depressive episode according to ICD-10. The patients were examined using clinical, psychometric, biochemical and statistical methods. Psychometric assessment of patients' condition was performed before the start of therapy and on the 28 th day of treatment using HAMD-17 and HARS. Blood sampling was carried out to determine the activity of cytochrome c- oxidase (COX), glutathione reductase (GR), glutathione S-transferase (GST) and glutamate dehydrogenase (GDH)., Results: Cluster analysis revealed 3 clusters (Cl.1, Cl.2, Cl.3), which differed in biochemical indicators. In Cl.1 ( n =24, 45.2%), there was a decrease in the activity of COX ( p <0.05) and a decrease of GR activity in red blood cells and GST activity in platelets ( p <0.001). Patients of Cl.2 ( n =11, 20.8%) had increased COX activity ( p <0.001) and decreased GDH activity ( p <0.001). In patients of Cl.3 ( n =18, 34%) the enzyme activity was similar to that in the controls. Later age at disease onset was observed in Cl.1 compared to Cl.2 (51 years [40; 60.5] and 32 years [19; 59], p =0.052). Compared with Cl.2 and Cl.3, patients of Cl.1 significantly more often ( p <0.05) had apathetic depressions (41.7%), while complex depressions were observed almost 2 times less often than in Cl.2 (50% and 91.9%, p <0.05). The effectiveness and tolerability of psychopharmacotherapy was higher in Cl.3., Conclusion: There is a relationship between the nature of changes in metabolic parameters and differences in the phenomenology and course of late-age depression. The results of the study open up new directions in the field of predicting the effectiveness of therapy and the development of personalized therapeutic approaches to improve the effectiveness and safety of treatment of depressed elderly patients.

Objective: To search for correlations between platelet cytochrome c-oxidase (COX) activity and the quality of therapeutic outcomes and other clinical parameters of depression in elderly patients., Material and Methods: Twenty elderly women, aged 55-78 years, with depressive episodes in recurrent depressive disorder (RDD) or bipolar affective disorder (BD) were studied. COX activity and severity of depression were evaluated twice: before the beginning of antidepressant treatment and at the 28-th day of the therapy, using the Hamilton Depression Rating Scale (HAMD-17) and the Hamilton Anxiety Rating Scale (HAM-A)., Results: Significant correlations were revealed between platelet COX activity and some clinical parameters of the disease and the severity of depression in patients after treatment. The baseline level of the platelet COX activity was correlated with the age of disease onset (R= -0.63, p =0.003) and its duration (R=0.55, p =0.010). Significant negative correlations were also found between the baseline level of COX activity and depression severity (HAMD-17 total score) (R= -0.48, p =0.032) and the severity of anxiety (HARSHAM-A total score) (R= -0.54, p =0.010) after 28-day treatment., Conclusion: This pilot study has revealed a link between platelet COX activity and the severity of depression and anxiety after a 28-day antidepressant therapy. The results indicate the prospects for further study of COX as a biomarker of therapeutic outcomes in elderly patients with depression.

Material and Methods: The study material was 20 autopsy samples obtained from males aged 65 to 72 years who died from acute atherosclerotic cardiovascular insufficiency. Aortic segments (from the arch, thoracic and abdominal regions), coronary arteries and the arteries of the base of the brain ( a. basilaris ) were investigated; these totaled 45 tissue segments. Neovessels and cellular responses in the arterial wall were examined by hematoxylin and eosin staining. VEGF was immunohistochemically detected using a highly sensitive two-stage streptavidin-biotin method., Results: In unstable atherosclerotic lesions, there were active neovascularization processes in both the fibrous cap and the underlying parts of the adventitia. These changes are usually combined with a pronounced cellular inflammatory response that can contribute to their development. Endothelial growth factor may be one of the causes of neovascularization in unstable atherosclerotic lesions., Conclusion: A comparative immunomorphological study in the human aorta, coronary arteries, and a. basilaris revealed active neovascularization processes in the cap and the underlying parts of the adventitia in unstable atherosclerotic lesions. The cause of this neovascularization is probably endothelial growth factor and cellular inflammatory responses.

