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Роль нейротрофических факторов в развитии постинсультной депрессии
Роль нейротрофических факторов в развитии постинсультной депрессии
Боголепова А.Н. Роль нейротрофических факторов в развитии постинсультной депрессии. Consilium Medicum. 2019; 21 (2): 18–23. DOI: 10.26442/20751753.2019.2.190304
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Аннотация
Цереброваскулярная патология является одной из важнейших причин инвалидизации. Депрессия, как сообщается, является наиболее распространенным психическим расстройством среди осложнений инсульта. Постинсультная депрессия отмечается примерно у 1/3 выживших пациентов с совокупной заболеваемостью 55%. Депрессия, возникшая после перенесенного инсульта, оказывает крайне негативное влияние на течение основного заболевания, ухудшая функциональное восстановление и качество жизни, увеличивая уровень смертности. Наличие у больного депрессивных расстройств является фактором риска развития дополнительных когнитивных нарушений, вплоть до деменции. В последние годы получено множество доказательств вовлечения нейротрофических ростовых факторов в патогенезе развития аффективных нарушений. У больных с депрессивным расстройством отмечено снижение уровня мозгового нейротрофического фактора (BDNF). Более того нейротрофические факторы могут рассматриваться как возможные биомаркеры не только самого постинсультного депрессивного расстройства, но и ответа на терапию антидепрессантами. Накопленные данные свидетельствуют о том, что BDNF играет ключевую роль в патофизиологии постинсультной депрессии. Очень важным аспектом лечения постинсультной депрессии является применения, средств нейротрофического действия, одним из которых является церебролизин. Доклинические работы наглядно демонстрируют, что Церебролизин способен модулировать уровни нейротрофических факторов, демонстрируя функциональную эквивалентность нейропептидов Церебролизина и естественных нейротрофических факторов. Клинические исследования продемонстрировали эффективность Церебролизина в отношении постинсультной депрессии. Получены положительные данные о комбинированном применении Церебролизина и антидепрессантов.
Ключевые слова: цереброваскулярная патология, ишемический инсульт, постинсультная депрессия, нейтротрофические факторы, BDNF, нейропластичность, церебролизин.
Ключевые слова: цереброваскулярная патология, ишемический инсульт, постинсультная депрессия, нейтротрофические факторы, BDNF, нейропластичность, церебролизин.
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Cerebrovascular disease is one of the most important causes of disability. Depression is reported to be the most widespread psychological disorder among stroke complications. Post-stroke depression is observed in about 1/3 of stroke survivors, the overall incidence rate is 55%. Depression that develops after stroke has a strong negative influence on the primary disease course, deteriorates functional improvement and quality of life and increases mortality rate. Depressive disorder in patients is a risk factor of additional cognitive disorders development, as much as to dementia. In recent years a lot of evidence on nerve growth factors involvement in pathogenesis of affective disorders development has been acquired. A decrease in brain-derived nerve factor (BDNF) levels was observed in patients with depressive disorders. Moreover, neurotrophic factors can be regarded as possible biomarkers not only of post-stroke depressive disorder itself but also of response to treatment with antidepressants. Acquired data show that BDNF has a key role in post-stroke depression pathophysiology. Use of medications with neurotrophic action such as cerebrolysin is an important aspect of post-stroke depression treatment. Preclinical studies showed that cerebrolysin influences levels of neurotrophic factor and demonstrated functional equivalence of cerebrolysin neuropeptides and neurotrophic factors. In clinical studies cerebrolysin effectiveness in post-stroke depression treatment was demonstrated. Positive results of cerebrolysin and antidepressants combined use were acquired.
Key words: cerebrovascular pathology, ischemic stroke, post-stroke depression, neurotrophic factors, BDNF, neuroplasticity, Cerebrolysin.
Key words: cerebrovascular pathology, ischemic stroke, post-stroke depression, neurotrophic factors, BDNF, neuroplasticity, Cerebrolysin.
