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Delirium is an acute, life-threatening condition manifested by disturbance in consciousness, attention and cognition, which has a multifactorial genesis, severe consequences and commonly seen in older and senile people inpatient. Clinical experience in domestic practice shows that delirium diagnosis in older and senile patients is often missed, and its signs may be considered as manifestations of other diseases, while the state of delirium is often perceived only as an alcohol withdrawal. The article presents a clinical protocol developed and based on the firsthand experience and modern ideas by a multidisciplinary team of the Russian Gerontology Research and Clinical Centre, in which the delirium in older and senile people is considered as a geriatric syndrome. The article shows the latest diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main diagnostic tools are given — Confusion assessment method (CAM), diagnostic and differential diagnostic algorithms; clinical subtypes, management tactics, non-drug and drug approaches to treatment, as well as principles for the prevention of geriatric delirium are described.

The present document developed by the Russian Association of Gerontologists and Geriatricians represents the Clinical guidelines on chronic pain in older and senile patients. The Clinical guidelines were endorsed by Scientific Council of the Ministry of Health of the Russian Federation in December 2020.Clinical guidelines are focused on geriatricians providing medical care in outpatient and hospital settings, general practitioners, and physiotherapists.The document sets out the pain syndrom screening and diagnosis principles in older patients, management and treatment approaches in patients with chronic pain, as well as the prevention, rehabilitation, medical care organization issues and quality control criteria for its provision in this category of persons.

Locomotive syndrome is a geriatric syndrome that corresponds to the model of autonomy loss and the emergence of addictions due to pathology of the musculoskeletal system with a heavy medical and social burden. Combination of musculoskeletal system diseases, including osteoarthritis, osteoporosis, dorsopathy, sarcopenia, neuropathy, together with impaired physical functioning are the clinical characteristics of locomotive syndrome. Only comprehensive programs, including pain treatment, the risk of osteoporetic fractures, prevention of falls, correction of sarcopenia, physical training, psychotherapeutic methods, etc., can increase the mobility of patients with locomotive syndrome and help reduce addictions in older age.

The standard for the treatment of dementia in Alzheimer's disease (AD) is the use of basic medicines affecting the cholinergic and glutamatergic systems. The aim of the study was a comparative evaluation of combined treatment with an NMDA receptor antagonist akatinol memantine and donepezil — acetylcholinesterase inhibitor, compared with donepezil monotherapy in AD patients with mild dementia. Material and methods . The study included 35 patients with AD (average age 78.51 years old ± 6.08) at the stage of mild dementia. 35% of patients received donepezil monotherapy (alzepil), 65% of patients received donepezil and akatinol memantine combined treatment. The observation period was 12 months. During this period, the patients underwent a neuropsychological examination every 3 months. It included a Mini Mental State Examination, Frontal assessment battery, memory test with an assessment of immediate and delayed reproduction of «12 words», verbal fluency (phonetic and semantic), clock drawing test, Trial making test, part A. Results . In patients, who received the combined treatment, improvement was detected on almost all cognitive scales, in 3 months of the therapy. It continued to increase throughout the whole observation period. And, contrary-wise, in patients, who received monotherapy, only stabilization of cognitive status was manifested. Conclusion . The administration of combined treatment with akatinol memantine and donepezil to patients with AD at the stage of mild dementia during the period of 12 months, is more effective than donepezil monotherapy.

The number of explosive eruptions at Shiveluch Volcano has significantly increased over the past years, which requires close volcanic monitoring using all available techniques. In order to implement a new monitoring technique into integrated methods of volcano monitoring, the authors analyze response to the intensity of the vertical component in the atmospheric electrical field (EZ AEF) during the movement of ash clouds. Two eruptions of different intensity that occurred December 16, 2016 and June 14, 2017 at Shiveluch were selected for study. We used a combination of satellite, seismic, and infrasound data to select signals in the EZ AEF field. Signals with negative polarity that accompanied ashfalls in the EZ AEF dynamics were registered for both eruptions within the closest area (< 50 km). In the former case, the ash cloud was “dry” and thus it caused aerial-electrical structure of the negatively charged cloud. In the latter case, a strong explosion sent into the atmosphere the large volume of ash and volcanic gases (98% in form of vapour) that resulted in the formation of a dipolar aerial-electrical structure caused by eolian differentiation within the closest area. At the distance of more than 100 km we registered a positive-going signal that is attributive to the aerial-electrical structure of the positively charged type of the cloud.

It is shown that the rate of explosive eruptions on Shiveluch Volcano has become increasingly high during recent years, which makes the monitoring of the volcano using all available means highly urgent. We seek to introduce another technique into the multidisciplinary monitoring of explosive eruptions by analyzing responses in the vertical component of the atmospheric electric field (EZ AEF) during the passage of eruptive plumes. We considered two Shiveluch eruptions that were different in vigor that occurred on December 16, 2016 and on June 14, 2017.The signals in the EZ AEF were selected using multidisciplinary observations, viz., satellite-based observations, seismic, and infrared observations. Signals of negative polarity were recorded in the EZ AEF dynamics in the near zone ( 100 km), the explosion produced a signal of positive polarity coming from an aero-electrical structure of the “positively charged plume” type from the aerosol column.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

This paper presents the results from a study of ash compositions that were erupted in 2013–2016. The juvenile component has been identified in the ejecta using data on the morphology and textural features of ash particles and the composition of volcanic glasses. The data set suggests that the activity of the volcano was phreatomagmatic.

