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Clinical manifestations and issues of diagnosis of chronic cerebrovascular disease (chronic cerebral ischemia) at an early (pre-dementia) stage

https://doi.org/10.14412/2074-2711-2021-1-4-12

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Abstract

The paper presents experts' opinion on the clinical manifestations and diagnosis of chronic cerebrovascular disease (CVD) (chronic cerebral ischemia (CCI) and dyscirculatory encephalopathy (DEP)) at the pre-dementia stage. It is noted that DEP/CCI is a common diagnosis in Russian neurological practice, the criteria for which have not been updated for a long time. DEP/CCI most often develops in the presence of cerebral small artery (CSA) disease (cerebral microangiopathy (CMA)), the severity of which can be quantified by magnetic resonance imaging. The main clinical manifestation of DEP/CCI is cognitive impairment that may be subjective or moderate at the pre-dementia stage. Emotional disorders (apathy, depression, anxiety) and instability are considered as possible manifestations of CSA disease. It is noted that headache and vestibular vertigo are not caused by chronic CVD; while in patients with CMA, they are usually associated with other diseases (primary headache, peripheral vestibular vertigo, and vestibular migraine). The diagnosis of DEP/CCI should be based on the presence of cognitive impairment, reliable neuroimaging signs of CVD, and the exclusion of another cause of cognitive impairment.

About the Authors

A. A. Kulesh
Academician E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation

Aleksey Aleksandrovich Kulesh

26, Petropavlovskaya St., Perm 614590



A. Yu. Emelin
S.M. Kirov Military Medical Academy, Ministry of Defense of Russia
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044


A. N. Bogolepova
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
1, Ostrovityanov St., Moscow 117997


O. B. Doronina
Novosibirsk State Medical University, Ministry of Health of Russia
Russian Federation
52, Krasnyi Prospect, Novosibirsk 630091


V. V. Zakharov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Build. 1, Moscow 119021


O. V. Kolokolov
V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia
Russian Federation
137, Bolshaya Sadovaya St., Saratov 410000


S. V. Kotov
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
61/2, Shchepkin St., Moscow 129110


L. L. Korsunskaya
S.I. Georgievsky Medical Academy, V.I. Vernadsky Crimean Federal University
Russian Federation
5/7, Lenin Boulevard, Simferopol 295051, Republic of Crimea


M. A. Kutlubaev
Bashkir State Medical University, Ministry of Health of Russia
Russian Federation
3, Lenin St., Ufa 450000


V. B. Laskov
Kursk State Medical University, Ministry of Health of Russia
Russian Federation
3, K. Marx St., Kursk 305000


O. S. Levin
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
2/1, Barrikadnaya St., Build. 1, Moscow 125993


V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Build. 1, Moscow 119021


References

1. O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol. 2003 Feb;2(2):89-98. doi: 10.1016/s14744422(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. Zhou J, Yu JT, Wang HF, et al. Association between stroke and Alzheimer's disease: systematic review and meta-analysis. J Alzheimers Dis. 2015;43(2):479-89. doi: 10.3233/JAD-140666

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

5. WHO/Dementia (2017). Available from: http://www.who.int/mediacentre/factsheets/fs362/en/ (accessed 3 Mar 2018).

6. 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 Nov 5;10(11):e0142388. doi: 10.1371/journal.pone.0142388. eCollection 2015.

7. 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 Mar;64(3):416-20. doi: 10.1001/archneur.64.3.416

8. 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. Epub 2018 Sep 30.

9. Markus HS, Schmidt R. Genetics of Vascular Cognitive Impairment. Stroke. 2019;50(3):765-72. doi: 10.1161/STROKEAHA.118.020379

10. Gong L, Liu XY, Fang M. Recent progress on small vessel disease with cognitive impairment. Int J Clin Exp Med. 2015 May 15;8(5):7701-9.

11. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration: a united approach. Lancet Neurol. 2013 Aug;12(8):822-38. doi: 10.1016/S1474-4422(13)70124-8

12. Charidimou A, Linn J, Vernooij MW, et al. Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions. Brain. 2015;138(Pt 8):2126-39. doi: 10.1093/brain/awv162

13. Van Veluw SJ, Shih AY, Smith EE, et al. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol. 2017 Sep;16(9):730-40. doi: 10.1016/S1474-4422(17)30196-5. Epub 2017 Jul 14.

