Chronic Cerebrovascular Pathology Research Articles

Vascular cognitive impairment: Advances in clinical research and management.

Vascular cognitive impairment (VCI) encompasses a wide spectrum of cognitive disorders, ranging from mild cognitive impairment to vascular dementia. Its diagnosis relies on thorough clinical evaluations and neuroimaging. VCI predominately arises from vascular risk factors (VRFs) and cerebrovascular disease, either independently or in conjunction with neurodegeneration. Growing evidence underscores the prevalence of VRFs, highlighting their potential for early prediction of cognitive impairment and dementia in later life. The precise mechanisms linking vascular pathologies to cognitive deficits remain elusive. Chronic cerebrovascular pathology is the most common neuropathological feature of VCI, often interacting synergistically with neurodegenerative processes. Current research efforts are focused on developing and validating reliable biomarkers to unravel the etiology of vascular brain changes in VCI. The collaborative integration of these biomarkers into clinical practice, alongside routine incorporation into neuropathological assessments, presents a promising strategy for predicting and stratifying VCI. The cornerstone of VCI prevention remains the control of VRFs, which includes multi-domain lifestyle modifications. Identifying appropriate pharmacological approaches is also of paramount importance. In this review, we synthesize recent advancements in the field of VCI, including its definition, determinants of vascular risk, pathophysiology, neuroimaging and fluid-correlated biomarkers, predictive methodologies, and current intervention strategies. Increasingly evident is the notion that more rigorous research for VCI, which arises from a complex interplay of physiological events, is still needed to pave the way for better clinical outcomes and enhanced quality of life for affected individuals.

Identification of lysosome-related hub genes as potential biomarkers and immune infiltrations of moyamoya disease by multiple bioinformatics methods and machine-learning strategies

BackgroundMoyamoya disease (MMD), characterized by chronic cerebrovascular pathology, poses a rare yet significant clinical challenge, associated with elevated rates of mortality and disability. Despite intensive research endeavors, the exact biomarkers driving its pathogenesis remain enigmatic. MethodsThe expression patterns of GSE189993 and GSE141022 were retrieved from the Gene Expression Omnibus (GEO) repository to procure differentially expressed genes (DEGs) between samples afflicted with MMD and those under control conditions. The Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine with Recursive Feature Elimination (SVM-RFE), and Random Forest (RF) algorithms were employed for identifying candidate diagnostic genes associated with MMD. Subsequently, these candidate genes underwent validation in an independent cohort (GSE157628). The CMAP database was ultimately employed to forecast drugs pertinent to MMD for clinical translation. ResultsA collective of 240 DEGs were discerned. Functional enrichment scrutiny unveiled the enrichment of the cholesterol metabolism pathway, salmonella infection pathway, and allograft rejection pathway within the MMD cohort. EPDR1, DENND3, and NCSTN emerged as discerned diagnostic biomarkers for MMD. The CMAP database was ultimately employed to scrutinize the ten most auspicious pharmaceutical compounds for managing MMD. Finally, after validation through in vitro experiments, EPDR1, DENND3, and NCSTN were identified as the key genes. ConclusionEPDR1, DENND3, and NCSTN have emerged as potential novel biomarkers for MMD. The involvement of T lymphocytes, neutrophilic granulocytes, dendritic cells, natural killer cells, and plasma cells could be pivotal in the pathogenesis and advancement of MMD.

Chronic Kidney Disease and Cerebrovascular Pathology: Incidence and Functional Outcomes in Riga East University Hospital.

