nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2020-4-131-136nnp-1419Research ArticleREVIEWSОБЗОРЫPossibilities of drug therapy for vascular cognitive impairment: a critical view and possible compromisesВозможности медикаментозной терапии сосудистых когнитивных нарушений: критический взгляд и возможные компромиссыЕмелинА. Ю.EmelinA. Yu.

Андрей Юрьевич Емелин

Кафедра нервных болезней

194044, Санкт-Петербург, ул. Академика Лебедева, 6

Andrey Yuryevich Emelin

Department of Nervous System Diseases

6, Academician Lebedev St., Saint Petersburg 194044

emelinand@rambler.ruЛобзинВ. Ю.LobzinV. Yu.

Кафедра нервных болезней

Кафедра неврологии им. акад. С.Н. Давиденкова

194044, Санкт-Петербург, ул. Академика Лебедева, 6191015, Санкт-Петербург, ул. Кирочная, 41 

Department of Nervous System Diseases

Acad. S.N. Davidenkov Department of Neurology

6, Academician Lebedev St., Saint Petersburg 19404441, Kirochnaya St., Saint Petersburg 191015 

ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны РоссииРоссияS.M. Kirov Military Medical Academy, Ministry of Defense of RussiaRussian FederationФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России; ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияS.M. Kirov Military Medical Academy, Ministry of Defense of Russia; I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaRussian Federation202027082020124131136Copyright © Emelin A.Y., Lobzin V.Y., 20202020Емелин А.Ю., Лобзин В.Ю.Emelin A.Y., Lobzin V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1419

To manage patients with vascular cognitive impairment (VCI) is an extremely difficult task, since drug therapy algorithms have not been elaborated, whereas the prescription of most drugs has not always been pathogenetically justified. Today, both our country and foreign countries have no uniform standards for VCI treatment, and the choice of drugs in everyday clinical practice is largely determined by a physician’s personal experience. The paper discusses main areas in the drug treatment of VCI and provides a detailed analysis of studies evaluating the efficacy and safety of basic drugs used to correct cognitive deficit. The basic anti-dementia medications (akatinol memantine and acetylcholinesterase inhibitors) recommended as mandatory treatment have been identified. The remaining groups of drugs are proposed to be used in combination therapy as add-on treatment, by taking into account individual indications. It is concluded that add-on investigations are needed to select the treatment algorithm differentiated preferably for different clinical and pathogenic VCI variants, which should also consider not only the features of clinical manifestations, but also the magnitude of structural and functional changes in the cerebral vessels and brain matter.

Ведение пациентов с сосудистыми когнитивными нарушениями (СКН) представляет собой крайне непростую задачу, поскольку алгоритмы медикаментозной терапии не разработаны, а назначение большинства лекарственных средств не всегда патогенетически обосновано. К сожалению, ни в нашей стране, ни за рубежом на сегодняшний день не существует единых стандартов лечения СКН и выбор препаратов в повседневной клинической практике во многом определяется личным опытом врача. В статье обсуждаются основные направления медикаментозного лечения СКН, проведен подробный анализ исследований эффективности и безопасности основных препаратов, назначаемых для коррекции когнитивного дефицита. Выделены базисные антидементные препараты (мемантин и ингибиторы ацетилхолинэстеразы), рекомендованные как обязательное направление терапии. Остальные группы препаратов предложено использовать в комплексной терапии в качестве дополнительного направления с учетом индивидуальных показаний. Сделан вывод о необходимости проведения дополнительных исследований для выбора терапевтического алгоритма, желательно дифференцированного для разных клинико-патогенетических вариантов СКН, который также должен учитывать не только особенности клинических проявлений, но и степень структурных и функциональных изменений со стороны церебральных сосудов и вещества мозга.

когнитивные нарушениядеменциясосудистые когнитивные нарушениясосудистая деменциялечениемемантинcognitive impairmentdementiavascular cognitive impairmentvascular dementiatreatmentakatinol memantineСтатья спонсируется компанией Мerz. Спонсор участвовал в разработке проекта исследования и поддержке исследовательской программы, а также принятии решения о представлении статьи для публикации.This article has been supported by Merz. The sponsor has participated in the development of the investigation project and supported the investigation program, as well as in the decision to submit the article for publication.ReferencesErkinjuntti T, Roman G, Gauthier S, et al. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke. 2004;35:1010. doi: 10.1161/01.STR.0000120731.88236.33Erkinjuntti T, Roman G, Gauthier S, et al. Emerging therapies for vascular dementia and vascular cognitive impairment. 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The authors declare that there are no conflicts of interest present.