14. Debette S, Schilling S, Duperron MG, et al. Clinical significance of magnetic resonance imaging markers of vascular brain injury: a systematic review and metaanalysis. JAMA Neurol. 2019 Jan 1;76(1):81-94. doi: 10.1001/jamaneurol.2018.3122

15. Kulesh AA, Drobakha VE, Shestakov VV. Cerebral small vessel disease: classification, clinical manifestations, diagnosis, and features of treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(Suppl. 3):4-17. doi: 10.14412/2074-2711-2019-3S-4-17 (In Russ.).

16. ICD (International Classification of Diseases 11). Available from: https://icd11.ru/ (In Russ.).

17. Charidimou A, Shams S, Romero JR, et al. Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1). Int J Stroke. 2018;13(5):454-68. doi: 10.1177/1747493017751931

18. Francis F, Ballerini L, Wardlaw JM. Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: A systematic review and meta-analysis. Int J Stroke. 2019 Jun;14(4):359-71. doi: 10.1177/1747493019830321. Epub 2019 Feb 14.

19. Jokinen H, Koikkalainen J, Laakso HM, et al. Global Burden of Small Vessel DiseaseRelated Brain Changes on MRI Predicts Cognitive and Functional Decline. Stroke. 2020 Jan;51(1):170-8. doi: 10.1161/STROKEAHA.119.026170. Epub 2019 Nov 8.

20. Jie W, Lin G, Liu Z, et al. The Relationship Between Enlarged Perivascular Spaces and Cognitive Function: A Meta-Analysis of Observational Studies. Front Pharmacol. 2020;11:715. doi: 10.3389/fphar.2020.00715

21. Levin OS, Damulin IV. Diffuse white matter lesion and vascular dementia problem. In: Yakhno NN, editor. Dostizheniya neyrogeriatrii [Achievements of neurogeriatrics]. Pt 2. Moscow; 1995. P. 189-228 (In Russ.).

22. Arablinskiy AV, Makotrova TA, Levin OS. Cerebral microbleeds in vascular and degenerative diseases of the brain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2013;113(7-2):45-51 (In Russ.).

23. Salvadori E, Poggesi A, Valenti R, et al. Operationalizing mild cognitive impairment criteria in small vessel disease: the VMCI-Tuscany Study. Alzheimers Dement. 2016 Apr;12(4):407-18. doi: 10.1016/j.jalz.2015.02.010. Epub 2015 Jun 13.

24. Rabin LA, Smart CM, Crane PK, et al. Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies. J Alzheimers Dis. 2015 Sep 24;48 Suppl 1 (0 1):S63-86. doi: 10.3233/JAD-150154

25. Rogne S, Vangberg T, Eldevik P, et al. Magnetic Resonance Volumetry: Prediction of Subjective Memory Complaints and Mild Cognitive Impairment, and Associations with Genetic and Cardiovascular Risk Factors. Dement Geriatr Cogn Dis Extra. 2016 Nov 25;6(3):529-40. doi: 10.1159/000450885

26. Yakhno NN, Zakharov VV, Lokshina AB, et al. Dementsii [Dementia]. Moscow: Medpressinform; 2011 (In Russ.).

27. Gurol ME, Sacco RL, McCullough LD. Multiple Faces of Cerebral Small Vessel Diseases. Stroke. 2020 Jan;51(1):9-11. doi: 10.1161/STROKEAHA.119.027969. Epub 2019 Nov 22.

28. Tiel C, Sudo FK, Alves GS, et al. Neuropsychiatric symptoms in Vascular Cognitive Impairment: a systematic review. Dement Neuropsychol. Jul-Sep 2015;9(3):230-6. doi: 10.1590/1980-57642015DN93000004

29. Hollocks MJ, Lawrence AJ, Brookes RL, et al. Differential relationships between apathy and depression with white matter microstructural changes and functional outcomes. Brain. 2015;138(Pt 12):3803-15. doi: 10.1093/brain/awv304

30. Tay J, Morris RG, Tuladhar AM, et al. Apathy, but not depression, predicts all-cause dementia in cerebral small vessel disease. J Neurol Neurosurg Psychiatry. 2020 Sep;91(9):953-9. doi: 10.1136/jnnp-2020323092. Epub 2020 Jul 10.

31. Aizenstein HJ, Baskys A, Boldrini M, et al. Vascular depression consensus report – a critical update. BMC Med. 2016 Nov 3;14(1):161. doi: 10.1186/s12916-016-0720-5

32. Bogolepova AN. Vascular depression and cognitive dysfunction. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(Suppl. 3):26-31. doi: 10.14412/20742711-2019-3S-26-31 (In Russ.).