Background and Objectives: The aim of this study was to investigate the incidence of cerebrovascular pathology in patients with chronic kidney disease and its effect on functional outcomes. Materials and Methods: In a retrospective cross-sectional study (2018-2021), the medical records of patients with acute hemorrhagic and ischemic stroke with concomitant chronic kidney disease who received treatment in Riga East University Hospital Stroke Unit were analyzed. Data were analyzed using IBM SPSS 26.0. The Kruskal-Wallis, Mann-Whitney U test, and Spearman's rank correlation coefficient methods were used. Results: The final sample consisted of 305 acute cerebrovascular pathology patients (56.4% females). Overall, 57.3% of stroke patients had second-stage chronic kidney disease with average serum creatinine levels of 104.3 mmol/L (±32.8). The functional outcome of the stroke depended on the stage of chronic kidney disease. There was a statistically significant non-linear correlation between glomerular filtration rate and NIHSS (National Institute of Health Stroke Scale) score on admission (Rho -0.194, p = 0.016), glomerular filtration rate and NIHSS score on discharge (Rho -0.186, p = 0.020), and glomerular filtration rate and modified Rankin score on admission (Rho -0.237, p = 0.003) and discharge (Rho -0.224, p = 0.05). The mean NIHSS score of ischemic stroke patients was 8.3 ± 5.9 on admission and 6.5 ± 5.8 on discharge. In the hemorrhagic stroke patient group, the mean NIHSS score was 9.5 ± 7.3 on admission and 7.1 ± 6.9 on discharge. On average, 34.0% of ischemic stroke patients had an mRS score of 5 on admission, while in the hemorrhagic stroke patient group, this figure was 41%. There was no statistical difference in the glomerular filtration rate between the thrombolyzed versus non-thrombolyzed patient groups (Mann-Whitney U test = 1457, p = 0.794). Conclusions: Chronic kidney disease is an important predictor of the severity and functional outcome of a stroke; furthermore, the early management and prevention of complications should be a top priority in the prophylaxis of this cerebrovascular pathology.

Cerebral hemodynamics and cognitive functions in the acute and subacute stage of mild ischemic stroke: a longitudinal pilot study.

The association between cerebral hemodynamics and cognitive impairment has been reported in neurodegenerative and cerebrovascular disorders (CVD). However, it is still unclear whether changes occur in the acute phase of CVD. Here we investigated cognitive and hemodynamic parameters and their association in patients with CVD during the acute and subacute phases. Seventy-three patients with mild stroke, not undergoing endovascular treatment, were recruited. All subjects were devoid of intracranial or external carotid stenosis, significant chronic cerebrovascular pathology, dementia or non-compensated cardiovascular diseases. Patients were evaluated within 7days from symptoms onset (T1) and after 3months (T2). Clinical and demographic data were collected. NIHSS, MoCA, FAB, and Word-Color Stroop test (WCST) were used to evaluate disease severity and cognitive functions. Basal hemodynamic parameters in the middle cerebral artery were measured with transcranial Doppler. Differences between T2 and T1, correlations between cognitive and hemodynamic variables at T1 and T2, as well as correlations between the T2-T1 variation in cognitive and hemodynamic parameters were assessed. At T1, cognitive performance of MoCA, FAB, and WCST was lower compared with T2; and pulsatility index, a parameter reflecting distal vascular resistance, was higher. However, no correlations between the changes in cognitive and hemodynamic variables were found; therefore, the two seems to be independent phenomena. In the acute phase, the linear association between cerebral blood flow and cognitive performances was lost, probably due to a differential effect of microenvironment changes and vascular-specific phenomena on cognition and cerebral hemodynamics. This relationship was partially restored in the subacute phase.

A psychiatric clinical picture revealing moyamoya disease

Moyamoya disease (MMD) is a rare entity. It is a chronic cerebrovascular pathology characterized by stenosis and progressive occlusion of the termination of the carotid arteries. It is of reserved prognosis. Its diagnosis can be evoked on computerized tomography and magnetic resonance imaging (MRI) but is essentially based on arteriography. Its treatment must be early and essentially consists of revascularization surgery. We report the case of a patient admitted to the psychiatric emergency room for management of a behavioral disorder, mutism and auditory and visual hallucination, a cerebral MRI was performed urgently and the diagnosis of MMD was laid. Through this observation and a review of the literature, we discuss the characteristics of this rare condition, in particular the psychiatric comorbidity.