Полный текст
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4. Alajbegovic A, Djelilovic-Vranic J, Nakicevic A et al. Post stroke depression. Med Arch 2014; 68 (1): 47–50.
5. Villa RF, Ferrari F, Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol. Ther 2018; 184: 131–44.
6. Gainotti G, Antonucci G, Marra C, Paolucci S. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry 2001; 7: 258–61.
7. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke 2005; 36: 1330–40.
8. Berg A, Palomaki H, Lehtihalmes M et al. Poststroke depression: an 18-month follow-up. Stroke 2003; 34: 138–43.
9. Robinson RG, Jorge RE. Post-stroke depression: A review. Am J Psychiatry 2016; 173: 221–31.
10. Spalletta G, Robinson RG. How should depression be diagnosed in patients with stroke? Acta Psychiatr Scand 2010; 121 (6): 401–3.
11. Chau JP, Thopson DR, Twinn S et al. Determinants of participation restriction among community dwelling stroke survivors: a path analysis. BMC Neurol 2009; 9 (49): 1–7.
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18. Snyder HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychol Bull 2013; 139: 81–132.
19. Douven E, Aalten P, Staals J et al. Co-occurrence of depressive symptoms and executive dysfunction after stroke: associations with brain pathology and prognosis. J Neurol Neurosurg Psychiatry 2018: jnnp-2017-317548 (published Online First: 14 Feb 2018).
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2. Пирадов М.А., Максимова М.Ю., Танашян М.М. Инсульт. Пошаговая инструкция. М.: ГЭОТАР-Медиа, 2019.
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[Skvortsova V.I. Interv'iu Ministra Veroniki Skvortsovoi "Nezavisimoi gazete". https: //www.rosminzdrav.ru/news/2017/05/17/5449-intervyu-ministra-veroniki-skvortsovoy-nezavisimoy-gazete (in Russian).]
4. Alajbegovic A, Djelilovic-Vranic J, Nakicevic A et al. Post stroke depression. Med Arch 2014; 68 (1): 47–50.
5. Villa RF, Ferrari F, Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol. Ther 2018; 184: 131–44.
6. Gainotti G, Antonucci G, Marra C, Paolucci S. Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry 2001; 7: 258–61.
7. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke 2005; 36: 1330–40.
8. Berg A, Palomaki H, Lehtihalmes M et al. Poststroke depression: an 18-month follow-up. Stroke 2003; 34: 138–43.
9. Robinson RG, Jorge RE. Post-stroke depression: A review. Am J Psychiatry 2016; 173: 221–31.
10. Spalletta G, Robinson RG. How should depression be diagnosed in patients with stroke? Acta Psychiatr Scand 2010; 121 (6): 401–3.
11. Chau JP, Thopson DR, Twinn S et al. Determinants of participation restriction among community dwelling stroke survivors: a path analysis. BMC Neurol 2009; 9 (49): 1–7.
12. Teoh V, Sims J, Milgrom J. Psychosocial predictors of quality of life in a sample of community-dwelling stroke survivors: a longitudinal study. Top Stroke Rehabil 2009; 16 (2): 157–66.
13. Morris J, Oliver T, Kroll T et al. The importance of psychological and social factors in influencing the uptake and maintenance of physical activity after stroke: a structured review of the empirical literature. Stroke Res Treat 2012; 2012: 1–20.
14. Thilarajah S, Mentiplay BF, Bower KJ et al. Factors Associated With Post-Stroke Physical Activity: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017 (published Online First: 24 Oct 2017).
15. Park G-Y, Im S, Lee S-J et al. The Association between Post-Stroke Depression and the Activities of Daily Living/Gait Balance in Patients with First-Onset Stroke Patients. Psychiatry Investig 2016; 13: 659–64.
16. Prasomsri J, Jalayondeja C, Bovonsunthonchai S et al. Walking and stair climbing abilities in individuals after chronic stroke with and without mental health problem. J Med Assoc Thai 2014; 97 (Suppl. 7): S10–15.
