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Patients with vertebrobasilar insufficiency, which are frequent in neurological and neurosurgical practice, require a complex examination to reveal its ethiology and to perform a differential diagnostics. The study objective was to develop a diagnostic algorithm for detection of clinically significant forms of Kimmerle anomaly, and to introduce a new technique for surgical treatment under intraoperative monitoring of the vertebral artery decompression. When a patient with the Kimmerle anomaly shows a vertebrobasilar insufficiency, a comprehensive surgical policy includes a complex clinicalphysiological assessment of the vertebrobasilar basin (from vertebral arteries entrances up to the basilar artery and its branches). If any other pathology is excluded, the Kimmerle rings (foramen arcuale) are removed and hemodynamics in the vertebrobasilar basin is estimated by clinical and graphical Doppler methods.

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<b><i>Background:</i></b> Chronic cerebral ischemia (CCI) is a form of cerebrovascular disease manifested as a vascular cognitive impairment (VCI). The management of the patients with CCI is determined by a healthy lifestyle and early therapy aimed at correcting and preventing this disease. Divaza is a drug with endothelial protective and nootropic effects. We present the final efficacy and safety analysis of all-Russian, open-label, prospective, observational, multicenter study of Divaza and emphasize the role of demographic and socioeconomic factors in cognitive disorder (CD) progression. <b><i>Methods:</i></b> CCI patients (<i>n</i> = 2,583) with or without CD were enrolled. Patients received Divaza (2 tablets 3 times per day for 12 weeks). Montreal Cognitive Assessment (MoCA) testing was required. The change in the mean MoCA score post-treatment was used as the primary endpoint. As the secondary endpoints, the number of patients with a MoCA &#x3c;26 and ≤17 (dementia); the percentage of patients with a MoCA score improvement in different age groups; the dynamics of mean MoCA score in age groups; and the relationship between CD and sex or regional social/economic factors were assessed. <b><i>Results:</i></b> Divaza therapy led to a significant improvement: the mean MoCA score was up to 20% higher post-treatment (Wilcoxon test, <i>p</i> &#x3c; 0.0001 vs. baseline). The number of participants with MoCA ≥26 increased by 33.6%. The number of patients with dementia was 4.1 times less after therapy (<i>p</i> &#x3c; 0.00001 vs. baseline). Divaza improved cognitive functions of patients in each age group. Findings demonstrate that regional socioeconomic factors contribute to CD development and severity. The observed divergence between sexes was a result of a larger number of women enrolled. The study confirmed the safety of Divaza. <b><i>Conclusions:</i></b> In the study, we observed the efficacy of Divaza for the treatment of CD: a therapy contributed to an increase in the mean MoCA score and the positive dynamics in the number of patients with cognitive improvement.

В статье рассматривается научно обоснованный подход к фармакотерапии сосудистой и смешанной деменции. Определены роль и место мемантина, неконкурентного низкоаффинного антагониста NMDA-рецепторов в регуляции глутаматзависимых звеньев эксайтотоксичности при смешанных деменциях. Показаны эффективность мемантина при различных формах и всех стадиях деменции, в т. ч. при смешанной деменции, а также сочетаемость с другими лекарственными препаратами при комбинированной терапии, благоприятный профиль безопасности и хорошая переносимость препарата.Ключевые слова: смешанная деменция, комплексная антидементная терапия, мемантин.The article provides a scientifically grounded approach to pharmacotherapy of vascular and combined mental debility. The role and place of memantin, an uncompetitive low-affinity antagonist of NMDA-receptors in regulation of glutamate-dependent links of excitotoxicity in combined mental debilities. The effectiveness of memantin is proved for all stages and in various forms of mental debility, including combined mental debility, as well as compatibility with other drugs in combined therapy, a favourable safety profile and good drug tolerability.