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Хроническая ишемия головного мозга: синдромологические подходы к терапии
Хроническая ишемия головного мозга: синдромологические подходы к терапии
Щукин И.А., Лебедева А.В., Бурд Г.С. и др. Хроническая ишемия головного мозга: синдромологические подходы к терапии. Неврология и Ревматология (Прил.). 2015; 1: 17–24.
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Аннотация
В статье рассматриваются вопросы синдромологического подхода к ведению пациентов с хронической ишемией головного мозга. Показано, что ведущими клиническими синдромами являются астенический и синдром умеренных когнитивных нарушений. Выявлено негативное влияние астении, когнитивных расстройств и эмоциональных нарушений на качество жизни пациентов с хронической ишемией головного мозга. Представлены данные по лечению пациентов с хронической ишемией головного мозга препаратами, обладающими метаболическими, энерготропными, антиоксидантными и гемореологическими свойствами (ацетил-L-карнитин и винпоцетин). Выявлено, что ацетил-L-карнитин обладает выраженной эффективностью в плане коррекции астенических и умеренных когнитивных расстройств у пациентов с хронической ишемией головного мозга.
Ключевые слова: хроническая ишемия головного мозга, астения, умеренное когнитивное расстройство, качество жизни, ацетил-L-карнитин.
Key words: chronic cerebral ischemia, asthenia, moderate cognitive impairment, quality of life, acetyl-L-carnitine.
Ключевые слова: хроническая ишемия головного мозга, астения, умеренное когнитивное расстройство, качество жизни, ацетил-L-карнитин.
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Key words: chronic cerebral ischemia, asthenia, moderate cognitive impairment, quality of life, acetyl-L-carnitine.
Полный текст
Список литературы
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2. Суслина З.А., Румянцева С.А. Нейрометаболическая терапия хронической ишемии мозга. Методическое пособие. М., 2009. / Suslina Z.A., Rumiantseva S.A. Neirometabolicheskaia terapiia khronicheskoi ishemii mozga. Metodicheskoe posobie. M., 2009. [in Russian]
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19. Schultz-Larsen K. Tiredness in daily activities: a subjective measure for the identification of frailty among non-disabled community-living older adults. Arch Gerontol Geriatr 2007; 44: 83–93.
20. Aggarwal VR, McBeth J, Zakrzewska JM et al. The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors? Int J Epidemiol 2006; 35: 468–76.
21. Kates AM, Herrero P, Dence C et al. Impact of aging on substrate metabolism by the human heart. J Am Coll Cardiol 2003; 41: 293–99.
22. Lanza IR, Nair KS. Muscle mitochondrial changes with aging and exercise. Am J Clin Nutr 2009; 89: 467–71.
23. Winblad B, Gauthier S, Scinto L et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology 2008; 70: 2024–35. [Erratum, Neurology 2010; 75: 1485.]
24. Feldman HH, Ferris S, Winblad B et al. Effect of rivastigmine on delay to diagnosis of Alzheimer’s disease from mild cognitive impairment: the InDDEx study. Lancet Neurol 2007; 6: 501–12. [Erratum, Lancet Neurol 2007; 6: 849.]
25. Thal LJ, Ferris SH, Kirby L et al. A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology 2005; 30: 1204–15.
26. Doody RS, Ferris SH, Salloway S et al. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology 2009; 72: 1555–61.
27. Petersen RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005; 352: 2379–88.
28. Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300: 1027–37.
29. Дума С.Н., Лисиченко О.В., Лукьянова Г.В. Психовегетативные, астенические и когнитивные нарушения при дисплазии соединительной ткани: выбор оптимальной терапии. Фарматека. 2012; 7. / Duma S.N., Lisichenko O.V., Luk'ianova G.V. Psikhovegetativnye, astenicheskie i kognitivnye narusheniia pri displazii soedinitel'noi tkani: vybor optimal'noi terapii. Farmateka. 2012; 7. [in Russian]
2. Suslina Z.A., Rumiantseva S.A. Neirometabolicheskaia terapiia khronicheskoi ishemii mozga. Metodicheskoe posobie. M., 2009. [in Russian]
3. Kral VA. Senescent forgetfulness: benign and malignant. Can Med Assoc J 1962; 86: 257–60.
4. Ritchie K, Touchon J. Mildcognitive impairment: conceptual basis and current nosological status. Lancet 2000; 355 (9199): 225–8.
5. Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol 2005; 62 (7): 1160–3.
6. Petersen RC, Smith GE, Waring SC et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56 (3): 303–8.
7. Petersen RC, Roberts RO, Knopman DS et al. Mild cognitive impairment: ten years later. Jr Arch Neurol 2009; 66 (12): 1447–55.
8. Molano J, Boeve B. Mild cognitive impairment associated with limbic and neocortical Lewy body disease: a clinicopathological study. Brain 2010; 133 (Pt 2): 540–56.
9. Gusev E.I., Bogolepova A.N. Kognitivnye narusheniia pri tserebrovaskuliarnykh zabolevaniiakh. M.: MEDpress-inform, 2013. [in Russian]
10. Modrego PJ, Ferrández J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol 2004; 61 (8): 1290–3.
11. Jokinen H, Lipsanen J, Schmidt R et al. Brain atrophy accelerates cognitive decline in cerebral small vessel disease: the LADIS study. Neurology 2012; 78 (22): 1785–92.
12. LADIS Study Group. 2001-2011: a decade of the LADIS (Leukoaraiosis And DISability) Study: what have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011; 32 (6): 577–88.
13. Eckerstrom C, Olsson E, Klasson N et al. High white matter lesion load is associated with hippocampal atrophy in mild cognitive impairment. Dement Geriatr Cogn Disord 2011; 31 (2): 132–8.
14. Devine ME, Fonseca JA,Walker Z. Do cerebral white matter lesions influence the rate of progression from mild cognitive impairment to dementia? Int Psychogeriatr 2013; 25 (1): 120–7.
15. Leegaard OF. Diffuse cerebral symptoms in convalescents from cerebral infarction and myocardial infarction. Acta Neurol Scand 1983; 67: 348–55.
16. Christensen D, Johnsen SP, Watt T et al. Dimensions of post-stroke fatigue: a two-year follow-up study. Cerebrovasc Dis 2008; 26: 134–41.
17. Glader EL, Stegmayr B, Asplund K. Poststroke fatigue: a two-year follow-up study of stroke patients in Sweden. Stroke 2002; 33: 1327–33.
18. Hardy SE. Qualities of fatigue and associated chronic conditions among older adults. J Pain Symptom Manage 2010; 39: 1033–42.
19. Schultz-Larsen K. Tiredness in daily activities: a subjective measure for the identification of frailty among non-disabled community-living older adults. Arch Gerontol Geriatr 2007; 44: 83–93.
20. Aggarwal VR, McBeth J, Zakrzewska JM et al. The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors? Int J Epidemiol 2006; 35: 468–76.
21. Kates AM, Herrero P, Dence C et al. Impact of aging on substrate metabolism by the human heart. J Am Coll Cardiol 2003; 41: 293–99.
22. Lanza IR, Nair KS. Muscle mitochondrial changes with aging and exercise. Am J Clin Nutr 2009; 89: 467–71.
23. Winblad B, Gauthier S, Scinto L et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology 2008; 70: 2024–35. [Erratum, Neurology 2010; 75: 1485.]
24. Feldman HH, Ferris S, Winblad B et al. Effect of rivastigmine on delay to diagnosis of Alzheimer’s disease from mild cognitive impairment: the InDDEx study. Lancet Neurol 2007; 6: 501–12. [Erratum, Lancet Neurol 2007; 6: 849.]
25. Thal LJ, Ferris SH, Kirby L et al. A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology 2005; 30: 1204–15.
26. Doody RS, Ferris SH, Salloway S et al. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology 2009; 72: 1555–61.
27. Petersen RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005; 352: 2379–88.
28. Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300: 1027–37.
