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Alzheimer's disease under the mask of stroke

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Cognitive impairments (CIs) are common in poststroke patients. The basis for this condition is frequently a neurodegenerative process and most often Alzheimer's disease (AD). Stroke may promote the manifestation of clinically asymptomatic AD, worsen prestroke cognitive deficit or merely manifest prestroke CIs.

The paper discusses the epidemiology, risk factors, and pathogenesis of poststroke CIs, current methods for its diagnosis, as well as symptomatic and pathogenetic treatment. The most informative method for the diagnosis of poststroke CIs is neuropsychological examination that should be made in the early poststroke period (if the patient's consciousness is clear). The most common screening tests include mini-mental state examination (the most sensitive to evaluate cognitive dysfunction in Alzheimer type dementias) and the Montreal cognitive assessment. Magnetic resonance imaging of the brain, positron emission tomography, cerebrospinal fluid examination, and genetic testing are used to reveal AD at its preclinical stages. Preventive measures include regular physical activity, a balanced diet, and sufficient mental workload. The prevention of stroke and other cardiovascular diseases are also important.

The major groups of drugs used to treat AD and vascular CIs are acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists. It is expedient to use glutamatergic and acetylcholinergic therapy earlier in patients with obvious CIs that are unassociated with emotional problems and disturbance of consciousness. Akatinol memantine is a drug that can be regarded not only as a symptomatic but also pathogenetic agent. 

About the Authors

A. A. Naumenko
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow
Russian Federation

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Moscow 119021 

N. V. Vakhnina
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow
Russian Federation

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Moscow 119021 


1. Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 298 c. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 298 p.]

2. Захаров ВВ, Вахнина НВ, Громова ДО, Тараповская АА. Диагностика и лечение когнитивных нарушений после инсульта. Медицинский совет. 2015;(10):14-21. [Zakharov VV, Vakhnina NV, Gromova DO, Tarapovskaya AA. Diagnosis and treatment of cognitive impairment after stroke. Meditsinskii sovet. 2015;(10):14-21. (In Russ.)].

3. Rasquin SM, Verhey FR, van Oostenbrugge RJ, et al. Demographic and CT scan features related to cognitive impairment in the first year after stroke. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1562-7.

4. Ihle-Hansen H, Thommessen B, Wyller TB, et al. Incidence and subtypes of MCI and dementia 1 year after first-ever stroke in patients without pre-existing cognitive impairment. Dement Geriatr Cogn Disord. 2011;32(6):401-7. doi: 10.1159/000335361. Epub 2012 Feb 3.

5. Srikanth VK, Anderson JF, Donnan GA, et al. Progressive dementia after first-ever stroke: a community-based follow-up study. Neurology. 2004 Sep 14;63(5):785-92.

6. Srikanth VK, Thrift AG, Saling MM, et al. Increased risk of cognitive impairment 3 months after mild to moderate first-ever stroke: a Community-Based Prospective Study of Nonaphasic English-Speaking Survivors. Stroke. 2003 May;34(5):1136-43. Epub 2003 Apr 17.

7. Sachdev PS, Brodaty H, Valenzuela MJ, et al. Clinical determinants of dementia and mild cognitive impairment following ischaemic stroke: the Sydney Stroke Study. Dement Geriatr Cogn Disord. 2006;21(5-6):275-83. Epub 2006 Feb 10.

8. Ivan CS, Seshadri S, Beiser A, et al. Dementia after stroke: the Framingham Study. Stroke. 2004 Jun;35(6):1264-8. Epub 2004 Apr 29.

9. Lisabeth LD, Sanchez BN, Baek J, et al. Neurological, functional, and cognitive stroke outcomes in Mexican Americans. Stroke. 2014 Apr;45(4):1096-101. doi: 10.1161/ STROKEАHA.113.003912. Epub 2014 Mar 13.

10. Захаров ВВ, Вахнина НВ. Инсульт и когнитивные нарушения. Неврология, нейропсихиатрия, психосоматика. 2011;3(2):8-16. [Zakharov VV, Vakhnina NV. Stroke and cognitive disorders. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2011;3(2):8-16. (In Russ.)]. DOI: 2011-141

11. Вахнина НВ. Профилактика и лечение постинсультных когнитивных нарушений. Эффективная фармакотерапия. 2014;42(4): 32-9. [Vakhnina NV. Prevention and treatment of post-stroke cognitive impairment. Effektivnaya farmakoterapiya. 2014;42(4):32-9. (In Russ.)].

