Neurometabolic Therapy Research Articles

Neurometabolic therapy of mild cognitive impairment in patients with chronic cerebral ischemia

To evaluate the effect of a sequential therapy regimen with Mexidol (500 mg injections intravenously for 14 days) and Mexidol FORTE 250 (250 mg tablets 3 times a day for 60 days) on higher cortical functions in patients with moderate cognitive disorders in chronic cerebral ischemia. A comparative, prospective study included 63 patients with chronic cerebral ischemia with moderate cognitive impairment. All patients received basic therapy aimed at reducing risk factors (antihypertensive, antithrombotic drugs as indicated). Patients of the main group (30 people: 12 men, 18 women) received Mexidol intravenously 500 mg in 100 ml of 0.9% NaCl solution once a day for 14 days, then Mexidol FORTE 250 (film-coated tablets) 250 mg 3 times a day for the next 60 days. The comparison group consisted of 33 patients (14 men, 19 women) who received only basic therapy. The groups were comparable in terms of age, sex characteristics and severity of cognitive deficit. We examined cognitive status (MoCA scale, Frontal Dysfunction Battery, 10 Word Memorization tests), severity of asthenia (MFI-20 scale), anxiety and depression (HADS scale), patient's subjective assessment of the dynamics of the condition (CGI-improvement scale) in 1st, 14th and 74th±5 days of observation. On days 1 and 74±5 of observation, patients were examined using transcranial magnetic stimulation to study the neuronal activity of the cerebral cortex. In the main group, at the time of completion of taking Mexidol and Mexidol FORTE 250, a pronounced cognitive regression was noted (MoCA scale +3 points, difference with the comparison group 1 point (p<0.0001); Frontal Dysfunction Battery test +4 points, difference with comparison group 2 points (p<0.001); memory test «10 words» +2 points, difference with the comparison group 1 point (p<0.05), emotional (HADS anxiety scale -8 points, difference with the comparison group 3 points (p<0.001), depression -3.5 points, difference with the comparison group 1.5 points (p<0.01), asthenic disorders (MFI-20 scale -30 points, difference with the comparison group 15.5 points (p<0.01), improvement in the well-being of patients (CGI-improvement scale -2 points, difference with the comparison group 1 point (p<0.0001). According to the transcranial magnetic stimulation performed, a statistically significant decrease in the central motor conduction time at the level of 1 and 2 motor neurons of the pyramidal tract bilaterally from the start to the end of therapy with Mexidol and Mexidol FORTE 250 was determined (p<0.01). An inverse correlation was found between the time of central motor conduction and the results of the Frontal Dysfunction Battery test at the same time points with left-sided localization of 1 motor neuron (p<0.01). The results of a study of the use of sequential therapy with Mexidol 500 mg IV drip 1 time per day for 14 days followed by oral administration of Mexidol FORTE 250 1 tablet 3 times a day for 60 days indicate its clinical effectiveness and safety in patients with chronic cerebral ischemia with mild cognitive impairment, and also confirm its importance for preventing the progression of cognitive disorders.

Results of evaluation of neurometabolic and rehabilitation therapy for vincristine polyneuropathy in children with acute lymphoblastic leukemia

Introduction. Vincristine-induced peripheral neuropathies (VIPN) is a current problem in the management of pediatric acute lymphoblastic leukemia (ALL). There are no effective therapeutic strategies for VIPN. The aim of the study to present the results of evaluation of neurometabolic therapy in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period. Materials and methods. The single-center prospective comparative pilot study involved 69 children with VIPN who were treated in the acute period with the following drugs: group 1 - pyridoxine, group 2 - thioktovic acid, group 3 - inosine + nicotinamide + riboflavin + succinic acid. Clinical and electrophysiological parameters before and after drug treatment were analyzed. Among 10 children with motor deficits in the lower extremities in the recovery period of VIPN, rehabilitation with immersive virtual reality was performed, and the clinical parameters before and after the course were compared. Results. A positive effect of the studied drugs on the clinical condition of patients by the 30th day of therapy was revealed. In groups 1 and 3 the total score on the NIS-LL scale correlated with mild polyneuropathy - 4 [2÷8] and 2 [2÷6] points, respectively. Neurologic impairment in each of these groups persisted for 19 [14÷25] and 19 [13÷30] days, which was less in contrast to the duration of symptoms in group 2 (p1-2 = 0.021 and p2-3 = 0.046). In the VIPN recovery period before and after virtual rehabilitation: muscle strength in the lower limbs increased (p = 0.025); the severity of polyneuropathy decreased according to the NIS-LL scale (p = 0.003); balance improved according to the Berg scale (p = 0.017); and patients’ mobility increased according to the Functional Walking Category test (p = 0.025) and walking speed according to the time-recorded walking test (p = 0.008). Discussion. Improvement of clinical parameters with neurometabolic therapy and virtual rehabilitation in children with VIPN has been shown. Conclusion. Preliminary results of the effectiveness of pyridoxine and inosine + nicotinamide + riboflavin + succinic acid in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period were obtained.