Cognitive impairment in the acute period of cardioembolic stroke

Background. Acute disorders of cerebral circulation are one of the most urgent problems of modern clinical neurology. Its significance is due to both the high frequency of occurrence and a large number of unsatisfactory outcomes, as well as the significant impact on the quality of life. Cognitive disorders are one of the main syndromes that manifest in post-stroke period and are associated with the rehabilitation potential, as well as opportunities for social and household adaptation. Our objective was to study the profile of cognitive impairment in a continuous sample of patients with cardioembolic stroke in the acute period of stroke, as well as to determine the correlations between their occurrence and the factors determining the course of the disease. Design and methods. The study involved 46 patients of both sexes in the acute stage of ischemic stroke (average age was 69 ± 11 years). The selection of patients was carried out in accordance with the diagnostic criteria of the International Association of Vascular Behavioral and Cognitive Disorders VASCOG. The results of the Hachinski scale were also considered. All patients underwent interview for history, complaints, as well as the assessment of the neurological status. Risk factors for stroke were evaluated. We also assessed the results of computer and magnetic resonance imaging, standard “stroke” scales and performed a neuropsychological examination aimed at a comprehensive study of cognitive functions. All studies were conducted at the end of 10-14 days from the development of focal neurological symptoms. Results. Cognitive disorders in patients with cardioembolic ischemic stroke turned out to be quite heterogeneous. Their severity in the majority of our patients was considered as mild cognitive impairment. Changes at dementia level were much less common and were characteristic of patients with extensive lesions or in the case of disorders in the field of cognitively significant “strategic” foci. Neurodynamic disorders predominated in the profile of disorders of higher cortical functions. Memory impairment was expressed slightly and was of a secondary nature. With the aggravation of cognitive disorders, mnestic disorders progressed. In addition, regulatory disorders began to be detected. The most significant correlations were found between the results of neurocognitive tests on the one hand and the assessment on the Bartel scales, the assessment of changes in white matter, as well as the volume of the necrosis focus, the presence of heart failure and dyscirculatory encephalopathy in the anamnesis. Conclusions. Cognitive impairment is a significant component of the clinical picture of cardioembolic stroke. Their severity is largely determined by the volume and topical localization of the ischemic focus, as well as the presence and severity of previous chronic cerebrovascular pathology. This determines the need to develop methods to assess the state of cognitive functions before the development of stroke.

Risk factors and adherence to treatment of patients with cerebrovascular diseases

To assess the representation of risk factors and treatment adherence in patients with cerebrovascular diseases. A single-stage cross-sectional non-comparable study was conducted, which included 492 patients, of whom 133 had an ischemic stroke/transient ischemic attack (main group, MG), 344 had chronic cerebrovascular pathology (comparison group, CG). The representation of risk factors, the state of cognitive functions, the severity of anxiety and depression were evaluated. MG respondents visit specialized specialists more often than CG (p<0.001), are more committed to taking antiplatelet agents (p<0.003), statins (p<0.005), antihypertensive drugs (p<0.005). Regular intake of antithrombotic drugs was associated with the history of ischemic stroke (r=0.483; p<0.01), type 2 diabetes (r=0.637; p<0.011), atrial fibrillation (r=0.481; p<0.001), living in a family (r=0.493; p<0.03). An inverse correlation was established between the systematic intake of antiplatelet drugs and the age of the respondents (r=-0.637; p<0.002), cognitive impairment (r=-0.433; p<0.05), the history of the gastrointestinal tract diseases (gastric ulcer and duodenal ulcer) (r=-0.563; p<0.001). Irregular medication intake was observed in patients aged over 60 years compared with younger (17.3% and 6.4%, respectively, p=0.001), patients living in a family compared with single (85.6% and 65.1%, p=0.032). The history of ischemic stroke or myocardial infarction is associated with increased adherence to regular medication. The study of risk factors and the assessment of treatment adherence can ensure the formation of an effective strategy for primary and secondary prevention of cerebrovascular diseases.

Results of a multicenter observational program to evaluate the effectiveness of complex therapy of patients with chronic cerebrovascular pathology with cognitive impairment with Cortexin and Neuromexol (CORNELia study)

