Visuospatial Deficits Research Articles

Clock-Drawing Tasks as Predictive Measurements for Disease Classification Among Patients With Parkinson’s Disease and Essential Tremor

BackgroundNonmotor cognitive symptoms are widely being recognized in both Parkinson’s Disease (PD) and Essential Tremor (ET), the two most common movement disorders. Clock-drawing (CD) test seems to be impaired early in the process of cognitive (executive) decline in PD. However, the optimal measures for detecting cognitive changes in ET patients have not been established. Examining whether the CD test is a quick test could identify frontal and visuospatial deficits in patients with Parkinson’s disease (PD) and essential tremor (ET).MethodsVisuospatial performance was assessed in 58 consecutive patients with ET and 75 with PD and 22 healthy controls (HC) who visited two neurological clinics of Athens in Greece. The CD and copy (CC) items of the PD-Cognitive Rating Scale were used as a test of visuospatial function.ResultsBoth CD and CC scores were lower for ET compared to PD patients and HC (p=<0.001 for both comparisons). A binomial logistic regression showed that both CD and CC items predict if participants had ET or PD with high sensitivity 94.7% and specificity 87.9% and an area under the curve (AUC) 0.980 (95% confidence interval, 0.962-0.997). The model explained 86.1% (Nagelkerke R2) of the variance in the disease variable (ET/PD) and correctly classified 91.7% of the cases.ConclusionPatients with ET have more visuospatial deficits compared to PD and HC. CD task may be an easy, useful tool to track cognitive changes in nondemented patients with ET in clinical practice.

Stereoscopic Depth Perception and Visuospatial Dysfunction in Alzheimer's Disease.

With visuospatial dysfunction emerging as a potential marker that can detect Alzheimer’s disease (AD) even in its earliest stages and with disturbance in stereopsis suspected to be the prime contributor to visuospatial deficits in AD, we assessed stereoscopic abilities of patients with AD and mild cognitive impairment (MCI). Whereas previous research assessing patients’ stereoacuity has yielded mixed results, we assessed patients’ capacity to process coarse disparities that can convey adequate depth information about objects in the environment. We produced two virtual cubes at two different distances from the observer by manipulating disparity type (absolute vs. relative), disparity direction (crossed vs. uncrossed) and disparity magnitude, then had participants judge the object that appeared closer to them. Two patient groups performed as well as, or even better than elderly controls, suggesting that AD patients’ coarse disparity processing capacity is capable of supporting common tasks involving reaching, grasping, driving, and navigation. Results may help researchers narrow down the exact cause(s) of visuospatial deficits in AD and develop and validate measures to assess visuospatial dysfunction in clinical trials and disease diagnosis.

Visuospatial deficit in neurodevelopmental disorders: what's in a name?

This commentary is on the original article by Pisella et al. on pages 457–464 of this issue.

Mini Review: Correlations of Cognitive Domains With Cerebrospinal Fluid α-Synuclein Levels in Patients With Parkinson's Disease.

The level of α-synuclein, a component of Lewy bodies, in cerebrospinal fluid (CSF) in Parkinson's disease (PD) has attracted recent attention. Most meta-analyses conclude that CSF levels of α-synuclein are decreased in PD. Patients with PD present with cognitive impairment, including frontal/executive dysfunction in the early phase and later emergence of visuospatial and mnemonic deficits. To examine whether CSF α-synuclein levels reflect the activities of various cognitive domains, we reviewed reports examining the association of these levels with cognitive performance in each domain in PD. Among 13 cross-sectional studies, five showed that a lower CSF α-synuclein level was associated with worse cognitive function. In four of these five reports, frontal/executive function showed this association, suggesting a link of the pathophysiology with Lewy bodies. In three other reports, a higher CSF α-synuclein level was associated with temporal-parieto-occipital cognitive deterioration such as memory. In the other five reports, the CSF α-synuclein level did not correlate with cognitive performance for any domain. In four longitudinal studies, a higher baseline CSF α-synuclein level was associated with a worse cognitive outcome, including cognitive processing speed, visuospatial function and memory in two, but not with any cognitive outcome in the other two. The different associations may reflect the heterogeneous pathophysiology in PD, including different pathogenic proteins, neurotransmitters. Thus, more studies of the association between cognitive domains and CSF levels of pathogenic proteins are warranted.

Adaptive Working Memory Training Can Improve Executive Functioning and Visuo-Spatial Skills in Children With Pre-term Spastic Diplegia.