An Integrated Approach to The Rehabilitation of Infants with Sepsis.

The results of a comparative study of two groups of children with sepsis who received combined rehabilitation therapy during the rehabilitation period, including correction of the intestinal biocenosis, neurometabolic therapy, and immunotherapy with Viferon, and children who received only the immunomodulator T-activin, showed that an integrated approach to rehabilitation was much more effective. In addition, a relatively rapid immunological effect, good tolerability of viferon, a non-invasive route of administration, and the absence of side effects with the described methods of immunorehabilitation allow us to recommend the use of this drug in infants suffering from sepsis.

Rehabilitation of patients with post-stroke aphasia using transcranial direct current electrical stimulation (tDCS)

BACKGROUND: Rehabilitation of patients with post-stroke aphasia is an important medical and social goal. The use of traditional methods of rehabilitation is often not effective enough, which forces us to look for new methods aimed at restoring lost functions.&#x0D; AIM: The aim of this study is to determine the effectiveness of non-invasive brain stimulation using transcranial direct electric current stimulation (tDCS) in patients with post-stroke aphasia.&#x0D; MATERIALS AND METHODS: 28 patients with motor post-stroke aphasia were examined according to the method of L.S. Tsvetkova with co-authors. All patients received a traditional rehabilitation complex: psychological and correctional classes with a speech therapist-aphasiologist; neurometabolic therapy. 14 patients (Group I) additionally had transcranial direct electric current stimulation; 14 patients had placebo transcranial direct electric current stimulation.&#x0D; RESULTS: All patients with post-stroke aphasia showed an improvement in expressive and impressive speech, however, in patients who had true transcranial direct electric current stimulation, the improvement in expressive and impressive speech was higher than in patients who had placebo transcranial direct electric current stimulation. There were no complications from the use of transcranial direct electric current stimulation.&#x0D; CONCLUSION: Based on the results of the study, it can be concluded that it is expedient to include the non-invasive transcranial direct electric current stimulation method in the rehabilitation of patients with post-stroke aphasia.

Вплив комбінованої нейрометаболічної терапії на регрес неврологічної симптоматики у хворих із гострим ішемічним інсультом

Досліджено ефективність комбінованої нейрометаболічної терапії у хворих із гострим порушенням мозкового кровообігу за ішемічним типом. Доведено, що застосування комбінації препаратів, що впливають на холінергічну систему, прискорює відновлення свідомості, зменшує неврологічний дефіцит та зберігає когнітивний статус.

Застосування кількісної електроенцефалографiї в діапазонах, що відображають нейромедiаторну активність, для оцінки ефективності нейрометаболічної терапії

Метою цього дослідження було вивчення нейрометаболічної дії препарату етилметилгiдроксипiридину сукцинату (Армадін) на центральну нервову систему в пацієнтів iз гострою церебральною недостатністю (ГЦН) різного генезу (тяжка черепно-мозкова травма, мозковий інсульт) за допомогою методів кількісної електроенцефалографiї (ЕЕГ). Матерiали i методи. Дизайн дослідження: відкрите проспективне дослідження за типом «випадок — контроль». Сорок хворих (група дослідження) отримували препарат етилметилгiдроксипiридину сукцинату на додаток до стандартного протоколу лікування, 48 пацієнтів iз ГЦН (група порівняння) — терапію за стандартним протоколом. Реєстрацію біопотенціалів мозку здійснювали за допомогою нейрофізіологічного комплексу DX-NT32. Для інтегрального кількісного аналізу ЕЕГ застосовували інтегральний коефіцієнт kfc1: (δ + θ + β1) / (α + β2). Для оцінки нейрогліальної та нейрометаболічної активності визначали показники відносної спектральної потужності у вузьких діапазонах ЕЕГ. Проводили ультразвукове допплерографiчне дослідження екстра- та інтракраніальних судин (апарат DWL EZ-Dop V2.1, Німеччина). Статистичний аналіз даних виконано за допомогою програми MedStat. Результати. Головні позитивні ефекти відновлення внутрішньочерепного кровообігу, що проявлялися зменшенням вазоконстрикції інтракраніальних судин, були зареєстровані після введення препарату в дозі 200 мг. При збільшеннi кількостi введеного препарату етилметилгiдроксипiридину сукцинату до 400 мг включалися нові рівні адаптації за рахунок активації дieнцефальних структур і функціонально пов’язаних з ними структур правої півкулі, де було зафіксовано значущі зміни ЕЕГ-предикторів нейроглiальної та нейромедіаторної (холін-, aдрен-, серотонін- та меншою мірою дофамінергічної) активності. Виснов­ки. Застосування в комплексі терапії ГЦН різного генезу етилметилгiдроксипiридину сукцинату підвищувало шанс на вiдновлення свідомості до 11 і більше балів за шкалою коми Глазго до 7-ї доби лікування. Використання препарату етилметилгiдроксипiридину сукцинату в комплексі терапії при мозковому інсульті та тяжкій черепно-мозковій травмі підвищує можливiсть скорочення термінів перебування у відділенні нейрохірургічної інтенсивної терапії до 8–10 діб.