33. Salo KI, Scharfen J, Wilden ID, et al. Confining the Concept of Vascular Depression to Late-Onset Depression: A Meta-Analysis of MRI-Defined Hyperintensity Burden in Major Depressive Disorder and Bipolar Disorder. Front Psychol. 2019;10:1241. doi: 10.3389/fpsyg.2019.01241

34. Kim S, Woo SY, Kang HS, et al. Factors related to prevalence, persistence, and incidence of depressive symptoms in mild cognitive impairment: vascular depression construct. Int J Geriatr Psychiatry. 2016;31(7):818-26. doi: 10.1002/gps.4400

35. Van Sloten TT, Sigurdsson S, van Buchem MA, et al. Cerebral Small Vessel Disease and Association With Higher Incidence of Depressive Symptoms in a General Elderly Population: The AGES-Reykjavik Study. Am J Psychiatry. 2015 Jun;172(6):570-8. doi: 10.1176/appi.ajp.2014.14050578. Epub 2015 Mar 3.

36. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010 Jul;9(7):689-701. doi: 10.1016/S14744422(10)70104-6

37. Pinter D, Ritchie SJ, Doubal F, et al. Impact of small vessel disease in the brain on gait and balance. Sci Rep. 2017 Jan 30;7:41637. doi: 10.1038/srep41637

38. Su N, Zhai FF, Zhou LX, et al. Cerebral Small Vessel Disease Burden Is Associated with Motor Performance of Lower and Upper Extremities in Community-Dwelling Populations. Front Aging Neurosci. 2017;9:313. doi: 10.3389/fnagi.2017.00313

39. Kaski D, Rust HM, Ibitoye R, et al. Theoretical framework for «unexplained» dizziness in the elderly: The role of small vessel disease. Prog Brain Res. 2019;248:225-40. doi: 10.1016/bs.pbr.2019.04.009. Epub 2019 May 20.

40. Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke. 2000 Aug;31(8):2011-23. doi: 10.1161/01.str.31.8.2011

41. Brandt T, Dieterich M. Vertigo and dizziness: common complains. London: Springer; 2004. 208 p.

42. Parfenov VA, Zakharov VV, Preobrazhenskaya IS. Kognitivnyye rasstroystva [Cognitive Disorders]. Moscow: Remedium; 2014 (In Russ.).

43. Parfenov VA. Distsirkulyatornaya entsefalopatiya i sosudistyye kognitivnyye rasstroystva [Dyscirculatory encephalopathy and vascular cognitive disorders]. Moscow: IMA-PRESS; 2017 (In Russ.).

44. Olesen J, Bes A, Kunkel R, et al. The International Classification of Headache Disorders, 3 rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658

45. Li Q, Yang Y, Reis C, et al. Cerebral Small Vessel Disease. Cell Transplant. 2018 Dec;27(12):1711-22. doi: 10.1177/0963689718795148. Epub 2018 Sep 25.

46. Tadic SD, Griffiths D, Murrin A, et al. Brain activity during bladder filling is related to white matter structural changes in older women with urinary incontinence. Neuroimage. 2010;51(4):1294-302. doi: 10.1016/j.neuroimage.2010.03.016

47. Yee CH, Leung C, Wong YY, et al. Lower Urinary Tract Symptoms in Subjects with Subclinical Cerebral White Matter Lesions. J Aging Res. 2018 Jul 30;2018:1582092. doi: 10.1155/2018/1582092. eCollection 2018.

48. Chertkow H, Feldman HH, Jacova C, Massoud F. Definitions of dementia and predementia states in Alzheimer's disease and vascular cognitive impairment: consensus from the Canadian conference on diagnosis of dementia. Alzheimers Res Ther. 2013 Jul 8;5(Suppl 1):S2. doi: 10.1186/alzrt198. Epub 2013 Jul 8.

49. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):263-9. doi: 10.1016/j.jalz.2011.03.004


For citation:


Kulesh A.A., Emelin A.Yu., Bogolepova A.N., Doronina O.B., Zakharov V.V., Kolokolov O.V., Kotov S.V., Korsunskaya L.L., Kutlubaev M.A., Laskov V.B., Levin O.S., Parfenov V.A. Clinical manifestations and issues of diagnosis of chronic cerebrovascular disease (chronic cerebral ischemia) at an early (pre-dementia) stage. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):4-12. https://doi.org/10.14412/2074-2711-2021-1-4-12

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ISSN 2074-2711 (Print)
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