Karaban' M. Complex pathogenetic therapy of the Parkinson's disease (clinical, diagnostic, and medico-social aspects).

This dissertation is devoted to study of the pathogenetic therapy effectiveness in Parkinson's disease (PD) patients on the basis of complex diagnostic approach to evaluat-ing clinical course of disease, its relationship with treatment outcomes observable at vari-ous stages of disease advancement and with medico-social factors leading to the disability; development of the algorithm for diagnosis and treatment of the PD, and elaboration of the step-by-step principles of pathogenetic therapy. Adverse phenomena due to long-term levodopa therapy are associated with the PD stage, patient's age, disease duration and length of treatment. Comorbid illnesses (Type 2 diabetes mellitus, arterial hypertension) cause dyslipoproteinemias in the PD patients, rep-resenting the risk factor for cerebral blood flow deceleration and vascular pathology onset. The PD accompanying nonmotor symptoms (cognitive impairments, depression) aggravat disease course. Cerebral atrophy, according to MRI data, is found in the temporal and oc-cipital cortex; and degree of cognitive impairments correlates with speech disorders and postural stability. Shortening of the telomeres length is the earliest predictor of preclinical PD stage. In PD, the ratios of cerebral metabolites (NAA/Cho and Cho/Cr) are reduced in the substantia negro (SN) and lenticular nuclei; Cho is increased and NAA is decreased in the SN. Regional differences of NAA/Cr in hippocampus provide a neuro-chemical marker of the risk of a development of the dementia in PD patients. MRS-indicator of the phar-maco-therapeutic activity of the levodopa drugs is considered to be increase of NAA con-centration and decrease of Cho concentration in the SN. The algorithm of complex pathogenetic therapy (CPT) at PD is based on the step-by-step treatment principle in compliance with standard variants of clinical course of the dis-ease and indices of the psycho-social adaptation of patients.