Effectiveness of combined neurometabolic therapy in complex treatment of patients with hemorrhagic hemispheric stroke in recovery period

Objective. The aim of this work was to estimate the effectiveness of combination neurometabolic therapy that includes 5 mg of ipidacrine hydrochloride and 300 mg of phenibut in complex therapy of patients with hemisphere hemorrhagic stroke in the early rehabilitation period. Material and methods. Open comparative randomized study and treatment of 46 patients (31 men and 15 women) with hemisphere hemorrhagic stroke in the early rehabilitation period was performed. The mean age of patients was 57.17 ±7.09 years. All patients were divided into two groups - the main group included 20 patients with hemorrhagic stroke, who took neurometabolic combination therapy (5 mg of ipidacrine hydrochloride and 300 mg of phenibut three times per day) in addition to complex recovery treatment during 30 days (start from 30th day after stroke) and control group, that included 26 patients with hemorrhagic stroke, who received standard complex recovery treatment without additional neurometabolic therapy. Outcomes. The median MoCA score of the main group of patients was 21.0 (19; 24), while the second group had 20.5 (18; 23.75) MoCA score, but without any intergroup difference. It was also identified reliable improvement of cognitive values on the MoCA scale after treatment (р ˂ 0.05). Besides, statistical difference was reached between groups in these measures. Also, we showed that statistical improvement in memory was observed in both groups at 1st and 2nd attempts using Luriya’s method “memorizing 10 words”. But subsequent such an effect took place only in the main group. The present study showed the absence of improvement “memorizing of 10 words” at 3rd, 4th and 5th attempts in control group. At the same time, patients of the main group had improved results at 4th and 5th ones (р ˂ 0.05). Conclusion. The combined drug of neurometabolic nature, consisting of 5 mg ipidacrinum and phenibut 300 mg, improved rehabilitation effectiveness rates for account of cognitive functions in patients with hemorrhagic hemispheric stroke during recovery period during comprehensive rehabilitation.

Neurometabolic Therapy in Patients with Encephalopathy Associated with COVID-19

The objective: to evaluate the effectiveness of neurometabolic therapy in patients with severe course of the new coronavirus infection of COVID-19 complicated by the development of encephalopathy.Subjects and Methods. A pilot prospective study was carried out with the participation of 61 patients with a severe course of COVID-19 complicated by encephalopathy. The patients were randomized into two groups: the study group (n = 34), the patients in which, in contrast to the control group (n = 27), received Cytoflavin in addition to the main therapy in a daily dose of up to 40 ml for 5 days. The dynamics of the general and neurological status was assessed on days 3‒4 and 6‒7 days of treatment using the NEWS (National Early Warning Score), Glasgow coma and ICDSC (Intensive Care Delirium Screening Checklist) scales. Additionally, the blood level of neuron-specific enolase (NSE) was investigated at baseline and on days 6‒7.Results. Patients in most cases were elderly or senile with a high comorbidity index (up to 4 points according to Charlson). The persistence of delirious symptoms correlated with their age and low SpO2 levels. In half of the cases (50.8%), the disease had an unfavorable outcome. In the study group, by the 6‒7th day of treatment, there was a significant positive dynamics of the general condition, assessed by the NEWS scale (p = 0.012), a tendency towards a faster recovery of the overall score on the Glasgow scale (p = 0.083), a tendency towards more rapid regression of delirious symptoms by ICDSC scale (p = 0.055) versus the comparison group.Conclusions. Given the high risk of an unfavorable outcome in patients with a severe course of COVID-19 complicated by the development of encephalopathy, the additional use of Cytoflavin is advisable since it contributes to the regression of the symptoms of encephalopathy and may have a positive effect on the course of the disease.