To evaluate the effectiveness of complex therapy with Cortexin and Neuromexol in patients with chronic cerebral ischemia (CCI) and cognitive impairment (CI). We examined 801 patients with CCI on the background of arterial hypertension and atherosclerosis with confirmed CI: 329 (41.1%) men and 472 (58.9%) women aged 30 to 80 years (mean age 64±10 years), who were examined. Cortexin and Neuromexol. Examination - Mini-Mental State Examination (MMSE) scale, hour-long drawing test (HDT) and severity of depressive states (Brief Geriatric Depression Scale, Mini Geriatric Depression Scal, MGDS). In 30 patients receiving Cortexin and Neuromexol (main group, MG) and 30 patients in the comparison group (CG), biomarkers of ischemic brain damage (NSE, antibodies to NR2, VEGFA) were determined. The examination was carried out before the start of treatment and after 30 days. During therapy with Cortexin and Neuromexol, characteristic signs of a decrease in the severity of CI were noted (p<0.05). A positive correlation was revealed between the performance indicators of the MMSE and TFC tests, both before and after treatment (r=0.5 and r=0.6, respectively; p<0.05). A positive effect of therapy on the emotional background of patients was noted, in particular, a decrease in the severity of depressive symptoms on the MGDS scale. During therapy, a 2-fold decrease in the NSE level (p<0.05) was detected in the MG, which indicates a decrease in the structural and functional parameters of biomembrane neurons in the brain. The concentration of antibodies to NR2 decreased compared to the baseline level in both groups (p<0.05), and VEGFA decreased only in the MG (p<0.05). The results of the study allow us to recommend the complex prescription of Cortexin 10 mg/day for 10 days and Neuromexol tablets 125 mg (375-750 mg/day) for 30 days for chronic CVD. Complex therapy with Cortexin and Neuromexol is effective and safe in patients with CCI and CI.

Difficulties and prospects of rational therapy of ischemic strokes

Despite significant progress in medical technology, many topical issues in neurology remain unresolved; among the latter, acute cerebrovascular accidents (strokes) continue to be one of the most important medical and social problems of the modern world, since their rates of morbidity, mortality and disability are steadily growing. The increase in the incidence of strokes over the past 30 years by 70% reflects the imperfection of modern medical strategies for the primary prevention of stroke and measures for their implementation among the population, which dictates the need to revise the prevailing ideas about the etiology, pathogenetic mechanisms and therapeutic approaches to managing patients with cerebrovascular pathology. The article presents a classification of strokes, a critical analysis of vascular risk factors (in particular, the emergence of new ones, such as acute coronavirus infection COVID-19), fundamental elements of the ischemic cascade, pathomorphological and pathophysiological consequences of ischemic damage to the central nervous system (necrosis and apoptosis of neurons, diaschisis in the penumbra zone), current theoretical (targets of drug exposure) and practical (therapeutic window) aspects of therapy and prevention of acute cerebrovascular accidents are outlined. The place and importance of the use of neuroprotective drugs in the combined therapy of patients with acute and chronic cerebrovascular pathology has been demonstrated. Particular attention is focused on neurometabolic drugs with a multimodal mechanism of action, which not only protect the neuronal cytoskeleton, but also increase the tolerance of brain tissue to hypoxia.

Nootropic properties of a new combined cytoprotective agent

Medicinal products of nootropic action, which have a positive effect on neurometabolism and normalize memory and intellectual functions, are an important component of complex pharmacotherapy for various neurological and cerebrovascular diseases. The aim of the work was an experimental study of the nootropic activity of the new combined drug Melarginin, which includes 3-(2,2,2-trimethylhydrazinium) propionate (meldonium), L-arginine, and inosine in a fixed ratio. In experiments on female Balb/c mice, it was established that Melarginin in doses of 250 and 500 mg/kg (per os for 14 days) statistically significantly increased the survival of animals in acute hypoxia, in a dose of 250 mg/kg - contributed to the preservation of cognitive function in experimental amnesia, improved spatial memory and recognition of the new location of the object, and in a dose of 500 mg/kg - increased muscle tone and endurance to physical and psychoemotional stress. The revealed effects indicate a nootropic effect due to the combined cyto- and cerebroprotective properties of the studied combined agent components. Based on the obtained data, the new pharmacological combination can be a promising drug for neurological recovery and improvement of physical and mental performance in chronic cerebrovascular pathology. Keywords: combined drug Melarginin, hypoxia, amnesia, nootropic activity.