Objective: To compare the activity of platelet glutathione reductase (GR) and glutathione-S-transferase (GST) in elderly patients with depression and in the control group, and to identify a possible relationship between the activity of these enzymes and clinical parameters of the disease., Material and Methods: We examined 42 elderly patients (60-86 years old) with depressive episodes of various nosological categories according to ICD-10: a single depressive episode (F32.0, F32.1), a depressive episode in recurrent depressive disorder (RDR - F33.0, F33.1), and a depressive episode in bipolar disorder (BD - F31.3). The GR, GST activity and the severity of depression were assessed twice: before the beginning of the course of 28-day antidepressant therapy (day 0) and on the 28th day of the course of therapy, using the Hamilton Depressive Scale (HAMD-17) and the Hamilton Anxiety Scale (HARS)., Results: As compared with the control group, a significant decrease in GST activity was found in patients before and after the course of therapy ( p <0.0001 and p <0.0003, respectively), no significant difference in GR activity was found. Significant correlations of the platelet GR activity in patients before thetreatment course with the age of disease manifestation (R= -0.44; p =0.004, inverse correlation) and with its duration (R=0.43, p =0.004, direct correlation), estimated after a 28-day course of therapy. A significant inverse correlation of the baseline (before treatment) GR activity with the HAMD score estimated after the course of therapy (R=-0.440; p =0.009) was found only in women subgroup ( n =33)., Conclusion: A pilot study has revealed a decrease in platelet GST activity, and a link between platelet GR activity and the severity of depression after a course of therapy. The results obtained indicate the promise of further study of glutathione metabolism enzymes as a biomarker for assessing the state.

Aim: To search for the immunological features of depressions in elderly patients, select certain immunophenotypes and analyze their possible connection with clinical and psychopathological features of depression of old age., Material and Methods: The study included 55 inpatients of old age (median 68 years) with a depressive episode of mild or moderate severity. The control group consisted of 41 elderly people (median 67 years) without depressive disorders. Clinical, psychometric, immunological and statistical methods were used. The rating scales were HAMD-17 and MMSE. The activity of inflammatory and autoimmune markers, including enzymatic activity of leukocyte elastase (LE), α1-proteinase inhibitor (α1-PI), level of autoantibodies to neurospecific antigens S-100B and myelin basic protein, in the serum of patients and control subjects was determined., Results and Conclusion: The scatter in the immunological parameters both in the direction of exceeding the average values and their decrease was shown in the group of depressed elderly patients compared to the controls. Cluster analysis revealed two immunophenotypes of elderly patients with depression. Immunophenotype A is a group of patients with increased PE activity and immunophenotype B is a group of patients with decreased LE activity (p<0.0000). Immunophenotype A includes patients with complex depressions, comorbid with anxiety and senesto-hypochondriac disorders. In immunophenotype B, patients with prolonged apatic/adynamic depressions (p<0.05), with an earlier onset and longer duration of the disease, with incomplete remissions and more burdened with cardiovascular diseases were more common (p<0.05).

