Диагностика и лечение сосудистых когнитивных нарушений
Диагностика и лечение сосудистых когнитивных нарушений
Захаров В.В., Вахнина Н.В. Диагностика и лечение сосудистых когнитивных нарушений. Consilium Medicum. Неврология и Ревматология (Прил.). 2015; 1: 5–10.
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Zakharov V.V., Vakhnina N.V. Diagnosis and treatment of vascular cognitive impairments. Consilium Medicum. Neurology and Rheumatology (Suppl.). 2015; 1: 5–10.
Диагностика и лечение сосудистых когнитивных нарушений
Захаров В.В., Вахнина Н.В. Диагностика и лечение сосудистых когнитивных нарушений. Consilium Medicum. Неврология и Ревматология (Прил.). 2015; 1: 5–10.
________________________________________________
Zakharov V.V., Vakhnina N.V. Diagnosis and treatment of vascular cognitive impairments. Consilium Medicum. Neurology and Rheumatology (Suppl.). 2015; 1: 5–10.
Сосудистые когнитивные нарушения (СКН) являются вторыми по распространенности после болезни Альцгеймера. Их причиной могут быть инсульты и/или хроническая недостаточность кровоснабжения головного мозга. Диагностика СКН базируется на наличии сосудистого заболевания головного мозга и характерных клинических особенностей когнитивных нарушений: преобладание нарушений управляющих функций (планирование и контроль), которые сочетаются со снижением фона настроения (сосудистая депрессия), лобной дисбазией и другими неврологическими расстройствами. При ведении пациентов с СКН следует в первую очередь добиться максимально возможного контроля базисного сосудистого заболевания для профилактики прогрессирования когнитивных расстройств и их трансформации в деменцию. Большое значение имеют немедикаментозные методы: физические упражнения, когнитивный тренинг и оптимизация диеты. С симптоматической целью используются ингибиторы ацетилхолинэстеразы, мемантин, нейрометаболические и вазоактивные препараты.
Vascular cognitive impairment (VCI) is the second wide-spread disoderafter Alzheimer's disease. The stroke and/or chronic insufficient blood flow to the brain are their causes. Diagnosis of VCI is based on the existence of the cerebrovascular disease and the characteristic clinical features of cognitive impairments: the predominance of executive function (planning and control), combined with the reduction of background mood (vascular depression), frontal dysbasia and other neurological disorders. When managing the patients with VCI one should achieve the greatest possible control of the base vascular diseases to prevent the progression of cognitive disorders and their transformation into dementia. The most important are drug-free methods: physical exercise, cognitive training and diet optimization approach. Acetylcholinesterase inhibitor, memantine, neurometabolic and vasoactive drugs are used for the symptomatic treatment.
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20. Яхно Н.Н., Левин О.С., Дамулин И.В. Сопоставление клинических и МРТ-данных при дисциркуляторной энцефалопатии. Сообщение 1: двигательные нарушения. Неврол. журн. 2001; 6 (2): 10–6. / Iakhno N.N., Levin O.S., Damulin I.V. Sopostavlenie klinicheskikh i MRT-dannykh pri distsirkuliatornoi entsefalopatii. Soobshchenie 1: dvigatel'nye narusheniia. Nevrol. zhurn. 2001; 6 (2): 10–6. [in Russian]
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32. Diener HC, Sacco RL, Yusuf S et al. Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) Study Group. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo controlled study. Lancet Neurol 2008; 7: 875–84.
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35. Yusuf S, Diener HC, Sacco RL et al. PRoFESS Study Group. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008; 359: 1225–37.
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1. Iakhno N.N., Levin O.S., Damulin I.V. Sopostavlenie klinicheskikh i MRT-dannykh pri distsirkuliatornoi entsefalopatii. Soobshchenie 2: kognitivnye narusheniia. Nevrol. zhurn. 2001; 6 (3): 10–9. [in Russian]
2. Iakhno N.N., Zakharov V.V., Lokshina A.B. Sindrom umerennykh kognitivnykh narushenii pri distsirkuliatornoi entsefalopatii. Zhurn. nevrol. i psikhiatr. im. S.S.Korsakova. 2005; 105 (2): 13–7. [in Russian]
3. Iakhno N.N., Lokshina A.B., Zakharov V.V. Legkie i umerennye kognitivnye rasstroistva pri distsirkuliatornoi entsefalopatii. Nevrol. zhurn. 2004; 2: 30–5. [in Russian]
4. Hachinski V. Vascular dementia: radical re-definition. In: Vascular dementia: ethiology, pathogenesis and clinical aspects. Ed. By LA Carlson, SG Gottfries, B Winblad. Basel ETC: S.Karger, 1994; p. 2–4.
5. Vakhnina N.V., Nikitina L.Iu., Parfenov V.A. Postinsul'tnye kognitivnye narusheniia. Zhurn. nevrol. i psikhiatrii im. S.S.Korsakova. Insul't (Pril.). 2008; 22: 16–21. [in Russian]
6. Verbitskaia S.V., Parfenov V.A. Klinicheskii opyt primeneniia memantina pri postinsul'tnoi dementsii. Nevrol. zhurn. 2008; 13 (4): 45–7. [in Russian]
7. Martynov A.I., Shmyrev V.I., Ostroumova O.D. i dr. Osobennosti porazheniia belogo veshchestva golovnogo mozga u pozhilykh bol'nykh s arterial'noi gipertenziei. Klin. meditsina. 2000; 6: 11–5. [in Russian]
8. Cummings JL. Vascular subcortical dementias: clinical aspects. In: Vascular dementia. Ethiological, pathogenetic, clinical and treatment aspects. Ed. By LA Carlson, CG Gottfries, B Winblad. Basel etc.: S.Karger, 1994: p. 49–52.