Chronic Stress exacerbates Tau production in the 3xTg Alzheimer’s Disease Mice

Alzheimer’s disease (AD) is the most prevalent type of dementia linked with progressive cognitive decline and behavioral impairment in humans. Currently, an estimated 6.2 million Americans are living with AD, and it is ranked as the 6th leading cause of death in the United States. AD is a multifactorial disorder associated with protein alterations, oxidative stress and neuroinflammation. A cumulative of these factors drive the AD pathogenesis stimulating neurons to produce excessive amounts of β‐amyloid protein (Aβ1‐42) and hyperphosphorylated tau proteins. The complex interplay among the abnormal Aβ1‐42and tau proteins lead to the development of senile plaques and neurofibrillary tangles in the hippocampus of the brain. Chronic psychosocial stress is a risk factor of dementia and is mediated by a pro‐oxidative microenvironment, a fundamental process associated with dementia. We have shown that the xanthine oxidase pathway plays a key role in the chronic stress‐induced cerebrovascular pathology. Thus, we test the hypothesis that chronic stress, using the unpredictable chronic mild stress (UCMS) model, will exacerbate tau pathology and thus, accelerate the early progression of AD. Further, we tested the hypothesis that blocking the xanthine oxidase pathway with febuxostat (Feb) will prevent this accelerated progression of AD.At 4 months‐of‐age, 3xTg mice were separated into 4 groups; AD control, AD control+Feb, AD+UCMS, AD+UCMS+Feb. UCMS was performed for 8 weeks, with or without Feb treated water (50mg/L). Mice were euthanized at 6 months‐of‐age and the harvested brains were flash frozen and stored at ‐80°C. Brains were homogenized to extract soluble and insoluble fractions of tau proteins using Western blot (WB) and normalized to GAPDH or B‐actin.At 6 months‐of‐age, UCMS accelerated total and phosphorylated tau protein expression by 83% (p&lt;0.05) and 350% (p&lt;0.001), respectively, compared to AD controls. Febuxostat prevented the increased expression of phosphorylated tau and lowered the total tau protein expression in the UCMS group. However, total tau protein expression remained higher compared to AD control levels. Thus, overall, these data suggests that chronic stress accelerates tau pathology in 3xTg mice partly through the xanthine oxidase pathway. We will further explore Aβ1‐42and xanthine oxidase in 3xTg brain homogenates at 6 and 9 months‐of‐age, to better understand how stress accelerates AD pathology.

CHRONIC RENAL DISEASE AND CEREBROVASCULAR PATHOLOGY (LITERATURE REVIEW)

Introduction. Chronic renal disease is an umbrella term including kidney impairment or impaired renal function for more than 3 months. According to various estimates, chronic renal disease affects 8-16% of the world's population, and this figure is growing steadily. The etiological factors of chronic renal disease the most commonly include diabetic nephropathy, glomerulonephritis, hypertensive nephropathy, tubulointerstitial kidney disease, and polycystic kidney disease. Glomerular filtration rate and albuminuria are the most valuable markers of chronic renal disease that determine the severity of the disease. The objectives of this article is to review and systematize the results of global studies of chronic renal disease as a risk factor for cerebrovascular pathology and a factor, which determines the severity of stroke as well as post-stroke consequences. Results. Decreased glomerular filtration rate is an independent risk factor for chronic renal disease. There is an independent link between proteinuria and the risk of stroke. Chronic renal disease is associated with the clinical severity of strokes and the severity of post-stroke sequelae. Chronic renal disease has significant associations with the severity of neuroimaging markers of cerebral microangiopathy. The mechanisms of the development of cerebrovascular pathology in patients with chronic kidney disease have not been clearly understood, but are thought to be complex, involving a variety of factors, including arterial hypertension, impaired lipid metabolism, diabetes mellitus, and some others. Haemo-cerebral barrier disruptions due to chronic renal disease may contribute to the development of chronic renal disease. Moreover, chronic renal disease is an independent risk factor for atherosclerotic lesions of cerebral arteries. Considerable attention is paid to the genetic factors in the axis "chronic renal disease cerebrovascular pathology". Certain monogenic mutations can simultaneously have a negative impact on the development of chronic renal disease and cerebrovascular pathology. Recently the role of haemodialysis as a factor that mediates the relationship between chronic kidney disease and cerebrovascular pathology has been found out. Conclusion. Chronic renal disease and cerebrovascular pathology have many common pathophysiological mechanisms. Understanding the interaction between renal damage and impaired cerebral blood supply as well as close collaboration between neurologists and nephrologists are important issues to manage cerebrovascular complications effectively in patients with chronic renal disease.

