RU2708838C1 - Method for differential diagnosis of cognitive disorders in alcoholic and dyscirculatory encephalopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, psychiatry, neuropsychology, and can be used in diagnosing alcoholic genesis and dyscirculatory encephalopathy. Indices of Δ-rhythm, β2-rhythm, β1-rhythm are determined; impressive speech parameter; index of visual imaginative memory, index by 1 scale of hypochondrium MMPI. Discriminant function (F) is calculated by original calculation formula using the derived values. If F is more than a constant, cognitive disorders accompanying alcoholic encephalopathy are diagnosed; if F is less than a constant, cognitive disorders are diagnosed in dyscirculatory encephalopathy; at F equal to constant - cognitive disorders combined with encephalopathy: alcoholic and vascular.

EFFECT: method enables high-accuracy differentiation of cognitive disorders in alcoholic and dyscirculatory encephalopathies in each specific case by mathematical processing of complex of indicators obtained using said tests.

1 cl, 1 tbl, 3 ex

Description

The invention relates to medicine, namely to neurology, psychiatry, neuropsychology.

When establishing a diagnosis of alcohol intoxication, doctors often have to resort to differential diagnosis of toxic encephalopathy of alcoholic origin from encephalopathy of another etiology. Most often, a differential diagnosis implies the need to distinguish between signs of alcoholic encephalopathy from brain damage of vascular origin. Currently, the differences in cognitive impairment in vascular and alcoholic pathologies of the brain remain poorly understood.

There are known methods for the differential diagnosis of mercury encephalopathy and discirculatory encephalopathy, mercury and alcohol encephalopathy, portosystemic encephalopathy and discirculatory encephalopathy, including clinical neurological examination, ultrasound dopplerography (Doppler ultrasound), magnetic encephal arterial magnetic resonance imaging, and tomography, rheoencephalography (REG), psychological research of emotional-volitional and mnestic intelligence in the natural areas, biochemical study of lipid metabolism, determination of the concentration and qualitative composition of short-chain fatty acids of the C2-C6 fraction with isomers in the blood serum [1, 2, 5, 6, 10, 12, 13-18]. However, these techniques are not accurate enough to detect signs of cognitive deficiency in alcoholic encephalopathy and discirculatory (vascular) encephalopathy.

The closest is the instruction for use in comparing cognitive impairment in patients with chronic toxic-metabolic encephalopathy and discirculatory encephalopathy, including analysis of dopplerographic, neuroimaging, neuropsychological and biochemical parameters [4]. However, the diagnosis of cognitive impairment of one syndrom complex with alcoholic encephalopathy with concomitant vascular damage to the brain can be difficult due to the lack of a systematic approach to the analysis and processing of data by methods that allow obtaining better results of modeling the dependencies between individual characters.

The objective of the invention is to improve the accuracy of the differential diagnosis of cognitive impairment in alcoholic encephalopathy and discirculatory encephalopathy, expanding the arsenal of available techniques that allows for diagnosis.

The problem is solved by identifying violations in the cognitive sphere with the help of a neurophysiological examination with the determination of indices of Δ-rhythm, β2-rhythm, β1-rhythm indices by EEG; psychological testing with determination of indicators of impressive speech, visual figurative memory, on the scale 1 of hypochondria of the SMIL test, calculation of discriminant function using the obtained indicators, followed by assigning the patient to a group with cognitive impairment in alcoholic encephalopathy or to a group with cognitive impairment in discirculatory encephalopathy.

A comparative analysis of the proposed solution with the prototype [4] shows that it is common to conduct neuropsychological testing, including the determination of indicators of impressive speech and visual figurative memory. Distinctive is that psychological testing additionally includes determining the indicator on the 1st hypochondria scale of the SMIL test; during a neurophysiological examination, electroencephalography is carried out with the determination of the Δ-rhythm, β2-rhythm, β1-rhythm indices, after which the discriminant function F is calculated, and when F is more constant, cognitive impairment is diagnosed with alcohol encephalopathy; when F is less than a constant, cognitive impairment is diagnosed with discirculatory encephalopathy; with F equal to 0 - with a combined variant of encephalopathy.

Thus, the proposed technical solution meets the criteria of the invention of "novelty."

Currently, there are known possibilities of using neurophysiological and neuropsychological methods to study cognitive impairment in organic brain damage [3, 7, 8, 9, 11, 19-24].

The use of the proposed complex of indicators obtained using these tests for mathematical calculation for the differential diagnosis of cognitive impairment in alcoholic encephalopathy and discirculatory encephalopathy is not found in the literature available to us.

