Affiliation:
1. Volgograd State Medical University
Abstract
The article is devoted to the analysis of various pathogenetic mechanisms involved in the formation of chronic brain ischemia. The authors discuss current trends in society, leading to a wide spread of cerebrovascular diseases: an increase in life expectancy and a constantly increasing level of psychosocial stresses. The paper considers the variety of clinical manifestations, course options, the pace of development of this pathology, diagnostic and therapeutic difficulties encountered by doctors treating this category of patients. Particular attention is paid to symptoms that prevent a full course of treatment and prevention of chronic cerebral ischemia, such as asthenia and impaired statolocomotor function. The leading pathogenetic mechanisms that play a role in the formation of these syndromes are discussed. Various approaches to the treatment of this pathological condition are considered. The possibility of using drugs with a multimodal effect is discussed. An analysis of a clinical case involving a patient with a long history of chronic brain ischemia is presented. The main factors that are obstacles to a full pathogenetically directed treatment are identified and ways to solve this therapeutic problem are given. The authors conclude that it is necessary to formulate a wellthought- out therapy strategy for this pathological condition, including timely, well-considered use of drugs with a neurotrophic, neuromodulating effect, which allows further measures, including non-pharmacological approaches. Particular attention is paid to the role of social support and physical activity for the prevention of cerebrovascular diseases.
Reference51 articles.
1. Skvorcova V.I., Stahovskaya L.V., Gudkova V.V., Alekhin A.V. Chronic insufficiency of cerebral circulation. In: Gusev E.I., Konovalov A.N., Skvorcova V.I. (eds.). Neurology. The national leadership. 2nd ed., Revised and add. М.: GEOTAR- Media; 2018. P. 338-345. (In Russ.)
2. Lucenteforte E., Lombardi N., Vetrano D., La Carpia D., Mitrova Z., Kirchmayer U., Corrao G., Lapi F., Mugelli A., Vannacci A. Inappropriate pharmacological treatment in older adults affected by cardiovascular disease and other chronic comorbidities: a systematic literature review to identify potentially inappropriate prescription indicators. Clin Interv Aging. 2017;12:1761–1778. doi: 10.2147/CIA.S137403.
3. Parfenov V.A. Combination and mutual effect of Alzheimer’s disease and cerebrovascular disease. Meditsinskiy sovet = Medical Council. 2019;(9):8-13. (In Russ.) doi: 10.21518/2079-701X-2019-9-8-13.
4. Scrobot O.A., O’Brien J., Black S. et al. The vascular impairment of cognition classification consensus study. Alzheimers Dement. 2016;13(6):624–633. doi: 10.1016/j.jalz.2016.10.007.
5. Tzourio C., Anderson C., Chapman N. et al. PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;163(9):1069–1075. doi: 10.1001/archinte.163.9.1069.