nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2015-3-62-69nnp-533Research ArticleREVIEWSОБЗОРЫThe heterogeneity of vascular cognitive impairments and the issues of therapyГетерогенность сосудистых когнитивных нарушений и вопросы терапииКатунинаЕлена АнатольевнаKatuninaElena Anatolyevna

Кафедра неврологии, нейрохирургии и медицинской генетики,

117997, Москва, ул. Островитянова, 1

Department of Neurology, Neurosurgery, and Medical Genetics,

1, Ostrovityanov St., Moscow 117997

Elkatunina@mail.ruГБОУ ВПО «Российский национальный исследовательский университет им. Н.И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian Federation201528102015736269Copyright © Katunina E.A., 20152015Катунина Е.А.Katunina E.A.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/533

Vascular cognitive impairments (CIs) are heterogeneous in the mechanism of their occurrence and may develop in different extent of brain damage, in different locations, and the number of foci. Their etiological factors are various. The mechanism for the development of CIs may be associated with impairments of both per se the structures responsible for cognitive functions (frontal cortex, subcortical-cortical interactions, and hippocampus) and deafferentation of the cortex and limbic structures due to periventricular white matter lesion or local lesion of the basal ganglia and thalamus. The pattern of CIs depends on the predominant involvement of cortical or subcortical regions or their combinations. The progression of CIs is also variable. In chronic cerebral circulatory insufficiency, CIs develop gradually over several years. Poststroke CIs manifest themselves acutely or subacutely. 6-27% of patients are diagnosed with dementia 3 months after acute cerebrovascular accident. The risk of subsequent dementia is 7% within the first year and 48% after 25 years.

The paper reviews the most important trials of citicoline used in CIs. The drug has a multicomponent activity spectrum that permits its use in CIs of varying genesis. By taking into account its good tolerability and safety, the drug may be recommended for a wide circle of patients, including for elderly patients with comorbidity.

Сосудистые когнитивные нарушения (КН) гетерогенны по механизму возникновения и могут развиваться при различном объеме поражения головного мозга, различной локализации и количестве очагов. Разнообразны и этиологические факторы, их вызывающие. Механизм развития КН может быть связан с нарушением как непосредственно структур, отвечающих за когнитивные функции (лобная кора, гиппокамп), так и подкорково-корковых взаимодействий, диафферентацией коры, лимбических структур вследствие поражения белого вещества околожелудочкого пространства или локального поражения базальных ганглиев и таламуса. Паттерн КН зависит от преимущественного вовлечения корковых или подкорковых отделов или их комбинации. Характер нарастания КН также вариабелен. При хронической недостаточности мозгового кровообращения КН развиваются постепенно, в течение нескольких лет. Постинсультные КН проявляются остро или подостро. У 6–27% пациентов деменция диагностируется через 3 мес после острого нарушения мозгового кровообращения. В последующем риск развития деменции составляет 7% в течение первого года и 48% через 25 лет.

Представлен обзор наиболее значимых исследований, посвященных применению цитиколина при КН. Цитиколин оказывает многокомпонентное действие, позволяющее использовать его при КН различного генеза. С учетом хорошей переносимости и безопасности препарат можно рекомендовать широкому кругу пациентов, в том числе пожилым больным с сопутствующей патологией.

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