Aim. To study the role of neuroinflammation and cerebral structural factors in the development of cognitive impairment in the recovery period of ischemic stroke. Methods. In 55 patients with ischemic stroke the assessment of global cognitive status in acute and recovery period of ischemic stroke, evaluation of cytokine concentrations (interleukin-1β, interleukin-4, interleukin-6, interleukin-10 and tumor necrosis factor α) in cerebrospinal fluid and blood serum, as well as a number of MRI morphometric and diffusion tensor parameters were performed. Results. Predictors of stable cognitive status were low concentration of interleukin-6 and -10 and interleukin-1β and -10 dominance in cerebrospinal fluid, high fractional anisotropy of ipsilateral superior longitudinal fasciculus in the acute phase of stroke. Predictors of positive trend of cognitive status include low level of C-reactive protein, intermediate values of fractional anisotropy of the designated tract, high level of high-density lipoproteins in serum and interleukin-10 in cerebrospinal fluid, codominance of interleukin-1β and -6 in serum and interleukin-10 in cerebrospinal fluid, predominance of interleukin-10 over interleukin-1β in serum, as well as lesser degree of stenosis of the ipsilateral internal carotid artery. Predominance of interleukin-1β over interleukin-10 in serum, large volume of the brain ventricles, lower values of fractional anisotropy of ipsilateral superior longitudinal fasciculus, low level of high-density lipoproteins and greater degree of stenosis of the ipsilateral internal carotid artery can be considered as predictors of negative trend of cognitive status. Conclusion. The trajectory of cognitive status in the recovery period of ischemic stroke is determined by the profile of neuroinflammation in conjunction with microstructural integrity of the ipsilateral superior longitudinal fasciculus, as well as severity of atherosclerosis of the carotid artery on the side of stroke, level of high-density lipoproteins and ventricular dilation in the acute period of the disease.
Arterial hypertension (AH) is the major modifiable risk factor for cognitive impairment (CI), including dementia, CI in cerebrovascular and neurodegenerative diseases, including Alzheimers disease. By 2050, the number of people with dementia will approximately 3 times increase due to the aging population and limited opportunities for drug prevention and treatment of severe CI. In connection with the above, it seems necessary to create an expert consensus, which would summarize the evidence-based medicine data available to date on the effect of antihypertensive therapy (AHT) on cognitive function (CF). In the expert consensus, the data of prospective randomized clinical trials, observational and population studies, meta-analyzes on the effect of AHT on the risk of dementia and CI progression, including certain CF, were summarized and analyzed. The consensus considers the effect of antihypertensive drugs (AHD) on various cognitive domains. Literature data give evidence that AHT reduces the risk for dementia, including vascular dementia, reduces the risk of for dementia in Alzheimers disease, as well as reduces the risk and can prevent the progression of non-dementia CI. The effect of AHT on various CF has been little studied. Most meta-analyzes did not reveal the benefits of any class of AHD; however, one study demonstrated the advantage of angiotensin receptor blockers, while another study diuretics. The consensus emphasizes that, given the high incidence of AH in the general population, AHT may be one of the most effective ways to prevent CI or delay CI progression. The effect of different classes of AHD on CF requires further study. It is necessary to conduct a larger number of well-designed randomized clinical trials that would assess the state of executive functions in patients with AH.
Cerebral amyloid angiopathy (CAA) is a specific variant of cerebral small vessel disease, associated with high risk of spontaneous intracerebral bleedings, cognitive disorders and hemorrhagic complications of antithrombotic and thrombolytic therapy. One of key markers of CAA is a relatively rare neurovisual phenomenon – cortical superficial siderosis (CSS). Two clinical cases of CAA with CSS are described in the present paper. In the first case, typical CAA complication were observed: intracerebral bleeding and cognitive disorders. In the second case, CAA was symptom-free. Analysis of clinical cases and literature data shows phenotypic heterogeneity of CAA and confirms advisability of routine use of paramagnetic conditions of MRT to examine patients with cerebrovascular disease.
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