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Drug therapy and cognitive stimulation in patients with poststroke cognitive impairments

https://doi.org/10.14412/2074-2711-2014-2S-23-27

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Abstract

Objective: to compare a multimodal drug approach to treating poststroke cognitive impairments (CI).

Patients and methods. Eighty patients with postroke CI in the early recovery period were examined. They were allocated to 4 groups:1) secondary stroke prevention only (a comparison nontreatment group); 2) actovegin infusions; 3) cerebrolysin infusions; 4) drug therapy in combination with non-drug cognitive training using the standard procedure. Follow-ups and neuropsychological assessments were made at the inclusion in the study and 3 and 6 months after stroke. The state of cognitive functions 6 months after stroke was considered to be an endpoint of the study.

Results and discussion. At the inclusion in the study, the mini-mental state examination and the frontal lobe dysfunction scale showed no statistical differences in cognitive functions in different patient groups. At a 3-month follow-up, the cognitive status in the neuronal plasticity stimulation groups was significantly better than in the comparison group (p≤0.05). At a 6-month follow-up, there was a significant cognitive improvement in the combined stimulation group versus the drug-therapy and comparison groups (p≤0.05). Day-to-day activities and independent functioning also improved significantly more promptly in the patients receiving drug or combined therapies. More complex instrumental activities of daily living recovered significantly better during combined cognitive function stimulation than during pharmacological stimulation only. There was evidence that the drugs with proven stimulating effects on neuronal plasticity and nondrug cognitive training were effective in treating CI in the early recovery period of stroke. The combined drug and nondrug poststroke CI treatments reflecting the multimodal approach versus drug therapy were found to be most effective in these patients.

About the Authors

D.R. Khasanova
Interregional Clinical and Diagnostic Center, Kazan; 12a, Karbyshev St., Kazan, 420101
Russian Federation


Yu.V. Zhitkova
Interregional Clinical and Diagnostic Center, Kazan; 12a, Karbyshev St., Kazan, 420101
Russian Federation


L.M. Yu.V.
Interregional Clinical and Diagnostic Center, Kazan; 12a, Karbyshev St., Kazan, 420101
Russian Federation


References

1. Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of NINDS-AIREN International Work Group. Neurology. 1993;43(2):250–60. DOI:

2. http://dx.doi.org/10.1212/WNL.43.2.250.

3. Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Dementia three months after stroke. Baseline frequency and effect of different definitions for dementia in the Helsinki Aging Memory Study (SAM) cohort. Stroke. 1997;28(4):785–92. DOI: http://dx.doi.org/10.1161/01.STR.28.4.785.

4. Kase CS, Wolf PA, Kelly-Hayes M,et al. Intellectual decline after stroke: the Framingham study. Stroke. 1998;29(4):805–12. DOI: http://dx.doi.org/10.1161/01.STR.29.4.805.

5. Tatemichi TK, Desmond DW, Mayeux R, et al Dementia after stroke: baseline frequency, risks and clinical features in a hospitalized cohort. Neurology. 1992;42(6):1185–93. DOI:http://dx.doi.org/10.1212/WNL.42.6.1185.

6. Tatemichi TK, Paik M, Bagiella E, et al Risk of dementia after stroke in a hospitalized cohort. Neurology. 1994;44(10):1885–91. DOI: http://dx.doi.org/10.1212/WNL.44.10.1885.

7. Barba R, Martinez-Espinosa S, Rodriquez-Garcia E, et al Poststroke dementia: clinical features and risk factors. Stroke. 2000;31(7):1494–501. DOI:http://dx.doi.org/10.1161/01.STR.31.7.1494.

8. Pasquier F, Leys D. Why are stroke patients prone to develop dementia? J Neurol. 1997;244(3):135–42. DOI: http://dx.doi.org/10.1007/s004150050064.

9. Jellinger KA, Atems J. Prevalence of dementia disorders in the oldest-old: an autopsy study.

10. Acta Neuropathol. 2010 Apr;119(4):421–33. DOI: 10.1007/s00401-010-0654-5. Epub 2010 Mar 4.

11. BrunnstrЪm H, Gustafson L, Passant U, Englund E. Prevalence of dementia subtypes: a 30-year retrospective survey of neuropathological reports. Arch Gerontol Geriatr. 2009;49(1):146–9. DOI: http://dx.doi.org/10.1016/j.archger.2008.06.005.