Aim: To develop a personalized approach to the appointment of a complex antidepressant therapy in combination with drugs of neuroprotective and neurotrophic action in depressed elderly patients based on the selection of predictors of low therapeutic response (LTR)., Material and Methods: The study included 152 hospitalized patients, aged 60 years and older, with moderate and mild depression (ICD-10) who received monotherapy (44 people) with antidepressants of the new generation and complex therapy (108 people) with the same antidepressants in combination with neuroprotective drugs. In the monotherapy group, correlations between treatment efficacy (change in average total HAMD-17 scores) and a set of parameters, including socio-demographic data, results of psychopathological, somatic, standardized assessment and neuroimaging (CT) of the brain were analyzed. The validity of the established correlations as predictors of LTR was estimated based on a comparison of their frequency among the responders (≥50% reduction) and non-responders (<50% reduction). Comparison of the efficacy of therapy in groups of patients with mono - and complex therapy was carried out depending on the presence or absence of predictors of LTR., Results: LTR predictors are living alone, complaints about memory loss and signs of pronounced diffuse lesions of the subcortical white matter of the brain, which are significantly more frequently observed in non-responders (p<0.05). The increase in the number of predictors (2 and more) correlates with a significant decrease in therapeutic efficacy (p<0.001). Patients with complex in structure and protracted depressions tend to decrease in efficiency, and in most of them (more than 87% of cases) LTR predictors are detected. In patients with LTR predictors, the complex therapy is significantly more effective than monotherapy, allowing in all cases to achieve 50% reduction of depressive symptoms by the 4th week of treatment., Conclusion: Personalized indications for the appointment of complex antidepressant therapy in combination with neuroprotective drugs in depressed elderly patients are formulated.

Sleep and wakefulness disorders are commonly seen in patients with Parkinson's disease, Lewy body dementia and Alzheimer's disease. Sleep provides a lot of functions which sustain normal condition of the brain and sleep disturbances can be one of the factors contributing to the development of neurodegenerative diseases. Sleep and wakefulness disorders can worsen the course of the neurodegenerative process and lead to an increase of symptoms, including cognitive dysfunction. In this review, the relationship between sleep and wakefulness disorders and cognitive impairment as well as clinical forms of sleep and wakefulness disorders and treatment methods in such patients are discussed.

Aim: To assess the plasma level of N-acetylaspartate (NAA) before and after combined therapy with antidepressants and actovegin in a group of elderly patients diagnosed with depression., Material and Methods: Nineteen patients, 7 men and 12 women, mean age 70.5±5.8 years, were studied using clinical examination and psychometric scales as well as computed tomography (CT). NAA plasma levels were determined. The duration of treatment with antidepressants (venlafaxine, fluvoxamine) and actovegin was 28 days, patients were examined at baseline and on the 28 th day of treatment., Results and Conclusion: The NAA plasma level was reduced in patients compared to healthy volunteers. The increase of this indicator after treatment reflected a significant improvement on clinical and psychometric measures. The dynamics of NAA changes (increase or decrease) showed heterogeneity in the group of patients, which was not related to the efficacy of treatment but was correlated with comorbid diseases, in particular vascular diseases, and CT changes (leukoaraiosis). The authors consider the results of this study as preliminary.

Aim: Comparative evaluation of the efficacy and safety of antidepressant monotherapy and complex antidepressant therapy in combination with carnicetine in the treatment of depression in elderly patients in a psychiatric hospital., Material and Methods: Two groups of hospitalized patients, aged from 60 to 79 years, with mild or moderate depression (according to ICD-10), comparable in basic demographic and clinical characteristics, received mono- or complex (in combination with carnicetine) antidepressant therapy for 8 weeks. Treatment efficacy was assessed with HAM-D, HARS, CGI-S and CGI-I; the level of cognitive activity was assessed with MMSE, the 10-word memory test and clock drawing test., Results: It has been established that the use of complex antidepressants therapy with the inclusion of carnicetine allows to achieve a more rapid and pronounced therapeutic response compared to antidepressant monotherapy. This is confirmed by the earlier (by the 4th week) and significant reduction of depressive and anxiety symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes to the end of treatment and a more rapid improvement in cognitive functioning., Conclusion: The results allow us to recommend the inclusion of carnicetine for the augmentation of antidepressant therapy in elderly patients of the psychiatric hospital to achieve a more rapid and complete therapeutic response and reduce the duration of hospitalization.