12. Захаров ВВ, Вахнина НВ. Особенности ведения пациентов с постинсультными ког- нитивными нарушениями. Атмосфера. Нервные болезни. 2011;(3):14-20. [Zakharov VV, Vakhnina NV. Management of patients with post-stroke cognitive impairment. Atmosfera. Nervnye bolezni. 2011;(3):14-20. (In Russ.)].

13. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with prestroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009 Nov;8(11):1006-18. doi: 10.1016/S1474- 4422(09)70236-4. Epub 2009 Sep 24.

14. Tham W, Auchus AP, Thong M, et al. Progression of cognitive impairment after stroke: one year results from a longitudinal study of Singaporean stroke patients. J Neurol Sci. 2002 Nov 15;203-204:49-52.

15. Преображенская ИС, Науменко АА. Патогенез, диагностика и терапия болезни Альцгеймера. Медицинский совет. Неврология. 2015;(5):46-54. [Preobrazhenskaya IS, Naumenko AA. Pathogenesis, diagnosis and therapy of Alzheimer's disease. Meditsinskii sovet. Nevrologiya. 2015;(5):46-54. (In Russ.)].

16. Яхно НН, Захаров ВВ, Локшина АБ и др. Деменции, руководство для врачей. Москва: МЕДпресс-информ; 2011. С. 53-75. [YakhnoNN, Zakharov VV, Lokshina AB, et al. Dementsii, rukovodstvo dlya vrachei [Dementia, a guide for physicians]. Moscow: MEDpressinform; 2011. P. 53-75.]

17. Chandra V, Ganguli M, Pandav R, et al. Prevalence of Alzheimer's disease and other dementias in rural India: the Indo-US study. Neurology. 1998 Oct;51(4):1000-8.

18. Hendrie HC, Ogunniyi A, Hall KS, et al. Incidence of dementia and Alzheimer disease in 2 communities. Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana. JAMA. 2001 Feb 14; 285(6):739-47.

19. Чердак МА, Яхно НН. Постинсультные когнитивные расстройства. Журнал неврологiї iм. Б.М. Маньковського. 2013;(1):31-7. [Cherdak MA, Yakhno NN. Post-stroke cognitive disorders. Zhurnal nevrologії іm. B.M. Man'kovs'kogo. 2013;(1):31-7. (In Russ.)].

20. Мхитарян ЭА, Преображенская ИС. Бо- лезнь Альцгеймера и цереброваскулярные расстройства. Неврологический журнал. 2006;11(1):31-6. [Mkhitaryan EA, Preobrazhenskaya IS. Alzheimer's disease and cerebrovascular disorders. Nevrologicheskii zhurnal. 2006;11(1):31-6. (In Russ.)].

21. Kalaria RN. The role of cerebral ischemia in Alzheimer's disease. Neurobiol Aging. 2000 Mar-Apr;21(2):321-30.

22. Patterson C, Feightner JW, Garcia A, et al. Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheimer disease. CMAJ. 2008 Feb 26;178(5): 548-56. doi: 10.1503/cmaj.070796.

23. Парфенов ВА, Захаров ВВ, Преображен- ская ИС. Когнитивные расстройства. Москва: Ремедиум; 2014. С. 1-106. [Parfenov VA, Zakharov VV, Preobrazhenskaya IS. Kognitivnye rasstroistva [Cognitive disorders]. Moscow: Remedium; 2014. P. 1-106.]

24. Barba R, Castro MD, del Mar Morin M, et al. Prestroke dementia. Cerebrovasc Dis. 2001;11(3):216-24.

25. Преображенская ИС. Постинсультные когнитивные расстройства: причины, клинические проявления, лечение. Фарматека. 2013;(9):49-53. [Preobrazhenskaya IS. Postinsul'tnye kognitivnye rasstroistva: prichiny, klinicheskie proyavleniya, lechenie. Farmateka. 2013;(9):49-53. (In Russ.)].

26. Чердак МА, Парфенов ВА. Когнитивные расстройства у пациентов, перенесших ишемический инсульт: обзор. Неврологический журнал. 2011;16(6):37-44. [Cherdak MA, Parfenov VA. Cognitive dysfunction in patients with ischemic stroke: a review. Nevrologicheskii zhurnal. 2011;16(6):37-44. (In Russ.)].

27. Barker WW, Luis CA, Kashuba A, et al. Relative frequencies of Alzheimer disease, Lewy body, vascular and frontotemporal dementia, and hippocampal sclerosis in the State of Florida Brain Bank. Alzheimer Dis Assoc Disord. 2002 Oct-Dec;16(4):203-12.

