This article is dedicated to the impact of dysfunction of the basal cholinergic system on the state of cognitive functions in various diseases of the brain. domestic and foreign literature is completely reviewed. The pathogenetic mechanisms of dysfunction cholinergic system of the brain are described in myasthenia gravis. Modern approaches in the treatment of cognitive impairment with using central cholinomimetics are described.
The study presents the results of a complex neuropsychological examination of patients with myasthenia gravis, which revealed intellectual disorders in 36.6% of cases, i.e., violations of memory processes, decreasing short-term memory level, and rapid deterioration of attention. A study of patients with myasthenia gravis with thymoma (before thymectomy) and patients with disease duration of more than 10 years found more pronounced memory and attention disorders (р < 0.05).
We performed a clinical, neurological, neuropsychological and laboratory examination of 30 patients with a confirmed diagnosis of myasthenia gravis, aged 25 to 69 years (49.0 ± 14.6 years), 11 men and 19 women. Among the examined patients, the generalized form of myasthenia was diagnosed in 20 (66.7%) patients: 4 (20.0%) cases of severe and 16 (80.0%) of moderate forms. The ocular form of myasthenia was found in 10 (33.3%) cases. Neuropsychological testing revealed memory impairment in 15 (50.0%), attention – 11 (36.7%), emotional disturbances – 13 (43.3%) patients with myasthenia gravis. A significant decrease in the concentration of brain-derived neurotrophic factor (BDNF) in the blood serum of patients with myasthenia was noted, compared with the control group (p < 0.01). When comparing the data of neuropsychological testing, the level of BDNF and the history of the disease, it was found that patients with a generalized form of myasthenia gravis and a disease duration of more than three years have a lower level BDNF, which has a reliable correlation with lower cognitive function scores.
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