Chronic cerebral ischemia and dizziness

Older age is characterized by a high prevalence of dizziness/vertigo, including various variants - central and peripheral vestibular disorders, feelings of instability, balance disorders. High frequency of dizziness and chronic cerebral ischemia in the elderly age category supports traditional ideas about relationship of these pathologies. However, there is a known overestimation of Chronic cerebral ischemia as a cause dizziness of and unclear mechanisms of this process. With a high prevalence of vestibular disorders in the elderly and their verification, in some cases, the causes of dizziness cannot be identified. This has prompted the designation of this type of dizziness as «unexplained». The article cites recent studies demonstrating a relationship between «unexplained» dizziness and chronic cerebrovascular pathology. The theories explaining the mechanisms of this association are proposed. The role of choline alphoscerate in the treatment of dizziness in Chronic cerebral ischemia has been demonstrated. The mechanisms of positive effect of choline alphocerate and prospects of its using.

Modern neuroprotection in the treatment of patients with cerebrovascular diseases

Currently, both in Russia and in the world as a whole, the problem of acute and chronic cerebrovascular pathology does not lose its relevance, despite the organizational measures taken to prevent and treat this pathology. The search for highly effective methods of treating stroke patients continues, while preference is given to drugs with polymodal neuroprotective, neuroreparative effects. In this regard, the promising Russian drug cellex, obtained from the embryonic brain tissue of pigs, is of interest. The drug contains tissue-specific signaling proteins and polypeptides (growth factors, differentiation of nerve cells). The article presents the results of a number of experimental and clinical studies proving its primary and secondary neuroprotective effects. In multicenter Russian studies, including placebo-controlled studies, convincing data were obtained on the effectiveness and safety of the drug in the acute and recovery periods of ischemic and hemorrhagic stroke, as well as in chronic brain ischemia. Based on the analysis of the results obtained during the research, it is concluded that it is advisable to use drugs with a pleiotropic effect. The complex of measures that contribute to improving the effectiveness of rehabilitation measures both in the acute and in the recovery period of stroke, as well as in chronic cerebrovascular pathology, should include drugs that have neurotrophic and neuroprotective properties. They significantly contribute to the activation of neuroplasticity capabilities, thereby providing a powerful therapeutic effect. One of the drugs in this group is cellex, which has a decent evidence base of effectiveness and safety.В настоящее время проблема острой и хронической цереброваскулярной патологии не теряет своей актуальности, несмотря на предпринимаемые организационные меры по предупреждению и лечению данной патологии. Продолжается поиск высокоэффективных способов лечения больных с инсультом, при этом предпочтение отдается препаратам с полимодальным нейропротективным, нейрорепаративным действием. В этой связи интерес представляет оригнальный российский препарат Целлекс, полученный из эмбриональной мозговой ткани свиней. Препарат содержит тканеспецифические сигнальные белки и полипептиды (факторы роста, дифференцировки нервных клеток). В статье анализируются результаты ряда экспериментальных и клинических исследований, доказывающих его первичное и вторичное нейропротективное действие. В результате проведенных российских многоцентровых рандомизированных плацебо-контролируемых исследованиях получены убедительные данные об эффективности и безопасности применения препарата в остром и восстановительном периодах ишемического и геморрагического инсульта, при хронической ишемии мозга. На основании анализа результатов исследований делается вывод о целесообразности применения Целлекса. В комплекс мер, способствующих повышению эффективности реабилитационных мероприятий в остром и восстановительном периодах инсульта, при хронической цереброваскулярной патологии, должны включаться препараты, обладающие нейротрофическими и нейропротективными свойствами. Они способствуют активации возможностей нейропластичности, обеспечивая мощный терапевтический эффект. Одним из препаратов этой группы является Целлекс, имеющий убедительную доказательную базу эффективности и безопасности.

Efficacy of Sermion in the treatment of tinnitus noise in patients with chronic cerebrovascular pathology

Of an open observational noncomparative clinical study was to study in patients with CCI and tinnitus and/or head the efficacy and tolerability of Sermion in a daily dose of 30 mg for 6 months. 56 patients (51.1±8.7 years) were clinically and neurologically examined using standard questionnaires to analyze the severity of tinnitus and its impact on daily life and the level of patient distress associated with noise, and to study the quality of life using the SF-36 questionnaire. All patients independently assessed the therapy satisfaction index. The safety, good tolerance and obvious clinical effect were shown when using the drug Sermion. The best results were obtained with the use of Sermion for 6 months in relation to the severity of tinnitus, the degree of its influence on daily activity, the level of distress and an increase in the quality of life of patients, as well as a significant improvement in well-being and cognitive functions in almost all subjects. It has been shown that after an adequate course of therapy and after 3 months, the therapeutic efficacy of Sermion is preserved, and the patients themselves were more satisfied with this remedy after 6 months of treatment. The data obtained suggest a wider use of Sermion in patients with cerebrovascular diseases and tinnitus and/or head, the use of which allows a safe, effective and pathogenetically reasonable effect on the existing disorders in these patients.