29. Duma S.N., Lisichenko O.V., Luk'ianova G.V. Psikhovegetativnye, astenicheskie i kognitivnye narusheniia pri displazii soedinitel'noi tkani: vybor optimal'noi terapii. Farmateka. 2012; 7. [in Russian]
2. Суслина З.А., Румянцева С.А. Нейрометаболическая терапия хронической ишемии мозга. Методическое пособие. М., 2009. / Suslina Z.A., Rumiantseva S.A. Neirometabolicheskaia terapiia khronicheskoi ishemii mozga. Metodicheskoe posobie. M., 2009. [in Russian]
3. Kral VA. Senescent forgetfulness: benign and malignant. Can Med Assoc J 1962; 86: 257–60.
4. Ritchie K, Touchon J. Mildcognitive impairment: conceptual basis and current nosological status. Lancet 2000; 355 (9199): 225–8.
5. Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol 2005; 62 (7): 1160–3.
6. Petersen RC, Smith GE, Waring SC et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56 (3): 303–8.
7. Petersen RC, Roberts RO, Knopman DS et al. Mild cognitive impairment: ten years later. Jr Arch Neurol 2009; 66 (12): 1447–55.
8. Molano J, Boeve B. Mild cognitive impairment associated with limbic and neocortical Lewy body disease: a clinicopathological study. Brain 2010; 133 (Pt 2): 540–56.
9. Гусев Е.И., Боголепова А.Н. Когнитивные нарушения при цереброваскулярных заболеваниях. М.: МЕДпресс-информ, 2013. / Gusev E.I., Bogolepova A.N. Kognitivnye narusheniia pri tserebrovaskuliarnykh zabolevaniiakh. M.: MEDpress-inform, 2013. [in Russian]
10. Modrego PJ, Ferrández J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol 2004; 61 (8): 1290–3.
11. Jokinen H, Lipsanen J, Schmidt R et al. Brain atrophy accelerates cognitive decline in cerebral small vessel disease: the LADIS study. Neurology 2012; 78 (22): 1785–92.
12. LADIS Study Group. 2001-2011: a decade of the LADIS (Leukoaraiosis And DISability) Study: what have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011; 32 (6): 577–88.
13. Eckerstrom C, Olsson E, Klasson N et al. High white matter lesion load is associated with hippocampal atrophy in mild cognitive impairment. Dement Geriatr Cogn Disord 2011; 31 (2): 132–8.
14. Devine ME, Fonseca JA,Walker Z. Do cerebral white matter lesions influence the rate of progression from mild cognitive impairment to dementia? Int Psychogeriatr 2013; 25 (1): 120–7.
15. Leegaard OF. Diffuse cerebral symptoms in convalescents from cerebral infarction and myocardial infarction. Acta Neurol Scand 1983; 67: 348–55.
16. Christensen D, Johnsen SP, Watt T et al. Dimensions of post-stroke fatigue: a two-year follow-up study. Cerebrovasc Dis 2008; 26: 134–41.
17. Glader EL, Stegmayr B, Asplund K. Poststroke fatigue: a two-year follow-up study of stroke patients in Sweden. Stroke 2002; 33: 1327–33.
18. Hardy SE. Qualities of fatigue and associated chronic conditions among older adults. J Pain Symptom Manage 2010; 39: 1033–42.
19. Schultz-Larsen K. Tiredness in daily activities: a subjective measure for the identification of frailty among non-disabled community-living older adults. Arch Gerontol Geriatr 2007; 44: 83–93.
20. Aggarwal VR, McBeth J, Zakrzewska JM et al. The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors? Int J Epidemiol 2006; 35: 468–76.
21. Kates AM, Herrero P, Dence C et al. Impact of aging on substrate metabolism by the human heart. J Am Coll Cardiol 2003; 41: 293–99.
22. Lanza IR, Nair KS. Muscle mitochondrial changes with aging and exercise. Am J Clin Nutr 2009; 89: 467–71.
23. Winblad B, Gauthier S, Scinto L et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology 2008; 70: 2024–35. [Erratum, Neurology 2010; 75: 1485.]
24. Feldman HH, Ferris S, Winblad B et al. Effect of rivastigmine on delay to diagnosis of Alzheimer’s disease from mild cognitive impairment: the InDDEx study. Lancet Neurol 2007; 6: 501–12. [Erratum, Lancet Neurol 2007; 6: 849.]
