Cognitive disorders in patients with cerebrovascular diseases in therapeutic practice: diagnostic and management algorithms

Abstract

This review summaries  the main present-day knowledge  on the pathogenesis of cognitive impairement in patients with cardiovascular and cerebrovascular diseases,  combining  both the development of severe  forms such as dementia, and early non-dementia forms of cognitive  impairment.  Risk factors, including  iatrogenic  ones, and the  mechanisms of development of various forms of cognitive impairment in patients with vascular pathologies are discussed  in detail. The definition of human cognitive functions and the modern classification  of cognitive impairment used in real clinical practice are given.  The clinical aspects  of cognitive impairment  in the  therapeutic practice  with a focus on the  review of a wide range  of specific complaints,  reflecting  the  likelihood  of cognitive impairment and non-cognitive symptoms are considered in detail, taking into account the current national  clinical guidelines of professional communities. Possible iatrogenic  factors that worsen the state  of cognitive functions, including an assessment of the anticholinergic drug load on the patient  are discussed  in detail, and a strategy for identifying and solving this issue as part of a therapeutic approach is provided. An algorithmic approach to the identification of non-dementia cognitive impairment in patients with cerebrovascular pathology  is presented by therapeutic specialists  working in the  primary outpatient healthcare sector. The laboratory and instrumental examination options for patients to identify reversible forms of cognitive impairment are considered in detail. The prospective of choosing preventive  non-drug and drug approaches, as well as the therapeutic strategy options for the use  of drugs  that  improve  the  central  nervous  system  functioning  during  management of patients with  cerebrovascular diseases, depending on the type of cognitive impairment in the general  practitioner practice are assessed.