References

nnp

Neurology, Neuropsychiatry, Psychosomatics

Неврология, нейропсихиатрия, психосоматика

2074-27112310-1342

"IMA-Press", LLC

10.14412/2074-2711-2014-4-94-100

nnp-460

Research Article

REVIEWS

ОБЗОРЫ

Dementia due to cerebral small vessel damage: Current ideas on its pathogenesis and therapy

Деменция вследствие поражения мелких церебральных сосудов: современные представления о патогенезе и терапии

Дамулин

И. В.

Damulin

I. V.

damulin@mmascience.ru

Екушева

Е. В.

Ekusheva

E. V.

Кафедра нервных болезней и нейрохирургии лечебного факультета НИЦ ГБОУ ВПО «Первый Мо- сковский государственный медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Россия 119021, Москва, ул. Россолимо, 11РоссияDepartment of Nervous System Diseases and Neurosurgery, Faculty of Therapeutics I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021Russian Federation

НИО неврологии НИЦ ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Россия 119021, Москва, ул. Россолимо, 11РоссияReseach Department of Neurology, Research Center, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021Russian Federation

2014

10122014

6494100

2014

Дамулин И.В., Екушева Е.В.

Damulin I.V., Ekusheva E.V.

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/460

Ever-increasing attention now focusses on dementia caused by small vessel damage when considering cerebrovascular disease leading to cognitive impairments (CIs). Stroke is one of the most important risk factors (RFs) of vascular CI, including vascular dementia. Experienced stroke increases thrice the risk of dementia. Diffuse changes in the cerebral white matter (leukoaraiosis) due to fluctuating blood pressure (BP) and cerebral small vessel damage in most cases play an important role in the genesis of vascular CIs. Executive dysfunctions frequently concurrent with delayed psychomotor speed are the leading clinical manifestations of subcortical vascular dementia. Severe memory impairments are nottypical for subcortical dementia, its early stages in particular. The basis for the pathogenesis of CIs is the dissociation phenomenon that disrupts connections between the frontal lobes and subcortical structures and other cerebral cortical areas. Inadequate hypertension correction at a middle age is responsible for more than one fourth of cases of dementia developing in the elderly. The detection and further elimination of vascular RFs can reduce the risk of developing dementia in elderly and senile patients. Correction of elevated BP in the middle-aged is regarded as an effective method to prevent dementia in the future, but no premium is placed upon antihypertensive therapy in the elderly to lower elevated BP that is an inherent characteristic of this category of patients. Medications affecting RFs and those improving cerebral metabolism and bloodflow, including nicergoline are widely used to treat PD.

В настоящее время при рассмотрении цереброваскулярной патологии, приводящей к когнитивным расстройствам (КН), все большее внимание уделяется деменции, обусловленной поражением мелких сосудов. Одним из наиболее значимых факторов риска (ФР) возникновения сосудистых КН, включая сосудистую деменцию, является инсульт. Перенесенный инсульт в три раза увеличивает риск возникновения деменции. В генезе сосудистых КН важную роль играют диффузные изменения белого вещества полушарий головного мозга (лейкоареоз), в большинстве случаев обусловленные колебаниями артериального давления (АД) и поражением мелких церебральных сосудов. Ведущими в клинической картине субкортикальной сосудистой деменции являются нарушения исполнительных функций, нередко сочетающиеся с замедлением скорости психомоторных процессов. Выраженные нарушения памяти для субкортикальной деменции, особенно для ее начальных этапов, не характерны. В основе патогенеза КН лежит феномен разобщения, заключающийся в нарушении связей лобных отделов с субкортикальными структурами и другими отделами коры головного мозга. Более 1/4 случаев развития деменции у пожилых обусловлены неадекватной коррекцией артериальной гипертензии в среднем возрасте. Выявление и последующее устранение сосудистых ФР позволяет уменьшить риск развития деменции в пожилом и старческом возрасте. Коррекция повышенного АД в среднем возрасте рассматривается как эффективный метод предотвращения развития деменции в будущем, а вот у пожилых – на фоне присущего этой категории больных снижения АД – гипотензивной терапии большого значения не придается Для лечения широко используются лекарственные средства, действующие на ФР, а также препараты, способные улучшать церебральный метаболизм и кровоток, включая ницерголин.

деменция вследствие поражения мелких церебральных сосудовсиндром разобщениядиагностикалечениеницерголин

dementia due to cerebral small vessel damagedisassociation syndromediagnosistreatmentnicergoline

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