The aim of this work was to study the typology of neuropsychiatric symptoms (NPS) of vascular dementia (VD), to determine their clinical and psychopathological features and relationships, to establish the prognostic significance of NPS VD and to substantiate and improve on this basis a therapeutic model of providing comprehensive care for NPS VD
The main tasks were: analysis of the phenomenology and relationships of NPS, study of their clinical and psychopathological features, establishment of the prognostic role of individual NPS for the course of VD, development of a model of therapeutic correction of NPS taking into account prognostic factors and improvement of the program for their management.
The study was conducted in four stages:
1. The diagnostic stage consisted of a clinical and pathological examination of the patient, questioning of caregivers, primary psychodiagnostics using psychometric methods and analysis of medical documentation. At this stage, groups of subjects were formed, the main psychometric methods were applied to identify and structure neurocognitive deficit and psychopathological symptoms in these groups.
2. Establishment of clinical features - determination of clinical and psychopathological features and clinical and phenomenological structure of NPS of dementia of different genesis, determination of further points for the formation of prognostic models. NPS were studied in general and separately, according to psychotic, affective and behavioral clusters. Also at this stage among the MG, intervention groups of patients (IG) were identified who took part in the implementation of the proposed comprehensive therapeutic model of NPS correction (IG-1) and those who did not participate (IG-2).
When studying NPS, it was found that in the MG, delusional syndrome (77% vs. 54%, p = 0.0419) and motor disorders (94% vs. 77%, p = 0.0147) were significantly more common than in CG-1, and apathy (55% vs. 81%, p = 0.0309) was less common than in CG-1, and eating behavior changes (60% vs. 84%, p = 0.0335) were less common than in CG-2. When studying only cases of the most severe manifestations of NPS among the study groups (8-12 points NPI), the results were somewhat different: although, in relation to delusional syndrome and apathy, the same difference was maintained, in the MG - statistically more often severe delirium was observed (55% vs. 15%, p = 0.0005), than in CG-1 and less often - apathy (20% vs. 50%, p = 0.009), there were no significant differences regarding motor disorders (MD) and eating behavior disorders (EBD); however, a difference was found regarding the most severe symptoms of agitation (more often (43%) in the MG than in CG-1 (7.7%, p = 0.0011) and CG-2 (30%, p = 0.037)), anxiety (less often in the MG (26%) than in CG-1 (65%, p = 0.0007) and CG-2 (57%, p = 0.006), irritability (more in the MG than in CG-1: 59% vs. 31%, p = 0.0211) and sleep disturbances (less often in the MG than in CG-2: 28% vs. 60%, p = 0.0034).
3. Controlled observation - study of the dynamics of NPS and continuation of support for the combined management system and information collection. At this stage, psychometric research methods and information collection were re-applied dynamically, according to the plan. A total of 7 meetings with each patient were planned, at the stage of controlled observation - from the 3rd to the 7th. The main endpoints of observation for the formation of prognostic markers for survival rates were: death, relapse (recurrence of NPS), sudden cardiovascular disease, institutionalization.
4. Evaluation of results - processing of the obtained material, determination of risk factors and algorithms for predicting NPS of VD, and the effectiveness of the application of the complex therapeutic model for correcting NPS among the studied contingents to improve the system of therapeutic measures.
When studying survival curves in the presence of specific NPS of VD, the following symptoms were identified as prognostically unfavorable: for overall survival (OS) - delusions (cumulative survival rate at 18 months 11.6% vs 100%, Cox's F criterion p=0.021), for relapse-free survival (RFS) - sleep disturbances (cumulative survival rate at 18 months 44% vs 50%, Cox's F criterion p=0.021) and for event-free survival (EFS) - anxiety (cumulative survival rate at 3 months 55% vs 75%, Cox's F criterion p=0.0045) and disinhibition (cumulative survival rate at 6 months 43% vs 50%, Cox's F criterion p=0.0075).
Based on the results of this study, a comprehensive therapeutic model for the correction of NPS VD has been developed and implemented in practice. The results of the implementation of the complex therapeutic model in combination with standardized medications and complex systematic care with the participation of medical personnel and caregivers, revealed a difference between the intervention groups where this model was implemented (IG-1) and the group where it was not implemented (IG-2)
