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Gafurov Bakhtiyor Gafurovich, head of the department of neurology, professor, Tashkent Institute of Postgraduate Medical Education Alikulova Nigora Abdukadirovna, associate professor Rakhmatova Sanobar Nizomovna, base doctoral E-mail: nilu74@list.ru
CORRELATIONS BETWEEN COGNITIVE AND LOCOMOTORS DISORDERS IN MEN AND WOMEN WITH CHRONIC CEREBRAL ISCHEMIA
Abstract: The aim of the research was to study the internal correlation links between locomotor and cognitive disorders in men and women suffering with moderate cognitive impairment ofvascular genesis. A total of 96 patients (50 men and 46 women) were examined with the MMSE, Frontal Assessment Battery and Tinetti tests. It has been established that global control of locomotor functions is more characteristic of the group of men, while non-verbal control is more characteristic of the group of women.
Keywords: chronic cerebral ischemia, sex, psychology.
Until recently, the factor of sex was not given special significance in the diagnosis and treatment ofmany diseases, including neurological ones. Research into the effects of new drugs has often been conducted only on male volunteers, and the characteristics of their impact on the female body have been overlooked [1]. In many publications there were no indications of sex of the research subjects, in others women were intentionally excluded for reasons of the "purity of experiment" [2]. However, practice has shown that some diseases are more common among men, while others are more common among women [3; 4].
The severity of the course of disease, its outcome, and response to treatment also depend on sex of the patient in many cases [5].
A real boom in the study of the problem of sex-related differences began about 10 years ago, after the widespread introduction of magnetic resonance imaging into practice, when morphological differences in the brain were found in men and women. Physicians, scientists, psychologists and sociologists presented a general picture, indicating a clear sexual differentiation [6]. There are few studies, however, on this problem in neurological diseases.
It is known that there are initial particularities of cognitive and psychological functions in men and women. The psychological profile of men and women is different. Accordingly, there are behavioral differences between males and females. These differences lead to the fact that men and women differently perceive the same impact and respond to the same situation [3; 4]. This is also true for neurology. The general pattern is that a higher level of anxiety and depression is found in various diseases in women [7; 9].
From the point of view of the problem of sexual dimorphism, chronic cerebral ischemia (CCI) is of particular interest. It is known that with CCI it develops the so-called "triad of frontal dysfunction" (TFD), which includes cognitive, locomotor and emotional disorders (depression). Clinical signs of TFD are interrelated, and the mechanisms of vascular and degenerative brain damage, mainly frontal lobes and their connections with deep structures of the brain, play a role in their genesis. Given the numerous morphofunctional differences in the brain between men and women, it can be assumed that the structure within the TFD has its sex-related peculiarities in CCI. This is important both in terms of further understanding of the differences between male and female brains, and for developing differentiated approaches to the treatment of CCI, depending on sex. This problem remains completely undeveloped.
Our goal in the presented study was to analyze the relationship between the nature of cognitive impairment, imbalance and gait abnormalities in patients with CCI in the aspect of sexual dimorphism.
Material and methods. A total of 96 patients with CCI were examined on a background of cerebral atherosclerosis, which were divided into a male group (50 patients) and a female group (46 patients). The groups were comparable in age (average age 66.4 years), and all the patients had mild cognitive impairment. They were evaluated using MMSE scales and Frontal Assessment Battery (FAB). Motor abnormalities were assessed using the Tinetti test. The obtained data were processed using mathematical cross-correlation analysis. Statistical differences between the groups were assessed with the Wilcoxon test.
CORRELATIONS BETWEEN COGNITIVE AND LOCOMOTORS DISORDERS IN MEN AND WOMEN WITH CHRONIC CEREBRAL ISCHEMIA
The averaged results for the applied tests are presented in the Table below, from which it can be seen that there are significant differences between men and women with CCI. First of all, noticeable is the presence of reliable differences between the sexes across all three scales with greater preservation of cognitive and locomotor functions in female
results were revealed when comparing by subtests within the used tests. In particular, subtests "balance" of the Ti-netti test and "nonverbal functions" in the MMSE test did not reveal any significant differences. With the exception of these differences, in general, unidirectional changes in both sexes were revealed for the locomotor and cognitive functions in CCI.
subjects. Against this background, some features of the
Table 1. - Data of tests of cognitive and locomotor disorders in CCI in men and women
Tests Whole group M F Ri (M: F)
Tinetti:
- overall score 19.45 17.5 21.4 0.05
- balance 11.6 10.4 12.8 -
- gait 7.85 7.1 8.6 0.05
FAB 13.45 12.9 14.0 0.01
MMSE:
- overall score 25.1 26.9 0.01
- verbal functions 26.0 5.1 7.0 0.05
- nonverbal functions 6.05 20.0 19.9 -
Very informative data were obtained when studying the structure of correlation relationships between the studied indicators in persons of different sexes. These data are presented in the Figure below, from which it can be seen that there are significant differences between the sexes. The arrows indicate statistically reliable positive correlation links.
As can be seen from the figure, in the general group of patients with CCI, the present positive reliable correlation links are quite logical. In particular, there is a close correlation between the overall indicators of the MMSE test, the Tinetti test, and the FAB test. In addition, there are positive correlation links between the verbal and non-verbal subtests of the MMSE test and between the gait and balance indicators in the Tinetti test. Positive correlations between the verbal component of the MMSE test and the gait indicators of the Tinetti test, and between the gait indicators of Tinetti and FAB tests were also revealed.
The analysis within the subgroups depending on sex showed significant differences in the structure of correlation links. Common to both groups, men and women, there was a positive correlation between the overall score of the MMSE test and the FAB test, but at the same time there are differences, which are characterized by the fact that, firstly, the structure of internal correlation links in the group of men is significantly poorer in number in comparison with the group of women and, secondly, there is a difference in the nature of the connections between the studied tests and their subtests. The difference is in the positive correlation between the Tinetti test and the verbal component of the MMSE test, as well as between the subtest of balance within the Tinetti test and
the verbal component of the MMSE test in the group of men. In addition, a positive correlation was established between the Tinetti test and the FAB test indicators. In the female group correlation links are more diverse. In particular, noticeable is a positive correlation between the verbal component of the MMSE test and the FAB test. Besides, non-verbal functions in the MMSE test positively correlate with indicators of both gait and balance. Also revealed was a close positive correlation between the balance score and the overall score of the FAB test.
Thus, with CCI, cognitive and locomotor disorders have some differences in the groups of men and women. In general, taking into account the revealed correlation links, it can be said that with CCI disturbances in balance, cognitive impairment, and the entire locomotor dynamics are closely interrelated. At the same time, in the male group there is a closer connection of locomotor disorders with the verbal component of the MMSE test, whereas in the female group closer links come to form around the non-verbal component of the MMSE test, i.e. nonverbal functions are more closely related to locomotor functions.
Based on the obtained data, it can be concluded that during the formation of the main symptoms of CCI the intersystem dissociation in the group of men and women exists already at the very beginning. With all that said, global control of locomotor functions is more characteristic of the group of men, whereas non-verbal control is more characteristic of the group of women.
The presented data should be taken into account when choosing both medication and non-pharmacological approaches to the correction of cognitive and motor impairment in CCI, depending on sex.
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