The developed method can be used by neurologists, psychiatrists, therapists, neuropsychologists, physiologists of medical institutions, scientific institutions, specialists of the medical units with a differentiated approach in the diagnosis of cognitive impairment in alcoholic encephalopathy and discirculatory encephalopathy. Thus, the method meets the criterion of "industrial applicability".

The method is as follows:

The patient undergoes a neurophysiological examination with the determination of indicators of Δ-rhythm indices by EEG in%; β2-rhythm by EEG in%; β1-rhythm by EEG in%; neuropsychological testing with the definition of indicators of impressive speech in points; visual figurative memory in points; on a scale of 1 hypochondria of the SMIL test in points. The discriminant function is calculated by the formula:

F = 26.19 + 0.25⋅a ₁ + 0.66⋅a ₂ + 0.19⋅a ₃ + 2.82⋅a ₄ + 2.29⋅a ₅ -0.43⋅a ₆

29.19 is a constant;

0.25; 0.66; 0.19; 2.82; 2.29; -0.43 - discrimination factors;

a _{1,2 ... 6} - numerical values of the indicators of the survey: a ₁ - index of the Δ-rhythm by EEG in%; and ₂ is an index of β ₂ - EEG rhythm in%; and ₃ is an indicator of the β1 rhythm by EEG in%; a ₄ is an indicator of impressive speech in points; a ₅ is an indicator of visual figurative memory in points; and ₆ is an indicator on a scale 1 (hypochondria) of the SMIL test in points.

With F, more constants are diagnosed with cognitive impairment in alcohol encephalopathy; when F is less than a constant, cognitive impairment is diagnosed with discirculatory encephalopathy; when F is equal to constant - cognitive impairment with a combined variant of encephalopathy: alcoholic and vascular.

To determine the differential diagnostic criteria for cognitive impairment in alcoholic encephalopathy and discirculatory encephalopathy, a discriminant analysis of the parameters of patients with alcoholic encephalopathy and patients with discirculatory encephalopathy was performed. The reliability of the obtained informative indicators is presented in table 1.

The calculation of the discriminant functions F ₁ and F _{2 is} performed according to the formulas:

F ₁ = -61.44 + 0.37⋅a ₁ +0.65 a ₂ -0.03⋅a ₃ + 5.80⋅a ₄ -2.45 a ₅ +0.53 a ₆ ;

F ₂ = -35.25 + 0.12⋅a ₁ -0.01 a ₂ + 0.22⋅a ₃ + 2.98⋅a ₄ -0.16 a ₅ -0.10 a ₆ ;

where F ₁ - discriminant function for encephalopathy from exposure to alcohol;

F ₂ - discriminant function for discirculatory encephalopathy; -35.25 and -61.44 are constants;

0.12; -0.01; 0.22; 2.98 _; -0.16; -0.10; 0.37; 0.65; -0.03; 5.80, -2.45 and 0.53 discrimination factors;

a _{1,2 ... 6} - numerical values of the indicators of the survey: a ₁ - index of the Δ-rhythm by EEG in%; and ₂ - index of the β2 rhythm index by EEG in%; and ₃ - indicator of β ₁ rhythm by EEG in%; a ₄ is an indicator of impressive speech in points; a ₅ is an indicator of visual figurative memory in points; and ₆ is an indicator on a scale 1 (hypochondria) of the SMIL test in points.

The discriminant function F is obtained by subtracting the discriminant functions of alcoholic and discirculatory encephalopathy:

F = 26.19 + 0.25⋅a ₁ + 0.66⋅a ₂ + 0.19⋅a ₃ + 2.82⋅a ₄ + 2.29⋅a ₅ -0.43⋅a ₆

With F, more constants are diagnosed with cognitive impairment in alcohol encephalopathy; when F is less than a constant, cognitive impairment is diagnosed with discirculatory encephalopathy; when F is equal to constant - cognitive impairment with a combined variant of encephalopathy: alcoholic and vascular.

Evaluation of the effectiveness of the proposed diagnostic method was carried out in training and control samples. In the training samples (30 and 25 people), the correct recognition was 98% for patients with alcoholic encephalopathy, 96% for patients with discirculatory encephalopathy, and 100% for conditionally healthy patients who did not have intoxication in the professional route of exposure to harmful substances (30 human).

The simulated relationship between the proposed indicators allowed us to achieve the objectivity of the assessment of the obtained indicators and, thus, to increase the accuracy of diagnosis compared to the prototype.

Example 1

Patient S. (age 60 years old, according to his words uses alcohol 1-2 times a week from 100 to 200 g), with complaints of headaches, sleep disturbance, memory loss, a neurophysiological examination was conducted with the determination of indices of the Δ-rhythm, β2-rhythm , β1 rhythm, neuropsychological testing with the definition of indicators of impressive speech and visual figurative memory, scale 1 of the hypochondria of the SMIL test and their numerical values are determined:

a1 - Index Δ - rhythm - 20.3%,

A2 - β2 - rhythm index - 4.4%,

A3 - Index β1 - rhythm - 32.5%,

A4 - Impressive speech - 0.8 points,

a5 - Visual figurative memory - 1.6 points

a6 - Scale 1 of the hypochondria of the SMIL test - 76.6 points.