12. Fö rst H, Einhä upl KM. Diagnose und Differentialdiagnose der Demenzen. In: Beyreuther K, Einhä upl KM, Fö rst H, Kurz A (Hrsg). Demenzen. Grundlagen und Klinik. Stuttgart: Thieme; 2002. C. 43–70.

13. Вахнина НВ. Сосудистые когнитивные нарушения. Неврология, нейропсихиатрия, психосоматика. 2014;(1):74–9. [Vakhnina NV. Vascular cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology,Neuropsychiatry, Psychosomatics. 2014;(1):74–9. (In uss.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2014-1-74-79.

14. Локшина АБ. Тяжелая деменция: диагностика, ведение пациентов, профилактика осложнений. Неврология, нейропсихиатрия, психосоматика. 2014;(1):54–60. [Lokshina AB. Severe dementia: diagnosis,patient management, prevention of complications. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry,Psychosomatics. 2014;(1):54–60. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2014-1-54-60.

15. Преображенская ИС. Деменция – эпидемиология, клиническая картина, диагностика, подходы к терапии. Неврология, нейропсихиатрия, психосоматика.2013;(4):71–7. [Preobrazhenskaya IS.

16. Dementia: epidemiology, clinical picture, diagnosis,approaches to therapy. Nevrologiya,neiropsikhiatriya, psikhosomatika = Neurology,Neuropsychiatry, Psychosomatics.2013;(4):71–7. (In Russ.)]. DOI:http://dx.doi.org/10.14412/2074-2711-2013-2459.

17. Van Praag H, Christie BR, Sejnowski TJ, Gage FH. Running enhances neurogenesis,learning and long-term potentiation in mice. Proc Natl Acad Sci USA. 1999;96(23):13427–31. DOI:http://dx.doi.org/10.1073/pnas.96.23.13427.

18. Van Praag H, Shubert T, Zhao C, Gage FH. Exercise enhances learning and hippocampal

19. neurogenesis in aged mice. J Neurosci. 2005;25(38):8680–5. DOI:http://dx.doi.org/10.1523/JNEUROSCI.1731-05.2005.

20. Komitova M, Mattsson B, Johansson BB, Eriksson PS. Enriched environment increases neural stem/progenitor cell proliferation and neurogenesis in the subventricular zone of stroke-lesioned adult rats. Stroke. 2005;36(6):1278–82. DOI: http://dx.doi.org/10.1161/01.STR.0000166197.94147.59.

21. Kempermann G, Kuhn HG, Gage G. More hippocampal neurons in adult mice living in an enriched environment. Nature. 1997;386(6624):493–5. DOI: http://dx.doi.org/10.1038/386493a0.

22. Gould E, Beylin A, Tanapat P, et al. Learning enhances adult neurogenesis in the hippocampal formation. Nature Neurosci. 1999;2(3):260–5. DOI: http://dx.doi.org/10.1038/6365.

23. Cao L, Jiao X, Zuzga DS, et al VEGF links hippocampal activity with neurogenesis, learning, 2010, 61–70 and memory. Nat Genet. 2004;36(8):827–35. DOI:http://dx.doi.org/10.1038/ng1395.

24. Fabel K, Fabel K, Tam B, et al. VEGF is necessary for exercise-induced adult hippocampal neurogenesis. Eur J Neurosci. 2003;18(10):2803–12. DOI: http://dx.doi.org/10.1111/j.1460-9568.2003.03041.x.

25. Matthew J, Cao L. VEGF a mediator of the effect of experience onhippocampal neurogenesis. Curr Alzheimer Res. 2006;3(1):29–33. DOI: http://dx.doi.org/10.2174/156720506775697133.

26. Spector A, Orrell M, Davies S, Woods B. Can reality orientation be rehabilitated? Development and piloting of an evidence based programme of cognition-based therapies for people with dementia. Neuropsychological Rehabilitation. 2001;11(3–4):377–97. DOI: http://dx.doi.org/10.1080/09602010143000068.