Radiation Risk Analysis of Neuropsychiatric Disorders in Ukrainian Chornobyl Catastrophe Liquidators.

Goal: To explore the possible impact of ionizing radiation in the pathophysiology of neuropsychiatric disorders amongst clean-up workers of the Chornobyl catastrophe (liquidators).Design, object, and methods: Retrospective-prospective study (1987–2015) of liquidators from the State Register of Ukraine (SRU) with radiation doses records and Clinical-Epidemiological Register (CER) of the State Institution ≪National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine≫ (NRCRM). Moreover, cohort and cross-sectional studies of the randomized sample of liquidators from the CER (exposed group, 198 subjects) were examined. Internal control group included the liquidators irradiated in doses <50.0 mSv (42 persons). All subjects were assessed by a detailed clinical examination and a battery of standardized neuropsychiatric scales, psychometric, and neuropsychological tests. Descriptive and variation statistics, non-parametric criteria, regression-correlation analysis, survival analysis by Kaplan & Meier, and risk analysis were used.Results: Exposed group vs. control group showed cognitive disorders in 99 (50.0%) vs. 20 (18.1%), (P = 0.04); affective disorders in 96 (48.3%) vs. 36 (32.7%) (P = 0.007), and stress-related disorders in 115 (58.4%) vs. 8 (7.3%) (P < 0.001). In the main group exposed to ≥50 mSv vs. internal control group (exposed to <50 mSv), affective disorders were present, respectively, in 89 (56.4%) vs. 7 (19.1%) (P < 0.001), and stress-related disorders in 98 (62.8%) vs. 17 (40.4%) (P = 0.009). Relative risks (RR) and 95% confidential intervals (95%CI) of Incidence of some neuropsychiatric disorders in liquidators of 1986–1987 related to internal control (doses <50 mSv) were as follows: organic psychosis (RR = 3.15; 95% CI: 2.6; 3.7); non-psychotic organic brain damage (RR = 1.99; 95% CI: 1.6; 2.5); acute (RR = 1.40, 95% CI: 1.3; 1.5), and chronic cerebrovascular disorders (RR = 1.23; 95% CI 1.0;1.5). Neuropsychiatric diseases show a strong, increasing, and approximately quadratic statistically significant (Pv < 0.001) relationship with individual dose, yielding an estimated excess relative risk ERR = 2.76 Sv−2 (95% CI 1.06–7.15).Conclusions: Liquidators have an excess of cognitive, affective, and stress-related disorders. The risk of diseases rises with radiation dose. Radiation risks are revealed for organic psychoses, non-psychotic organic brain damage, acute and chronic cerebrovascular pathology.

Neurophysiological Changes in Patients with Discirculatory Encephalopathy Associated with Ischemic Optic Neuropathy

Background. The most common chronic cerebrovascular pathology is dyscirculatory encephalopathy, in which a decrease in blood supply due to damage to brachiocephalic vessels leads to damage to brain substances and analyzers, including visual, with the possible development of severe damage in the form of ischemic optic neuropathy. Many studies have been devoted to the relationship between atherosclerotic damage to the neck vessels and ischemic damage to the visual organ, but little attention has been paid to the study of the functional activity of the altered visual analyzer in patients with dyscirculatory encephalopathy, and the results are scattered. Aim. To conduct a comparative analysis of changes in neurophysiological parameters of the brain and visual analyzer in patients with dyscirculatory encephalopathy and patients with a combination of dyscirculatory encephalopathy and ischemic optic neuropathy. Materials and methods. 34 patients with the 2nd stage of dyscirculatory encephalopathy were examined and divided into two groups based on the presence/absence of ischemic optic neuropathy of various prescription periods. All patients underwent ultrasound scanning of neck vessels, visual fields determination, electroretinography, visual evoked potentials, and electroencephalogram. Results. The results revealed changes in a number of indicators in the group of patients with a combination of two diseases: more pronounced atherosclerotic lesion of brachiocephalic vessels, a decrease in the amplitude and the alpharhythm prevalence index, a decrease in oscillatory potentials, a change in latency and amplitudes the visual analyzer according, lengthening of time indicators with a simultaneous decrease in amplitudes and depression of retinal sensitivity. Conclusion. Patients with dyscirculatory encephalopathy complicated by ischemic optic neuropathy have a combined lesion of the brain and visual analyzer, which determines the severity of the detected changes and requires a comprehensive multidisciplinary approach to the treatment of these patients.