Pre-term spastic diplegia (pSD) due to periventricular leukomalacia is a form of cerebral palsy in which weaknesses in executive functions are reported beyond the core visuo-spatial deficits. The study aimed at improving executive functioning and visuo-spatial skills with an evidence-based training focused on working memory in children with pSD. The intervention study followed a stepped wedge design. 19 children with pSD (11 female and 8 male; age range: 4;1–13;1 years), mild to moderate upper limb impairment and Verbal Intelligence Quotient (VIQ) >80 participated to the study. The children were trained with a home-based adaptive working memory training (CogMed®) over a 5-week period. The primary outcome measure was the CogMed Improvement index; pre- and post-test explorative neuropsychological assessment was conducted with a subset of tests from the NEPSY-II battery. Working memory training in children with pSD significantly improved trained working memory abilities (CogMed indices) as well as non-trained skills, such as visuo-spatial skills, inhibition of automatic responses and phonological processing. The results suggest that standard rehabilitation schedules for children with pSD should be integrated with trainings on executive functions.

Asomatognosia: Structured Interview and Assessment of Visuomotor Imagery.

Asomatognosia designates the experience that one’s body has faded from awareness. It is typically a somaesthetic experience but may target the visual modality (“asomatoscopy”). Frequently associated symptoms are the loss of ownership or agency over a limb. Here, we elaborate on the rigorous nosographic classification of asomatognosia and introduce a structured interview to capture both its core symptoms and associated signs of bodily estrangement. We additionally report the case of a pure left-sided hemiasomatognosia occurring after surgical removal of a meningioma in the right atrium. Despite the wide lesions of the right angular gyrus and of the temporo-parietal junction, the patient did not present visuospatial deficits or bodily awareness disorders other than hemiasomatognosia. The patient and 10 matched controls’ motor imagery was formally assessed with a limb laterality task in which they had to decide whether hands and feet presented under different angles of rotation depicted a left or a right limb. Bayesian statistics showed that patient’s reaction times were significantly impaired exclusively for the left foot and especially for mental rotations requiring somatomotor rather than visual limb representations. This was in accordance with a more enduring left-sided hemiasomatognosia for the lower limbs confined to the somesthetic modality. Our findings shed new light on motor imagery in asomatognosia and encourage the future use of the structured interview introduced here. In addition, the limb laterality task may capture phenomenological elements of a case by chronometric means. This allows a more standardized reporting of phenomenological detail and improves communication across different clinical facilities.

Different Cognitive Profiles Are Associated with Progression Rate and Age at Death in Probable Alzheimer's Disease.

Cognitive profiles characterized by primarily language or visuospatial deficits have been documented in individuals meeting diagnostic criteria for probable Alzheimer's disease (AD), but their association with progression rate or overall survival is not well described. To compare time from diagnosis to severe disease stage and death in probable AD patients classified into three groups based on neuropsychological test performance: marked verbal impairment (Verb-PI) with relatively preserved visuospatial function, marked visuospatial impairment with preserved verbal function (Vis-PI), and balanced verbal and visuospatial impairments (Bal-PI). This prospective cohort study included 540 probable AD patients attending an academic memory clinic who were enrolled from 1995-2013 and followed annually. Eligible individuals had a Mini-Mental State Exam (MMSE) score ≥10 at baseline, and at least one annual follow up visit. We used Cox proportional hazards modeling to analyze the association of cognitive profiles with time to decline in MMSE and CDR Global Score. Sixty-one (11.3%) individuals had a Verb-PI profile, 86 (16%) had a Vis-PI profile, and 393 (72.8%) a Bal-PI profile. MMSE decline to <10 was faster in Verb-PI than Vis-PI (HR 2.004, 95%CI, 1.062-3.780; p = 0.032). Progression to CDR-GS = 3 was faster in Verb-PI individuals compared to Bal-PI (HR 1.604, 95%CI, 1.022-2.515; p = 0.040) or Vis-PI (HR 2.388, 95%CI, 1.330-4.288; p = 0.004) individuals. Baseline cognitive profile did not affect mortality. A recognition of different AD profiles may help to personalize care by providing a better understanding of pathogenesis and expected progression.

Functional Consequences of Poor Binaural Hearing in Development: Evidence From Children With Unilateral Hearing Loss and Children Receiving Bilateral Cochlear Implants.

