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Dementia due to cerebral small vessel damage: Current ideas on its pathogenesis and therapy

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Ever-increasing attention now focusses on dementia caused by small vessel damage when considering cerebrovascular disease leading to cognitive impairments (CIs). Stroke is one of the most important risk factors (RFs) of vascular CI, including vascular dementia. Experienced stroke increases thrice the risk of dementia. Diffuse changes in the cerebral white matter (leukoaraiosis) due to fluctuating blood pressure (BP) and cerebral small vessel damage in most cases play an important role in the genesis of vascular CIs. Executive dysfunctions frequently concurrent with delayed psychomotor speed are the leading clinical manifestations of subcortical vascular dementia. Severe memory impairments are not
typical for subcortical dementia, its early stages in particular. The basis for the pathogenesis of CIs is the dissociation phenomenon that disrupts connections between the frontal lobes and subcortical structures and other cerebral cortical areas. Inadequate hypertension correction at a middle age is responsible for more than one fourth of cases of dementia developing in the elderly. The detection and further elimination of vascular RFs can reduce the risk of developing dementia in elderly and senile patients. Correction of elevated BP in the middle-aged is regarded as an effective method to prevent dementia in the future, but no premium is placed upon antihypertensive therapy in the elderly to lower elevated BP that is an inherent characteristic of this category of patients. Medications affecting RFs and those improving cerebral metabolism and blood
flow, including nicergoline are widely used to treat PD.

About the Authors

I. V. Damulin
Department of Nervous System Diseases and Neurosurgery, Faculty of Therapeutics I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021
Russian Federation

E. V. Ekusheva
Reseach Department of Neurology, Research Center, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021
Russian Federation


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For citations:

Damulin I.V., Ekusheva E.V. Dementia due to cerebral small vessel damage: Current ideas on its pathogenesis and therapy. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(4):94-100. (In Russ.)

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