9. Hershey LA, Olszewski WA. Ischemic vascular dementia. In: Handbook of Demented Illnesses. Ed. by JC Morris. New York etc.: Marcel Dekker, Inc., 1994; p. 335–51.
10. Preobrazhenskaia I.S., Iakhno N.N. Sosudistye kognitivnye narusheniia: klinicheskie proiavleniia, diagnostika, lechenie. Nevrol. zhurn. 2007; 12 (5): 45–50. [in Russian]
11. Rosvold HE. The frontal lobe system: cortical-subcortical interrelationships. Acta Neurobiol Exp 1972; 32: 49–460.
12. Saint-Cyr JA, Taylor AE, Nikolson K. Behaviour and Вasal ganglia. In: Behavioral Neurology of Movement Disorder. WJ Weiner, AE Lang (eds). Adv Neurol 1995; 65: 1–29.
13. Zakharov V.V., Iakhno N.N. Narusheniia pamiati. M.: GEOTAR-MED, 2003; s. 150. [in Russian]
14. Zakharov V.V., Voznesenskaia T.G. Nervno-psikhicheskie narusheniia: diagnosticheskie testy. M.: MEDpress, 2013. [in Russian]
15. Voznesenskaia T.G. Nekognitivnye nervno-psikhicheskie rasstroistva pri kognitivnykh narusheniiakh v pozhilom vozraste. Nevrol. zhurn. 2010; 2: 4–18. [in Russian]
16. Voznesenskaia T.G. Depressiia pri tserebrovaskuliarnykh zabolevaniiakh. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2009; 2: 9–13. [in Russian]
17. Voznesenskaia T.G. Depressiia pri sosudistykh zabolevaniiakh golovnogo mozga. Med. sovet. 2012; 4: 12–6. [in Russian]
18. Alexopoulos GS, Meners BS, Young RC et al. Clinically defined vascular depression. Am J Psychiatry 1997; .9: 22–9.
19. Krishnan KRR, Hays JC, Blazer DG. MRI-defined vascular depression. Am J Psychiatry 1997; 154: 497–501.
20. Iakhno N.N., Levin O.S., Damulin I.V. Sopostavlenie klinicheskikh i MRT-dannykh pri distsirkuliatornoi entsefalopatii. Soobshchenie 1: dvigatel'nye narusheniia. Nevrol. zhurn. 2001; 6 (2): 10–6. [in Russian]
21. Haag MD, Hofman A, Koudstaal PJ et al. Duration of antihypertensive drug use and risk of dementia: a prospective cohort study. Neurology 2009; 72: 1727–234.
22. Perila R, White LR, Masaki K et al. Reducing the risk of dementia: efficacy of long term treatment of hypertension. Stroke 2006; 37: 1165–70.
23. Guo Z, Fratiglioni L, Zhu L et al. Occurrence and progression of dementia in a community population aged 75 years and older: relationship of antihypertensive medication use. Arch Neurol 1999; 56: 991–6.
24. Khachaturian AS, Zandi PP, Lyketos CG et al. Antihypertensive medication use and incidence of Alzheimer’s disease: the Cache County Study. Arch Neurol 2006; 63: 686–92.
25. Qui C, von Strauss E, Fastbom J et al. Low blood pressure and risk of dementia in the Kungholmen study: a 6 years follow-up study. Arch Neurol 2003; 60: 223–8.
26. Veld BA, Ruitenberg A, Hofman A et al. Antihypertensive drugs and incidence of dementia in the Rotterdam study. Neurobiol Aging 2001; 22: 407–12.
27. Lindsay J, Laurin D, Verreault R et al. Risk factors for Alzheimer’s disease: a prospective analysis from the Canadian study of health and aging. Am J Epidemiol 2002; 152: 445–56.
28. Morris MC, Scherr PA, Hebert LE et al. Association of incident Alzheimer’s disease and blood pressure measured from 13 years after diagnosis in the large community study. Arch Neurol 2001: 1640–6.
29. Forette F, Seux ML, Staessen JA et al. Prevention of dementia in randomised double-blind placebo controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352: 1347–51.
30. Tzourio C, Anderson C, Chapman N et al. PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 2003; 163: 1069–75.
31. SHEP Cooperative Research group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertention.
32. Diener HC, Sacco RL, Yusuf S et al. Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) Study Group. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo controlled study. Lancet Neurol 2008; 7: 875–84.
33. Lithell H, Hansson L, Skoog I et al. SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
34. Peters R, Beckett N, Forette F et al. HYVET Investigators. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 2008; 7: 683–9.
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Авторы
В.В.Захаров*, Н.В.Вахнина
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*zakharovenator@gmail.com
________________________________________________
V.V.Zakharov*, N.V.Vakhnina
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*zakharovenator@gmail.com