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Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy)

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The paper reviews the literature on vascular cognitive impairment (VCI), the diagnosis widely used in foreign neurological practice, as well as chronic cerebral ischemia (CCI) and dyscirculatory encephalopathy (DEP), the common diagnoses in Russian neurological practice. According to the etiology, risk factors, and manifestations, Stages I and II DEP largely corresponds to moderate VCI; Stage III DEP does to severe VCI. The results of the author’s studies show that a considerable proportion of patients followed up with a diagnosis of CCI, DEP, have no signs of chronic cerebrovascular disease (CVD), but suffer from primary or secondary headache, vertigo of various origins, emotional disorders, and other diseases. The diagnosis of CCI, DEP should be based on the presence of CCI, the reliable neuroimaging signs of chronic CVD, and the ruling out of other diseases. When treating and preventing VCI, CCI, and DEP, a premium is placed upon both non-drug (regular physical activity, smoking cessation, rational nutrition) and drug therapy aimed at normalizing blood pressure and blood lipid spectrum, preventing blood clots, and improving cognitive functions.

About the Author

V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine, 

11, Rossolimo St., Build. 1, Moscow 119021


1. O’Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol. 2003;2:89-98. doi: 10.1016/S1474-4422(03) 00305-3

2. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:2672-713. doi: 10.1161/STR.0b013e3182299496

3. Graff-Radford J. Vascular Cognitive Impairment. Continuum (Minneap Minn). 2019;25(1):147-64. doi: 10.1212/CON.0000000000000684

4. Hachinski VC, Bowler JV. Vascular dementia. Neurology. 1993;43:2159-61. doi: 10.1212/WNL.43.10.2159-a

5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

6. Dichgans M, Leys D. Vascular cognitive impairment. Circ Res. 2017;120:573-91. doi: 10.1161/CIRCRESAHA.116.308426

7. WHO Dementia (2017). Available from: /fs362/en/. Accessed 3 Mar 2018.

8. Sachdev PS, Lipnicki DM, Kochan NA, et al. The prevalence of mild cognitive impairment in diverse geographical and ethnocultural regions: the COSMIC collaboration. PLoS One. 2015;10:e142388. doi: 10.1371/journal.pone. 0142388

9. Lopez OL, Kuller LH, Becker JT, et al. Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol. 2007;64:416-20. doi: 10.1001/archneur.64.3.416

10. Cuadrado-Godia E, Dwivedi P, Sharma S. Cerebral small vessel disease: A review focusing on pathophysiology, biomarkers, and machine learning strategies. J Stroke. 2018;20(3):302-20. doi: 10.5853/jos.2017.02922

11. Markus HS, Schmidt R. Genetics of vascular cognitive impairment. Stroke. 2019;50:00- 00. doi: 10.1161/STROKEAHA.118.020379

12. Sun J-H, Tan L, Yu J-T. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med. 2014; 2(8):80.

13. Gutierrez Perez C, Savborg M, Pahlman U, et al. High frequency of cognitive dysfunction before stroke among older people. Int J Geriatr Psychiatry. 2011;26:622-9. doi: 10.1002/gps.2573

14. Douiri A, Rudd AG, Wolfe CD. Prevalence of poststroke cognitive impairment: South London Stroke Register 1995–2010. Stroke. 2013;44:138-45. doi: 10.1161/STROKEAHA.112.670844

15. Alonso A, Arenas de Larriva AP. Atrial fibrillation, cognitive decline and dementia. Eur Cardiol. 2016;11(1):49-53. doi: 10.15420/ecr. 2016:13:2

16. Diener HC, Hart RG, Koudstaal PJ, et al. Atrial Fibrillation and Cognitive Function: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;73(5):612-9. doi: 10.1016/j.jacc.2018.10.077

17. Chen LY, Lopez FL, Gottesman RF, et al. Atrial fibrillation and cognitive decline – the role of subclinical cerebral infarcts: the Atherosclerosis Risk in Communities Study. Stroke. 2014;45:2568-74. doi: 10.1161/STROKEAHA.114.005243

18. Gaita F, Corsinovi L, Anselmino M, et al. Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function. J Am Coll Cardiol. 2013;62:1990-7. doi: 10.1016/j.jacc. 2013.05.074

19. Gong L, Liu X-Y, Fang M. Recent progress on small vessel disease with cognitive impairment. Int J Clin Exp Med. 2015;8(5):7701-9.