Bezymianny Volcano is one of the most active volcanoes in Kamchatka and in the world. This paper describes the preparation, behavior, products, dynamics, and the geological effect of the March 15, 2019 explosive eruption of the volcano, which was predicted 6.5 h before it began. The sequence of eruptive events was analyzed using data provided by video and satellite-based monitoring of the volcano; the quantitative characteristics for the distribution of pyroclastic deposits were obtained in the information system “Remote Monitoring of Activity of Volcanoes in Kamchatka and the Kurile Islands”. The explosions lifted ash to heights of 15 km above sea level (up to 12 km above the volcano), the eruptive cloud was moving northeastward and east from the volcano, the main ashfall area was 210 400 km2, including 15 000 km2 on land. Apart from tephra, the eruption produced pyroclastic flows and pyroclastic surges covering an area of 30 km2. The total volume of explosive products is estimated as 0.1–0.2 km3. The eruptive rocks are calc-alkaline moderate-K basaltic andesites (SiO2 = 54.84–56.29 wt %), they are the most mafic among all rocks of the current Bezymianny eruption cycle.

To analyze the geriatric status of patients with chronic pain.One hundred and sixteen patients of a geriatric unit, aged 75.66±7.98 years (110 women, 94.8%), were studied. All patients underwent general clinical examination and complex geriatric assessment, on the results of which geriatric syndromes were identified. Characteristics of pain syndrome (cause, intensity, localization) are described.Chronic pain syndrome is identified in 85 (73.3%) patients. Most often pain is localized in large joints (n=44 (51.76%)) and back (n=50 (58.8%)). The intensity of pain was higher in patients with moderate dependence in daily activities compared to those with mild dependence (p0.05). Pain intensity is associated with the degree of impairment of physical functioning (p0.05). Patients with chronic pain have more geriatric symptoms (6.8±2.8). More syndromes (9.11±2.37) are identified in patients with marked impairment of physical functioning. The reduction of muscle strength is observed in 45.9% patients with- and 9.7% patients without chronic pain syndrome. The velocity of pace is 0.59 m/s and 0.71 m/s, respectively.The high prevalence of chronic pain in patients of a geriatric unit is shown. The intensity of pain iss higher in patients with moderate dependence in daily activities compared to those with mild dependence. Pain intensity increases with the reduction of patient's physical functioning. Patients with chronic pain more often have dynapenia and significantly lower velocity of pace that indicates the poor outcome in elderly patients.Цель исследования - анализ гериатрического статуса пациентов с хронической болью. Материал и методы. Обследованы 116 пациентов гериатрического отделения в возрасте 75,66±7,98 года (110 женщин, 94,8%). Всем пациентам проведены общеклиническое исследование и комплексная гериатрическая оценка, на основе которых диагностированы гериатрические синдромы. Дана характеристика болевого синдрома (причина, интенсивность, локализация). Результаты. Хронический болевой синдром выявлен в 85 (73,3%) случаях. Наиболее часто боль локализовалась в крупных суставах - 44 (51,76%) случая и спине - 50 (58,8%) случаев. Интенсивность боли у пациентов с умеренной зависимостью в повседневной жизни была выше по сравнению с пациентами с легкой зависимостью в повседневной жизни (р0,05). Также установлено достоверное различие (р0,05) интенсивности боли в зависимости от степени снижения физического функционирования больных. У больных с хроническим болевым синдромом при комплексной гериатрической оценке выявлено 6,8±2,8 гериатрических синдрома. Большее число синдромов (9,11±2,37) выявлено у больных с выраженным снижением физического функционирования. Среди пациентов с хроническим болевым синдромом в 45,9% случаев выявлено снижение мышечной силы, без такового - в 9,7% случаев. Скорость ходьбы у пациентов с болью составила 0,59 м/с, без боли - 0,71 м/с. Заключение. Выявлена высокая распространенность хронической боли среди пациентов гериатрического стационара. Интенсивность боли выше у пациентов с умеренной зависимостью в повседневной жизни в сравнении с пациентами с легкой зависимостью. Возрастание интенсивности боли происходит по мере снижения физического функционирования пациентов. При этом у пациентов с хронической болью чаще встречаются динапения и достоверно более низкая скорость ходьбы, что свидетельствует о неблагоприятном прогнозе для пациентов старших возрастных групп.

