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Cognitive impairments in cerebrovascular disease

https://doi.org/10.14412/2074-2711-2014-4-11-18

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Abstract

Cerebrovascular diseases belong to a group of the major causes of cognitive impairments, in the elderly in particular. The paper presents current ideas on the etiology and pathogenesis of vascular cognitive impairments (VCI). The etiological factors of VCI may be divided into genetic, sociodemographic, and common risk factors for vascular and other diseases. The pathogenesis of VCI is multifactorial; cognitive function decrement results from brain damage due to cerebral circulatory disorders. Damage to the deep white matter portions and basal ganglions plays a leading role in the development of cognitive deficit in cerebral circulatory insufficiency, disrupting the connections between the frontal lobes and subcortical structures (a dissociation phenomenon). Regulatory functions are impaired; instability of volitional attention develops; the speed of thinking processes and the performance of professional and everyday skills are suffered, mnestic functions being impaired to a lesser extent. Impairments in other higher cortical functions, such as speech, gnosis, praxis, thinking, generally occur in the later stages of cognitive deficit. The comprehensive approach to examining patients with cognitive dysfunctions, which encompasses physical examination with a mandatory evaluation of neurological symptoms, neuropsychological testing, laboratory studies, instrumental diagnostic methods, and structural and functional neuroimaging techniques, are most justified now. VCI therapy is a challenging task requiring the specific features of different types of cognitive deficit to be analyzed, by providing a rationale for the choice of medications. Therapeutic effectiveness may be enhanced by rational combined multimodal therapy, by keeping in mind a variety of factors for the pathogenesis of VCI.

About the Author

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


References

1. Lobo A, Launer L, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of populationbased cohorts. Neurologic diseases in the elderly research group. Neurology. 2000;54(11 Suppl 5):S4–9.

2. Ruitenberger A, Ott A, van Swieten JC, et al. Incidence of dementia: does gender make a difference? Neurobiol Aging. 2001;22(4):575–80. DOI: http://dx.doi.org/10.1016/S0197- 4580(01)00231-7.

3. Roman G. Vascular dementia prevention: a risk factor analysis. Cerebrovas Dis. 2005;20(Suppl 2):91–100.

4. Одинак ММ, Емелин АЮ, Лобзин ВЮ. Нарушение когнитивных функций при цереброваскулярной патологии. Санкт-Петербург: ВМедА; 2006. 158 с. [Odinak MM, Emelin AYu, Lobzin VYu. Narushenie kognitivnykh funktsii pri tserebrovaskulyarnoi patologii [Violation of cognitive functions at cerebrovascular pathology]. St-Petersburg: VMedA; 2006. 158 p.]

5. Jellinger K. Morphologic diagnosis of «vascular dementia» – a critical update. J Neurol Sci. 2008;270(1–2):1–12.

6. Parsons C, Danysz W, Hesselink M, et al. Modulation of NMDA receptors by glycine – introduction to some basic aspects and recent developments. Amino Acids. 1998;14(1–3):207–16.

7. Яхно НН, Захаров ВВ. Когнитивные и эмоционально-аффективные нарушения при дисциркуляторной энцефалопатии. Русcкий медицинский журнал. 2002;10(12/13):531–51. [Yakhno NN, Zakharov VV. Cognitive and emotional and affective violations at discirculatory encephalopathy. Rusckii meditsinskii zhurnal. 2002;10(12/13):531–51. (In Russ.)]

8. Roman GC, Sachdev P, Royall DR, et al. Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. J Neurol Sci. 2004;226(1–2):81–7. DOI: http://dx.doi.org/10.1016/j.jns.2004.09.016.

9. Pantoni L, Poggesi A, Inzitari D. Cognitive decline and dementia related to cerebrovascular diseases: some evidence and concepts. Cerebrovasc Dis. 2009;27(S1):191–6. DOI: http://dx.doi.org/10.1159/000200459.

10. Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia. A case of mental deterioration in the elderly. Lancet. 1974;2(7874):207–10. DOI: http://dx.doi.org/10.1016/S0140- 6736(74)91496-2.

11. Chui HC, Victoroff JI, Margolin D, et al. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's disease diagnostic and treatment centers. Neurology. 1992;42(6):473–80. DOI: http://dx.doi.org/10.1212/WNL.42.3.473.

12. Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International workshop. Neurology. 1993;43(2):250–60. DOI: http://dx.doi.org/10.1212/WNL.43.2.250.

