Cognitive impairment, dizziness, and unsteadiness in hypertensive patients
https://doi.org/10.14412/2074-2711-2020-5-92-97
Abstract
Hypertension is a widespread disease related to modifiable vascular risk factors for stroke and chronic cerebrovascular diseases. The pathogenetic basis of brain damage in hypertension is cerebral microangiopathy that leads to vascular cognitive impairment (CI), instability, and falls. Microcirculatory changes in the presence of hypertension at the initial stages of cerebrovascular disease occur without visible clinical manifestations of brain damage. Pathogenetically justified treatment used at an early stage of the disease makes it possible to achieve good results in the prevention of vascular brain damage. An important aspect of selecting effective therapy is the competent diagnosis of the causes of dizziness and instability, which can be caused not only by brain damage, but also by peripheral vestibular system diseases. Early diagnosis of vascular CI, selection of adequate therapy, and prevention of their further progression are of great importance. The studies performed have shown the high efficacy of vinpocetine (Cavinton®) that has a multifactorial mechanism of action in the treatment and prevention of CI, dizziness, and instability caused by cerebrovascular disease.
About the Authors
L. M. Antonenko
N.V. Sklifosovsky Institute of Clinical Medicine I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
Russian Federation
Lyudmila M. Antonenko
11, Rossolimo St., Build. 1, Moscow 119021
N. V. Vakhnina
N.V. Sklifosovsky Institute of Clinical Medicine I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
Russian Federation
11, Rossolimo St., Build. 1, Moscow 119021
D. O. Gromova
N.V. Sklifosovsky Institute of Clinical Medicine I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
Russian Federation
11, Rossolimo St., Build. 1, Moscow 119021
References
1. Chazova IE, Zhernakova YuV on behalf of the experts. Clinical guidelines. Diagnostics and treatment of arterial hypertension. Sistemnyye gipertenzii. 2019;16(1):6-31. doi: 10.26442/2075082X.2019.1.190179 (In Russ.).
2. Algoritmy vedeniya patsiyenta s arterial'noy gipertenziyey i gipertonicheskim krizom [Algorithms for managing a patient with arterial hypertension and hypertensive crisis]. St. Petersburg: All-Russian public organization «Promotion of prevention and treatment of arterial hypertension “Antihypertensive League”»; 2019. 90 p. (In Russ.).
3. Muromtseva GA, Kontsevaya AV, Konstantinov VV. The prevalence of non-infectious diseases risk factors in russian population in 2012–2013 years. The results of ECVD-RF. Kardiovaskulyarnaya terapiya i profilaktika. 2014;13(6):4-11 (In Russ.).
4. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005 Jan 15- 21;365(9455):217-23. doi: 10.1016/S0140-6736(05)17741-1
5. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. doi: 10.1093/eurheartj/ehy339
6. Lonn EM, Bosch J, Lopez-Jaramillo P, et al.; HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016 May 26;374(21):2009-20. doi: 10.1056/NEJMoa1600175. Epub 2016 Apr 2.
7. Vakhnina NV, Milovanova OV. Neurological disorders in patients with hypertension and their correction. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(4):32-7. doi: 10.14412/2074-2711-2016-4-32-37 (In Russ.).
8. Esin RG, Khairullin IKh, Abrarova GF, Esin OR. Cerebral small vessel disease and silent cerebrovascular diseases: modern standards of diagnosis, prevention, treatment prospects. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(4):81-7. doi: 10.17116/jnevro201911904181 (In Russ.).
9. Kozlovskiy IV. Cerebral hypoperfusion in arterial hypertension. Some aspects of medical tactics. Meditsinskiye novosti. 2017;(11):45-9 (In Russ.).
10. Zakharov VV, Vakhnina NV. Cognitive impairment in cerebrovascular diseases. Effektivnaya farmakoterapiya. Nevrologiya i psikhiatriya. 2014;(1):14-22 (In Russ.).
11. Parfenov VA, Starchina YuA. Cognitive disorders in patients with essential hypertension and their treatment. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2011;3(1):27- 33. doi: 10.14412/2074-2711-2011-130 (In Russ.).
12. Parfenov VA. Distsirkulyatornaya entsefalopatiya i sosudistye kognitivnye rasstroistva [Dyscirculatory encephalopathy and vascular cognitive disorders]. Moscow: Ima-Press; 2017. 124 p..
