Biriuk V. Optimization of diagnosis and treatment of the early stages of Parkinson’s disease

The thesis is devoted to increasing the effectiveness of diagnosis and treatment of the early stages of Parkinson’s disease (PD) through a complex clinical, neurological, neuropsychological, neurophysiological and biochemical studies, and with using citicoline and biofeedback. To achieve this aim 100 patients in the I – II Hoehn & Yahr PD stages of the base group (mean age – 66.0 ± 5.44 years) and 20 practically healthy individuals without signs of extrapyramidal pathology of the control group (mean age – 64.35 ± 5.45 years) were enrolled. The study participants underwent a general clinical examination, neurological examination, neuropsychological testing, neurophysiological study of cognitive evoked potentials (CEP) P300, as well as laboratory studies (determination of α-synuclein, glutathione peroxidase, glutathione transferase, 3-nitrotyrosine and melatonin levels in the blood plasma). For the first time, the application of the biofeedback for the correction of non-motor manifestations in the complex therapy of patients in the early stages of PD has been substantiated. Specific features of the early stages of PD based on a comprehensive clinical-neurological, neuropsychological, neurophysiological and biochemical study were clarified. The data on the state of cognitive functions in patients with PD according to neurophysiological examination results – CVP P300 – were supplemented. A comprehensive assessment of the changes in the endogenous glutathione antioxidant system (glutathione peroxidase and glutathione transferase activity in the blood plasma), the content of α-synuclein, melatonin and 3-nitrotyrosine in the blood plasma of patients with I, II stages of PD was deepened and a comprehensive assessment was given. The prognostic value of α-synuclein in the blood plasma as a possible marker of the progression of the PD stage was determined. The study of the relationship between biochemical and clinical-neurological, neuropsychological and neurophysiological parameters in patients in the early stages of PD has been further developed. The appointment of the neuroprotective drug citicoline to patients with PD is substantiated, taking into account the effect on cognitive functions, the psycho-emotional state of patients, neurophysiological indicators and the state of the endogenous antioxidant system of glutathione in the blood plasma. A method of assessing cognitive functions and psycho-emotional state in patients in the I-II stages of PD was developed and implemented by using complex neuropsychological testing and neurophysiological research in the form of an instrumental assessment of the state of working memory using the CEP P300. The use of citicoline and biofeedback in the complex therapy and rehabilitation of cognitive and psycho-emotional disorders in patients with PD I – II stages is recommended, as well as the detection of α-synuclein in blood plasma as a marker of PD and the antioxidant activity of glutathione peroxidase in blood plasma to monitor the effectiveness of neuroprotective therapy.