27. Spector A, Thorgrimsen L, Woods B, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised Controlled Trial. Br J Psychiatry. 2003;(183):248–54. DOI: http://dx.doi.org/10.1192/bjp.183.3.248.

28. Spector A, Aguirre E, Orrell M. Translating research into practice: a pilot study examining

29. the use of Cognitive Stimulation Therapy (CST) after a one-day training course. Non-pharmacological

30. Therapies in Dementia Journal. 2010;1(1):61–70.

31. Spector A, Gardner C, Orrell M. The impact of Cognitive Stimulation Therapy groups on people with dementia: views from participants, their carers and group facilitators. Aging Ment Health. 2011 Nov;15(8):945–9. DOI: 10.1080/13607863.2011.586622. Epub 2011 Jul 4.

32. Woods RT. Non-pharmacological techniques. In: Qizilbash N. Evidence-based dementia practice. Oxford: Blackwell; 2002. C. 428–46.

33. Orrell M, Spector A, Thorgrimsen L, Woods B. A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia. Int J Geriatr Psychiatry. 2005;20(5):446–51. DOI: http://dx.doi.org/10.1002/gps.1304.

34. Knapp M, Thorgrimsen L, Patel A, et al. Cognitive Stimulation Therapy for people with dementia: cost effectiveness analysis. Br J Psychiatry. 2006;(188):574–80. DOI: http://dx.doi.org/10.1192/bjp.bp.105.010561.

35. Herrmann WM, Bohn-Olszewsky WJ, Kuntz G. Actovegin infusion treatment in patients with primarily degenerative dementia of the Alzheimer type and multiinfarct dementia. Z Geriatr. 1992;(5):46–55.

36. Oswald WD, Steiger W, Oswald B, Kuntz G. Die Verbesserungfluider kognitiver leistunger als indicator fuer die klinische Wirksamkeit einer nootropen Substanz. Eine Placebo-kontrollierte Doppelblind-Studie mit Actovegin. Zeitschrifft fü r Gerontopsychologie und psychiatrie. 1991;(4):209–20.

37. Kanowski S. Confirmed Clinical Efficacy of Actovegin in Elderly patients with Organic Brain Syndrome. Pharmacopsychiatry. 1995;4(28):125–33. DOI:http://dx.doi.org/10.1055/s-2007-979604.

38. Rettig K, Lehmann F. Biometric report on the study «Tizentrische, doppelblinde, randomisierte

39. placebokontrollierte Studie zur Wirksamkeit und Unbedenklichkeit von ACTOHORM bei Patienten mit organischem Psychosyndrom» Study 89 HIMO, 13.06.1992. Unpublished report.

40. Ückert B. Medical report on the AFB-KFB study (08/0390-90) «Doppelblinde, placebokontrollierte,

41. randomisierte Phase IIIPrü fung zur Wirksamkeit und VertrКglichkeit von Actovegin forte Dragees bei ambulanten Patienten mit leichtem bis mittelgradigem organischem Psychosyndrom». 13.07.1992. Unpublished report.

42. Schumann G. A multi-centre, national, double-blind, placebo-controlled and randomised phase III study to evaluate the efficacy and safety of ActoHorm 2000 pro infusione and ActoHorm coated tablets in moderate dementia. Date of final report by Retting K: 03.01.2001. Unpublished report.

43. Ladurner G, Kalvach P, Moessler H. Neuroprotective treatment with Cerebrolysin in patients with acute stroke: a randomized controlled trial. J Neural Transm. 2005;112(3):415–28. DOI:

44. http://dx.doi.org/10.1007/s00702-004-0248-2.

45. Chen CC, Wei ST, Tsaia SC, et al. Cerebrolysin enhances cognitive recovery of mild traumatic brain injury patients: doubleblind, placeboontrolled, randomized study. Br J Neurosurg. 2013;27(6):803–07.

