[Cognitive impairment in patients of cardiac surgery with senile asthenia syndrome and preastenia]. / Narusheniya kognitivnykh funktsii u patsientov kardiokhirurgicheskogo profilya s sindromom starcheskoi astenii i preastenii.

OBJECTIVE: To identify the features of the cognitive status in patients with cardiac surgery profile with senile asthenia syndrome (SAS) and preasthenia. MATERIAL AND METHODS: A study included 272 patients admitted for coronary artery bypass grafting (CABG). Screening for preasthenia and SAS in patients before surgery was performed using the Brief Battery of Physical Functioning Tests. SAS and preasthenia were detected in 15% of patients (n=41). Seventy-five patients were selected in the comparison group without asthenia. Assessment of the state of cognitive functions was carried out using screening neuropsychological scales - the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). RESULTS: The median of the MMSE score (27 [26; 28] and 28 [27; 29], p=0.04), and the MoCA score (23 [19; 25] and 25 [23; 27], p=0.0085) was significantly lower in patients with asthenia and pre-asthenia compared to patients without asthenia. According to the MoCA, about 60% of patients in the pre-asthenia-asthenia group had severe cognitive impairment, while in the group without asthenia, more than 30% of cases had normal cognitive functions (p=0.003). Significant intergroup differences were found in MoCA subtests, reflecting visuospatial skills, abstraction, verbal fluency and working memory (p=0.01-0.04). Regression analysis showed that age and physical functioning index (severity of asthenia) most significantly contributed to the basic cognitive status assessed by MoCA. CONCLUSION: Features of the cognitive status in patients of cardiac surgery with the SAS and preasthenia are impairments of visuospatial thinking, verbal fluency, abstract thinking and working memory. The MoCA was shown to be informative in determining the basic cognitive status of cardiac surgical patients. At the same time, the greatest contribution to the basic cognitive status is made by age and the indicator of physical functioning, which characterizes the degree of asthenia.

[Cerebrovascular complications in patients with moderate and small stenosis of the carotid arteries in the hospital period of coronary artery bypass grafting using cardiopulmonary bypass]. / Tserebrovaskulyarnye oslozhneniya u patsientov s gemodinamicheski neznachimymi stenozami sonnykh arterii v gospital'nom periode koronarnogo shuntirovaniya s ispol'zovaniem iskusstvennogo krovoobrashcheniya.

OBJECTIVE: Assessment of the incidence of acute cerebral circulatory disorder (ACCD) and decompensation of chronic cerebral ischemia (CCI) in the hospital period of coronary artery bypass graft performed using artificial circulation in patients with- and without moderate and minor carotid artery stenosis. MATERIAL AND METHODS: One hundred and twenty-eight patients were examined. Neurological and neuropsychological examinations, neuroimaging were performed, concentrations of S100ß protein in blood serum were determined. RESULTS: In the group with stenosis, 3.5% of patients were diagnosed with ACCD, while patients without carotid artery damage did not have this complication. The frequency of decompensation of CCI in patients with stenosis was significantly higher (52%) compared with the group without stenosis (34%). Early postoperative cognitive dysfunction (POCD) with an equally high frequency was diagnosed in both groups: 63% with stenosis and 65% without carotid artery stenosis. A decrease in the strength and mobility of nervous processes, deterioration of memory, workability and increased exhaustion of attention were revealed. CONCLUSION: Patients with moderate and minor stenoses are more susceptible to the development of cerebrovascular complications than patients who do not have atherosclerotic lesions of the carotid arteries and need more thorough preoperative preparation.

[Neurophysiological correlates of postoperative cognitive disorders]. / Neirofiziologicheskie korrelyaty posleoperatsionnykh kognitivnykh rasstroistv.

OBJECTIVE: A special place among cognitive disorders in patients with cardiovascular diseases is given to postoperative cognitive dysfunction (POCD). The study aimed at investigating the patterns of beta-2 activity associated with postoperative cognitive dysfunction (POCD) in patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: The study included 60 patients who underwent neuropsychological testing 3-5 days before surgery and on the 7-10th day of CABG. A multichannel electroencephalogram of resting state with eyes closed in 62 standard leads was recorded. Statistical processing of the results was carried out using Statistica 10 (StatSoft Inc, USA) and the developed method of data clustering with a minimax criterion, a software implementation of the binary clipping and branching algorithm was used to find optimal solutions. RESULTS: Patients with POCD had higher pre- and postoperative high-frequency beta-2 rhythm power (20-30 Hz) compared with patients without cognitive impairment. The regression model demonstrated that POCD was associated with high values of preoperative beta-2 activity in the right frontal cortex and with low values in the left parietal areas after CABG. The clustering of beta-2 rhythm power before and after CABG revealed that the best cognitive status corresponded to a stable affiliation of patients with the selected clusters. CONCLUSION: The specific POCD correlates were established in patients after CABG. Low cognitive status was characterized by the preoperative beta-2 power increase in the right frontal areas and postoperative decrease in the left parietal cortex. The developed method for classifying patients according to the level of pre- and postoperative beta-2 rhythm power has a good discriminant ability. Stable patient affiliation with the selected clusters was associated with a higher level of cognitive status.

[Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention].

Aim        To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods        The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results   Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion            This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification.

[Incidence of postoperative cognitive dysfunction after simultaneous carotid surgery and coronary artery bypass grafting in patients with asymptomatic cerebral atherosclerosis]. / Chastota razvitiia posleoperatsionnoi kognitivnoi disfunktsii posle simul'tannoi operatsii na koronarnykh i vnutrennikh sonnykh arteriiakh pri asimptomnom techenii tserebral'nogo ateroskleroza.

AIM: To evaluate the incidence of early postoperative cognitive dysfunction (POCD) after simultaneous carotid surgery and coronary artery bypass grafting (CABG) in patients with asymptomatic cerebral atherosclerosis. MATERIAL AND METHODS: Fifty-three patients with polyvascular disease and asymptomatic cerebral atherosclerosis undergoing simultaneous unilateral carotid endarterectomy (CEE) and CABG were recruited in the study. Core cognitive functions were assessed with the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) at days 2-3 before the indexed surgery and at days 7-10 after it. All the patients were assigned to two groups based on the baseline MMSE score: one group with mild cognitive impairment (MCI) and another one without MCI. Neurodynamic measurements were performed using the Status-PF hardware-software complex (certificate #2001610233 of the Russian Agency for Patents and Trademarks), followed by the calculation of the integral indicator of the main cognitive domains according to the corresponding algorithms. Attention, memory and neurodynamics were evaluated in all participants. POCD was diagnosed with a decrease from the initial indicators of memory, attention and neurodynamics by 20% in 20% of the tests. RESULTS: Patients had complications in the early postoperative period, regardless of the presence of MCI. A decline among the core cognitive functions was observed in both groups of patients at days 7-10 after the surgery. Patients demonstrated an increase in the reaction time while performing neurodynamic test battery compared with the baseline values. Alterations in memory and attention were not significant. Significant changes in the integral indicator of cognitive status were determined in both groups of patients. It increased by 14% in patients without MCI (0.34±0.2 in the preoperative period vs. 0.39±0.3 in the postoperative period, p=0.04), and by 36% in patients with MCI (0.25±0.19 vs. 0.39±0.3, p=0.003). Regardless of the presence or absence of MCI, all patients had low cognitive status or even that below the average in the perioperative period. Despite the increase in the average values of cognitive status indicators in the postoperative period, 56% of patients (n=14) without MCI and 71% of patients with MCI (n=20) had early POCD. CONCLUSION: Patients with polyvascular disease, regardless of the presence of MCI, had low cognitive status or even that below the average, probably contributing to the elimination of the expected positive effects of CEE. The absence of MCI at baseline does not guarantee the preservation of cognitive status after surgery. Patients with polyvascular disease after myocardial and cerebral revascularization remain at high risk of exacerbating cognitive impairment, and, therefore, require an individual approach and a reasonable choice of the optimal surgical strategy.

[Electric brain activity in patients with simultaneous coronary artery bypass grafting and carotid endarterectomy]. / Izmeneniia pokazatelei élektricheskoi aktivnosti golovnogo mozga u patsientov, perenesshikh odnomomentnoe koronarnoe shuntirovanie i karotidnuiu éndarteréktomiiu.

AIM: To analyze the postoperative electroencephalography (EEG) power changes in patients after simultaneous coronary artery bypass grafting (CABG) and a left- or right-sided carotid endarterectomy (CEE). MATERIAL AND METHODS: Forty-four patients with indications for surgical myocardial revascularization, including 24 patients with indications for CEE, were studied. Patients after simultaneous coronary and carotid surgery were divided into groups depending on the side of CEE: the left+CEE CABG group included 14 patients, the right CEE+CABG group included 10 patients. The group of isolated CABG consisted of 20 patients. The resting-state EEG with closed eyes was recorded before and at the 7-10th day after surgery. The changes of the spectral power (µV2/Hz), theta1 (4-6 Hz), theta2 (6-8 Hz), alpha1 (8-10 Hz), alpha2 (10-13 Hz) rhythms were analyzed, the hemispheric asymmetry (HA) coefficient of the rhythms was calculated. RESULTS AND CONCLUSION: In the early postoperative period, the power of theta1 and theta2 rhythms increased compared to the preoperative level regardless of the type of cardiosurgical intervention. A local character of postoperative theta activity changes was revealed in the left+CEE CABG group, whereas the most pronounced decrease of the alpha-rhythm HA coefficient was observed in the right CEE+CABG group at the 7-10th day after surgery in comparison to the preoperative level. The results of the study suggest that the simultaneous coronary and carotid surgery does not significantly exacerbate the severity of brain damage compared to isolated CABG.

