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Clinical and etiological associations in chronic cerebral ischemia

https://doi.org/10.14412/2074-2711-2015-4-11-17

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Abstract

Objective: to study the clinical features of chronic cerebral ischemia (CCI) in relation to the leading etiological factor.

Patients and methods. Examinations were made in 515 non-stroke CCI patients: 306 men and 209 women aged 58 to 75 years with hypertension and no obvious atherosclerosis of head and neck vessels (n=197); with obvious atherosclerosis of head and neck vessels and no hypertension (n=157); with obvious atherosclerosis of head and neck vessels and hypertension (n=161). In all cases, the investigators performed standard neurological examination and evaluated cognitive, affective symptoms with a set of neuropsychological scales and equilibrium and gait abnormalities with the Tinetti scale.

Results and discussion. The development of extrapyramidal syndrome was more related to hypertension or its concurrence with the atherosclerotic process. The patients with atherosclerosis and no hypertension showed a more distinct differentiation of clinical syndromes, which was associated with stenosis in the specific vascular bed; this was probably due to decreased local perfusion. A relationship was established between hypertension and the development of severe cognitive impairments (CIs) that had predominantly a dysregulation neuropsychological profile. In the patients with atherosclerosis and no hypertension, emotional disorders were more common than CI and the latter resembled Alzheimer’s disease. A differentiated prophylactic and therapeutic strategy accounting for the leading etiological factor will be able to prevent or significantly reduce functional limitations in patients with CCI.

About the Author

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


References

1. Гусев ЕИ, Коновалов АН, Скворцова ВИ, Гехт АБ, редакторы. Неврология. Национальное руководство. Москва: ГЭОТАР-Медиа; 2010. 1054 с. [Gusev EI, Konovalov AN, Skvortsova VI, Gekht AB, editors. Nevrologiya. Natsional'noe rukovodstvo [Neurology. National guide]. Moscow: GEOTAR-Media; 2010. 1054 p.]

2. Парфенов ВА, Неверовский ДВ. Ведение пациентов с дисциркуляторной энцефалопатией в амбулаторной практике. Неврология, нейропсихиатрия, психосоматика. 2015;7(1):37–42. [Parfenov VA, Neverovskii DV. Outpatient management of patients with dyscirculatory encephalopathy. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2015;7(1):37–42. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2015-1-37-42

3. Парфенов ВА. Дисциркуляторная энцефалопатия: дифференциальный диагноз и лечение. Клиницист. 2008; (1):38–44. [Parfenov VA. Dyscirculatory encephalopathy: differential diagnosis and treatment. Klinitsist. 2008; (1):38–44. (In Russ.)].

4. Парфенов ВА, Замерград МВ, Мельников ОА. Головокружение: диагностика и лечение, распространенные диагностические ошибки. Москва: МИА; 2011. 192 c. [Parfenov VA, Zamergrad MV, Mel'nikov OA. Golovokruzhenie: diagnostika i lechenie, rasprostranennye diagnosticheskie oshibki [Dizziness: diagnosis and treatment, common diagnostic errors]. Moscow: MIA; 2011. 192 p.]

5. Суслина ЗА, редактор. Очерки ангионеврологии. Москва: Атмосфера; 2005. 368 с. [Suslina ZA, editor. Ocherki angionevrologii [Essays of angioneurology]. Moscow: Atmosfera; 2005. 368 p.]

6. Rogaeva E. The Genetic Profile of Alzheimer’s Disease. Geriatrics & Aging. 2008;1:577-81.

7. Carvalho JO, Tommet D, Crane PK, et al. Deconstructing Racial Differences: The Effects of Quality of Education and Cerebrovascular Risk Factors. J Gerontol B Psychol Sci Soc Sci. 2015 Jul;70(4):545-56. doi: 10.1093/geronb/gbu086. Epub 2014 Aug 5.

8. Gonzalez CE, Pacheco J, Beason-Held LL, Resnick SM. Longitudinal changes in cortical thinning associated with hypertension. J Hypertens. 2015 Jun;33(6):1242-8. doi: 10.1097/HJH.0000000000000531.

9. Donnan G, Norrving B, Bamford J, Bogousslavsky J, editors. Subcortical Stroke. 2nd edition. New York: Oxford University Press; 2002.

10. Donnan GA, Norrving B. Lacunes and lacunar syndromes. Handb Clin Neurol. 2009;93:559-75. doi: 10.1016/S0072-9752(08)93027-X.

11. Caplan LR. The Intracranial Vertebral Artery: A Neglected Species. Cerebrovasc Dis. 2012;34(1):20-30. doi: 10.1159/000339629. Epub 2012 Jun 28.

12. Дамулин ИВ, Екушева ЕВ. Деменция вследствие поражения мелких церебральных сосудов: современные представления о патогенезе и терапии. Неврология, нейропсихиатрия, психосоматика. 2014;6(4):94–100. [Damulin IV, Ekusheva EV. Dementia due to cerebral small vessel damage: Current ideas on its pathogenesis and therapy. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2014;6(4):94–100. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2014-4-94-100

13. Pendlebury ST, Markwick A, de Jager CA, et al. Cognitive Profiles in TIA, Stroke and Memory Subjects: MMSE versus MoCA. Cerebrovasc Dis. 2012;34(1):48-54. doi: 10.1159/000338905. Epub 2012 Jun 29.

14. Jackson C, Sudlow C. Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke. 2005 Apr;36(4):891-901. Epub 2005 Mar 10.

15. Jackson CA, Hutchison A, Dennis MS, et al. Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke. 2010 Apr;41(4):624-9. doi: 10.1161/STROKEAHA.109.558809. Epub 2010 Feb 11.

16. Alexopoulos G.S., Meyers B.S., Young R.C. et al. Vascular depression hypothesis. Stroke. 2010 Apr;41(4):624-9. doi: 10.1161/STROKEAHA.109.558809. Epub 2010 Feb 11.

17. Парфенов ВА, Алексеев ВВ, Шварева НС, Рыжак АА. Головная боль у больных артериальной гипертонией. Клиническая геронтология. 2001;(5-6):3-9. [Parfenov VA, Alekseev VV, Shvareva NS, Ryzhak AA. Headache in patients with arterial hypertension. Klinicheskaya gerontologiya. 2001;(5-6):3-9. (In Russ.)].

18. Яхно НН, Парфенов ВА, Алексеев ВВ. Головная боль. Справочное руководство для врачей. Москва: Ремедиум; 2000. 75 с. [Yakhno NN, Parfenov VA, Alekseev VV. Golovnaya bol'. Spravochnoe rukovodstvo dlya vrachei [Headache. Reference guide for physicians]. Moscow: Remedium; 2000. 75 p.]

19. Шток ВН, Иванова-Смоленская ИА, Левин ОС, редакторы. Экстрапирамидные расстройства. Руководство по диагностике и лечению. Москва: МЕДпресс-информ; 2002. 606 с. [Shtok VN, Ivanova-Smolenskaya IA, Levin OS, editors. Ekstrapiramidnye rasstroistva. Rukovodstvo po diagnostike i lecheniyu [Extrapyramidal disorders. Guidelines for the diagnosis and treatment]. Moscow: MEDpressinform; 2002. 606 p.]


For citation:


Zhitkova Y.V. Clinical and etiological associations in chronic cerebral ischemia. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(4):11-17. (In Russ.) https://doi.org/10.14412/2074-2711-2015-4-11-17

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)