nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2014-1-68-73nnp-379Research ArticleREVIEWSОБЗОРЫSleep and cognitive dysfunctions. Therapeutic approachНарушения сна и когнитивных функций, подходы к терапииПолуэктовМ.Г.PoluektovM.G.1@ru.ruПреображенскаяИ.С.PreobrazhenskayaI.S.1@ru.ruКафедра нервных болезней и нейрохирургии ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, Москва, РоссияРоссияDepartment of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, RussiaRussian Federation201406052014616873Copyright © Poluektov M., Preobrazhenskaya I., 20142014Полуэктов М., Преображенская И.Poluektov M., Preobrazhenskaya I.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/379

This review focuses on the possible mechanisms of sleep disorders in patients with cognitive impairment (CI) of different severity. The interrelation between CI, emotional disorders and insomnia, as well as the dependence of CI severity on the degree of sleep disorders, are discussed.

The issues related to treatment of sleep disorders in patients with CI, the advantages and disadvantages of modern somnogenic medications are studied. Recommendations on management of patients with a combination of sleep disorders and CI are provided. Data on the use of Egb 761 to treat CI no dementia and melatonin-based drugs to treat sleep disorders in patients with CI are presented. 

Обзор литературы посвящен возможным механизмам развития расстройств сна у пациентов с когнитивными нарушениями (КН) разной степени выраженности. Обсуждается взаимосвязь КН, эмоциональных нарушений и инсомнии; зависимость тяжести КН от выраженности нарушений сна. Рассматриваются вопросы лечения нарушений сна у пациентов с КН, недостатки и преимущества современных сомногенных средств. Даны рекомендации по ведению пациентов с сочетанием нарушений сна и познавательных функций. Приведены данные об использовании Egb 761 при недементных КН, препаратов мелатонина при расстройствах сна у пациентов с КН. 

когнитивные нарушенияумеренные когнитивные нарушениядеменцияболезнь Альцгеймерасосудистая де- менциясосудистые когнитивные нарушениянарушения снаEgb 761препараты мелатонина.cognitive impairmentmild cognitive impairmentdementiaAlzheimer's diseasevascular dementiavascular cognitive impair- mentsleep disordersEgb 761melatonin-based drugs.ReferencesЛурия АР. Мозг человека и психические процессы. Т. 1. Москва: Педагогика; 1963. Т. 2. Москва: Педагогика; 1970. [Luriya AR. Mozg cheloveka i psikhicheskie protsessy [Brain of the person and mental processes]. Moscow: Pedagogika; 1963. Vol. 1. Moscow: Pedagogika; 1970. Vol. 2.]Лурия АР. Мозг человека и психические процессы. Т. 1. Москва: Педагогика; 1963. Т. 2. Москва: Педагогика; 1970. [Luriya AR. Mozg cheloveka i psikhicheskie protsessy [Brain of the person and mental processes]. Moscow: Pedagogika; 1963. Vol. 1. Moscow: Pedagogika; 1970. Vol. 2.]Ковальзон ВМ. Обучение и сон. Природа. 2009;(7):3–11. [Kovalzon VM. Learning and Sleep. Priroda. 2009;(7):3–11. (In Russ.)]Ковальзон ВМ. Обучение и сон. Природа. 2009;(7):3–11. [Kovalzon VM. Learning and Sleep. Priroda. 2009;(7):3–11. (In Russ.)]Walker MP, Stickgold R. Sleep-dependent memory consolidation and reconsolidation. Sleep Med. 2007 Jun;8(4):331–43. DOI: http://dx.doi.org/10.1016/j.sleep.2007.03.011. Epub 2007 Apr 30.Walker MP, Stickgold R. Sleep-dependent memory consolidation and reconsolidation. Sleep Med. 2007 Jun;8(4):331–43. DOI: http://dx.doi.org/10.1016/j.sleep.2007.03.011. Epub 2007 Apr 30.Walker MP, Stickgold R. Sleep, memory, and plasticity. Ann Rev Psychol. 2006;57:139–66. DOI: http://dx.doi.org/10.1146/annurev.psych. 56.091103.070307.Walker MP, Stickgold R. Sleep, memory, and plasticity. Ann Rev Psychol. 2006;57:139–66. DOI: http://dx.doi.org/10.1146/annurev.psych. 56.091103.070307.Alchanatis M, Zias N, Deligiorgis N, et al. Comparison of cognitive performance among different age groups in patients with obstructive sleep aphnea. Sleep Breath. 