Interactions Between Acute Infarcts and Cerebrovascular Pathology Predict Poststroke Dementia.

Chronic cerebrovascular pathology accelerates the incidence of poststroke dementia (PSD). Whether the risk of PSD varies according to different types of chronic cerebrovascular pathology remains unclear. We investigated whether PSD is associated with a unique pattern of interactions between chronic cerebrovascular pathologies and acute stroke lesions. In this case-control study of acute mild stroke patients (n=185), cases included patients who developed PSD at a 6-month poststroke follow-up, and controls included patients who remained nondemented at 6 months, matched on prestroke cognitive status. Magnetic resonance imaging was performed at initial stroke presentation; neuropsychological assessments were performed 6 months after the stroke. White matter hyperintensities (WMH), chronic lacunes, microbleeds, and acute infarcts were not associated with PSD after controlling for demographics, cardiovascular risk, and global cortical atrophy. The risk of PSD was largest for patients with acute large subcortical infarcts (>15 mm) and concomitant periventricular WMH compared with patients with large subcortical infarcts and punctate/absent periventricular WMH [odds ratio (OR)=5.85, 95% confidence interval (CI)=1.85-40.04]. A moderate risk of PSD was observed for patients with acute multiple small infarcts (3 to 15 mm) and concomitant lacunes (OR=2.48, 95% CI=0.94-6.51) or concomitant lobar microbleeds (OR=2.20, 95% CI=0.89-5.41), compared with patients with acute multiple small infarcts and absent lacunes or microbleeds. Single small infarcts did not interact with cerebrovascular pathology to affect PSD. The risk of PSD varies depending on the presence of chronic cerebrovascular pathologies and type of acute infarcts. Clinical implications support a precision medicine approach for stratifying those at highest risk of PSD.

Сравнение двух методов лабораторной оценки агрегации тромбоцитов и резистентности к антиагрегантной терапии

Сравнение двух методов лабораторной оценки агрегации тромбоцитов и резистентности к антиагрегантной терапии

A multicenter observation study of the efficacy of cortexin and recognan (citicoline) in the treatment of cognitive impairments in chronic cerebrovascular pathology

To make a critical assessment of the therapeutic effect of complex therapy with cortexin and recognan (citicoline) for cognitive impairments in patients with chronic cerebrovascular pathology. Presented is an analysis of results of the multicenter observation program to assess the efficacy of cortexin and recognan (citicoline) in the treatment of cognitive impairments in patients with chronic cerebrovascular pathology. Three hundred and nine patients with chronic cerebrovascular pathology, including 134 (43.4%) men and 175 (56.6%) women, aged from 30 to 80, average age 63.4±9.4 years, with confirmed cognitive deficit were examined. The diagnosis was established on the basis of complaints, case reports, the results of CT/MRI studies, as well as assessments of the neurological status and cognitive functions. Cognitive impairments were confirmed by the number of points on the Mini-mental state examination (MMSE) and the Clock drawing test. The assessment of depression was made with the Mini Geriatric Depression Scale (MGDS). All patients received cortexin and recognan (citicoline) ('Geropharm', Russia) at doses 10 mg/day for 10 days and 1000 mg/day for 1 month, respectively. Complex therapy with cortexin and recognan (citicoline) showed high efficacy in the treatment of vascular cognitive disorders. The results of the study allow us to recommend the complex administration of cortexin and recognan (citicoline) ('Geropharm', Russia) in doses of 10 mg/day for 10 days and 1000 mg/day for 1 month, respectively, for chronic cerebrovascular pathology.