Investigation of the Effectiveness of Cortexin in the Treatment of Cardiac Arrhythmias in Children

In this article, a new look at cardiac rhythm and conduction disorders in children is outlined. These deviations, along with congenital malformations, have taken one of the first places in the structure of cardiovascular pathologies. This is one of the most serious problems that stands at the intersection of cardiology and pediatrics. The frequency of occurrence of severe forms of arrhythmias reaches 1:5000 of the child population, and life-threatening arrhythmias – 1:7000. Treatment of cardiac arrhythmias and conduction disorders is one of the most difficult sections of clinical pediatrics. There are medicinal and non-medicinal methods. According to experimental new data, nootropics, in particular the drug Cortexin, along with cardiotrophic drugs, form the basis of neuro-metabolic therapy and correction of children's arrhythmias.

Влияние нейрометаболической терапии на уровень нейронспецифической энолазы и когнитивный статус у больных в остром периоде ишемического инсульта

Исследована эффективность нейрометаболической терапии у больных с острым нарушением мозгового кровообращения по ишемическому типу путем определения уровня нейронспецифической энолазы и динамики когнитивного статуса. Доказано, что применение комбинации препаратов, которые влияют на холинергическую систему, ускоряет восстановление сознания, уменьшает неврологический дефицит и сохраняет когнитивный статус.

Efficiency of dimephosphonum, cytochrom cand mexidol in the treatment of cardiac rhythm disorders in children

The efficiency of dimephosphonum, cytochrom c and mexidol in the treatment of ventricular, supraventricular arrhythmias in children is shown. Dimephosphonum (100 mg/kg i.v.), mexidol (10 mg/kg p.o.) and cytochrom c (0,5 mg/kg i.v.) were studied in comparison with cordaron, finoptin and also with the standard neurometabolic therapy. It is shown that dimephosphonum was the most effective drug in all kinds of disturbances of cardiac rhythm and conductivity in children. In supraventricular arrithmias and sinus node dysfunction it surpasses traditional drugs. At ventricular arrhythmias dimephosphonum was less effective than cordaron. However, cordaron induced cardiac (20%) and extracardiac (20%) negative effects. The dimephosphonum treatment was safe and was accompanied by favourable influence on the basic heart functions

Comprehensive prognosis of the consequences of secondary encephalitis in children

The paper presents the analysis of a study of children with secondary encephalitis, depending on the beginning of the acute period of which more than 6 months – a year has passed, the degree of neurological disorders, neuroimaging comparison and prediction depending on these indicators for timely neurometabolic therapy.The purpose of our study was to study the complex prognosis of the consequences of secondary encephalitis in children. We observed 58 children with a consequence of encephalitis.The total number of girls is 37 %, boys are 63 % which are the main group of patients. The control group of children are healthy identical in age 3‒10 years. All children admitted to the hospital underwent a standard examination, anamnesis, clinical and neurological examination, and neuroimaging (MRI, CT) studies. In addition, all children were determined on electromyography somatosensory evoked potential, including at admission, as well as at discharge.The results of our study revealed that the prognosis only for clinical and neurological disorders gives 66.2 %, with the addition of neuroimaging assessment increased to 79 %, and meningial-somatosensory indicators still increases the forecast by 12 %, which is very important for timely neurometabolic therapy. In turn, the prognosis of the outcome of encephalitis in children will allow timely reduction of residual neurological manifestations.