Poor binaural hearing in children was hypothesized to contribute to related cognitive and academic deficits. Children with unilateral hearing have normal hearing in one ear but no access to binaural cues. Their cognitive and academic deficits could be unique from children receiving bilateral cochlear implants (CIs) at young ages who have poor access to spectral cues and impaired binaural sensitivity. Both groups are at risk for vestibular/balance deficits which could further contribute to memory and learning challenges. Eighty-eight children (43 male:45 female, aged 9.89 ± 3.40 years), grouped by unilateral hearing loss (n = 20), bilateral CI (n = 32), and typically developing (n = 36), completed a battery of sensory, cognitive, and academic tests. Analyses revealed that children in both hearing loss groups had significantly poorer skills (accounting for age) on most tests than their normal hearing peers. Children with unilateral hearing loss had more asymmetric speech perception than children with bilateral CIs (p < .0001) but balance and language deficits (p = .0004, p < .0001, respectively) were similar in the two hearing loss groups (p > .05). Visuospatial memory deficits occurred in both hearing loss groups (p = .02) but more consistently across tests in children with unilateral hearing loss. Verbal memory was not significantly different than normal (p > .05). Principal component analyses revealed deficits in a main cluster of visuospatial memory, oral language, mathematics, and reading measures (explaining 46.8% data variability). The remaining components revealed clusters of self-reported hearing, balance and vestibular function, and speech perception deficits. The findings indicate significant developmental impacts of poor binaural hearing in children.

Elementary visuospatial perception deficit in children with neurodevelopmental disorders

To assess the prevalence of elementary visuospatial perception (EVSP) deficit in children with neurodevelopmental disorders. Using a screening test designed and validated to measure dorsal EVSP ability, 168 children (122 males, 46 females; mean age 10y [SD 1y 10mo], range 4y 8mo-16y 4mo) diagnosed with developmental coordination disorder (DCD), specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), and/or oral language disorder were compared with a group of 184 typically developing children. We also tested 14 children with binocular vision dysfunction and no neurodevelopmental disorder. Children with SLD scored below the interquartile range of typically developing children as frequently (59%) as children with DCD, but only 5% were severely impaired (i.e. scored as outliers). Children with DCD were the most severely impaired (22% of outliers), even more so when they exhibited a co-occuring disorder. Children with language disorder and those with binocular vision dysfunction scored similarly to the group of typically developing children. These results confirm the importance of assessing EVSP in the clinical evaluation of children with neurodevelopmental disorders, in particular those presenting with DCD or SLD. What this paper adds More than half of children with developmental coordination disorder (DCD) scored below the normal interquartile range on the elementary visuospatial perception (EVSP) test. More than half of children with specific learning disorder (SLD) scored below the normal interquartile range on the EVSP test. Twenty-two percent of children with DCD performed as outliers on the EVSP test. Children with language disorder and those with binocular vision dysfunction scored similarly to typically developing children.

Brief Visuospatial Memory Test-Revised: normative data and clinical utility of learning indices in Parkinson’s disease

ABSTRACT Introduction: The Brief Visual Memory Test-Revised (BVMT-R) is a frequently used visuospatial declarative memory test, but normative data in the Czech population are lacking. Moreover, the BVMT-R includes promising learning indexes that can be used to detect learning deficits in Parkinson’s disease (PD). However, its clinical usefulness has not yet been thoroughly examined. Early detection of memory impairment in PD is essential for effective treatment. Therefore, this study aimed to provide BVMT-R Czech normative data for clinical use and to find the detection potential of the principal BVMT-R scores, including new learning indices, to capture the cognitive deficit in PD. Method: The BVMT-R were administered to a normative sample of 920 participants aged 17 to 95 years and to a clinical sample of 60 PD patients; 25 with mild cognitive impairment (PD-MCI) and 35 with normal cognition (PD-NC). In order to provide normative values, multiple regression analyses were employed, and to compare the clinical and control sample, Bayesian Hierarchical Linear Models were used. Results: The best model for regression-based norms showed to be with age + age2 + education + sex as predictors. From all learning indexes, L6 (sum of trials 1–3), followed by, L4 (sum of trials 1–3 multiplied by the difference between the highest and the lowest score) best differentiated between controls or PD-NC and PD-MCI. Conclusions: We provide regression-based normative values for BVMT-R that could be used in clinical settings and meta-analytic efforts. Furthermore, we revealed visuospatial learning and memory deficit in PD-MCI. We have also identified the most discriminative learning index adapted to BVMT-R.