28. Fu C, Chute DJ, Farag ES, et al. Comorbidity in dementia: an autopsy study. Arch Pathol Lab Med. 2004 Jan;128(1):32-8.

29. Hulette CM. Brain banking in the United States. J Neuropathol Exp Neurol. 2003 Jul;62(7):715-22.

30. Knopman DS, Parisi JE, Boeve BF, et al. Vascular dementia in a population-based autopsy study. Arch Neurol. 2003 Apr;60(4):569-75.

31. Левин ОС. Когнитивные нарушения в практике невролога. Москва: МедПресс- информ; 2006. [Levin OS. Kognitivnye narusheniya v praktike nevrologa [Cognitive impairments in the practice of neurologist]. Moscow: MedPress-inform; 2006.]

32. Парфенов ВА. Артериальная гипертония и инсульт. Неврологический журнал. 2001;(6):4–7. [Parfenov VA. Hypertension and stroke. Nevrologicheskii zhurnal. 2001;(6):4–7. (In Russ.)].

33. Li X, Li D, Li Q, et al. Hippocampal sub￾feld volumetry in patients with subcortical vas￾cular mild cognitive impairment. Sci Rep. 2016 Feb 15;6:20873. doi: 10.1038/srep20873.

34. Kim GH, Lee JH, Seo SW, et al. Hippocampal volume and shape in pure subcortical vascular dementia. Neurobiol Aging. 2015 Jan;36(1):485-91. doi: 10.1016/j.neurobiolaging.2014.08.009. Epub 2014 Sep 28.

35. Захаров ВВ. Когнитивные нарушения после инсульта: медико-социальная значимость и подходы к терапии. Нервные болезни. 2015;(2):2-8. [Zakharov VV. Cognitive impairment after stroke: medical and social significance and approaches to therapy. Nervnye bolezni. 2015;(2):2-8. (In Russ.)].

36. Wu Y, Wang M, Ren M, et al. The effects of educational background on Montreal Cognitive Assessment screening for vascular cognitive impairment, no dementia, caused by ischemic stroke. J Clin Neurosci. 2013 Oct;20(10):1406- 10. doi: 10.1016/j.jocn.2012.11.019. Epub 2013 Jul 24.

37. Brickman AM, Siedlecki KL, Stern Y. Cognitive and Brain reserve. In: Depp CA, Jeste DV, editors. Successful Cognitive and Emotional Aging. Arlington, USA: American Psychiatric Publishing, Inc; 2010. P. 157-172.

38. Яхно НН, Лавров АЮ. Изменения центральной нервной системы при старении. В кн.: Завалишин ИА, Яхно НН, Гаврилова СИ, редакторы. Нейродегенеративные болезни и старение (Руководство для врачей). Москва; 2001. С. 242 – 61. [Yakhno NN, Lavrov AYu. Changes of the Central nervous system during aging. In: Zavalishin IA, Yakhno NN, Gavrilova SI, editors. Neirodegenerativnye bolezni i starenie (Rukovodstvo dlya vrachei) [Neurodegenerative diseases and aging (Manual for doctors)]. Moscow; 2001. P. 242 – 61.]

39. Snowdon DA, Greiner LH, Mortimer JA, et al. Brain infarction and the clinical expres￾sion of Alzheimer's disease. The Nun Study. JAMA. 1997 Mar 12;277(10):813-7.

40. Singh-Manoux A, Marmot MG, Glymour M, et al. Does cognitive reserve shape cognitive decline? Ann Neurol. 2011 Aug;70(2):296-304. doi: 10.1002/ana.22391. Epub 2011 May 11.

41. Zahodne LB, Glymour MM, Sparks C, et al. Education does not slow cognitive decline with aging: 12-year evidence from the victoria longitudinal study. J Int Neuropsychol Soc. 2011 Nov;17(6):1039-46. doi: 10.1017/S13556177 11001044. Epub 2011 Sep 19.

42. Jorm A. The informant questionnare on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr. 2004 Sep;16(3):275-93.

43. Henon H, Durieu I, Lebert F, et al. Influence of pre-stroke dementia on early and delayed mortality in stroke patients. J Neurol. 2003 Jan;250(1):10-6.

44. Вахнина НВ, Никитина ЛЮ, Парфeнов ВА. Постинсультные когнитивные нарушения. Журнал неврологии и психиатрии им. С.С. Корсакова. Прил. Инсульт. 2008;(22):16-21. [Vakhnina NV, Nikitina LYu, Parfenov VA. Post-stroke cognitive impairment. Zhurnal nevrologii i psikhiatrii im. S.S.Korsakova. Suppl. Stroke. 2008;(22):16-21. (In Russ.)].