POSSIBILITIES OF DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC BRAIN ISCHEMIA

Aim: To study the formation of pathological brain systems and their transformation during treatment in patients with acute and chronic cerebral ischemia, using the method of quantitative EEG with wavelet analysis. Material and methods: In the period from 2016 to 2020, 120 people aged 40 to 68 years with CSI and IS were comprehensively examined in dynamics. Patients underwent quantitative EEG (qEEG) with wavelet analysis on days 1, 7, 14, 21, 28. In addition to the protocol, one group of patients received ethylmethyhydropyridoxine succinate. Results: The formation of a new system with a decrease or disappearance of the dominant frequency in the delta range, the appearance of a dominant frequency in the theta range and a subdominant frequency in the alpha range indicates the restoration of brain function. The applied course of neurometabolic therapy leads to such a change in the EEG wavelet graphs after 3-4 weeks in 86.6% of patients. And in the control group, similar changes occur during this period only in 53.3% of patients. Conclusions: To assess the effectiveness of treatment of acute and chronic cerebral ischemia, it is advisable to use a complex of amplitude-time representation of an EEG signal using continuous wavelet transform. The effectiveness of neuromethobolic therapy aimed at eliminating mitochondrial dysfunction can be assessed using the method of quantitative EEG with wavelet transformation, to study the formation and destruction of stable pathological brain systems in patients with cerebral ischemia.

Клинические аспекты применения витаминов группы В

Polyneuropathy is a common disorder of the peripheral nervous system. Diabetic neuropathy is the most common and most studied variant of polyneuropathies. The duration of carbohydrate metabolism disorders and inadequate glycemic control are risk factors for nervous system damage in diabetes. Distal neuropathy is a common type of neuropathy associated with diabetes. Interconnecting pathological mechanisms initiated by high blood glucose result in the damage of peripheral nerve fibers. Clinical presentations of distal neuropathy depend on the damage of proximal or distal and sensory or motor nerve fibers and the involvement of the vegetative nervous system. Medications improving metabolic processes in nerve fibers and reducing the severity of peripheral nerve damage are beneficial in addressing the harmful effects of hyperglycemia. Neurometabolic therapy includes thiamine, pyridoxine, and cyanocobalamin (B vitamins) which provide neurotropic effects. B vitamins acting as co-factors in many enzymatic reactions significantly affect the normal functioning of nerve fibers. B vitamins are effective and safe agents used to treat peripheral nervous system diseases for many years. This paper discusses the potential use of B vitamins for diabetic neuropathy and the COVID-19 treatment and rehabilitation. KEYWORDS: polyneuropathy, hyperglycemia, diabetes, distal neuropathy, B vitamins, thiamine, pyridoxine, cyanocobalamin, COVID-19. FOR CITATION: Biryukova E.V., Shinkin M.V. Clinical aspects of B vitamin use. Russian Medical Inquiry. 2021;5(9):579–585 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-579-585.

Charcot - Marie - Toots disease: description of 2 clinical cases of the disease in members of the same family (father and daughter)

Charcot — Marie — Tooth disease belongs to a genetically heterogeneous group of monogenic diseases with a predominant lesion of the peripheral nervous system associated with predominant degeneration of the myelin sheath and/or axon of the motor and sensory nerves and spinal roots, accompanied by motor disorders and specific pain syndrome. The article presents a description of 2 clinical cases of patients (father and daughter), whose disease was manifested by chronically progressive weakness and atrophy of the distal limb muscles, reflexes reduction, foot and hand deformation, gait changes and sensory disorders. Genetic tests were performed to detect duplication/deletion of the PMP22 gene and the expansion of GAA repeats in the FXN gene, which yielded negative results. Based on complaints, neurological examination, family medical history and data of instrumental research (EMNG), we made a clinical diagnosis of the CMT with an autosomal dominant type of inheritance and a high degree of penetrance. At the department, patients received the infusion therapy (neurometabolic therapy, vitamin therapy), physical therapy courses according to an individual plan, physiotherapy and reflexotherapy with a moderate positive effect in the form of a subjective increase in muscle strength in the lower extremities, increasing walking stability and confidence. The article also highlights the peculiarities of the pathogenesis of different genetic variants of CMT and prospect for pathogenetic treatment of this disease.

Нейрометаболическая поддержка у пациентов с двигательными нарушениями при инсульте на втором этапе реабилитации