2008;12(1):17–24. DOI: http://dx.doi.org/10.1007/ s11325-007-0133-y.Alchanatis M, Zias N, Deligiorgis N, et al. Comparison of cognitive performance among different age groups in patients with obstructive sleep aphnea. Sleep Breath. 2008;12(1):17–24. DOI: http://dx.doi.org/10.1007/ s11325-007-0133-y.Macey PM, Henderson LA, Macey KE, et al. Brain morphology associated with obstructive sleep aphnea. Am J Respir Crit Care Med. 2002;166(10):1382–87. DOI: http://dx.doi.org/10.1164/rccm.200201-050OC.Macey PM, Henderson LA, Macey KE, et al. Brain morphology associated with obstructive sleep aphnea. Am J Respir Crit Care Med. 2002;166(10):1382–87. DOI: http://dx.doi.org/10.1164/rccm.200201-050OC.Chang WP, Liu ME, Chang WC, et al. Sleep apnea and the risk of dementia: a population-based 5-year follow-up study in taiwan. PLoS One. 2013 Oct 24;8(10): e78655. DOI: 10.1371/journal.pone.0078655.Chang WP, Liu ME, Chang WC, et al. Sleep apnea and the risk of dementia: a population-based 5-year follow-up study in taiwan. PLoS One. 2013 Oct 24;8(10): e78655. DOI: 10.1371/journal.pone.0078655.Noh HJ, Joo EY, Kim ST, et al. The relationship between hippocampal volume and cognition in patients with chronic primary insomnia. J Clin Neurol. 2012;8(2):130–8. DOI: http://dx.doi.org/10.3988/ jcn.2012.8.2.130.Noh HJ, Joo EY, Kim ST, et al. The relationship between hippocampal volume and cognition in patients with chronic primary insomnia. J Clin Neurol. 2012;8(2):130–8. DOI: http://dx.doi.org/10.3988/ jcn.2012.8.2.130.Jelicic M, Bosma H, Ponds RW, et al. Subjective sleep problems in later life as predictors of cognitive decline. Report from the Maastricht Ageing Study (MAAS). Int J Geriatr Psychiatry. 2002 Jan;17(1):73–7. DOI: http://dx.doi.org/10.1002/gps.529.Jelicic M, Bosma H, Ponds RW, et al. Subjective sleep problems in later life as predictors of cognitive decline. Report from the Maastricht Ageing Study (MAAS). Int J Geriatr Psychiatry. 2002 Jan;17(1):73–7. DOI: http://dx.doi.org/10.1002/gps.529.Xie L, Kang H, Chen MJ, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373. DOI: 10.1126/science.1241224.Xie L, Kang H, Chen MJ, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373. DOI: 10.1126/science.1241224.Negergaard M. Neuroscience. Garbage Truck of the Brain. Science. 2013;340(6140):1529–30. DOI: 10.1126/science.1240514.Negergaard M. Neuroscience. Garbage Truck of the Brain. Science. 2013;340(6140):1529–30. DOI: 10.1126/science.1240514.Захаров ВВ. Нарушения памяти и сна в амбулаторной практике. Неврология, нейропсихиатрия, психосоматика. 2013;(1):54–8. [Zakharov VV. Memory and sleep disorders in an outpatient setting. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(1):54–8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2400.Захаров ВВ. Нарушения памяти и сна в амбулаторной практике. Неврология, нейропсихиатрия, психосоматика. 2013;(1):54–8. [Zakharov VV. Memory and sleep disorders in an outpatient setting. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(1):54–8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2400.Полуэктов МГ. Современные представления о природе и методах лечения инсомнии. Российский физиологический журнал им. И.М. Сеченова. 2012;98(10):1188–99. [Poluektov MG. Origin and treatment of insomnia: current status of knowledge. Rossiiskii fiziologicheskii zhurnal im. I.M.Sechenova. 2012;98(10):1188–99. (In Russ.)]Полуэктов МГ. Современные представления о природе и методах лечения инсомнии. Российский физиологический журнал им. И.М. Сеченова. 2012;98(10):1188–99. [Poluektov MG. Origin and treatment of insomnia: current status of knowledge. Rossiiskii fiziologicheskii zhurnal im. I.M.Sechenova. 2012;98(10):1188–99. (In Russ.)]Магомедова КА, Полуэктов МГ. Особенности нарушений сна у больных пожилого возраста. Медико-социальная экспертиза и реабилитация. 2013;(3):44–6. [Magomedova KA, Poluectov MG. Characteristics of sleep disorders among elderly patients. Mediko-sotsial'naya ekspertiza i reabilitatsiya. 2013;(3):44–6. (In Russ.)]Магомедова КА, Полуэктов МГ. Особенности нарушений сна у больных пожилого возраста. Медико-социальная экспертиза и реабилитация. 