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Vascular cognitive impairment (VCI) is the main manifestation of dyscirculatory encephalopathy (DEP). According to the severity of cognitive impairment, Stage I DEP corresponds to mild (subjective) cognitive impairment; stage II DEP to moderate cognitive impairment; stage III DEP to severe cognitive impairment or vascular dementia. VCI is diagnosed on the basis of cognitive impairment, the clinical and neuroimaging findings confirming the presence of cerebrovascular disease, and the neuropsychological study results indicating a cognitive defect. Citicoline is one of the most widely used nootropic drugs for cerebrovascular pathology. The treatment of VCI involves the prevention of stroke and progressive chronic cerebrovascular disease (CCVD) and the use of drugs improving cognitive functions. Citicoline is one of the most widely used nootropic drugs for cerebrovascular disease. This drug was synthesized in Japan to treat stroke, then it became widely used in different countries in patients with CCVD and VCI. The data of clinical trials and a Cochrane systematic review prove the efficacy and safety of citicoline in the elderly and senile patients.

Cognitive impairment (CI) associated with brain aging is a consequence of disorders varying in etiology and pathogenesis, which often coexist in elderly patients and can have a mutual impact on the clinical manifestation, severity, and rate of progression of CI. Alzheimer's disease (AD) and vascular CI are the most common forms of dementia in the elderly. In recent decades, there has been increasing evidence that there is a close relationship between these forms due to a substantial overlap of their risk factors, clinical manifestations, neuromorphological changes, as well as genetic and neuroimaging biomarkers. The complex multicomponent relationship of these disorders also makes it difficult to elaborate effective preventive and therapeutic approaches in these patients.

The article presents a modern view of the pathogenic mechanisms of cerebrovascular diseases was Observed that currently available data indicate the existence of different variants of ischemic lesions of the brain and their clinical manifestations. Based on the available data and the results of our own studies, it is concluded that therapeutic strategies in patients with CVD should take into account the variety of clinical manifestations, the existence of various options for ischemic lesions of the brain substance, especially the course of the disease, heterogeneity of pathogenetic mechanisms and risk factors, as well as multi-morbidity of patients. Discusses the use of the drug Vazobral in CVD.

IntroductionThe role of circulating immune cells in the pathophysiology of cerebrovascular accidents is currently under debate. The aim of this study was to characterize peripheral immune cell subsets in patients undergoing carotid endarterectomy (CEA).Material and methodsWe conducted a prospective observational study in a group of 124 patients with significant carotid stenosis undergoing carotid endarterectomy, both symptomatic and asymptomatic. We compared the percentages of circulating immune cells: B lymphocytes, T lymphocytes, T helper, cytotoxic T, CD4+/CD8+ ratio, T regulatory, monocytes and NK cells before CEA and 6 h after the procedure.ResultsTotal lymphocyte count and cytotoxic T lymphocyte count decreased 6 h after CEA in both subgroups. The NK cell level decrease was statistically significant only in the symptomatic subgroup (19.41 ±9.30 before CEA and 16.52 ±9.37 after CEA; p = 0.0044), but not in the asymptomatic subgroup (17.88 ±9.14 before CEA and 15.91 ±9.51 after CEA; p = 0.0886). The T lymphocyte level showed a statistically significant increase only in symptomatic patients (69.74 ±10.16 before CEA vs. 71.45 ±9.77 after CEA; p = 0.0462), and not in the asymptomatic subgroup (70.08 ±11.19 prior to CEA and 70.21 ±12.35; p = 0.9048). B lymphocyte, helper T lymphocyte and regulatory T (Treg) lymphocyte (CD4+/CD25+) levels showed a significant increase after CEA.ConclusionsThis is the first study to compare circulating immune cells in patients undergoing carotid endarterectomy. Only the symptomatic subgroup experienced a significant decrease in the NK cell level and an increase in the T lymphocyte count after CEA. This study enriches our understanding of immune cell kinetics during carotid endarterectomy.