45. Парфeнов ВА, Вахнина НВ, Никитина ЛЮ. Когнитивные нарушения после инсульта и их лечение мемантином. Клиническая геронтология. 2005;11(8):49-52. [Parfenov VA, Vakhnina NV, Nikitina LYu. Cognitive impairment after stroke and their treatment with memantine. Klinicheskaya gerontologiya. 2005;11(8):49-52. (In Russ.)].

46. Климов ЛВ, Парфeнов ВА. Когнитивные нарушения в остром периоде ишемического инсульта. Неврологический журнал. 2006;(11 Прил. 1):53-6. [Klimov LV, Parfenov VA Cognitive impairment in acute period of ischemic stroke. Nevrologicheskii zhurnal. 2006;(11 Suppl. 1):53-6. (In Russ.)].

47. Scahill RI, Schott JM, Stevens JM, et al. Mapping the evolution of regional atrophy in Alzheimer's disease: Unbiased analysis of яuidregistered serial MRI. Proc Natl Acad Sci USA. 2002 Apr 2;99(7):4703-7.

48. Lehericy S, BaulacM, Chiras J, et al. Amygdalohippocampal MR volume measurements in the early stages of Alzheimer disease. AJNR Am J Neuroradiol. 1994 May;15(5):929-37. 49. Chan D, Fox NC, Scahill RI, et al. Patterns of temporal lobe atrophy in semantic dementia and Alzheimer's disease. Ann Neurol. 2001 Apr;49(4):433-42.

49. Dickerson BC, Goncharova I, SullivanMP, et al. MRI-derived entorhinal and hippocampal atrophy in incipient and very mild Alzheimer's disease. Neurobiol Aging. 2001 Sep-Oct; 22(5):747-54.

50. Killiany RJ, Hyman BT, Gomez-Isla T, et al. MRImeasures of entorhinal cortex vs hip￾pocampus in preclinical AD. Neurology. 2002 Apr 23;58(8):1188-96.

51. Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol. 1991;82(4):239-59.

52. Johnson KA, Fox NC, Sperling RA, Klunk WE. Brain Imaging in Alzheimer Disease. Cold Spring Harb Perspect Med. 2012 Apr;2(4): a006213. doi: 10.1101/cshperspect.a006213.

53. Whitwell JL. Longitudinal imaging: change and causality. Curr Opin Neurol. 2008 Aug;21(4): 410-6. doi: 10.1097/WCO.0b013e32830719d4.

54. Парфенов ВА. Профилактика болезни Альцгеймера. Неврология, нейропсихиат- рия, психосоматика. 2011;3(3):8-13. [Parfenov VA. Prevention of Alzheimer's dis￾ease. Nevrologiya, neiropsikhiatriya, psikhoso￾matika = Neurology, Neuropsychiatry, Psychosomatics. 2011;3(3):8-13. (In Russ.)]. DOI: 2011-159

55. Morris MC, Evans DA, Tangney CC, et al. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. 2006 Oct 24;67(8):1370-6.

56. Del Parigi A, Panza F, Capurso C, Solfrizzi V. Nutritional factors, cognitive decline, and dementia. Brain Res Bull. 2006 Mar 15;69(1):1-19. Epub 2005 Nov 21.

57. Bayer-Carter JL, Green PS, Montine TJ, et al. Diet intervention and cerebrospinal fluid biomarkers in amnestic mild cognitive impairment. Arch Neurol. 2011 Jun;68(6):743-52. doi: 10.1001/archneurol.2011.125.

58. Парфенов ВА, Науменко АА, Преобра- женская ИС. Лекарственные и нелекарственные методы лечения болезни Альцгеймера. Фарматека. 2015;(7):72-9. [Parfenov VA, Naumenko AA, Preobrazhenskaya IS. Lekarstvennye i nelekarstvennye metody lecheniya bolezni Al'tsgeimera. Farmateka. 2015;(7):72-9. (In Russ.)].

59. Вахнина НВ, Захаров ВВ. Опыт применения ривастигмина (экселона) в лечении постинсультных когнитивных нарушений. Неврологический журнал. 2009;14(4):42-6. [Vakhnina NV, Zakharov VV. Experience of use of rivastigmine (Exelon) in the treatment of post-stroke cognitive impairment. Nevrologicheskii zhurnal. 2009;14(4):42-6. (In Russ.)].

