Cognitive disorders in patients with cerebrovascular diseases in therapeutic practice: diagnostic and management algorithms

Abstract

This review summaries the main present-day knowledge on the pathogenesis of cognitive impairement in patients with cardiovascular and cerebrovascular diseases, combining both the development of severe forms such as dementia, and early non-dementia forms of cognitive impairment. Risk factors, including iatrogenic ones, and the mechanisms of development of various forms of cognitive impairment in patients with vascular pathologies are discussed in detail. The definition of human cognitive functions and the modern classification of cognitive impairment used in real clinical practice are given. The clinical aspects of cognitive impairment in the therapeutic practice with a focus on the review of a wide range of specific complaints, reflecting the likelihood of cognitive impairment and non-cognitive symptoms are considered in detail, taking into account the current national clinical guidelines of professional communities. Possible iatrogenic factors that worsen the state of cognitive functions, including an assessment of the anticholinergic drug load on the patient are discussed in detail, and a strategy for identifying and solving this issue as part of a therapeutic approach is provided. An algorithmic approach to the identification of non-dementia cognitive impairment in patients with cerebrovascular pathology is presented by therapeutic specialists working in the primary outpatient healthcare sector. The laboratory and instrumental examination options for patients to identify reversible forms of cognitive impairment are considered in detail. The prospective of choosing preventive non-drug and drug approaches, as well as the therapeutic strategy options for the use of drugs that improve the central nervous system functioning during management of patients with cerebrovascular diseases, depending on the type of cognitive impairment in the general practitioner practice are assessed.