Can adenosine A2A receptor antagonists be used to treat cognitive impairment, depression or excessive sleepiness in Parkinson's disease?

Treatment of non-motor symptoms of Parkinson's disease (PD) is a major unmet need. Targeting adenosine A2A receptors may address some of the neuropsychiatric components of non-motor symptoms – notably cognitive impairment, depression and excessive daytime sleepiness. A2A receptors are located primarily on the indirect gamma-aminobutyric acid (GABA)-ergic striatal output pathway but are also present to some extent in limbic areas of the brain, particularly the nucleus accumbens. Extensive studies show that adenosine antagonists are effective in reversing cognitive deficits in a range of experimental models related to the early executive and visuo-spatial deficits seen in PD. Similarly, A2A receptor antagonists can reverse depressive symptoms in experimental models of PD, including models with high predictive value of effect in humans, and to the same extent as classical antidepressants. Importantly, A2A antagonists are effective in models of the motivational symptoms of depression, which may relate to the apathetic/anhedonic expression of depression that can occur in PD. Adenosine and A2A receptors play a prominent role in regulating the sleep-wake cycle with arousal attributed to A2A receptor antagonism. In rodents, A2A receptor antagonists appear to induce arousal in the active part of the daily cycle only, and not during the inactive phase. This was suggested in small clinical studies in PD where A2A antagonism improved daytime sleepiness without impairing nocturnal sleep. In conclusion, A2A antagonists have potential to affect a range of neuropsychiatric components of PD; this clinical potential requires further investigation in humans.

The effect of Subthalamic nucleus deep brain stimulation on verb and noun naming in Turkish-Speaking Parkinson’s disease patients

Parkinson’s disease (PD) is associated with an action language deficit. Subthalamic nucleus deep brain stimulation (STN DBS) deteriorates verbal fluency, but may improve verb naming more than nouns in PD. We investigated effects of grammatical class (verb vs noun), action content (action vs non-action) of words and unilateral, bilateral or no stimulation on naming. Nouns were named more accurately and faster by controls and PD participants; however the noun-verb difference was higher for PD participants. Language, executive and visuospatial function deficits in PD accounted for this difference between PD group and controls. Noun-verb difference was accounted by differences in imageability, familiarity and complexity of the stimuli. Non-action words were named more accurately than action words in the overall sample. Stimulation conditions did not have an effect on naming. This study in Turkish-speaking participants show an action language deficit due to underlying cognitive deficits without an STN DBS effect in PD.

Differential associations of hypoxia, sleep fragmentation, and depressive symptoms with cognitive dysfunction in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete cessation of breathing during sleep and increased effort to breathe. This study examined patients who underwent overnight polysomnographic studies in a major sleep laboratory in Saudi Arabia. The study aimed to determine the extent to which intermittent hypoxia, sleep disruption, and depressive symptoms are independently associated with cognitive impairments in OSA. In the sample of 90 participants, 14 had no OSA, 30 mild OSA, 23 moderate OSA, and 23 severe OSA. The findings revealed that hypoxia and sleep fragmentation are independently associated with impairments of sustained attention and reaction time (RT). Sleep fragmentation, but not hypoxia, was independently associated with impairments in visuospatial deficits. Depressive symptoms were independently associated with impairments in the domains of sustained attention, RT, visuospatial ability, and semantic and episodic autobiographical memories. Since the depressive symptoms are independent of hypoxia and sleep fragmentation, effective reversal of cognitive impairment in OSA may require treatment interventions that target each of these factors.

The correlation between apraxia and neglect in the right hemisphere: A voxel-based lesion-symptom mapping study in 138 acute stroke patients

