Purpose: to evaluate the effectiveness of treatment of cognitive disorders with the use of piracetam and choline alfoscerate in patients with arterial hypertension combined with hypothyroidism, according to the data of cognitive auditory evoked potentials (CAEP).
Object and research methods. 60 patients with arterial hypertension combined with hypothyroidism were examined: 23.3% were men, the average age was 50 (45, 56) years, mean duration of the disease was 9 [6, 15] years. Cognitive functions were studied using the Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination (ACE-R) with determination of the affected domains, as well as the P300 CAEP in Fp1/Fp2, T3/T4, P3/P4 leads. Patients were randomized into three groups according to the treatment method: 1st group (n=20) served as a control group, patients received basic therapy for arterial hypertension and hypothyroidism; 2nd group (n=20) — piracetam at a dose of 4.8 g/day was included in the basic therapy; 3rd group patients received choline alfoscerate 800 mg/day in addition to piracetam. The control group consisted of 20 practically healthy persons (PHPs) of the appropriate age. The examination was performed at the first visit and two months after treatment. Statistical analysis of the results was applied.
Results. The latent period (LP) of the P300 CAEP in the studied patients was prolonged in Fp1/Fp2, T3/T4 leads compared with the PHPs (p<0.05), the P300 amplitude was reduced in Fp1/Fp2 (p<0.05). Error rate when pressing the button on the sensor when an insignificant sound signal appears: Me=23% with Me=12% in PHPs (p<0.05). There was a correlation between cognitive functions according to the MMSE scale and P300: «attention and calculation» and LP of Fр1 the P300 CAEP /Fр2 (r=0.59; p=0.039), «attention and calculation» and LP of T3/T4 (r=0.64; p=0.048), «fixation in memory» and LP of T3/T4 (r=0.58; p=0.034), «orientation» and LP of Fр1/Fр2 (r=0.46; p=0.047); a slightly stronger relationship was observed between ACE-R indicators: «attention» and LP of Fr1/Fr2 (r=0.66; p=0.021), «memory» and LP of Fr1/Fr2 (r=0.74; p=0.019), «memory» and LP of T3/T4 (r=0.76; p=0.018), «spatial abilities» and P3/P4 (r=0.61; p=0.019). After two months of treatment, there was a decrease in the error rate in the study of an insignificant sound signal compared with the data before treatment in 2nd group (28 (19, 47) vs 35 (23, 47); p<0.05) and 3rd group (26 (18, 42) vs 34 (23, 49); p<0.05) without intergroup difference (p>0.05). In 2nd and 3rd groups, there was a significant prolongation of the LP in Fp1/Fp2 and T3/T4 leads (p<0.05), with a difference in the effectiveness of treatment in 3rd group: a significant difference between the LP indicators in T3/T4 lead (p<0.05). The P300 amplitude after treatment in 2nd and 3rd groups increased and was within the limits of the PHPs (p>0.05).
Conclusion. Patients with arterial hypertension combined with hypothyroidism, even with relative compensation of the diseases, have cognitive disorders. Changes in the P300 CAEP in the anterior-frontal and posterior-temporal leads in the form of LP lengthening and a decrease in the P300 amplitude were detected, which correlated with the MMSE and ACE-R scores, according to which the most vulnerable domains were «fixation in memory», «attention», and «recall». The use of piracetam has a positive effect on improving memory, attention, and memorization; the additional administration of choline alfoscerate has an addictive effect on memory function.