Aim: Increasing the effectiveness of treatment of elderly depressed patients in the conditions of the gerontopsychiatric hospital by augmentation of actovegin to antidepressants of new generations (fluvoxamine, venlafaxine or agomelatine)., Material and Methods: The efficacy of the therapy was compared in two groups of 21 patients aged 60 to 79 years with mild to moderate depression in ICD-10 receiving 8-week antidepressant mono- or combined therapy with actovegin. The effectiveness criteria were changes in the mean total scores on the HAMD-17, HARS, CGI scales, as well as the proportion of respondents and the quality of getting out of depression. Cognitive activity was assessed using MMSE, 10 word memory tests and drawing of clock., Results: It has been established that the use of complex antidepressants therapy with the inclusion of actovegin allows for a more rapid and pronounced therapeutic effect compared to monotherapy with antidepressants. This is confirmed earlier (by the 4th week) and significant reduction of depressive and anxious symptoms (p<0.01), a greater number of responders and better quality of depressive outcomes by the end of treatment. In patients with complex therapy, there was also a faster improvement in cognitive functioning., Conclusion: Obtained results allow us to recommend the inclusion of actovegin in the antidepressant therapy regimen of elderly in-patients with the aim of achieving a faster and fuller therapeutic response and shortening hospitalization.

Traditionally, Parkinson's disease (PD) is associated with the lesion of the substantia nigra and dopamine system dysfunction. However, current studies show the involvement of other CNS regions, which extend far beyond the substantia nigra, in the pathogenesis of PD. The prevalence of altered α-synuclein in PD leads to the dysfunction of several neurotransmitter systems including the orexin system located in the hypothalamus. The involvement of this system in the neurodegenerative process explains some symptoms of PD including daily drowsiness and eating disorders. The authors consider the pathophysiology of the orexin system and its role in the pathogenesis of PD.

The article reviews the phenomenology of sleep and wakefulness disorders in Parkinson's disease and Alzheimer's disease. Degeneration of sleep and wakefulness centers, secondary effect of other symptoms of diseases and side-effects of drug therapy lead to a widespread prevalence of sleep and wakefulness disturbances in these patients. Along with the review of actual literature concerning mechanisms of development and clinical features of these disorders, the authors discuss principal methods for their treatment.

Aim: A comparative evaluation of the efficacy and safety of monotherapy with one of the modern antidepressants (venlafaxine, agomelatine, or fluvoxamine) and combination treatment of one of the above mentioned antidepressants with acetyl-L-carnitine (ALС, carnicetine) in the geriatric psychiatric unit., Material and Methods: Two groups of elderly patients (aged 60-79 years) with mild or moderate depression, randomized according to a number of demographic and clinical characteristics, were treated with antidepressants in monotherapy or combined therapy (antidepressant/carnicetine) within 8 weeks., Results: Combination therapy with the neurotrophic agent carnicetine proved to be more effective compared to monotherapy. At the end of treatment, the more rapid clinical response has been shown for depression, anxiety, apathy, and cognitive dysfunction. Furthermore, combination therapy provides less adverse effects., Conclusion: Antidepressant/carnicetine combination therapy may be recommended for treatment of depression in elderly patients.

Objective: To assess therapeutic efficacy, tolerability and safety of valdoxan (agomelatine) in the treatment of depression in elderly inpatients of the psychiatric hospital., Material and Methods: The study included 20 patients, aged 60 years and older, with depression of varying severity. Patients received valdoxan in standard doses 25-50 mg/day during 42 days., Results: Valdoxan showed a good balanced profile (in terms of indicators of depression, anxiety and anhedonia) of therapeutic response and tolerability in inpatients with mild to moderate depression. The use of valdoxan led to a significant reduction of depressive disorders and anxiety already in the early period of treatment. The severity of anhedonia decreased to the 14th day of treatment. A significant improvement in cognitive functioning of patients was noted to the end of treatment., Conclusion: Valdoxan can be recommended for treatment of mild and moderate depression in inpatients of psychiatric hospitals.