17. Matsuzaki S, Hashimoto M, Yuki S et al. The relationship between post-stroke depression and physical recovery. J Affect Dis 2015; 176: 56–60.
18. Snyder HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychol Bull 2013; 139: 81–132.
19. Douven E, Aalten P, Staals J et al. Co-occurrence of depressive symptoms and executive dysfunction after stroke: associations with brain pathology and prognosis. J Neurol Neurosurg Psychiatry 2018: jnnp-2017-317548 (published Online First: 14 Feb 2018).
20. Гусев Е.И., Боголепова А.Н. Когнитивные нарушения и деменция. М.: Группа Ремедиум, 2018.
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[Gusev E.I., Boiko A.N., Sidorenko T.V. et al. Priverzhennost' osnovnoi terapii u bol'nykh s postinsul'tnoi depressiei. Nevrol. zhurn. 2011; 4: 1–6 (in Russian).]
22. Brilleman SL, Purdy S, Salisbury C et al. Implications of comorbidity for primary care costs in the UK: a retrospective observational study. Br J Gen Pract 2013; 63: 274–82.
23. Ayerbe L, Ayis S, Rudd AG et al. Natural history, predictors, and associations of depression 5 years after stroke: The South London Stroke Register. Stroke 2011; 42: 1907–11.
24. Cuijpers P, Beekman AT, Reynolds CF. Preventing depression: a global priority. JAMA 2012; 307 (10): 1033–4.
25. Nakase T, Tobisawa M, Sasaki M, Suzuki A. Outstanding Symptoms of Poststroke Depression during the Acute Phase of Stroke. PLoS ONE 2016; 11 (10): e0163038. DOI: 10.1371/journal.pone.0163038
26. Zhang Y, Zhao H, Fang Y et al. The association between lesion location, sex and poststroke depression: Meta-analysis. Brain and Behavior 2017; 7: e00788. https://doi.org/10.1002/brb3.788
27. Carson AJ, MacHale S, Allen K et al. Depression after stroke and lesion location: A systematic review. Lancet 2000; 356: 122–6.
28. Hadidi N, Treat-Jacobson DJ, Lindquist R. Poststroke depression and functional outcome: A critical review of literature. Heart and Lung 2009; 38: 151–62.
29. Wei N, Yong W, Li X et al. Post-stroke depression and lesion location: A systematic review. J Neurol 2015; 262: 81–90.
30. Bae KY, Kang HJ, Kim JW et al. Associations of white matter hyperintensities with poststroke depression: A 1-year longitudinal study. Int J Geriatr Psychiatry 2019; 34 (1): 162–8. DOI: 10.1002/gps.5005
31. Tsai C-S, Wu Ch-L, Hung T-H et al. Incidence and risk factors of poststroke depression in patients with acute ischemic stroke: A 1-year prospective study in Taiwan. Biomed J 2016; 39: 195–200. http: //dx.doi.org/10.1016/j.bj.2015.10.004
32. Salinas J, Ray RM, Nassir R et al. Factors Associated With New-Onset Depression Following Ischemic Stroke: The Women’s Health Initiative. J Am Heart Assoc 2017; 6: e003828. DOI: 10.1161/JAHA.116.003828
33. Salinas J, Beiser A, Himali JJ et al. Factors Associated with New-Onset Depression After Stroke. J Neuropsychiatry Clin Neurosci 2016. DOI: 10.1176/appi.neuropsych.15110388
34. Park E-Y, Kim J-H. An analysis of depressive symptoms in stroke survivors: verification of amoderating effect of demographic characteristics. BMC Psychiatry 2017; 17: 132. DOI 10.1186/s12888-017-1292-4
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Авторы
А.Н.Боголепова
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России, Москва, Россия
annabogolepova@yandex.ru
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России, Москва, Россия
annabogolepova@yandex.ru
________________________________________________
Anna N. Bogolepova
Pirogov Russian National Research Medical University, Moscow, Russia
annabogolepova@yandex.ru
Pirogov Russian National Research Medical University, Moscow, Russia
annabogolepova@yandex.ru
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