20. Sweeney MD, Montagne A, Sagare AP, et al. Vascular dysfunction – The disregarded partner of Alzheimer’s disease. Alzheimer’s Dement. 2019;15:158-67. doi: 10.1016/j.jalz.2018.07.222

21. Toledo JB, Arnold SE, Raible K, et al. Contribution of cerebrovascular disease in autopsy confirmed neurodegenerative disease cases in the National Alzheimer’s Coordinating Centre. Brain. 2013;136:2697-706. doi: 10.1093/brain/awt188

22. Azarpazhooh MR, Avan A, Cipriano LE, et al. Concomitant vascular and neurodegenerative pathologies double the risk of dementia. Alzheimers Dement. 2018;14:148-56. doi: 10.1016/j.jalz.2017.07.755

23. Sachdev P, Kalaria R, O’Brien J, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014;28(3):206-18. doi: 10.1097/ WAD.0000000000000034

24. Skrobot OA, Black SE, Chen C, et al. Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the vascular impairment of cognition classification consensus study. Alzheimers Dement. 2018; 14(3):280-92. doi: 10.1016/j.jalz.2017.09.007

25. Snyder HM, Corriveau RA, Craft S, et al. Vascular Contributions to Cognitive Impairment and Dementia Including Alzheimer’s Disease. Alzheimers Dement. 2015;11(6):710-7. doi: 10.1016/j.jalz.2014.10.008

26. Shmidt EV. Classification of vascular lesions of the brain and spinal cord. Zhurnal Nevropatologii i Psikhiatrii. 1985;85(9): 1281-8 (In Russ.).

27. Gusev EI, Skvortsova VI. Ishemiya golovnogo mozga [Cerebral ischemia]. Moscow: Meditsina; 2001 (In Russ.).

28. Gusev EI, Bogolepova AN. Cognitive impairment in cerebrovascular diseases]. Moscow: MEDpress-inform; 2013. 180 p. (In Russ.).

29. Gusev EI, Chukanova EI. Modern pathogenetic aspects of the formation of chronic cerebral ischemia. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2015;115(3):4-8 (In Russ.).

30. Yakhno NN, Levin OS, Damulin IV. Comparison of clinical and MRI data with dyscirculatory encephalopathy. Message 2: Cognitive Impairment. Nevrologicheskii Zhurnal. 2001;6(3):10 (In Russ.).

31. Yakhno NN. Cognitive impairment in neurological practice. Nevrologicheskii Zhurnal. 2006;11(Suppl. 1):4-12 (In Russ.).

32. Yakhno NN, Zakharov VV, Lokshina AB, et al. Dementsii [Dementia]. Moscow: Medpress-inform; 2011 (In Russ.).

33. Parfenov VA, Zakharov VV, Preobrazhenskaya IS. Cognitive disorders. Moscow: Remedium; 2014 (In Russ.).

34. Parfenov VA. Dyscirculatory encephalopathy and vascular cognitive disorders. Moscow: IMA-PRESS; 2017 (In Russ.).

35. Golovacheva VA, Parfenov VA, Tabeeva GR, et al. Optimizing the management of patients with chronic daily headache. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2017;117(2):4-9 (In Russ.).

36. Antonenko LM, Parfenov VA. A specialized approach to diagnosing and treating vertigo. Nevrologiya, Neiropsikhiatriya, Psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(1):56-60 (In Russ.). doi: 10.14412/2074-2711-2016-1-56-60

37. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA. 2003;290:2015-22. doi: 10.1001/jama.290.15.2015

38. Sposato LA, Kapral MK, Fang J, et al. Declining incidence of stroke and dementia: Coincidence or prevention opportunity? JAMA Neurol. 2015;72:1529-31. doi: 10.1001/jamaneurol.2015.2816

39. De Bruijn RFAG, Bos MJ, Portegies MLP, et al. The potential for prevention of dementia across two decades: the prospective, populationbased Rotterdam Study. BMC Med. 2015;13:132. doi: 10.1186/s12916-015-0377-5

40. Ngandu T, Lehtisalo J, Solomon AA. 2-Year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in atrisk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385:2255-63. doi: 10.1016/S0140-6736(15)60461-5

41. Barnes JN. Exercise, cognitive function, and aging. Adv Physiol Educ. 2015;39(2):55-62. doi: 10.1152/advan.00101.2014

42. Lewis M, Peiris CL, Shields N. Long-term home and community-based exercise programs improve function in community-dwelling older people with cognitive impairment: a systematic review. J Physiother. 2017;63:23-9. doi: 10.1016/j.jphys.2016.11.005

43. Liu-Ambrose T, Best JR, Davis JC, et al. Aerobic exercise and vascular cognitive impairment: a randomized controlled trial. Neurology. 2016;87(20):2082-90. doi: 10.1212/WNL.0000000000003332

44. Xu W, Wang HF, Wan Y, et al. Leisure time physical activity and dementia risk: a doseresponse meta-analysis of prospective studies. BMJ Open. 2017;7:e014706. doi: 10.1136/bmjopen-2016-014706