F = 26.19 + 0.25⋅20.3 + 0.66⋅4.4 + 0.19⋅32.5 + 2.82⋅0.8 + 2.29⋅1.6-0.43⋅ 76.6 = 13.3, F <constants.

Conclusion: Patient C. has cognitive impairment in discirculatory encephalopathy.

Example 2

Patient A. (age 58 years old, according to words he drinks alcohol 1-2 times a week from 100 to 200 g, was observed for some time by a narcologist with a diagnosis of alcoholism, denies excessive drinking), with complaints of decreased mood, increased fatigue, decreased memory and of attention, a neurophysiological examination was carried out with the determination of indices of the Δ-rhythm, β2-rhythm, β1-rhythm indices, neuropsychological testing with the determination of indicators of impressive speech and visual figurative memory, hypochondria scale 1 of the SMIL test and their numerical values were determined Niya:

a1 - Index Δ - rhythm - 56.4%,

A2 - Index β2 - rhythm - 10.0%,

A3 - Index β1 - rhythm - 7.9%,

A4 - Impressive speech - 1.3 points,

a5 - Visual figurative memory - 0.8 points

a6 - Scale 1 of the hypochondria of the SMIL test - 56 points.

F = 26.19 + 0.25⋅56.4 + 0.66⋅10.0 + 0.19⋅7.9 + 2.82⋅1.3 + 2.29⋅0.8-0.43⋅ 56 = 29.8, F> constants.

Conclusion: Patient A. has cognitive impairment in alcoholic encephalopathy.

Example 3

Patient D. (age 56 years, from the words he drinks alcohol 1-2 times a week from 100 to 200 g, denies drunken drinking), with complaints of persistent headaches, memory loss, general weakness, irritability, a neurophysiological examination was conducted with the determination of indicators indices of Δ-rhythm, β2-rhythm, β1-rhythm, neuropsychological testing with the definition of indicators of impressive speech and visual figurative memory, scale 1 of the hypochondria of the SMIL test and their numerical values are determined:

a1 - Index Δ - rhythm - 39.0%,

A2 - Index β2 - rhythm - 5.0%,

A3 - Index β1 - rhythm - 28.9%,

A4 - Impressive speech - 1 point,

a5 - Visual figurative memory - 1 point,

a6 - Scale 1 of the hypochondria of the SMIL test - 55 points.

F = 26.19 + 0.25⋅39.0 + 0.66⋅5.0 + 0.19⋅28.9 + 2.82⋅1 + 2.29⋅l-0.43⋅55 = 26, 19, F = constants.

Conclusion: Patient D. has cognitive impairment with a combined variant of encephalopathy: alcoholic and vascular.

The proposed method makes it possible to differentially approach the diagnosis of cognitive impairment in alcoholic and discirculatory encephalopathy.

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Claims (7)

A method for the differential diagnosis of cognitive impairment in alcoholic and discirculatory encephalopathy, including neurophysiological examination and neuropsychological testing, characterized in that during a neurophysiological examination, electroencephalography is performed and indices of Δ-rhythm, β2-rhythm, β1-rhythm are determined, and neuropsychological testing of speech determines indicators visual figurative memory, an indicator on the 1st hypochondria scale of the SMIL test, discriminant function is calculated by the formula: F = 26.19 + 0.25⋅a ₁ + 0.66⋅a ₂ + 0.19⋅a ₃ + 2.82⋅a ₄ + 2.29⋅a ₅ -0.43⋅a ₆ , where F is the discriminant function; 26.19 is a constant; 0.25; 0.66; 0.19; 2.82; 2.29; -0.43 - discrimination factors; a _{1,2 ... 6} - numerical values of the indicators of the survey: a ₁ -indicator of the Δ-rhythm index by EEG in%; and ₂ - index of the β2 rhythm index by EEG in%; and ₃ is an indicator of the β ₁ rhythm index by EEG in%; a ₄ is an indicator of impressive speech in points; a ₅ is an indicator of visual figurative memory in points; and ₆ is an indicator on a scale of 1 hypochondria of the SMIL test in points; with F, more constants are diagnosed with cognitive impairment in alcohol encephalopathy; when F is less than a constant, cognitive impairment is diagnosed with discirculatory encephalopathy; with F equal to a constant - cognitive impairment in the combined variant of encephalopathy: alcoholic and vascular.