Apraxia is frequently described after left hemisphere stroke and results from lesions to a complex network for motor cognition with dorso-dorsal, ventro-dorsal and ventral processing streams. Apraxia also occurs after right hemisphere stroke, but lesion correlates and underlying mechanisms remain to be elucidated.To clarify the role of the right hemisphere in apraxic deficits and the influence of neglect, we prospectively examined apraxia (imitation of meaningless postures and pantomime of tool use) and neglect in 138 acute right hemisphere stroke patients with first-ever ischemic stroke in the middle cerebral artery territory and identified corresponding lesion correlates using voxel-based lesion-symptom mapping.Imitation of meaningless postures was impaired as frequently as after left hemisphere stroke (38.4%) and was significantly associated with neglect. Imitation of meaningless postures was related to temporal (middle temporal gyrus, temporoparietal junction, superior temporal gyrus and sulcus), parietal (angular gyrus, parieto-occpitpial sulcus), secondary sensorimotor cortex and (peri-)insular lesions. Presence of neglect dichotomized the results: a lesion correlate for isolated imitation without neglect was found in the right parieto-occipital cortex, while imitation deficits, when co-occurring with neglect, were related to lateral occipito-temporal, superior temporal sulcus and (peri-)insular lesions. Pantomime of tool use deficits, typical for apraxia after left hemisphere lesions, were found in only 5 cases (3.6%) and only in the context of neglect, and were associated with occipital lobe, ventral and anterior temporal lobe, and inferior frontal (areas 45/47) lesions.The syndrome of apraxia after right hemisphere stroke differs from apraxia after left hemisphere stroke. Imitation deficits are found in both hemispheres after dorso-dorsal stream lesions. Neglect also leads to and explains deficits in imitation and pantomime in patients with right ventral stream lesions. Therefore, in right hemisphere lesions, apraxia can either be explained as impaired visuomotor transformation or as a result of visuospatial deficits.

Working memory and short-term memory deficits in ADHD: A bifactor modeling approach.

Objective: Attention-deficit/hyperactivity disorder (ADHD) has been associated with large magnitude impairments in working memory, whereas short-term memory deficits, when detected, tend to be less pronounced. However, confidence in these findings is limited due to task impurity combined with methodological and statistical limitations of the current evidence base. Method: A well-characterized, clinically evaluated sample of 172 children ages 8-13 years (M = 10.30, SD = 1.42; 72 girls; 64% White/non-Hispanic) were administered multiple, counterbalanced working memory tests. Bifactor-(s-1) modeling was used to characterize the presence and magnitude of central executive working memory, phonological short-term memory, and visuospatial short-term memory deficits in pediatric ADHD. Results: ADHD status was associated with very large magnitude impairments in central executive working memory that are present in most pediatric cases (d = 1.63-2.03; 75%-81% impaired), and these deficits covaried with ADHD inattentive and hyperactive/impulsive symptom severity based on both parent and teacher report. There was also evidence for a unique, albeit significantly smaller, impairment in visuospatial short-term memory (d = 0.60; 38% impaired); however, visuospatial short-term memory abilities did not covary with ADHD symptom severity. There was no evidence linking ADHD with phonological short-term memory deficits across either the dimensional or categorical analyses. Conclusion: These findings provide strong evidence that ADHD is associated with marked central executive working memory deficits that covary with their behavioral symptom presentation across settings. In contrast, visuospatial short-term memory deficits, when present, are likely epiphenomenal, and the most parsimonious conclusion appears to be that phonological short-term memory is intact in pediatric ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Six-item Clock-Drawing Scoring System: a rapid screening for cognitive impairment in Parkinson's disease.

Cognitive impairment, characterised by predominant executive dysfunction and visuospatial deficit, is frequently observed in Parkinson's disease (PD) and may lead to mild cognitive impairment (PD-MCI) and dementia (PD-D). The clock-drawing test (CDT) is a rapid cognitive evaluation that is appropriate for screening frontoparietal lobe dysfunction. This study aimed to evaluate the screening performance of the Six-item Clock-Drawing Scoring System (6-CDSS) in detecting cognitive impairment in PD patients. A retrospective analysis of free-drawn clocks from 136 PD patients was performed. The presence of cognitive impairment and dementia was documented by neurologists according to the standard diagnostic criteria. Diagnostic performance and the optimal screening cut-off scores for cognitive impairment and dementia using the 6-CDSS were determined. One hundred and thirteen patients were documented as having PD with cognitive impairment (PD-CI). Of those, 39 were diagnosed as probable PD-D and 74 with PD-MCI. The optimal screening cut-off scores for PD-CI were 4/5 and 1/2 for probable PD-D. The area under the receiver operating characteristic curve was 0.88 and 0.91, respectively. Multiple regression analysis revealed that low education levels, poor activity of daily living, and older age were associated with low 6-CDSS scores. CDT scoring using the 6-CDSS is a reliable system to screen cognitive impairment in PD and may serve as a simple screening tool for PD-D in clinical practice.