Введение. Метод Борна стал золотым стандартом тромбоцитарной агрегометрии вполне заслуженно: он исторически был разработан первым, первым же вошел в клиническую практику и за счет этого приобрел самую обширную доказательную базу. Имеющиеся сведения наглядно демонстрируют его достоинства и недостатки. Метод Platelet Function Analysis (PFA) был разработан значительно позднее, но во многом в ответ на ограничения метода Борна и в соответствии с клиническим требованием иметь в практике pointofcare метод оценки агрегационной активности тромбоцитов. Особенностью PFA является оценка агрегационного ответа тромбоцитов текущей (это важно) цельной крови в условиях имитации повреждения сосудистой стенки мелких сосудов. Цель исследования: изучить соответствие результатов теста PFA данным, получаемым с помощью золотого стандарта агрегатометрии по Борну, а также определить причины и диагностическое значение расхождений. Материалы и методы. Обследован 51 пациент (28 мужчин и 23 женщины) с хронической цереброваскулярной патологией. Из них 35 человек получали per os препараты ацетилсалициловой кислоты (АСК) в дозе 100 150 мг/сут (группа 1), а 16 пациентов клопидогрел в дозе 75 мг/сут (группа 2). Кроме того, 20 человек, получавших АСК, были обследованы дважды: до начала приема и через 14 дней. Все пациенты были обследованы по следующим показателям: концентрация гемоглобина, количество тромбоцитов, скорость оседания эритроцитов (СОЭ), содержание общего белка, глюкозы, триглицеридов и общего холестерина. Также определяли коагулологические показатели: активированное частичное тромбопластиновое время, протромбиновое время с расчетом международного нормализованного отношения, уровень фибриногена и концентрацию Ддимера методом латексных частиц с высоко специфичными моноклональными антителами к Ддимеру на автоматическом коагулометре ACL ElitePro (США) с использованием наборов реагентов фирмы Instrumentation Laboratory (США). Результаты. Группы оказались практически одинаковыми по возрасту, наличию и выраженности фонового воспалительного процесса и состоянию системы гемостаза. Оценка агрегации тромбоцитов в ответ на АДФ и адреналин у пациентов до начала приема АСК в дозе 150 мг/сут и через 2 нед не выявила противоречивых данных и показала, что оба метода отчетливо регистрируют ее угнетение. На фоне приема АСК результаты агрегометрии тромбоцитов обоими методами с индуктором АДФ совпали с коэффициентом корреляции r 0,74 (p 0,05), с индуктором адреналин с коэффициентом r 0,63 (p 0,05). На фоне приема клопидогрела результаты АДФиндуцированной агрегометрии, полученные обоими метода ми, совпадали с большим коэффициентом корреляции: r 0,82 (p 0,05), адреналининдуцированной агрегации r 0,88 (p 0,05). Корреляционный анализ выявил зависимость результатов, получаемых каждым методом на фоне приема АСК или клопидогрела, от следующих параметров: возраст, концентрация фибриногена, количество тромбоцитов и СОЭ, что в большей степени проявилось для PFA. Заключение. Очевидно, что метод Борна показывает лишь то, насколько тромбоциты в целом чувствительны к действию ингибитора агрегации, тогда как метод PFA демонстрирует реальную картину образования сгустка на фоне всех имеющихся условий, т.е. как результат всего многообразия взаимодействий тромбоцитов per se в цельной крови. Другими словами, метод PFA отражает общий уровень тромбогенности, которая, в свою очередь, очевидно является причиной так называемой резистентности к антиагрегантам, нередко наблюдаемой у данной категории больных., Introduction. Borns method became the gold standard of platelet aggregometry because it has been developed historically the first. On today it has the most extensive evidence base showing clearly its advantages and disadvantages. The Platelet Function Analysis (PFA) is a method developed much later as a response to the limitations of the Borns method in order to have a pointofcare platelet aggregometry in practice. The main feature of PFA is the evaluation of platelet aggregation occurring in flowing whole blood under conditions simulating vascular wall damage. Aim: to study the compliance between PFA test results and the data obtained by Borns aggregatometry as well as to determine the causes and diagnostic value of their discrepancies. Materials and methods. The study included 51 patients (28 men and 23 women) with chronic cerebrovascular pathology, from them 35 were intaking acetylsalicylic acid, ASA (100 150 mg/day per os, group 1), and clopidogrel in 16 patients (75 mg/day per os, group 2). In addition, 20 patients with ASA were examined twice as before as well as in 14 days. Lab testing included hemoglobin, platelet count, erythrocyte sedimentation rate, total protein, glucose, triglyceride, total cholesterol, activated partial thromboplastin time, prothrombin time as international normalized ratio, fibrinogen and Ddimer with using of ACL ElitePro coagulometer and reagents kits by Instrumentation Laboratory (USA). Results. The groups were appeared almost identical in age, the severity of the background inflammatory and the clotting conditions. Both methods have registered clearly platelet aggregation inhibition in 2 weeks of ASA administration both in response to ADP and to epinephrine, and no any disagreements was found between the methods. By ASA administration the ADPinduced aggregations from Borns method and PFA showed the correlation r 0.74 (p 0.05), the epinephrininduced aggregations have coincided with r 0.63 (p 0.05). In cases with clopidogrel we found large correlation coefficients as r 0.82 (p 0.05) and r 0.88 (p 0.05) between ADPinduced aggregations and between epinephrininduced aggregations, respectively. The correlation analysis revealed that the results obtained by each method were closely related to parameters such as age, fibrinogen, platelet count and erythrocyte sedimentation rate, and that was more evident for PFA. Conclusion. Obviously, the Borns method shows only how platelets are sensitive generally to the antiaggregation agents, whereas the PFA method plots a real picture of clot formation against all available conditions, i.e. as a result of the whole variety of platelet interactions per se in whole flowing blood. It does mean the PFA method reflects the overall level of thrombogenicity. In turn that is obviously the cause of the socalled resistance to antiplatelets observed often in such category of patients., №3(79) (2019)