The active andesitic Zhupanovsky Volcano consists of four coalesced stratovolcano cones. The historical explosive eruptions of 1940, 1957, and 2014‒2016 discharged material from the Priemysh Cone. The recent Zhupanovsky eruptions were studied using satellite data supplied by the Monitoring of Active Volcanoes in Kamchatka and on the Kuril Islands information system (VolSatView), as well as based on video and visual observations of the volcano. The first eruption started on October 22 and lasted until October 24, 2013. Fumaroles situated on the Priemysh western slope were the centers that discharged gas plumes charged with some amount of ash. The next eruption started on June 6, 2014 and lasted until November 20, 2016. The explosive activity of Zhupanovsky was not uniform in 2014–2016, with the ash plumes being detected on satellite images for an approximate total duration of 112 days spread over 17 months. The most vigorous activity was observed between June and October, and in November 2014, with a bright thermal anomaly being nearly constantly seen on satellite images around Priemysh between January and April 2015 and in January–February 2016. The 2014–2016 eruption culminated in explosive events and collapse of parts of the Priemysh Cone on July 12 and 14, November 30, 2015, and on February 12 and November 20, 2016.

The first historical eruption of Kambalny volcano began on March 24, 2017 with the powerful ash emission from the summit crater reaching as high as 6 km above sea level. The explosive activity continued without interruption from March 24 to March 30. The most powerful ash emission was registered on March 25–26, when the ash plume drifted several thousand kilometers SW, S, and SE from the volcano. On April 2 and April 9, after several calm days, powerful ash explosions occurred generating ash plumes up to 7 km high. The area of the land and sea over which the ash plume drifted during the day of March 25, was 650000 km2; the area of the ash accumulation on the land that was formed from March 24 to April 9, exceeded 1500 km2. These parameters were measured using the satellite-based data in the VolSatView information system. Domination of the silty fraction and the presence of secondary minerals (pyrite, gypsum, sulfur, and others) in the ash point to the phreatic character of the volcanic eruption.

Chronic fatigue is among the manifestations of focal brain lesions. It is most often encountered in multiple sclerosis (MS) and patients with the sequelae of traumatic, inflammatory, and vascular brain damage (encephalopathies). The aim of the present work was to study the mechanisms of formation of this syndrome in 50 patients with focal brain lesions of different origins (in the inactive stage) and to assess the possibility of correcting it using the combined agent Fezam (2 capsules t.i.d. for one month), which contains piracetam and cinarrizine. In patients with encephalopathies, chronic fatigue syndrome was directly associated with the severity of depression. Patients with MS showed changes in the value-sense sphere. Neuropsychological testing showed that the psychological and personality components played a greater role in the origins of chronic fatigue in patients with encephalopathies than in those with MS. Fezam significantly decreased the severity of chronic fatigue, particularly in patients with MS; in the second group (non-MS patients) this was accompanied by a decrease in the severity of depression. Mild side effects (in six patients--12%) consisted generally of sleep disturbances. These results indicate that Fezam should be used in the treatment of chronic fatigue in patients with focal brain lesions; in encephalopathies it should be combined with psychoactive agents.

Chronic fatigue (CF) is a syndrome manifesting in cases with focal brain damage. It is frequent in multiple sclerosis (MS) and encephalopathies (post-traumatic, cerebrovascular, etc). Treatment of this syndrome remains problematic. The study aimed to analyze the genesis of CF in patients with different non-active neurological diseases with brain damage and possibility of its treatment with the complex drug fezam (piracetam plus cinnarizin) in dosage 2 capsules 3 times per day. Before the treatment, all the patients had CF, which was directly associated with severity of depression in patients with encephalopathies. In MS patients, changes in the valuable-and-sense sphere that plays a significant role in human behavior and activity underlying self-regulation in critical situations were found. Neuropsychological data revealed that in patients with encephalopathies psychological and behavioral aspects were more significant in regard with CF genesis than in patients with MS. Fesam caused significant decrease of the CF severity, which was more prominent in the MS group, while in another group it was associated with a decrease of depression severity. Mild side-effects were observed in 6 patients (12%) and appeared mainly as sleep disorders. This trial allows recommending Fezam for complex treatment of CF syndrome in MS and in combination with psychocorrective medicines in cases of encephalopathies.

Neurological and psychiatric examination of 334 children, aged 7-15 years, 87 (23%) of them suffering from chronic tension-type headache (CTTH) is presented. All the patients had mental (mostly depressive and anxiety) disorders and 95.3% of them--psychosomatic ones. Clinical heterogeneity of CTTH was revealed: in the cases of daily continuous headache there were depressive disorders, in daily intermittent headache--depressive and anxiety-phobic disorders and in frequent headache pattern neurasthenia was predominantly detected. Personality features of CTTH patients were as follows: high anxiety, aggressiveness, asthenia, low "Ego" power, high frustration, sensitivity, hypochondriac, depressive and hysterical tendencies, affective rigidity. Patients realized mostly non-adaptive coping styles both for high and low pain intensiveness. Combination of psychopharmacology, psychotherapy and biofeedback for the CTTH treatment is recommended.