An open controlled trial of the use of galantamine at a maximum dose of 16 mg/day included 41 patients with Parkinson's disease with dementia randomized to a galantamine treatment group (21 patients) and a control group (20 patients). Cognitive, neuropsychiatric, and motor symptoms were assessed clinically before the trial and at 4, 12, and 24 weeks, using the Mini Mental State Examination (MMSE), the cognitive Alzheimer's Disease Assessment Scale (ADAS-cog), the clock drawing test, the Frontal Assessment Battery (FAB), and the Neuropsychiatric Inventory (NPI) with assessment of distress in relatives. Patients treated with galantamine had better scores on the MMSE (p < 0.05),ADAS-cog (p < 0.05), the clock drawing test (p < 0.05), and the FAB (p < 0.01) at the end of the study period as compared with the control group. Changes in total point scores on the NPI-12 at the ends of weeks 12 and 24, as compared with the beginning of the trial, were in favor of the group treated with galantamine, with significant changes in the hallucinations (p = 0.0002), anxiety (p = 0.04), sleep disturbance (p = 0.04), and apathy (p = 0.006) sections. Galantamine treatment was accompanied by decreases in the level of distress in patients' relatives (p = 0.007) and improvements in daily activity (p = 0.003). Improvements in gait and decreases in freezing and falls were seen in the galantamine treatment group. However, two patients of this group showed minor increases in tremor. Side effects (drooling, postural hypotension, nausea, dysuria) occurred in seven patients (30%).
Epidemiological data show that Alzheimer's disease (AD) is the most common cause of acquired cognitive impairment (CI). At the same time, according to statistics, vascular CI and vascular dementia predominate in Russia, which is mainly due to imperfect diagnosis, when any pathological condition associated with cerebral dysfunction in a patient with vascular risk factors is interpreted as dyscirculatory encephalopathy or chronic brain ischemia. However, this can be asthenoneurotic syndrome, migraine, vestibular dysfunction, and a number of neurodegenerative diseases, the most common condition of which is certainly AD. What is more, the treatment of age-related diseases, with the exception of acute vascular disease, is receiving manifestly inadequate attention. All this leads to the lack of a unified methodology for the management of these patients, to the impossibility to have adequate primary medical care, to the low detection rate of CI, to the prescription of drugs without appropriate indications, and to the denial of psychological correction methods. The review highlights the challenges facing the management of patients with AD and the possible ways of their solution.
The paper presents experts' opinion on the clinical manifestations and diagnosis of chronic cerebrovascular disease (CVD) (chronic cerebral ischemia (CCI) and dyscirculatory encephalopathy (DEP)) at the pre-dementia stage. It is noted that DEP/CCI is a common diagnosis in Russian neurological practice, the criteria for which have not been updated for a long time. DEP/CCI most often develops in the presence of cerebral small artery (CSA) disease (cerebral microangiopathy (CMA)), the severity of which can be quantified by magnetic resonance imaging. The main clinical manifestation of DEP/CCI is cognitive impairment that may be subjective or moderate at the pre-dementia stage. Emotional disorders (apathy, depression, anxiety) and instability are considered as possible manifestations of CSA disease. It is noted that headache and vestibular vertigo are not caused by chronic CVD; while in patients with CMA, they are usually associated with other diseases (primary headache, peripheral vestibular vertigo, and vestibular migraine). The diagnosis of DEP/CCI should be based on the presence of cognitive impairment, reliable neuroimaging signs of CVD, and the exclusion of another cause of cognitive impairment.
The paper provides data on current neuroimaging techniques for diagnosing Alzheimer’s disease and vascular cognitive impairment (CN). Structural neuroimaging methods can identify potentially treatable diseases leading to dementia and assess the magnitude and localization of atrophic and cerebrovascular changes in brain tissue. Particular attention is paid to the specific signs of Alzheimer’s disease: to the visual assessment of sections and the use of various rating scales (GCA, MTA, Koedam). Vascular changes that are most significant for the development of CI are considered. A new approach to diagnosing CI is presented, by taking into account the biomarkers of amyloidosis, tauopathy, neurodegeneration, and cerebrovascular damage. The results of the authors’ own investigations using positron emission tomography, single photon emission computed tomography, magnetic resonance spectroscopy, and functional magnetic resonance imaging at rest allow these techniques to be recommended for the early diagnosis of CI of different genesis.
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