Post-stroke cognitive impairment: risk factors and treatment approaches, use of memantine

Stroke remains the second leading cause of death worldwide, and post-stroke cognitive impairment (PSCI) is a common complication that ranges from mild impairments to dementia, negatively affecting memory, attention and learning, reducing quality of life and placing a greater burden on family carers. Factors associated with a poor prognosis include severe or recurrent stroke, advanced age, multifocal brain lesions and pre-existing cognitive impairment; pathologically, PSCI is associated with direct structural damage, disrupted neural connections and neurodegenerative changes (neuroinflammation, oxidative stress), making appropriate management of such patients particularly important. PSCI requires a comprehensive approach: secondary prevention, correction of vascular risk factors, and discontinuation of drugs with anticholinergic effects. There are no officially approved drugs for the treatment of PSCI: donepezil, which is effective in Alzheimer's disease, is of limited efficacy in PSCI and is associated with frequent adverse reactions, whereas memantine – a non-competitive NMDA receptor antagonist – reduces neuronal damage, improves cognitive function in ischaemia, slows functional decline and behavioural disturbances (agitation, aggression, irritability), enhances independence in daily living, and causes virtually no side effects. According to a network meta-analysis, memantine demonstrated the most significant effect on the Mini-Mental State Examination scale. The optimal time to start memantine therapy is 3–6 months after a stroke, and its domestic dispersible analogue (Memoritab®) is an effective and safe agent for managing cognitive function, particularly in patients with swallowing difficulties and low adherence to treatment. Memoritab, which is therapeutically equivalent to the original, improves patient adherence to treatment and facilitates their care thanks to its convenient formulation.

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