Study Objective: To evaluate dose-dependent effects of adjunctive treatment with ethylmethylhydroxypyridine succinate within a comprehensive course of rehabilitation, in cerebral stroke patients with movement disorders in the second stage of rehabilitation. Study Design: This was a randomized study. Materials and Methods: Forty ischemic stroke patients were examined, and divided into three groups. Ethylmethylhydroxypyridine succinate was given intramuscularly to 18 patients: 250 mg/day (5 mL) in Group 1 (n = 9) and 100 mg/day (2 mL) in Group 2 (n = 9). In Group 3 (n = 22) patients did not receive this drug. All patients underwent a complete examination, including assessment of the following parameters: static and dynamic balance, as assessed by the Standing Balance Test and the Berg Balance Test; walking (Hauser Ambulation Index); and emotional (Hospital Anxiety and Depression Scale), cognitive (Montreal Cognitive Assessment), and sensory (Fugl-Meyer Assessment Scale) functions. Patients’ balance status was objectively assessed using stabilometric parameters. Study Results: Group 1 patients showed a significant increase in Berg Balance Test scores (from 44.00 [42.00; 47.00] to 46.00 [42.00; 49.00]) and a decrease in statokinesigram area (with eyes closed) (from 910.92 [36.20; 2,633.50] mm2 to 620.98 [213.40; 1,676.30] mm2 (p &lt; 0.05). All groups exhibited trends toward improvement of static balance, quality of walking, and cognitive and sensory functions, but only the changes in the Montreal Cognitive Assessment in Group 1 were statistically significant (from 24.67 [19; 27] to 26.67 [22; 29]). Conclusion: Adjunctive ethylmethylhydroxypyridine succinate, 5 mL (250 mg/day), within a course of rehabilitation improved patients’ balance status and cognitive functions. Patients who received this medication at a dose of 2 mL (100 mg/day) and those who did not receive it showed no significant improvement during rehabilitation. Keywords: stroke, balance, neurometabolic therapy, ethylmethylhydroxypyridine succinate.

On Possibility of Machine Learning Application for Diagnosing Dementia by Eeg Signals

The purpose of this study was to investigate the possibility to use electroencephalography for early diagnostics of dementia and for objective assessment of disease severity and neurometabolic treatment results. The study was based on application of machine learning methods for computer diagnosis of dementia by the energy spectra of EEG signals. Effectiveness of various machine learning technologies was investigated in order to separate different groups of patients with varying severity of dementia from healthy ones and patients with pre-dementia disorders according to the vectors of spectral indicators. Applying of cross-validation procedure showed that separation of the group with dementia from the group of people with normal physiological aging and groups of young people reaches 0.783 and 0.786, respectively by parameter ROC AUC. The results of the study allow to make an assumption, that the algorithmic assessment of dementia severity by EEG corresponds to the actual course of the disease. So, the number of cases with algorithmically identified positive dynamics significantly exceeds the number of cases with algorithmically detected negative dynamics after neurometabolic therapy in the group with mild dementia. In a combined group with both average and heavy severity of the disease such an increase was not observed.

Advances in neurometabolic therapy

Actovegin is a calf blood extract that contains more than 200 biologically active compounds. Experiments have shown that Actovegin reduces the neurotoxic effect of amyloid, neutralizes reactive oxygen species, and normalizes the endothelial function of small vessels. The drug has not been shown to stimulate tumor growth in the neuroblastoma model. Clinical experience with Actovegin suggests that the drug has an undoubted efficacy in treating moderate vascular cognitive impairment and chronic distal symmetric diabetic polyneuropathy and that it is used as additional therapy for primary degenerative and vascular dementia. The clinical efficacy of Actovegin in chronic obliterating diseases of the lowerlimb arteries is being actively studied now.

An effect of complex therapy on cognitive impairment in patients with chronic cerebral ischemia

To study the efficacy of complex therapy in the correction of cognitive impairment in patients with chronic cerebral ischemia. One hundred patients with chronic cerebral ischemia were examined. All of them received standard neurometabolic therapy. In the main group, patients were additionally treated with soft techniques of manual therapy. Cognitive status was assessed using the frontal assessment battery, the clock drawing test, MMSE, the Global Deterioration Scale and a sequencing test. Patients with chronic cerebral ischemia demonstrated a significant impairment of cognitive functions. Patients who received comprehensive (drug and non-drug) treatment showed a more significant improvement in cognitive status than those receiving only neurometabolic therapy.

Diagnosis and treatment of chronic cerebral ischemia (clinical discussion)

The article presents a clinical case of diagnosis and treatment of the initial presentations of chronic cerebral ischemia (CCI) in the form of cognitive impairments in a middle-aged patient. The authors describe such features of cognitive impairments (CI) as the predominance of «subcortical» symptoms (bradyfrenia, fluctuation), which is typical for CCI. The article presents modern approaches to the diagnosis of CCI, according to which it is necessary to focus on the assessment of higher brain functions, while the significance of «focal microsymptoms» is not large. The article discusses the treatment issues of CCI, which should first include the achievement of the maximum possible control over the underlying vascular disease. It also provides the results of recent studies of the effectiveness of pathogenetic neurometabolic therapy for vascular CIs.