25. Thal LJ, Ferris SH, Kirby L et al. A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology 2005; 30: 1204–15.
26. Doody RS, Ferris SH, Salloway S et al. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology 2009; 72: 1555–61.
27. Petersen RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005; 352: 2379–88.
28. Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300: 1027–37.
29. Дума С.Н., Лисиченко О.В., Лукьянова Г.В. Психовегетативные, астенические и когнитивные нарушения при дисплазии соединительной ткани: выбор оптимальной терапии. Фарматека. 2012; 7. / Duma S.N., Lisichenko O.V., Luk'ianova G.V. Psikhovegetativnye, astenicheskie i kognitivnye narusheniia pri displazii soedinitel'noi tkani: vybor optimal'noi terapii. Farmateka. 2012; 7. [in Russian]
________________________________________________
2. Suslina Z.A., Rumiantseva S.A. Neirometabolicheskaia terapiia khronicheskoi ishemii mozga. Metodicheskoe posobie. M., 2009. [in Russian]
3. Kral VA. Senescent forgetfulness: benign and malignant. Can Med Assoc J 1962; 86: 257–60.
4. Ritchie K, Touchon J. Mildcognitive impairment: conceptual basis and current nosological status. Lancet 2000; 355 (9199): 225–8.
5. Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol 2005; 62 (7): 1160–3.
6. Petersen RC, Smith GE, Waring SC et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56 (3): 303–8.
7. Petersen RC, Roberts RO, Knopman DS et al. Mild cognitive impairment: ten years later. Jr Arch Neurol 2009; 66 (12): 1447–55.
8. Molano J, Boeve B. Mild cognitive impairment associated with limbic and neocortical Lewy body disease: a clinicopathological study. Brain 2010; 133 (Pt 2): 540–56.
9. Gusev E.I., Bogolepova A.N. Kognitivnye narusheniia pri tserebrovaskuliarnykh zabolevaniiakh. M.: MEDpress-inform, 2013. [in Russian]
10. Modrego PJ, Ferrández J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol 2004; 61 (8): 1290–3.
11. Jokinen H, Lipsanen J, Schmidt R et al. Brain atrophy accelerates cognitive decline in cerebral small vessel disease: the LADIS study. Neurology 2012; 78 (22): 1785–92.
12. LADIS Study Group. 2001-2011: a decade of the LADIS (Leukoaraiosis And DISability) Study: what have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011; 32 (6): 577–88.
13. Eckerstrom C, Olsson E, Klasson N et al. High white matter lesion load is associated with hippocampal atrophy in mild cognitive impairment. Dement Geriatr Cogn Disord 2011; 31 (2): 132–8.
14. Devine ME, Fonseca JA,Walker Z. Do cerebral white matter lesions influence the rate of progression from mild cognitive impairment to dementia? Int Psychogeriatr 2013; 25 (1): 120–7.
15. Leegaard OF. Diffuse cerebral symptoms in convalescents from cerebral infarction and myocardial infarction. Acta Neurol Scand 1983; 67: 348–55.
16. Christensen D, Johnsen SP, Watt T et al. Dimensions of post-stroke fatigue: a two-year follow-up study. Cerebrovasc Dis 2008; 26: 134–41.
17. Glader EL, Stegmayr B, Asplund K. Poststroke fatigue: a two-year follow-up study of stroke patients in Sweden. Stroke 2002; 33: 1327–33.
18. Hardy SE. Qualities of fatigue and associated chronic conditions among older adults. J Pain Symptom Manage 2010; 39: 1033–42.
19. Schultz-Larsen K. Tiredness in daily activities: a subjective measure for the identification of frailty among non-disabled community-living older adults. Arch Gerontol Geriatr 2007; 44: 83–93.
20. Aggarwal VR, McBeth J, Zakrzewska JM et al. The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors? Int J Epidemiol 2006; 35: 468–76.
21. Kates AM, Herrero P, Dence C et al. Impact of aging on substrate metabolism by the human heart. J Am Coll Cardiol 2003; 41: 293–99.