An analysis of data of carotid angiographies was made in 146 patients with chronic cerebrovascular disease. Combined lesions of the common and internal carotid artery with clinical signs were revealed in 2 (1,4%) patients. A crossed extraanatomic bypass from the left common carotid artery to the right internal carotid artery was performed in one patient. The orthotopic common-internal autovenous bypass on the right side was carried out for another patient. According to obtained results, the authors suggested that the orthotopic or extraanatomic common-internal carotid artery bypasses could be applied in case of impossibility of endovascular intervention, when patients had the combined atherosclerotic lesions of common carotid and internal carotid artery.

Objective : to investigate the specific features of epilepsy that manifests itself in the presence of chronic cerebrovascular disease. Patients and methods. A total of 304 patients (a study group of 174 patients with new-onset seizures developing in the presence of cerebrovascular disease and a control group of 130 patients with cerebrovascular disease and no seizures) were examined. They underwent clinical neurological examination, electroencephalography (EEG), ultrasonic duplex scanning of extra- and intracranial arteries with functional tests, and visualization of brain structures. Results. Focal seizures were prevalent in the patients with cerebrovascular disease and epilepsy. It was found that there was a preponderance of left-sided localization of EEG foci of abnormal activity and a tendency to more commonly detect subcritical and critical stenoses in the left carotid bed in the patients with epileptic seizures. Diminished perfusion reserves in the posterior circulation system were more frequently observed in the patients with seizures in the presence of cardiovascular diseases. Moreover, the patients with seizures displayed a more profound degree of brain ischemia with the frequent cortical and subcortical localization of dyscirculatory foci. Thus, a study of perfusion reserves, localization of vascular foci, and degree of occlusive changes in the wall of brachiocephalic vessels allows identification of risk factors for epilepsy in the patients with cerebrovascular disease and promotes the prediction of the course of the disease.

Purpose: The aim of this study was to clarify whether decreases in baseline regional cerebral blood flow (rCBF) and in residual cerebral vasoreactivity (CVR), assessed by the acetazolamide (ACZ) challenge, can detect misery perfusion in patients with chronic cerebrovascular disease (CVD). Methods: Oxygen extraction fraction (OEF) and other haemodynamic parameters were measured in 115 patients (64±9 years old) with unilateral cerebrovascular steno- occlusive disease (>70% stenosis) using 15 O-gas and water PET. A significant elevation of OEF, by greater than the mean+2SD compared with healthy controls, was defined as misery perfusion. CBF, CVR determined by percent change in CBF after ACZ administration, OEF and other haemodynamic parameters in the territories of the bilateral middle cerebral arteries were analysed. Diagnostic accu- racy for the detection of misery perfusion using the criteria determined by baseline CBF and CVR was evaluated in all patients and in only those patients with occlusive lesions. Results: Ten of 24 patients with misery perfusion showed a significant reduction in CVR. Using criteria determined by significant decreases in CVR and baseline CBF, misery perfusion was detected with a sensitivity of 42% and a specificity of 95% in all patients. In patients with occlusive lesions (n=50), sensitivity was higher but specificity was slightly lower. The diagnostic accuracy of the threshold determined by baseline CBF alone was similar in all patients and in only those patients with occlusive lesions, and was higher than that achieved using the asymmetry index of OEF. Conclusion: Reductions in CVR and baseline CBF in the ACZ challenge for CVD would detect misery perfusion with high specificity. Reduction in baseline rCBF is more accurate than reduction in CVR alone for the detection of misery perfusion.