2013;(3):44–6. [Magomedova KA, Poluectov MG. Characteristics of sleep disorders among elderly patients. Mediko-sotsial'naya ekspertiza i reabilitatsiya. 2013;(3):44–6. (In Russ.)]Филатова ЕГ, Наприенко МВ. Терапия нарушений памяти и внимания у молодых пациентов. Неврология, нейропсихиатрия, психосоматика. 2013;(3):18–23. [Filatova EG, Naprienko MV. Therapy for memory and attention impairments in young patients. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(3):18–23. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2334.Филатова ЕГ, Наприенко МВ. Терапия нарушений памяти и внимания у молодых пациентов. Неврология, нейропсихиатрия, психосоматика. 2013;(3):18–23. [Filatova EG, Naprienko MV. Therapy for memory and attention impairments in young patients. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(3):18–23. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2334.Захаров ВВ. Факторы риска и профилактика когнитивных нарушений в пожиломЗахаров ВВ. Факторы риска и профилактика когнитивных нарушений в пожиломвозрасте. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112(8):69–74. [Zakharov VV. Risk factors and prevention of cognitive impairment in elderly people. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(8):69–74. (In Russ.)]возрасте. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112(8):69–74. [Zakharov VV. Risk factors and prevention of cognitive impairment in elderly people. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(8):69–74. (In Russ.)]Левин ЯИ, Ковров ГВ, Полуэктов МГ и др. Инсомния, современные диагностические и лечебные подходы. Москва: Медпрактика-М; 2005. [Levin YaI, Kovrov GV, Poluektov MG, et al. Insomniya, sovremennye diagnosticheskie i lechebnye podkhody [Insomniya, modern diagnostic and medical approaches]. Moscow: Medpraktika-M; 2005.]Левин ЯИ, Ковров ГВ, Полуэктов МГ и др. Инсомния, современные диагностические и лечебные подходы. Москва: Медпрактика-М; 2005. [Levin YaI, Kovrov GV, Poluektov MG, et al. Insomniya, sovremennye diagnosticheskie i lechebnye podkhody [Insomniya, modern diagnostic and medical approaches]. Moscow: Medpraktika-M; 2005.]Парфенов ВА, Старчина ЮА. Когнитивные нарушения у пациентов с артериальной гипертензией и их лечение. Неврология, нейропсихиатрия, психосоматика. 2011;(1):27–33. [Parfenov VA, Starchina YA. Cognitive disorders in patients with essential hypertension and their treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2011;(1):27–33. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2011-130.Парфенов ВА, Старчина ЮА. Когнитивные нарушения у пациентов с артериальной гипертензией и их лечение. Неврология, нейропсихиатрия, психосоматика. 2011;(1):27–33. [Parfenov VA, Starchina YA. Cognitive disorders in patients with essential hypertension and their treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2011;(1):27–33. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2011-130.Соловьева Э, Карнеев А. Эффективность танакана в лечении когнитивных расстройств у пациентов с хронической ишемией головного мозга. Врач. 2012;(12):50–7. [Solovyeva E, Karneyev A. Efficacy of tanakan in the treatment of cognitive impairments in patients with chronic brain ischemia. Vrach. 2012;(12):50–7. (In Russ.)]Соловьева Э, Карнеев А. Эффективность танакана в лечении когнитивных расстройств у пациентов с хронической ишемией головного мозга. Врач. 2012;(12):50–7. [Solovyeva E, Karneyev A. Efficacy of tanakan in the treatment of cognitive impairments in patients with chronic brain ischemia. Vrach. 2012;(12):50–7. (In Russ.)]Amieva H, Meillon C, Helmer C, et al. Gingko biloba extract and long term cognitive decline: a 20 years follow up population based study. PLoS One. 2013;8(1):e52755. DOI: 10.1371/journal.pone.0052755.Amieva H, Meillon C, Helmer C, et al. Gingko biloba extract and long term cognitive decline: a 20 years follow up population based study. PLoS One. 2013;8(1):e52755. DOI: 10.1371/journal.pone.0052755.Epub 2013 Jan 11.Epub 2013 Jan 11.Vellas B, Coley N, Ousset PJ, et al. Longterm use of standardised ginkgo biloba extract for the prevention of Alzheimer’s disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012;11(10):851–9. DOI: http://dx.doi.org/10.1016/S1474-4422(12)70206-5.Vellas B, Coley N, Ousset PJ, et al. Longterm use of standardised ginkgo biloba extract for the prevention of Alzheimer’s disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012;11(10):851–9. DOI: http://dx.doi.org/10.1016/S1474-4422(12)70206-5.