Treatment for mixed cognitive impairments and emotional disorders in young and middle-aged patients

Objective: to evaluate the efficacy of Tanakan® (EGB761®) used in young and middle-aged patients with mixed cognitive impairments (CI) and emotional diseases.Patients and methods. An open-label observational study of the efficacy of Tanakan® was conducted in 54 patients aged 18–4 years with CI and psychoemotional disorders. Tanakan® was administered at a daily dose of 120 mg (40 mg t.i.d) for 3 months.Results. Tanakan® therapy resulted in health improvement, as shown by the HAM (Health, Activity, Mood) questionnaire; the mean score of the latter increased from 3.86 at baseline to 4.84 after 3 months of treatment. There were improvements in three HAM questionnaire items: the mean score of the item «Health» increased from 3.69 to 4.79; that of the item «Activity» from 3.65 to 4.58, and that the item «Mood» from 4.25 to 5.14 after the completion of the investigation.Tanakan® therapy also demonstrated improvements in memory (the mean number of correctly repeated words increased from 5.7 to 6.7 at the beginning of a visit and from 4.2 to 5.8 at its end) and in attention (the mean symbol-digit coding test score increased from 48.1 to 55.7%. There were no clinically relevant differences between patients with higher and secondary education in the efficacy of Tanakan®.Conclusion. Tanakan® had a very good safety profile; no adverse drug events were recorded during the investigation. Almost all the 53 (98.1%) of the 54 patients were satisfied with Tanakan® therapy results after 3 months of treatment

Management of patients with demension: holinergic deficiency and its correction

The article discusses clinical symptoms, diagnostic criteria and basic principles of managing patients with dementia. It also provides the classification of cognitive disorders by severity degrees and considers the differences between the different degrees of dementia severity. The main features of the pathogenesis of cognitive disorders in dementia, the most important approaches to managing patients with dementia are highlighted. The article presents a detailed review of modern drugs used to correct cognitive and other manifestations of dementia

Diagnosis and treatment of vascular cognitive impairments

Vascular brain diseases are one of the leading causes of death and disability in developed countries. Along with acute disorders of cerebral circulation, chronic cerebrovascular disorders are of great medical and social importance, one of the main clinical manifestations is vascular cognitive impairments. The article discusses the pathogenetic and clinical variants of vascular cognitive impairments, presents their modern classification and approaches to diagnosis. The importance of the earliest possible diagnosis of vascular cognitive impairments is due to the fact that they can be one of the first manifestations of cerebrovascular insufficiency, before the development of clinically obvious strokes or cardiovascular diseases in general. Early diagnosis of vascular cognitive impairments is necessary both for the prevention of vascular and neurodegenerative dementia and for the prevention of strokes and other acute vascular episodes. A clinical example of non-stroke formation of mild vascular cognitive impairment is presented. Signs of cognitive impairments typical of chronic cerebrovascular insufficiency, such as a slowdown in the rate of mental activity and disorders of frontal executive functions in combination with behavioral and emotional disorders, are described. The article discusses the issues of treatment of vascular cognitive impairments, which should be comprehensive and include the correction of the underlying vascular disease, non-drug (regular physical activity, smoking cessation, cognitive training) and drug treatment methods aimed at improving cognitive functions. Possibilities of modern neuroprotective and symptomatic therapy of cognitive disorders, the place of EGb 761® in the treatment of vascular cognitive impairments are shown

Diagnosis and treatment for frontotemporal degenerations

Frontotemporal degeneration (FTD) is a heterogeneous group of diseases causing neurodegeneration on the frontal and/or anterior temporal lobes. FTD is the second most common dementia in presenile age (up to 65 years) after Alzheimer’s disease. Usually, FTD is diagnosed at the age of 45-65 years, but an earlier and later onset is possible. Up to 40% of FTD cases have a positive family history. According to the current classification, the following clinical variants of FTD are distinguished: behavioral variant of FTD, agrammatic variant of primary progressive aphasia (PPA) and semantic variant of PPA. As they develop, these clinical syndromes overlap widely with each other and with atypical parkinsonism syndromes (progressive supranuclear paralysis, cortico-basal syndrome) and less often with motor neuron disease. Variations in the clinical features are determined by the localization of the degenerative-atrophic process. The behavioral variant of FTD accounts for more than half of the cases of FTD and is characterized by a combination of cognitive, behavioral, and emotional-affective disorders. In PPA, speech disorders appear for no apparent reason and progress continuously in the absence or with minimal severity of other cognitive and behavioral disorders for two or more years. The clinical features of PPA depend on the localization of the pathological process. The article reviews a clinical case of an agrammatic variant of PPA. Modern approaches to the diagnosis and management of this group of patients are shown. It seems appropriate to use memantin in patients with agrammatic variant of PPA

NAFTIDROFURYL USE IN MODERATE VASCULAR COGNITIVE DISORDERS

Prevention of progression to moderate vascular cognitive disorders (MVCD) in dementia is based on medicinal and nonmedicinal correction of major cardiovascular risk factors, at the same time antidementia, vasoactive and nootropic drugs efficiency is not proven. The own experience of use in 30 patients (22 women and 8 men) with MVCD in age from 46 to 75 years (mean age 67,1 ± 6.6 years) of Naftidrofuryl (Duzofarm) at a dose of 100 mg three times a day for 30 days is provided. After a month of treatment a significant improvement of cognitive function by the Montreal scale assessment of mental functions, the alpha-numeric coding test, and emotional state test is established as measured by the hospital scale of anxiety and depression. Good tolerability, absence of significant side effects when using Naftidrofuryl for MVCD are observed. Longer placebo-controlled studies of the effectiveness of Naftidrofuryl in patients with MVCD are needed

Prevalence of cognitive impairments in neurological diseases: Analysis of the activities of a specialized outpatient reception office

The paper gives the data obtained from the preliminary analysis of the activities of RussiaХs first Memory Impairment Laboratory. The findings allowed the authors to estimate the approximate prevalence of cognitive impairments (CIs) in patients with various pathological processes. The authors made a differential analysis of the causes of the varying severity of CIs. The causes of the latter in patients of varying age were shown to be different. There were preliminary data on the association of cognitive with other neuropsychological impairments. The ongoing studies make it possible to make a more in-depth analysis of the mechanisms of the development of these or those CIs in a Russian population, to define diagnostic approaches in detail, and to improve the quality and timeliness of medical care given to these patients

ENDOVASCULAR INTERVENTION OF CORONARY ARTERY BYPASS GRAFT

In the first year occlusion occurs 10-15% of coronary artery bypass graft in 10 years - 50%, which causes the resumption of anginal patients after CABG. One of the most effective and safe methods of treatment of these patients is recognized endovascular intervention artery bypass graft failure or inter-vention of native coronary artery. In contrast classical percutaneous coronary reconstructions, for which there exist algorithms endovascular treatment for minimizing intraoperative risk and achieving the best long term results, treatment of saphenous vein grafts (SVG) still remains a challenging clinical problem. This article is a summary review of the literature dedicated to endovascular interventions for myocardial revascularization on the coronary artery bypass graft in patient after CABG. Analysis of the research allowed us to draw conclusions about the tactics of endovascular treatment of patients with return of angina after CABG, as well as about the defeat of the saphenous vein grafts lesions for endovascular interventions, and to identify the technical features of the SVG stenting