46. DOI: 10.3109/02688697.2013.793287. Epub 2013 May 8.

47. Chen N, Yang M, Guo J, et al. Cerebrolysin for vascular dementia. Cochrane Database Syst Rev. 2013 Jan 31;1:CD008900. DOI: 10.1002/14651858.CD008900.pub2.

48. Heiss WD, Brainin M, Bornstein NM, et al. Cerebrolysin in patients with acute ischemic stroke in Asia: results of a double-blind, placebo-controlled randomized trial. Stroke. 2012;43(3):630–6. DOI: 10.1161/STROKEAHA.111.628537. Epub 2012 Jan 26.

49. Wei Z-H, He Q-B, Wang H, et al. Metaanalysis: the efficacy of nootropic agent Cerebrolysin in the treatment of Alzheimer's disease. J Neural Transm. 2007;114(5):629–34. DOI: http://dx.doi.org/10.1007/s00702-007-0630-y. Epub 2007 Feb 23

50. Виленский БС, Кузнецов АН, Виноградов ОИ. Новое направление применения церебролизина – повторное курсовое введение препарата больным, перенесшим полушарный ишемический инсульт. Неврологический журнал. 2007;12(1):44–6. [Vilenskii BS, Kuznetsov AN, Vinogradov OI. Modern approach to cerebrolysin administration – repeated course treatment oa this medicine in

51. patients with the history of recurrent hemispherical ischemic stroke. Nevrologicheskii zhurnal. 2007;12(1):44–6. (In Russ.)]

52. Гаврилова СИ, Колыхалов ИВ, Коровайцева ГИ и др. АроЕ-генотип и эффективность нейротрофической и холинергической терапии при болезни Альцгеймера. Журнал неврологии и психиатрии им. С.С. Корсакова. 2005;105(4):27–34. [Gavrilova SI, Kolykhalov IV, Korovaitseva GI, et al. ApoEgenotype and efficacy of neurotrophic and cholinergic therapy in Alzheimer's disease. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2005;105(4):27–34. (In Russ.)]

53. Guekht AB, Moessler H, Novak PH, Gusev EI. Cerebrolysin in Vascular Dementia: Improvement of Clinical Outcome in a Randomised, Double-Blind, Placebo-Controlled Multicenter Trial. J Stroke

54. Cerebrovasc Dis. 2011 Jul-Aug;20(4):310–8. DOI: 10.1016/j.jstrokecerebrovasdis.2010.01.012. Epub 2010 Jul 24.

55. Калын ЯБ, Сафарова ТП, Шешенин ВС, Гаврилова СИ. Сравнительная эффективность и безопасность антидепрессивной моно- и мультимодальной терапии у пожилых больных депрессией (опыт клинического применения в геронтопсихиатрическом стационаре). Журнал неврологии и психиатрии им. С.С. Корсакова. 2014;114(6–2):20–9. [Kalyn YaB, Safarova TP, Sheshenin VS, Gavrilova SI. Comparative efficiency and safety anti-depressive mono- and multimodal therapy at elderly patients with a depression (experience of clinical application in a gerontopsikhiatrichesky hospital). Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2014;114(6–2):20–9. (In Russ.)]

56. Чуканова ЕИ. Сравнительный анализ эффективности Церебролизина при лечении пациентов с хронической ишемией мозга. Фармакоэкономические аспекты. Трудный пациент. 2011;9(1):1–7.

57. [Chukanova EI. The comparative analysis of efficiency of Tserebrolizin at treatment of patients with chronic ischemia of a brain. Farmakoekonomichesky aspects. Trudnyi patsient.2011;9(1):1–7. (In Russ.)]

58. Шпрах ВВ, Суворова ИА. Эффективность длительной терапии сосудистой деменции. Клиническая медицина. 2011;89(5):57–60. [Shprakh VV, Suvorova IA. Efficacy of prolonged therapy of vascular dementia. Klinicheskaya meditsina. 2011;89(5):57–60. (In Russ.)]


For citation:


Khasanova D., Zhitkova Y., Yu.V. L. Drug therapy and cognitive stimulation in patients with poststroke cognitive impairments. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2S):23-27. (In Russ.) https://doi.org/10.14412/2074-2711-2014-2S-23-27

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