[The relationship of pathological ankle-brachial index and cognitive decline in patients after ischemic stroke]. / Sviaz' lodyzhechno-plechevogo indeksa i kognitivnykh narushenii u bol'nykh, perenesshikh ishemicheskii insul't.

AIM: To identify associations between cognitive impairment and values of ankle-brachial index (ABI) in patients after ischemic stroke at discharge from the hospital and over one-year follow-up. MATERIAL AND METHODS: The study included 375 patients with normal (n=192) and elevated (n=153) ABI who underwent ischemic stroke (IS). Neurological examination was performed using NIHSS, the Rankin scale, Barthel index, Rivermead Mobility Index at discharge from the hospital and over one-year follow-up. RESULTS AND CONCLUSION: Patients with elevated ABI had marked cognitive impairment and more severe neurological deficit compared to patients with normal ABI. Evaluation of ABI can help in predicting the development of post-stroke cognitive impairment in patients with IS.

[Factors for the development of persistent postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery under extracorporeal circulation]. / Faktory razvitiia stoikoi posleoperatsionnoi kognitivnoi disfunktsii u patsientov, perenesshikh koronarnoe shuntirovanie v usloviiakh iskusstvennogo krovo-obrashcheniia.

AIM: To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC). SUBJECTS AND METHODS: 257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3-5 days before, 7-14 days and 1 year after CABS. Persistent POCD was diagnosed if there was a 20% decline in cognitive domains at 1-year postoperatively versus preoperatively in 20% of the tests of an entire neuropsychological battery. Binary logistic regression analysis was applied to identify the factors supposedly increasing the risk of persistent POCD. RESULTS: It was found that high baseline cognitive status, early POCD after CABG under EC, low adherence to the prescribed treatment regimen, as well as progressive carotid artery (CA) stenosis could predict with a high (85%) probability that persistent POCD might develop at 1 year after surgery. CONCLUSION: The findings are suggestive of the multifactorial origin of persistent POCD, a significant role in the development of which is played by not only the preoperative cognitive status, but also by postoperative factors, such as the degree of adherence to the prescribed treatment regimen, early POCD, and progressive CA stenosis.

[Stenosis of the carotid artery in women with ischemic stroke and markers of inflammation]. / Stenozy karotidnykh arterii u zhenshchin s ishemicheskim insul'tom i markery vospaleniia.

AIM: To assess the relationship between the severity of stenosis of the carotid arteries, the level of female sex hormones and markers of subclinical inflammation in women with ischemic stroke (IS). MATERIAL AND METHODS: Two hundred and eleven women (mean age 68.9±9.23 years) were examined. A history of cardiovascular disease, previous cardiovascular events, type and subtype of stroke were recorded. Neurological status was assessed using neurological scales. Atherosclerosis was diagnosed by color duplex scanning of brachiocephalic arteries and laboratory testing (estradiol, markers of subclinical inflammation). RESULTS: Carotid artery stenosis of ≥50% was found in 13.3% of patients, less severe stenosis in 36.0%. Stenosis of ≥50% was positively correlated with the level of IL-18, TNF-alpha, and negatively correlated with the level of IL-6, IL-4, and MMSE score. In dynamics, there was a decrease in the level of TNF-alpha in all groups of patients, and an increase in the IL-4 level in women with carotid artery stenosis of ≥50%. CONCLUSION: Study of the influence of markers of subclinical inflammation on the atherosclerosis progression and recurrent disorders of cerebral circulation in women with IS should be continued.

[Clinical significance of the cardio-ankle vascular index in patients with stroke]. / Klinicheskoe znachenie otsenki serdechno-lodyzhechnogo sosudistogo indeksa u bol'nykh s ostrym narusheniem mozgovogo krovoobrashcheniya.