Полуэктов МГ. Нарушение цикла сон – бодрствование – диагностика и лечение. Лечение заболеваний нервной системы. 2012;1(9):3–9. [Poluektov MG. Cycle violation a dream – wakefulness – diagnostics and treatment. Lechenie zabolevanii nervnoi sistemy. 2012;1(9):3–9. (In Russ.)]Полуэктов МГ. Нарушение цикла сон – бодрствование – диагностика и лечение. Лечение заболеваний нервной системы. 2012;1(9):3–9. [Poluektov MG. Cycle violation a dream – wakefulness – diagnostics and treatment. Lechenie zabolevanii nervnoi sistemy. 2012;1(9):3–9. (In Russ.)]Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15;4(5):487–504.Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15;4(5):487–504.Полуэктов МГ. Мелатонин и нарушение цикла сон – бодрствование. Справочник поликлинического врача. 2012;(3):16–8. [Poluektov MG. Melatonin and cycle violation a dream – wakefulness. Spravochnik poliklinicheskogo vracha. 2012;(3):16–8. (In Russ.)]Полуэктов МГ. Мелатонин и нарушение цикла сон – бодрствование. Справочник поликлинического врача. 2012;(3):16–8. [Poluektov MG. Melatonin and cycle violation a dream – wakefulness. Spravochnik poliklinicheskogo vracha. 2012;(3):16–8. (In Russ.)]Srinivasan V. Melatonin, oxidative stress and neurodegenerative disorders. Ind J Exp Biol. 2002;40(6):668–79.Srinivasan V. Melatonin, oxidative stress and neurodegenerative disorders. Ind J Exp Biol. 2002;40(6):668–79.Cardinali DP, Srinivasan V. Melatonin and its analogs in insomnia and depression. J Pineal Res. 2012;52(4):365–75. DOI: 10.1111/j.1600-079X.2011.00962.x. Epub 2011 Sep 23.Cardinali DP, Srinivasan V. Melatonin and its analogs in insomnia and depression. J Pineal Res. 2012;52(4):365–75. DOI: 10.1111/j.1600-079X.2011.00962.x. Epub 2011 Sep 23.Srinivasan V, Smith M, Spence W, et al. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138–51. DOI: http://dx.doi.org/10.1080/15622970600571822.Srinivasan V, Smith M, Spence W, et al. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138–51. DOI: http://dx.doi.org/10.1080/15622970600571822.Cardinalli DP, Brusco L, Liberczuk C, Furio AM. The use of melatonin in Alzheimer’s disease. Neuro Endocrinol Lett. 2002;23 Suppl 1:20–3.Cardinalli DP, Brusco L, Liberczuk C, Furio AM. The use of melatonin in Alzheimer’s disease. Neuro Endocrinol Lett. 2002;23 Suppl 1:20–3.Papolla MA, Bozner B. Inhibition of Alzheimer’s beta-fibrillogenesis by melatonin. J Biol Chem. 1998;273(13):7185–9. DOI: http://dx.doi.org/10.1074/jbc.273.13.7185.Papolla MA, Bozner B. Inhibition of Alzheimer’s beta-fibrillogenesis by melatonin. J Biol Chem. 1998;273(13):7185–9. DOI: http://dx.doi.org/10.1074/jbc.273.13.7185.Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007;16(4):372–80.Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007;16(4):372–80.Wade AG, Ford I, Crawford G, et al. Efficacy of prolonged release melatonin in insomnia patients aged 55–80 years: quality of sleep and next-day alertness outcomes. Curr Med Res Opin. 2007;23(10):2597–605. DOI: http://dx.doi.org/10.1185/030079907X233098. 32. Petersen RC. Early diagnosis of Alzheimer’s disease: is MCI too late? Curr Alzheimer Res. 2009;6(4):324–30. DOI: http://dx.doi.org/10.2174/ 156720509788929237.Wade AG, Ford I, Crawford G, et al. Efficacy of prolonged release melatonin in insomnia patients aged 55–80 years: quality of sleep and next-day alertness outcomes. Curr Med Res Opin. 2007;23(10):2597–605. DOI: http://dx.doi.org/10.1185/030079907X233098. 32. Petersen RC. Early diagnosis of Alzheimer’s disease: is MCI too late? Curr Alzheimer Res. 2009;6(4):324–30. DOI: http://dx.doi.org/10.2174/ 156720509788929237.

The authors declare that there are no conflicts of interest present.