22. Lanza IR, Nair KS. Muscle mitochondrial changes with aging and exercise. Am J Clin Nutr 2009; 89: 467–71.
23. Winblad B, Gauthier S, Scinto L et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology 2008; 70: 2024–35. [Erratum, Neurology 2010; 75: 1485.]
24. Feldman HH, Ferris S, Winblad B et al. Effect of rivastigmine on delay to diagnosis of Alzheimer’s disease from mild cognitive impairment: the InDDEx study. Lancet Neurol 2007; 6: 501–12. [Erratum, Lancet Neurol 2007; 6: 849.]
25. Thal LJ, Ferris SH, Kirby L et al. A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology 2005; 30: 1204–15.
26. Doody RS, Ferris SH, Salloway S et al. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology 2009; 72: 1555–61.
27. Petersen RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005; 352: 2379–88.
28. Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300: 1027–37.
29. Duma S.N., Lisichenko O.V., Luk'ianova G.V. Psikhovegetativnye, astenicheskie i kognitivnye narusheniia pri displazii soedinitel'noi tkani: vybor optimal'noi terapii. Farmateka. 2012; 7. [in Russian]
Авторы
И.А.Щукин*1, А.В.Лебедева1, Г.С.Бурд1, М.С.Фидлер1, Р.К.Шихкеримов2, А.М.Исмаилов3, М.Э.Бельгушева4, С.В.Петров5
1 ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ГБУЗ Городская поликлиника №166 Департамента здравоохранения г. Москвы. 115551, Россия, Москва, Домодедовская ул., д. 9;
3 ГБУЗ Городская поликлиника №218 Департамента здравоохранения г. Москвы. 127642, Россия, Москва, Шокальского пр-д, д. 8;
4 ГБУЗ Городская больница г. Московский Департамента здравоохранения г. Москвы. 142784, Россия, Московский, 3-й мкр., д. 7;
5 ГБУЗ Городская поликлиника №69 Департамента здравоохранения г. Москвы. 111401, Россия, Москва, 2-я Владимирская ул., д. 31а
*ivashchukin@gmail.com
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2 Ambulance unit of Polyclinic №166 of the Department of Health of Moscow. 115551, Russian Federation, Moscow, Domodedovskaia ul., d. 9;
3 Ambulance unit of Polyclinic №218 of the Department of Health of Moscow. 127642, Russian Federation, Moscow, Shokal'skogo pr-d, d. 8;
4 Moskovsky City Hospital of the Department of Health of Moscow. 142784, Russian Federation, Moskovsky, 3-y mkr., d. 7;
5 Ambulance unit of Polyclinic №69 of the Department of Health of Moscow. 111401, Russian Federation, Moscow, 2-ia Vladimirskaia ul., d. 31a
*ivashchukin@gmail.com
1 ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ГБУЗ Городская поликлиника №166 Департамента здравоохранения г. Москвы. 115551, Россия, Москва, Домодедовская ул., д. 9;
3 ГБУЗ Городская поликлиника №218 Департамента здравоохранения г. Москвы. 127642, Россия, Москва, Шокальского пр-д, д. 8;
4 ГБУЗ Городская больница г. Московский Департамента здравоохранения г. Москвы. 142784, Россия, Московский, 3-й мкр., д. 7;
5 ГБУЗ Городская поликлиника №69 Департамента здравоохранения г. Москвы. 111401, Россия, Москва, 2-я Владимирская ул., д. 31а
*ivashchukin@gmail.com
________________________________________________
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2 Ambulance unit of Polyclinic №166 of the Department of Health of Moscow. 115551, Russian Federation, Moscow, Domodedovskaia ul., d. 9;
3 Ambulance unit of Polyclinic №218 of the Department of Health of Moscow. 127642, Russian Federation, Moscow, Shokal'skogo pr-d, d. 8;
4 Moskovsky City Hospital of the Department of Health of Moscow. 142784, Russian Federation, Moskovsky, 3-y mkr., d. 7;
5 Ambulance unit of Polyclinic №69 of the Department of Health of Moscow. 111401, Russian Federation, Moscow, 2-ia Vladimirskaia ul., d. 31a
*ivashchukin@gmail.com
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