45. Valls-Pedret C, Sala-Vila A, Serra-Mir M, et al. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med. 2015;175(7):1094-103. doi: 10.1001/jamainternmed.2015.1668

46. Wu L, Sun D. Adherence to Mediterranean diet and risk of developing cognitive disorders: an updated systematic review and meta-analysis of prospective cohort studies. Sci Rep. 2017;7: 41317. doi: 10.1038/srep41317

47. Levi Marpillat N, Macquin-Mavier I, Tropeano AI, et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens. 2013; 31(6):1073-82. doi:10.1097/HJH.0b013e3283603f53

48. Peng J, Lu F, Wang Z, et al. Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study. J Am Med Dir Assoc. 2014;15:904-10. doi: 10.1016/j.jamda.2014.07.005

49. McGuinness B, Todd S, Passmore P, Bullock R. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;4:CD004034. doi: 10.1002/14651858.CD004034.pub3

50. Spinelli C, Fara De Caro M, Schirosi G. Impaired cognitive executive dysfunction in adult treated hypertensives with a confirmed diagnosis of poorly controlled blood pressure. Int J Med Sci. 2014;11(8):771-8. doi: 10.7150/ijms.8147

51. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2014;45:2160-236. doi: 10.1161/STR.0000000000000024

52. Wang Z, Soo YOY, Mok VCT. Cerebral microbleeds. Stroke. 2014;45:2811-7. doi: 10.1161/STROKEAHA.114.004286

53. Henry G, Williamson D, Tampi RR. Efficacy and tolerability of antidepressants in the treatment of behavioral and psychological symptoms of dementia, a literature review of evidence. Am J Alzheimers Dis Other Demen. 2011;26(3):169-83. doi: 10.1177/15333 17511402051

54. Pizzi C, Rutjes AW, Costa GM, et al. Metaanalysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease. Am J Cardiol. 2011;107: 972-9. doi: 10.1016/j.amjcard.2010.11.017

55. Herrmann N, Lanctot KL, Hogan DB. Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers Res Ther. 2013;5(Suppl 1):S5. doi: 10.1186/alzrt201

56. Hausner L, Frö lich L. Antidementia drug therapy of Alzheimer's dementia: Status 2018 and Outlook. Dtsch Med Wochenschr. 2019; 144(3):156-60.

57. Jin BR, Liu HY. Comparative efficacy and safety of cognitive enhancers for treating vascular cognitive impairment: systematic review and Bayesian network meta-analysis. Neural Regen Res. 2019;14(5):805-16. doi: 10.4103/1673- 5374.249228

58. Chen N, Yang M, Guo J, et al. Cerebrolysin for vascular dementia. Cochrane Database Syst Rev. 2013;1:CD008900. doi: 10.1002/14651858.CD008900.pub2

59. Zhang H-F, Huang L-B, Zhong Y-B. An overview of systematic reviews of Ginkgo biloba extracts for mild cognitive impairment and dementia. Front Aging Neurosci. 2016;8:276. doi: 10.3389/fnagi.2016.00276

60. Guekht A, Skoog I, Edmundson S, et al. ARTEMIDA Trial (a randomized trial of efficacy, 12 months international double-blind actovegin). Stroke. 2017;48:1262-70. doi: 10.1161/STROKEAHA.116.014321

61. Nicholson CD. Pharmacology of nootropics and metabolically active compounds in relation to their use in dementia. Psychopharmacology (Berl). 1990;101:147-59. doi: 10.1007/BF02244119

62. Balestreri R, Fontana L, Astengo F. A double-blind placebo controlled evaluation of the safety and efficacy of vinpocetine in the treatment of patients with chronic vascular senile cerebral dysfunction. J Am Geriatr Soc. 1987; 35:425-30. doi: 10.1111/j.1532-5415.1987.tb04664.x

63. Szatmari SZ, Whitehouse PJ. Vinpocetine for cognitive impairment and dementia. Cochrane Database Syst Rev. 2003;(1): CD003119. doi: 10.1002/14651858.CD003119

64. Chukanova EI. The effectiveness of Cavinton in the treatment of patients with chronic cerebrovascular insufficiency. Russian multicenter clinical and epidemiological program «Calypso». Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2010;110(12):49-52 (In Russ.).

65. Zhang W, Huang Y, Li Y, et al. Efficacy and safety of Vinpocetine as part of treatment for acute cerebral infarction: A randomized, openlabel, controlled, multicenter CAVIN (Chinese Assessment for Vinpocetine in Neurology) trial. Clin Drug Investig. 2016;36(9):697-704. doi: 10.1007/s40261-016-0415-x

For citation:

Parfenov V.A. Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):61-67. (In Russ.)

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ISSN 2074-2711 (Print)
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