60. Преображенская ИС, Громова ДО. Некоторые аспекты терапии нейродегенеративных деменций. Медицинский совет. 2014;(10):36-42. [Preobrazhenskaya IS, Gromova DO. Some aspects of the therapy of neurodegenerative dementia. Meditsinskii sovet. 2014;(10):36-42. (In Russ.)].

61. Baskys A, Hou AC. Vascular dementia: pharmacological treatment and perspectives. Clin Interv Aging. 2007;2(3):327-35.

62. Oertel W, Ross JS, Eggert K, et al. Rationale for transdermal drug administration in Alzheimer's disease. Neurology. 2007 Jul 24;69 (4 Suppl 1):S4-9.

63. Дамулин ИВ, Кононенко ЕВ. Статолокомоторные нарушения у больных с полушарным инсультом. Клиническая геронтология. 2007;13(8):42-9. [Damulin IV, Kononenko EV. Statolocomotor disorders in patients with hemispheric stroke. Klinicheskaya gerontologiya. 2007;13(8):42-9. (In Russ.)].

64. Ярыгин КН, Ярыгин ВН. Нейрогенез в центральной нервной системе и перспекти- вы регенеративной неврологии. Журнал неврологии и психиатрии им. С. С. Корсако- ва. 2012;112(1): 4-13. [Yarygin KN, Yarygin VN. Neurogenesis in the Central nervous system and prospects of regenerative neurology. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(1): 4-13. (In Russ.)].

65. Захаров ВВ. Глутаматергическая терапия в восстановительном периоде после ишемического инсульта. Эффективная фармакотерапия. Неврология. 2014;(4):6-14. [Zakharov VV. Glutamatergic therapy in the rehabilitative period after ischemic stroke. Effektivnaya farmakoterapiya. Nevrologiya. 2014;(4):6-14. (In Russ.)].

66. Гаврилова СИ. Фармакотерапия болезни Альцгеймера. Москва: Пульс; 2003. 320 c. [Gavrilova SI. Farmakoterapiya bolezni Al'tsgeimera [Pharmacotherapy of Alzheimer's disease]. Moscow: Pul's; 2003. 320 p.]

67. Дамулин ИВ. Болезнь Альцгеймера и сосудистая деменция. Москва; 2002. 85 с. [Damulin IV. Bolezn' Al'tsgeimera i sosudistaya dementsiya [Alzheimer's disease and vascular dementia].Moscow; 2002. 85 p.]

68. Гусев ЕИ, Скворцова ВИ. Ишемия головного мозга. Москва: Медицина; 2001. 325 с. [Gusev EI, Skvortsova VI. Ishemiya golovnogo mozga [Cerebral ischemia]. Moscow: Meditsina; 2001. 325 p.]

69. Areosa SA, Sheriff F, McShane R. Memantine for dementia. The Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003154.

70. Petrilli S, Durufle A, Nicolas B, et al. Prognostic factors in recovery of the ability to walk after stroke. J Stroke Cerebrovasc Dis. 2002 Nov-Dec;11(6):330-5.

71. Kleiser B, Diepers M, Geiger S, et al. Combned therapy with flunarizine and memantine of experimental intracerebral hematoma in rats. Neurol Psych. 1995;(3):219-224.

72. Яхно НН, Преображенская ИС, Захаров ВВ, Мхитарян ЭА. Эффективность мемантина у пациентов с недементными когнитивными расстройствами. Результаты многоцентрового клинического наблюдения. Неврологический журнал. 2010;15(2): 52-8. [Yakhno NN, Preobrazhenskaya IS, Zakharov VV, Mkhitaryan EA. The efficacy of memantine in patients with non-demental cognitive disorders. Results of a multicenter clinical observations. Nevrologicheskii zhurnal. 2010;15(2):52-8. (In Russ.)].

73. Левин ОС, Юнищенко НА, Дударова МА. Эффективность акатинола мемантина при умеренно выраженном когнитивном расстройстве. Журнал неврологии и психиатрии им С.С. Корсакова. 2009;(7):36-42. [Levin OS, Yunishchenko NA, Dudarova MA. The effectiveness of akatinol memantine in patients with moderate cognitive disorder. Zhurnal nevrologii i psikhiatrii im S.S. Korsakova. 2009;(7):36-42. (In Russ.)].

For citation:

Naumenko A.A., Vakhnina N.V. Alzheimer's disease under the mask of stroke. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):100-106. (In Russ.)

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