13. Pohjasvaara T, Mantyla R, Ylikoski R, et al. Comparison of different clinical criteria for the vascular cause of vascular dementia (ADDTC, DSM-III, DSM-IV, ICD-10, NINDSAIREN). Stroke. 2000;31(12):2952–7. DOI: http://dx.doi.org/10.1161/01.STR.31.12.2952.

14. Яхно НН, Захаров ВВ, Локшина ФБ и др. Танакан (EGb 761) в терапии умеренных когнитивных нарушений (мультицентровое исследование). Журнал неврологии и психиатрии им С.С. Корсакова. 2006;106(12):48–53. [Yakhno NN, Zakharov VV, Lokshina FB, et al. Tanakan (EGb 761) in therapy of moderate cognitive impairments (multicenter research). Zhurnal nevrologii i psikhiatrii im S.S. Korsakova. 2006;106(12):48–53. (In Russ.)]

15. Meyer J, Xu C, Thornby J, et al. Is mild cognitive impairment prodromal for vascular dementia like Alzheimer's disease? Stroke. 2002;33(8):1981–5. DOI: http://dx.doi.org/10. 1161/01.STR.0000024432.34557.10.

16. Erkinjuntti T, Gauthier S. The concept of vascular cognitive impairment. Front Neurol Neurosci. 2009;24:79–85. DOI: http://dx.doi.org/10.1159/000197886.

17. Gorelick P, Scuteri A, Black S, Decarli C. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(9):2672–713. DOI: http://dx.doi.org/10.1161/STR.0b013e318229949618.

18. Емелин АЮ. Структурная нейровизуализация в дифференциальной диагностике сосудистых когнитивных нарушений. Вестник Российской военно-медицинской академии. 2010;(3):97–102. [Emelin AYu. Structural neuroimaging in the differential diagnostics of vascular cognitive impairment. Vestnik Rossiiskoi voenno-meditsinskoi akademii. 2010;(3):97–102. (In Russ.)]

19. Емелин АЮ, Одинак ММ, Труфанов ГЕ и др. Возможности позитронной эмиссионной томографии в дифференциальной диагностике деменций. Вестник Российской военно-медицинской академии. 2010;(4):46–51. [Emelin AYu, Odinak MM, Trufanov GE, et al. Positron-emission tomography possibilities in differential diagnostics of the dementias. Vestnik Rossiiskoi voenno-meditsinskoi akademii. 2010;(4):46–51. (In Russ.)]

20. Захаров ВВ, Яхно НН. Нарушения памяти. Москва: ГЭОТАР-Мед; 2003. 160 с. [Zakharov VV, Yakhno NN. Narusheniya pamyati [Memory violations]. Moscow: GEOTARMed; 2003. 160 p.]

21. Abbott RD, White RD, Ross GW, et al. Walking and dementia in physically capable elderly men. JAMA. 2004;292(12):1447–53. DOI: http://dx.doi.org/10.1001/jama.292.12.1447.

22. Chan A, Paskavitz J, Remington R, et al. Efficacy of a vitamin/nutriceutical formulation for early-stage Alzheimer's disease: a 1-year, open-label pilot study with an 16-month caregiver extension. Am J Alzheimers Dis Other Demen. 2008;23(6):571–85. DOI: http://dx.doi.org/10.1177/1533317508325093.

23. Scrameas N, Stern Y, Tang MX, et al. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006;59(6):877–9. DOI: http://dx.doi.org/10.1002/ana.20898.

24. Meyer JS, McClintic KL, Rogers RL, et al. Aetiological considerations and risk factors for multi-infarct dementia. J Neurol Neurosurg Psychiatry. 1988;51:1489–97. DOI: http://dx.doi.org/10.1136/jnnp.51.12.1489.

25. Forette F, Seux ML, Staessen J, et al. Prevention of dementia in randomised doubleblind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet. 1998;352:1347–51. DOI: http://dx.doi.org/10.1016/S0140-6736(98)03086-4.

26. Tzourio C, Anderson C, Chapman N, et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;163(9):1069–75. DOI: http://dx.doi.org/10.1001/archinte.163.9.1069.

27. Bernick C, Katz R, Smith NL, et al. Statins and cognitive function in the elderly. The Cardiovascular Health Study. Neurology. 2005;65:1388–94. DOI: http://dx.doi.org/10.1212/01.wnl.0000182897.18229.ec.

28. Erkinjuntti T, Roman G, Gauthier S, et al. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke. 2004;35:1010. DOI: http://dx.doi.org/10.1161/ 01.STR.0000120731.88236.33.

