NMDA receptor antagonists in the treatment of patients with vascular cognitive imprairments

The paper discusses the possibilities of using the NMDA receptor antagonist memantine in patients with vascular cognitive impairments (CIs). The author gives the data available in the literature and the results of her investigations into the efficiency and safety of treatment in patients with vascular dementia and moderate vascular CIs. The paper presents the results of a Russian multicenter trial of the efficacy and safety of akatinol memantine in patients with CIs, which enrolled 240 patients (mean age 69.5±5.5 years) with moderate CIs or mild dementia (the total Mini-Mental State Examination (MMSE) scores were 22–28). A study group included 148 patients who took akatinol memantine during a follow-up; a comparison group consisted of 92 patients who did not. Therapeutic effectiveness was evaluated using the quantitative neuropsychological scales and from changes in the somatic and neurological status and in the magnitude of emotional disorders at the inclusion in the study (before treatment initiation) and at 1.5, 3, and 6 months of therapy. During akatinol memantine therapy, there were significant reductions in the degree of CIs (lower total MMSE scores; p<0.00000), abnormalities in programming, generalization, and control over performed actions (a change in the total frontal lobe dysfunction battery scores;p<0.00000), and memory disorders, a significant increase in speech fluency (p<0.00000) and attention level (p< 0.00000), and a decrease in the degree of visuospatial deficits (p<0.00000). The effect of the therapy showed itself at its 3 months and continued to rise later on. The performed trial has indicated that akatinol memantine is an effective symptomatic drug to treat both moderate CIs and mild dementia

Sleep and cognitive dysfunctions. Therapeutic approach

This review focuses on the possible mechanisms of sleep disorders in patients with cognitive impairment (CI) of different severity. The interrelation between CI, emotional disorders and insomnia, as well as the dependence of CI severity on the degree of sleep disorders, are discussed. The issues related to treatment of sleep disorders in patients with CI, the advantages and disadvantages of modern somnogenic medications are studied. Recommendations on management of patients with a combination of sleep disorders and CI are provided. Data on the use of Egb 761 to treat CI no dementia and melatonin-based drugs to treat sleep disorders in patients with CI are presented