AIM: To study the clinical significance of the cardio-ankle vascular index (CAVI) in patients with stroke. MATERIAL AND METHODS: The study included 374 post-stroke patients. The state of peripheral arteries was assessed using CAVI and the ankle-shoulder index (ASI). RESULTS AND CONCLUSION: The pathological CAVI (>9.0) was identified in 45.4% patients, the reduced ASI (<0.9) in 19.8% patients. Stressful factors of daily life, hypodynamia, lack of work, low education were characteristic of the patients with pathological CAVI and ASI compared to those with normal CAVI. The frequency of diabetes mellitus, clinical signs of peripheral atherosclerosis, chronic heart failure and atrial fibrillation was higher in these patients as well. Ischemic stroke was more frequent in patients with peripheral atherosclerosis and higher vascular wall rigidity. Assessments of CAVI and ASI are necessary in patients with ischemic stroke to identify those with higher vascular wall rigidity and peripheral atherosclerosis and to undertake targeted preventive measures.

[PREDICTORS OF MODERATE COGNITIVE DISORDERS IN PATIENTS WITH CORONARY HEART DISEASE AND TYPE 2 DIABETES MELLITUS].

AIM: To study predictors of moderate cognitive disorders (MCD) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: The study included 54 men with CPD andDM2 (mean age 56.8 ± 4.5 years). Standard medical examination was supplemented by the assessment of cognitive status, characteristics of lipid and carbohydrate metabolism. Factors allegedly influencing MCD development included the patients' age, education level, stenosis of carotid arteries, LV ejection fraction, arterial hypertension, insulin and HbAlc levels, HOMA and QUICKI indices, lipid metabolism, concentrations of total, HDL and LDL cholesterol, fructosamine, triglycerides, severity of coronary lesions (Syntax scale), trait and state anxiety. RESULTS: Fructosamine level and HOMA index were the most important characteristics responsible for MCD in patients with CPD and DM2. CONCLUSION: The data obtained demonstrate the significance of fructosamine level and HOMA index in the development of MCD in patients with CPD and DM2.

[Cognitive dysfunction after coronary artery bypass grafting]. / Kognitivnaia disfunktsiia posle koronarnogo shuntirovaniia.

Despite the advances in surgical and anesthetic techniques for coronary artery bypass grafting (CABG), the incidence of neurological complications, including postoperative cognitive dysfunction (POCD), remains high. CABG is performed more often in elderly patients with severe comorbidities. However, comprehensive prevention measures and POCD rehabilitation have not yet been developed. Physical training is an effective and safe method for correcting endothelial dysfunction, severe systemic inflammatory response syndrome, lipid peroxidation, i.e. mechanisms contributing to the development and severity of POCD.

[THE COGNITIVE STATUS OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AFTER CORONARY BYPASS SURGERY].

The aim of the study was to evaluate the neuropsychological status of patients with type 2 diabetes mellitus (DM2) before and I year after coronary bypass surgery performed under conditions of artificial circulation. It included 114 patients (54 with and 60 without DM2). Prior to surgery, the patients with DM2 had positive characteristics of neurodynamics and attention. They deteriorated 1 year after coronary bypass surgery, but improved in the patients without DM2.

[Effect of Statins on Development of Early Cognitive Dysfunction After Coronary Artery Bypass Grafting].

We studied the effect of rosuvastatin on the development of early postoperative cognitive dysfunction (POCD) in patients after coronary artery bypass grafting (CABG). One hundred nine men aged 45-70 year was divided into two groups. Group 1 comprised 69 patients (mean age 56.8 ± 5.2 years) who were given 20 mg of rosuvastatin for 10-14 days before CABG and until discharge. Patients of group 2 (n=40, mean age 55.9 ± 5.3 years) did not take rosuvastatin. It was shown that patients of group 2 had better neuropsychological parameters after CABG in comparison with the patients of group 2. Patients of group 1 had lower concentrations of interleukin (IL)-1ß, IL-6, IL-8, tumor necrosis factor α, high sensitivity C reactive protein, and higher concentrations of IL-10. Group 2 patients had worse neuropsychological parameters which were associated with higher concentrations of proinflammatory cytokines. These results may indicate that preoperative therapy with rosuvastatin had decreased the severity of systemic inflammatory response and reduced the development of early POCD after CABG.

[Factors associated with the detection of carotid artery stenosis of different severity in ischemic stroke patients]. / Faktory, assotsiirovannye s vyiavleniem stenozov karotidnykh arterii razlichnoi vyrazhennosti, u bol'nykh s ishemiches-kim insul'tom.