29. Парфенов ВА. Лечение постинсультных когнитивных нарушений. Применение Омарона. Русский медицинский журнал. Неврология, психиатрия. 2010;18(16):986–90. [Parfenov VA. Treatment

30. of postinsult cognitive violations. Omaron's application. Russkii meditsinskii zhurnal. Nevrologiya, psikhiatriya. 2010;18(16):986–90. (In Russ.)]

31. Winblad B, Fioravanti M, Dolezal T, et al. Therapeutic use of nicergoline. Clin Drug Investig. 2008;28(9):533–52. DOI: http://dx.doi.org/10.2165/00044011- 200828090-00001.

32. Pantoni L. Treatment of vascular dementia: evidence from trials with non-cholinergic drugs. J Neurol Sci. 2004;226(1–2):67–70. DOI: http://dx.doi.org/10.1016/j.jns.2004.09.01431.

33. LeBars P, Katz M, Berman N, et al. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA. 1997;278:1327–32. DOI: http://dx.doi.org/10.1001/jama.1997.03550160047037.

34. Parnetti L, Mignini F, Tomassoni D, et al. Cholinergic precursors in the treatment of cognitive impairment of vascular origin: ineffective approaches or need for re-evaluation? J Neurol Sci. 2007;257(1–2):264–9. DOI: http://dx.doi.org/10.1016/j.jns.2007.01.043.

35. Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP-choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly. Cochrane Database Syst Rev.

36. ;18(2):CD000269.

37. Wilkinson D, Doody R, Helme R, et al. Donepezil in vascular dementia: a randomized, placebo-controlled study. Neurology. 2003;61(4):479–86. DOI: http://dx.doi.org/10. 1212/01.WNL.0000078943.50032.FC.

38. Craig D, Birks J. Galantamine for vascular cognitive impairment. Cochrane Database Syst Rev. 2006;25(1): CD004746.

39. Ballard C, Sauter M, Scheltens P, et al. Efficacy, safety and tolerability of rivastigmine capsules in patients with probable vascular dementia: the VantagE study. Curr Med Res Opin. 2008;9:2561–74. DOI: http://dx.doi.org/10.1185/03007990802328142.

40. Orgogozo J-M, Rigaud A-S, Stoffler A, et al. Efficacy and safety of memantine in patients with mild to moderate vascular dementia. A randomized, placebo-controlled trial (MMM 300). Stroke. 2002;33:1834–9. DOI: http://dx.doi.org/10.1161/01.STR. 0000020094.08790.49.

41. Wilcock G, Mobius HJ, Stoffler A. A double-blind, placebo-controlled multicentre study of memantine in mild to moderate vascular dementia (MMM 500). Int Clin Psychopharmacol. 2002;17:297–305. DOI: http://dx.doi.org/10.1097/00004850-200211000-00005.

42. Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:1154–66. DOI: http://dx.doi.org/10. 1212/WNL.56.9.1154.

43. Kanowski S, Kinzler E, Lehmann E, et al. Confirmed clinical efficacy of Actovegin in elderly patients with organic brain syndrome. Pharmacopsychiatry. 1995;28(4):125–33. DOI: http://dx.doi.org/10.1055/s-2007-979604.

44. Saletu B, Grü nberger J, Linzmayer L, et al. EEG brain mapping and psychometry in ageassociated memory impairment after acute and 2-week infusions with the hemoderivative Actovegin: Double-blind, placebo-controlled trials. Neuropsychobiology. 1990;24(3):135–48. DOI: http://dx.doi.org/10.1159/000119476.

45. Селезнева НД, Михайлова НМ, Калын ЯБ и др. Исследование эффективности и безопасности применения актовегина у больных пожилого возраста с синдромом мягкого когнитивного снижения церебрально-сосудистого генеза. Психиатрия. 2009;1(37):37–50. [Selezneva ND, Mikhailova NM, Kalyn YaB, et al. Research of efficiency and safety of application of an aktovegin for patients of advanced age with a syndrome of soft cognitive decrease in cerebral and vascular genesis. Psikhiatriya. 2009;1(37):37–50. (In Russ.)]

46. Guekht A, Skoog I, Korczin A, et al. A randomized, double-blind, placebo-controlled trial of actovegin in patients with poststroke cognitive impairment ARTEMIDA Study Design. Dement Geriatr Cogn Dis Extra. 2013;3(1):459–67. DOI: http://dx.doi.org/ 10.1159/000357122.


For citation:


Emelin A.Yu. Cognitive impairments in cerebrovascular disease. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(4):11-18. (In Russ.) https://doi.org/10.14412/2074-2711-2014-4-11-18

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