Profound regional spectral, connectivity, and network changes reflect visual deficits in posterior cortical atrophy: an EEG study

Patients with posterior cortical atrophy (PCA-AD) show more severe visuospatial and perceptual deficits than those with typical AD (tAD). The aim of this study was to investigate whether functional alterations measured by electroencephalography can help understand the mechanisms that explain this clinical heterogeneity. 21-channel electroencephalography recordings of 29 patients with PCA-AD were compared with 29 patients with tAD and 29 controls matched for age, gender, and disease severity. Patients with PCA-AD and tAD both showed a global decrease in fast and increase in slow oscillatory activity compared with controls. This pattern was, however, more profound in patients with PCA-AD which was driven by more extensive slowing of the posterior regions. Alpha band functional connectivity showed a similar decrease in PCA-AD and tAD. Compared with controls, a less integrated network topology was observed in PCA-AD, with a decrease of posterior and an increase of frontal hubness. In PCA-AD, decreased right parietal peak frequency correlated with worse performance on visual tasks. Regional vulnerability of the posterior network might explain the atypical pattern of neurodegeneration in PCA-AD.

Toward an integrative model accounting for typical and atypical development of visuospatial short-term memory

ABSTRACT The origin of visuospatial short-term memory (STM) impairment is poorly investigated and is generally considered to be the result of a more global visuospatial deficit. However, previous studies suggest an important influence of two elements on performance in visuospatial STM tasks, the mode of presentation (i.e., simultaneous and sequential), and the visuospatial arrangement (structured vs. unstructured). With regards to a recent proposal, the aim of this study was to examine the development of the two modes of presentation and the visuospatial arrangement of visuospatial information in STM in a hundred typically developing participants aged from 4 years old to adults. Moreover, we also examined how the model explains the pattern of visuospatial STM deficit in two neurodevelopmental syndromes with different profiles in terms of STM abilities, namely Williams syndrome and Down syndrome. We found distinct performance for sequential and simultaneous presentation only from 11 years old with better performance in simultaneous than in sequential presentation mode and a sensitivity to visuospatial arrangement that increases with age. Both syndromes presented deficits at different levels, people with Williams syndrome for visuospatial arrangement and with Down syndrome for simultaneous visuospatial information in STM. The results demonstrate the importance to consider the influence of preexisting visuospatial knowledge on STM abilities. A two processing route model of STM is an interesting framework to interpret the different results.

Peripersonal Visuospatial Abilities in Williams Syndrome Analyzed by a Table Radial Arm Maze Task.

Williams syndrome (WS) is a genetic deletion syndrome characterized by severe visuospatial deficits affecting spatial exploration and navigation abilities in extra-personal space.To date, little is known about spatial elaboration and reaching abilities in the peripersonal space in individuals with WS. The present study is aimed at evaluating the visuospatial abilities in individuals with WS and comparing their performances with those of mental age-matched typically developing (TD) children by using a highly sensitive ecological version of the Radial Arm Maze (table RAM). We evaluated 15 individuals with WS and 15 TD children in two different table RAM paradigms: the free-choice paradigm, mainly to analyze the aspects linked to procedural and memory components, and the forced-choice paradigm, to disentangle the components linked to spatial working memory from the procedural ones.Data show that individuals with WS made significantly more working memory errors as compared with TD children, thus evidencing a marked deficit in resolving the task when the mnesic load increased. Our findings provide new insights on the cognitive profile of WS.

Diagnostics and treatment of chronic cerebral ischemia

5560 patients with the diagnosis “Other cerebral vascular diseases” per 100 000 of elderly population were registered in RF in 2017. Usually this is a code for chronic brain ischemia (CBI) – the most popular diagnosis in Russian neurological practice. However, diagnostic criteria of CBI are not well defined and need to be ascertained. Recent studies show that the most reliable clinical feature of CBI could be cognitive impairment. It is developed before other clinical signs and correlate with severity of vascular brain lesions. Typically, cognitive impairment is subcortical with prominent bradyphrenia, attentional, dysexecutive and visuospatial deficit and relative sparing of memory. However clinical diagnosis of CBI could be only hypothetical. Diagnosis should be verified by MRI or other visualization technic. Diagnosis is verified if neuroimaging revealed silent strokes, microbleeds and vascular leukoencephalopathy. The most important objective of chronic brain ischemia management is the control of basic vascular disease. Besides this, pathogenetic therapy should be performed to improve cerebral microcirculation, neuronal metabolism and to provide neuroprotection. There is positive data on dipyridamole usage in chronic brain ischemia. It has desagregative, vasotropic, antioxidative and antiinflammation properties. Dypiridamole treatment in CBI patients lead to decrease of neuropsychiatric symptoms and improvement of well-being.