Objective. To study the factors associated with the detection of carotid artery (CA) stenosis of different severity in patients with ischemic stroke (IS). Material and methods. We studied 694 patients with IS. The assessment of brachiocephalic arteries (BCA) was performed using ultrasound duplex scanning. All patients were stratified into three groups by CA stenosis severity: group 1 included patients without stenosis or with mild CA stenosis (30%), group 2 - patients with moderate stenosis (30-49%) and group 3 - patients with ≥50% stenosis. The severity of neurological deficits was evaluated with the NIH Stroke Scale (NIHSS), IS subtypes were defined according to the TOAST. Results. Patients with ≥50% stenosis were more likely to have atherothrombotic IS subtype, risk factors for stroke and pronounced "rough" neurological deficit compared to patients with mild, moderate stenosis or without it. Patients with moderate stenosis more often had cardioembolic IS subtype with mild neurological deficits, whereas the hemodynamic IS subtype with mild to moderate neurological deficits was defined in the group without stenosis. Conclusion. Detection of CA stenosis of different severity allows to identify IS patients with unfavorable prognosis and a high risk of concomitant coronary artery disease.

[A role of carotid stenoses in the structure of early postoperative cognitive dysfunction in patients underwent coronary artery bypass grafting].

OBJECTIVE: To analyze the structure and severity of early postoperative cognitive dysfunction as well the accompanying spectral electroencephalographic (EEG) changes in patients underwent coronary artery bypass grafting (CABG) depending on the presence or absence of small and moderate internal carotid stenosis. MATERIAL AND METHODS: Fifty seven patients, aged from 45 to 70 years, were stratified into two groups: without stenosis (n=35, mean age 54.3±6.4 years) and with internal carotid stenosis (n=22, mean age of 57.5±5.8 years). For all patients planned on-pump CABG was performed. RESULTS: The frequency and severity of cognitive deficits in the postoperative period were higher in patients with internal carotid stenosis compared to patients without stenosis. Also, the patients with stenosis had more pronounced EEG signs of cortical dysfunction and brain damage after CABG compared to patients without stenosis. CONCLUSION: The presence of carotid >50% stenosis increases the severity of cognitive deficits and brain damage in patients underwent on-pump CABG.

[Neuropsychological status of patients with low and moderate carotid artery stenoses after the coronary artery bypass surgery].

The purpose of the study was a comparative evaluation of a neurological and neuropsychological status of patients with and without carotid artery stenoses less than 50% after coronary artery bypass grafting. The study involved 65 patients divided into two groups: the first group included 35 patients (mean age 56.2±5.7 years) without carotid artery stenoses, the second group included 30 patients (56.8±5.5 years) with the presence of carotid artery stenoses. Initially, all patients had comparable clinical parameters. Before surgery, the high frequency of asthenic, vestibulopathic and vestibular-atactic syndromes was observed in patients with the presence of low and moderate stenoses of carotid arteries compared to patients without stenoses. After coronary artery bypass grafting, the neurological status of patients became worse in both groups. Patients with the presence of low and moderate stenoses of carotid arteries performed worse on neuropsychological tests one month after surgery.

[EEG changes in patients undergoing on-pump coronary artery bypass grafting].

We studied the changes of electroencephalograms (EEG) related to on-pump coronary artery bypass grafting (CABG) in 28 right-handed male patients with coronary heart disease (CHD), 10 from which had accompanying moderated (30-50%) carotid artery (CA) stenoses. All EEG studies were performed 3-5 days before and 7-11 days after CABG. EEG data of healthy age-matched males (n=14) were examined. Before surgery, the CHD patients differed from the control group by less expressed theta2 and beta1 rhythm power asymmetry. The differences demonstrated worse conditions for cognitive processes in CHD patients. After CABG, the higher power of teta1 and 2 rhythms, predominantly in the frontal lobe of the left hemisphere which was mostly expressed in patients with CA stenosis, was observed in all CHD patients. This effect can be considered as the appearance of ischemic neuronal injury caused by on-pump CABG. The localization of changes in the frontal cortex of the left hemisphere can be related to a high vulnerability of these regions. The deficit of cerebral blood flow in these regions will define a clinical picture of cognitive decline after CABG.

[Effect of perindopril on cognitive functions in young and middle aged patients with hypertensive disease].

We studied 40 men aged 26 - 59 years (mean age 49.0 +/- 1.9 years) with hypertensive disease (HD) and found that therapy based on the use of angiotensin converting enzyme inhibitor perindopril in young and middle aged patients with stage I and II HD appeared to be not only one of effective methods of correction of elevated arterial pressure (AP) but also of associated with it cognitive abnormalities. Effect of therapy was determined by achievement of target AP values and was more pronounced in patients older than 44 years. Favorable effects of perindopril in relation to parameters of cognitive functions in patients with HD allows to rate perindopril not only as effective and safe hypotensive preparation but as remedy exerting cerebroprotective effect.