Slobodin T. Сliniko-pathogenetic aspects of emotional and cognitive impairments in Parkinson's disease

The existence of separate variants of Parkinson's disease differing among themselves not only by motor features, such, as absence of the tremor and balance impairment, but non-motor manifestations (cognitive, depressive, anxiety, motivational) and their interrelations that becomes the basis for the differentiated approach to treatment, was revealed on the basis of сliniko-neurologic, neuropsychological, neuroimaging investigation, transcranial sonography and the method of mathematical modeling. Right-side akinetiko-rigid variant of Parkinson's disease is the most adversive for development and progression of cognitive impairment and depression. The heterogeneity of depression in PD was proved by lifetime studying of the core brain metabolites (NAA, Cho, Cr) relations by the MRS in the most vulnerable in depression brain regions (designated on the basis of the constructed theoretical model of the emotional control regulation) - Hipp, Amg and cingulated girus- and with a help of a Transcranial sonography method. Motivational and anxiety disorders are the integral component of all spectrum PD non-motor features, which combined with depression, but may exist separately. Dopaminergic deficiency of mesolimbic and mesocortical afferents lay in their basis. In theraputical tactics of Parkinson's disease the main point is clinical variant with the account of not only motor, but also cognitive and emotional disturbanses for timely prescription of the medicines, capable to slow down disease progression. Key words: Parkinson's disease, emotional and cognitive impairment.