13. Vakhnina NV. Cognitive impairment in hypertension. Meditsinskii Sovet. 2015;(5):34-9. (In Russ.).
14. Bowler JV. Vascular cognitive impairment. Stroke. 2004 Feb;35(2):386-8. doi: 10.1161/01.STR.0000115301.12426.2B
15. Bryzhakhina VG, Damulin IV, Yakhno NN. Gail and equilibrium disorders in dyscirculatory encephalopathy. Communication 1. Nevrologicheskiy zhurnal. 2004;9(2):11-6 (In Russ.).
16. Nutt JC, Marsden CD, Thompson PD. Human walking and higher-level gait disorders, particularly in the elderly. Neurology. 1993 Feb;43(2):268-79. doi: 10.1212/wnl.43.2.268
17. Lebedeva NV, Zamergrad MV, Parfenov VA, Antonenko LM. Diagnosis and treatment of patients with benign paroxysmal positional vertigo in common clinical practice. Terapevticheskij arhiv. 2017;89(1):57-61. doi: 10.17116/terarkh201789157-61 (In Russ.).
18. Antonenko LM. Diagnosis, treatment, and rehabilitation in patients with dizziness and cognitive impairment. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3):76- 80. doi: 10.14412/2074-2711-2017-3-76-80 (In Russ.).
19. Parfenov VA. Differential diagnosis and treatment of dizziness in patients with arterial hypertension. Terapevticheskij arhiv. 2005;77(1):56-8 (In Russ.).
20. Parfenov VA, Abdulina OV, Zamergrad MV. Peripheral vestibulopathy simulating a stroke. Nevrologicheskij zhurnal. 2005;(6):28-32 (In Russ.).
21. Formeister EJ, Rizk HG, Kohn MA, et al. The epidemiology of vestibular migraine: a population-based survey study. Otol Neurotol. 2018 Sep;39(8):1037-44. doi: 10.1097/MAO.0000000000001900
22. Sohn JH. Recent advances in the understanding of vestibular migraine. Behav Neurol. 2016;2016:1801845. doi: 10.1155/2016/1801845. Epub 2016 Oct 16.
23. Yollu U, Uluduz DU, Yilmaz M, et al. Vestibular migraine screening in a migrainediagnosed patient population, and assessment of vestibulocochlear function. Clin Otolaryngol. 2017 Apr;42(2):225-33. doi: 10.1111/coa.12699. Epub 2016 Aug 1.
24. Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res. 2012;22(4):167-72. doi: 10.3233/VES2012-0453
25. Arima H, Chalmers J, Woodward M, et al. PROGRESS Collaborative Group. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial. Hypertens. 2006 Jun;24(6):1201-8. doi: 10.1097/01.hjh.0000226212.34055.86
26. Ley Beth M. Vinpocetine: revitalize your brain with periwinkle extract. Detroit Lakes, MN: BL Publications; 2000. 17 p.
27. Parfenov VA, Zhivolupov SA, Zakharov VV, et al. Chronic cerebrovascular diseases: use of vinpocetine in neurological practice (Round Table proceedings). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(4):139-45. doi: 10.14412/2074-2711-2018-4-139-145 (In Russ.).
28. Cai Y, Knight WE, Guo S, et al. Vinpocetine Suppresses Pathological Vascular Remodeling by Inhibiting Vascular Smooth Muscle Cell Proliferation and Migration. J Pharmacol Exper Ther. 2012;343(2):479-88. doi: 10.1124/jpet.112.195446
29. Szatmari S, Whitehouse P. Vinpocetine for cognitive impairment and dementia. Cochrane Database Syst Rev. 2003;(1):CD003119. doi: 10.1002/14651858.CD003119
30. Chukanova EI. Current aspects of the epidemiology and treatment of chronic brain ischemiain the presence of essential hypertension (results of the CALIPSO program). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2011;3(1):38- 42. doi: 10.14412/2074-2711-2011-132 (In Russ.).
31. Tabeeva GR, Kalimeeva EYu, Koberskaya NN, Gereeva SI. Possibilities of therapy for early manifestations of chronic cerebral ischemia: results of the PROFILE program. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3): 36-41. doi: 10.14412/2074-2711-2017-3-36-41 (In Russ.).
Review
For citations:
Antonenko L.M., Vakhnina N.V., Gromova D.O. Cognitive impairment, dizziness, and unsteadiness in hypertensive patients. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):92-97. (In Russ.) https://doi.org/10.14412/2074-2711-2020-5-92-97
Views: 379
Email this article 